The role of physicians at the centre of health care is under pressure

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You are assuming that physicians are the "store owners". This is not the majority of cases.
Payments to the clinic will be more, yes.

I'm not assuming anything. That's just what's paid for physician services. Some have their own private practice, some don't. I'm saying from the perspective of the payor, the payments for the services of the physician are a large portion of the pie.

That, of course, does not imply that the payments are wasted, or that they are inflated, but the reality is that they exist. Which is the only point I was making -- as I've mentioned, I do not feel that the average physician salary is extravagant considering the services that they provide and the responsibilities that they have.

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no. and it wouldnt make any difference which form of average they use.

if different sources give different numbers for their reported "average", then it is appropriate to average them together ;) so.... seemingly redundant but not.

also, median is a measure which partially corrects for the data being skewed in one direction by gross ouliers. But for what we want to do here we want to know the actual dollar value spent which means "mean", since regardless of skewing or outlying data if you perform the multiplication as described you get the actual dollar value spent. Median would reduce this number as it will exclude the beverly hills millionaire doctors.

It looked like you were saying average and mean were different things. I now see you meant you were averaging the means. Nevermind.
 
I'm not assuming anything. That's just what's paid for physician services. Some have their own private practice, some don't. I'm saying from the perspective of the payor, the payments for the services of the physician are a large portion of the pie.

That, of course, does not imply that the payments are wasted, or that they are inflated, but the reality is that they exist. Which is the only point I was making -- as I've mentioned, I do not feel that the average physician salary is extravagant considering the services that they provide and the responsibilities that they have.

And I'm still saying that "cut physician salaries" will not get the payer what he wants.... so why are we arguing?
 
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I have no idea. I only had issue with the 6% that was given, not whether cutting physician salaries will solve the healthcare cost problem :).
 
I have no idea. I only had issue with the 6% that was given, not whether cutting physician salaries will solve the healthcare cost problem :).

the 6% IS the physician salaries that was given. nobody is saying that patient payment is 6% of healthcare costs.... That figure is significantly higher. But the conversation you entered was concerning the arguments made that physicians make too much money and this is why costs are so high. at 6%, the salaries really cannot be argued to be driving up costs.
same page now?
 
The physician salaries are much higher than 6%. The 6% is just what physicians might have left over after paying for all the administrative costs like rent, utilities, etc. Meaning people get charged for physician services which is much higher than 6%. The 6% is meaningless from a budgetary perspective.
 
the 6% IS the physician salaries that was given. nobody is saying that patient payment is 6% of healthcare costs.... That figure is significantly higher. But the conversation you entered was concerning the arguments made that physicians make too much money and this is why costs are so high. at 6%, the salaries really cannot be argued to be driving up costs.
same page now?

For one, the ~6% figure fails to account for benefits, which often include malpractice. Total compensation, which would be a better marker than salary, may be 8%, 9%, 10%, who knows.

For two, when I look at 6% I don't think "Oh, what a tiny percentage, surely we aren't the ones driving health costs!" To the contrary, in a fee-for-service model I wonder how much borderline unnecessary stuff physicians had to do in order to clear even 6%.

In other words, let's say I have to incur 15K in health care expenditure for every 1K I net for myself. My pay is only 6.7% of that pie, but my work drives a much larger percentage of the money spent. My salary is just the tip of the proverbial iceberg.

I once had a practice manager turned financial consultant tell me that when a hospital bought out a private group and put the docs on salary, average physician "productivity" (in terms of billable services performed) would drop 15%. My question is if that decline reflects new found laziness, or if it's just that the docs don't feel they have to overwork themselves in order to sustain their take home pay.
 
Io
For one, the ~6% figure fails to account for benefits, which often include malpractice. Total compensation, which would be a better marker than salary, may be 8%, 9%, 10%, who knows.

For two, when I look at 6% I don't think "Oh, what a tiny percentage, surely we aren't the ones driving health costs!" To the contrary, in a fee-for-service model I wonder how much borderline unnecessary stuff physicians had to do in order to clear even 6%.

In other words, let's say I have to incur 15K in health care expenditure for every 1K I net for myself. My pay is only 6.7% of that pie, but my work drives a much larger percentage of the money spent. My salary is just the tip of the proverbial iceberg.

I once had a practice manager turned financial consultant tell me that when a hospital bought out a private group and put the docs on salary, average physician "productivity" (in terms of billable services performed) would drop 15%. My question is if that decline reflects new found laziness, or if it's just that the docs don't feel they have to overwork themselves in order to sustain their take home pay.

IIRC, benefits were included in that calculation. Those in private practice often pay malpractice out of pocket so this would be accounted for

Also, once again, the rest of your argument is completely irrelevant. Attacking doctor salary will still not affect Joe Schmoe's costs. In fact, your argument suggests that doctor pay should be increased (or that we should at least get more pie) in order to retain the income level without incurring so much cost to the consumer.

And you need to remember the patient in all of this. In spite of what SDN pre-allo would have you think, doctors are not all bleeding hearts who would just as happily do this for free. They need to support themselves, and given the high stakes nature of the job they have earned the right to do so very comfortably. $200k is in no way exorbitant. If we cut doctor salary you are only asking for 1) doctors to incur MORE cost to keep the income up or 2) refusal to do more work for the same pay. That is reasonable to me. Nobody else is expected to go above and beyond out of the goodness of their hearts. Why us?

Also you ask how much needless work is being done to achieve that 6%. Well.... none. The fun thing about percents is that it will always be that percent ;) if doctors did half the work then costs would be half and salaries would be half and they would still get 6%. The question that needs to be asked is if 1) doctors will have the incentive to work (I don't want to take 50 years to catch up to the guy who works in brown shorts) and 2) is performing half the work going to adequately cover patients
 
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The physician salaries are much higher than 6%. The 6% is just what physicians might have left over after paying for all the administrative costs like rent, utilities, etc. Meaning people get charged for physician services which is much higher than 6%. The 6% is meaningless from a budgetary perspective.

No no no. Salary is a measure of take home. Whether gross or net doesn't really matter but it doesn't include overhead. Admin costs and the like do not drop.
You're making the assumption that 100% of what a patient spends goes first to the doctor, and then the doctor divvies out funds to keep the clinic and practice afloat. This is really just not the norm. The patient pays the owner of the practice and the owner of the practice pays the physician according to contract. Now, these people can often be the same person, but it is also very often the hospital or university. In private practice it can be a law firm or some LLC that own the practice and employs docs. It can even be an NP or PA that owns the practice and employs docs to get the legal oversight necessary. Either way, it is wrong to assume that patient costs go first to the doctor and then out to cover overhead.

And remember, the only argument i made is that it is wrong to attack doctor salaries based on the 6% figure. You cant say "well they are actually higher than that". No they are not. They are 6%...... yes, there is more money involved, but salary has a specific definition, and since doctors are very often employees of the practice for which they work, your argument is directly parallel to complaining about the gas station attendant's pay being responsible for the outrageous prices of gas. The overhead and workflow is another matter. Doctor salary is doctor salary and you cannot arbitrarily lump other dollar figures in there with it. If we cut doctor salary the patient simply will not get the outcome they asked for. If you want to "go deeper", we still arent talking about doctor salary. I agree, cut administrative and overhead costs to healthcare. That doesnt necessarily mean doctors bring home less cash - and will very likely mean doctors bring home more pie ;)
So I am pretty certain the angles you guys are taking are not at "doctor salary". If we propose other changes, the salary may be affected, but that will be a secondary effect of the changes made. The proposed change which claims doctors simply make too much is to just cap the take-home. Per everything weve talked about, this simply will not get the patient what they want.
 
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No no no. Salary is a measure of take home. Whether gross or net doesn't really matter but it doesn't include overhead. Admin costs and the like do not drop.
You're making the assumption that 100% of what a patient spends goes first to the doctor, and then the doctor divvies out funds to keep the clinic and practice afloat.

Actually, admin costs and such can, and often must, drop depending on measures taken (merging practices, other cost cutting measures, etc). Regardless, you're talking it from the profitability standpoint, I'm talking about it from the consumer's perspective. The consumer pays a LOT more than 6% for physician services - some practices are more efficient than others and net more profit than others - that's fine and not really relevant to the guy paying the bills. He just looks at what it costs overall and by each component. To say only 6% of the $2.2 trillion goes to physicians is completely false.
 
Actually, admin costs and such can, and often must, drop depending on measures taken (merging practices, other cost cutting measures, etc). Regardless, you're talking it from the profitability standpoint, I'm talking about it from the consumer's perspective. The consumer pays a LOT more than 6% for physician services - some practices are more efficient than others and net more profit than others - that's fine and not really relevant to the guy paying the bills. He just looks at what it costs overall and by each component. To say only 6% of the $2.2 trillion goes to physicians is completely false.

That's kind of a silly argument.

It's pretty clear that what Specter is saying is that only 6% goes to physician salaries.

In other words, reduce the average physician salary by 15% and you'd save less than 1% of total health costs.

I'm not sure if his numbers are right, but your point is trivial.
 
Actually, admin costs and such can, and often must, drop depending on measures taken (merging practices, other cost cutting measures, etc). Regardless, you're talking it from the profitability standpoint, I'm talking about it from the consumer's perspective. The consumer pays a LOT more than 6% for physician services - some practices are more efficient than others and net more profit than others - that's fine and not really relevant to the guy paying the bills. He just looks at what it costs overall and by each component. To say only 6% of the $2.2 trillion goes to physicians is completely false.

who cares? it is also false to say that the moon is made of bacon and gravy (but that would be pretty baller amirite?)

Nobody said that the consumer only pays 6% (in fact I said the exact opposite of this a few posts ago). The argument presented was as such: "physicians make too much money! If we lower physician salaries we will fix the healthcare crisis!"
but since salary is only 6% of the whole this is not the case. And if you read my original post on the matter I mentioned that most of the pie charts list total clinical costs as about 20-25% (which i think is the number you are getting confused with) All I said in the first post was that it is wrong to assume that this 20% is equivalent with "doctor take-home". It is not. If anything your persistence is just evidence that such pie charts which are biased in their creation anyways are getting their desired effect.


It is literally as simple as this:
if the money that goes into the doctors' pockets at the end of the year is 6% of the whole, cutting into the money that goes into the doctors' pockets at the end of the year can not reduce costs by more than 6%.........

The money that goes into the doctors' pockets at the end of the year = salary. If they want to cut 15% of of that pie in admin costs that is fine, and per their current representation of the data the slice that includes salary would also shrink, but this in no way dictates that the money that goes into the doctors' pockets at the end of the year will be reduced. :thumbup:
 
That's kind of a silly argument.

It's pretty clear that what Specter is saying is that only 6% goes to physician salaries.

In other words, reduce the average physician salary by 15% and you'd save less than 1% of total health costs.

I'm not sure if his numbers are right, but your point is trivial.

The numbers were just what I got out of that equation we dicussed earlier. Nobody other than people who blame physician salaries anyways are interested in calculating this number, and since it is so small (I assume this is their rationale) they, in every case ive seen, lump salaries in with related expenditures in order to make it look bigger and then label it as "Doctor salary and clinic costs" - which is technically true, they just dont explain everything that goes into clinic costs. This includes the salaries of all healthcare personnel as well as a buttload of other costs.
 
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The numbers were just what I got out of that equation we dicussed earlier. Nobody other than people who blame physician salaries anyways are interested in calculating this number, and since it is so small (I assume this is their rationale) they, in every case ive seen, lump salaries in with related expenditures in order to make it look bigger and then label it as "Doctor salary and clinic costs" - which is technically true, they just dont explain everything that goes into clinic costs. This includes the salaries of all healthcare personnel as well as a buttload of other costs.

Yeah, the main issue with healthcare costs anyway is not the $200,000 physician's salary, but the $200,000,000 insurance company CEO's salary.

Insurance companies are almost by definition parasitic and if they're pulling in that much dough they're clearly a cause of unnecessary costs.
 
Although Specter, you are leaving out one way in which physicians' salaries do increase healthcare costs.

Thanks to pay for service, even of a physician only gets 1% of the total bill for a procedure, the profit motive may still encourage him to do too many of those procedures.

This will only increase the physician's salary by a little bit, but increases the overall bill by a significant amount.

So the current level of salary for physicians is reasonable, but the associated healthcare costs may not be.
 
Although Specter, you are leaving out one way in which physicians' salaries do increase healthcare costs.

Thanks to pay for service, even of a physician only gets 1% of the total bill for a procedure, the profit motive may still encourage him to do too many of those procedures.

This will only increase the physician's salary by a little bit, but increases the overall bill by a significant amount.

So the current level of salary for physicians is reasonable, but the associated healthcare costs may not be.

we talked about that earlier. People will work within their capacity to support themselves to the level they see fit. I dont disagree that this happens, but I think if we do away with a fee-for-service system that it will be much much harder to get anything done.

And if we want to "look at it from the consumers perspective", the same people signing up for crap they dont need are the ones complaining it costs too much (if we cast that net wide enough anyways....) the same argument from the "consumer" will persist in a new flavor of "It's outrageous that I can't get my 40% occluded coronary artery catheterized and I have to wait for it to become more dangerous, damn lazy doctors all driving their toyota camrys and stuff!" :laugh:

also to that point, what you are saying still doesnt suggest we cut physician salaries. We need to attack a different angle of healthcare. If salaries are affected in the fallout well..... **** happens. The only thing ive been saying is that the notion that physician salary is to blame is just silly.
 
I'm not looking at it from a consumer's perspective, I'm looking at it from an overall perspective.

Fee for service provides an incentive to doctors to do unnecessary procedures. Ethics should restrict them a bit, but money usually trumps ethics in the real world.

Switching from a fee for service to a results based system on the same general pay scale would drastically reduce healthcare costs.

And I don't give a f*** what patients want to do if it is medically unnecessary. They can do whatever they want if they pay cash.


EDIT: To respond to your edit, no, I dont think most physician salaries should be reduced (only unethical procedures R us practices should be cut). I was just saying that physician salaries are tied to a cause of increased costs, not the increased costs themselves.
 
Not to mention brand name drugs which are absurdly marked up. They can virtually block generics from entering the market for 5 years by just suing the generic companies (the brand names always lose, but the money they make with a monopoly for 5 years more than covers their losses).
 
Seriously guys?!
Jim Cawley is one of the most respected and published PAs in the US. He has a PhD in Health Economics and has been a professor at GWU for many years. He has the research to back up his claim that PAs can do 85% of what GPs do.
So why am I back in med school after 12 years as a PA? I want to do the other 15%.

QUOTE=neusu;12604461]What exactly is he a doctor of? PAC is physician assistant-certified, a masters level degree. MPH is masters of public health, a masters level degree.

Did I miss something?[/QUOTE]
 
Not to mention brand name drugs which are absurdly marked up. They can virtually block generics from entering the market for 5 years by just suing the generic companies (the brand names always lose, but the money they make with a monopoly for 5 years more than covers their losses).

Eh, that's a more complicated issue.

I actually think the current structure of patents for drugs works pretty well.

It's broken for biologics, but that's another issue.

A limited monopoly for brand name drugs encourages research and innovation. It should not be extended past the normal limits, but most lawsuits against generics involve them trying to sell a drug before the patent has expired.
 
I'm not looking at it from a consumer's perspective, I'm looking at it from an overall perspective.

Fee for service provides an incentive to doctors to do unnecessary procedures. Ethics should restrict them a bit, but money usually trumps ethics in the real world.

Switching from a fee for service to a results based system on the same general pay scale would drastically reduce healthcare costs.

And I don't give a f*** what patients want to do if it is medically unnecessary. They can do whatever they want if they pay cash.


EDIT: To respond to your edit, no, I dont think most physician salaries should be reduced (only unethical procedures R us practices should be cut). I was just saying that physician salaries are tied to a cause of increased costs, not the increased costs themselves.

I'm not disagreeing with you. All I'm saying is "blame doctor salary" is overly simplistic and will not get the desired effect on costs. That's all. Honestly I don't blame the physicians here at all (am I biased? :D) if someone wants to pay out of pocket for something or the insurance is covering it why not provide the service?
 
I'm not disagreeing with you. All I'm saying is "blame doctor salary" is overly simplistic and will not get the desired effect on costs. That's all. Honestly I don't blame the physicians here at all (am I biased? :D) if someone wants to pay out of pocket for something or the insurance is covering it why not provide the service?

We agree.

But don't consider physicians blameless (some MDs are also shady MFs).

Patients will trust us more if they know we aren't getting a cut from the therapies we prescribe.
 
Seriously guys?!
Jim Cawley is one of the most respected and published PAs in the US. He has a PhD in Health Economics and has been a professor at GWU for many years. He has the research to back up his claim that PAs can do 85% of what GPs do.
So why am I back in med school after 12 years as a PA? I want to do the other 15%.

There is a very noticeable "can" absent after the letters "GPs" up there :cool:
 
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What this stupid Economist article failed to mention is that the value of the US dollar is approximately 50 times that of the Indian Rupee (and much more in other cases). Of course a surgeon in india can do an open heart procedure in $2000, EVERYTHING is comparably cheaper over there. Sure, some of it is maybe because they have some streamlined procedures and practices but a lot of it is simple currency conversion.
 
What this stupid Economist article failed to mention is that the value of the US dollar is approximately 50 times that of the Indian Rupee (and much more in other cases). Of course a surgeon in india can do an open heart procedure in $2000, EVERYTHING is comparably cheaper over there. Sure, some of it is maybe because they have some streamlined procedures and practices but a lot of it is simple currency conversion.

I think you do not understand how currencies and exchange rates work.
 
That may have been a different thread, my phone is acting up now so I cant check
 
Io

IIRC, benefits were included in that calculation. Those in private practice often pay malpractice out of pocket so this would be accounted for

Really? I thought the equation was [(number of physicians) x (average salary)] / (total health care spending), which would not account for benefits. Malpractice is paid for indirectly, and only very rarely comes "out of pocket."

SpecterGT260 said:
Also, once again, the rest of your argument is completely irrelevant. Attacking doctor salary will still not affect Joe Schmoe's costs. In fact, your argument suggests that doctor pay should be increased (or that we should at least get more pie) in order to retain the income level without incurring so much cost to the consumer.

As a doctor trying to earn a living, I am not attacking doctor salary. I am merely pointing out why the 6% figure isn't as insignificant as some make it, given the dominant reimbursement model in this country.

SpecterGT260 said:
And you need to remember the patient in all of this. In spite of what SDN pre-allo would have you think, doctors are not all bleeding hearts who would just as happily do this for free. They need to support themselves, and given the high stakes nature of the job they have earned the right to do so very comfortably. $200k is in no way exorbitant. If we cut doctor salary you are only asking for 1) doctors to incur MORE cost to keep the income up or 2) refusal to do more work for the same pay. That is reasonable to me.

Feel better?

SpecterGT260 said:
Also you ask how much needless work is being done to achieve that 6%. Well.... none. The fun thing about percents is that it will always be that percent ;) if doctors did half the work then costs would be half and salaries would be half and they would still get 6%.

Uh, yeah, but that 6% also reflects a particular dollar amount that, divided by the number of practicing physicians, reflects average salary. And if you think we, collectively, don't do questionable things to bring in extra dollars, I would ask that you read The Cost Conundrum.

SpecterGT260 said:
The question that needs to be asked is if 1) doctors will have the incentive to work (I don't want to take 50 years to catch up to the guy who works in brown shorts) and 2) is performing half the work going to adequately cover patients

The relationship of work/expenditure to health outcomes is anything but clear and linear. See linked article in reference to McAllen vs. El Paso.
 
Not to mention brand name drugs which are absurdly marked up. They can virtually block generics from entering the market for 5 years by just suing the generic companies (the brand names always lose, but the money they make with a monopoly for 5 years more than covers their losses).

If new drugs were to cost as little as the generics do then after a few years there wouldn't be any new drugs.

The pharm companies that engineer new drugs need the 5 years of temporary monopoly so they can cover the costs of researching and producing those drugs, not to mention recouping their losses from the dozens of drugs that failed to ever make it to the market.
 
For one, the figures were normalized against per capita income

I didn't see what you are talking about in the article. As a person who has lived and worked several years in india I can tell you that there are MANY reasons why healthcare is cheaper over there.
1. Labor is VERY cheap.
2. There are essentially 2 healthcare systems: one is the government run system which takes care of most people, and the private system for those who can afford it.
3. The dollar goes a LONG way in India. And it absolutely has to do with currency exchange. For the amount I pay to buy a house in america, converting that into indian rupees would buy me a mansion in India.
4. The cost of living is much lower as is the per capita income.
5. Almost all goods, excluding gasoline and a few others, are cheaper
6. Hospitals in india don't have the same regulations and overhead as india (e.g. Litigation coverage)
7. Healthcare costs are transparent. You can go up to a hospital and ask how much a procedure actually costs, then compare to another. Not possible in the US.
etc.....
 
And in the government hospitals, the doctor sees probably 20 times more pts per day. It's ludicrous to compare the two systems in any way.

In the town I used to live in, you can get a full time driver for 3500 rupees/mo (which is $65/mo). A maid that comes and cleans your house and washes your dishes and clothes every day costs 300 rupees/mo ($6/mo). The costs are not comparable.

As the economy improves, the price of labor is going up, as thankfully people who have been socioeconomically disadvantaged for generations start finding better opportunities, but you can't just compare the costs directly like that.
 
Really? I thought the equation was [(number of physicians) x (average salary)] / (total health care spending), which would not account for benefits. Malpractice is paid for indirectly, and only very rarely comes "out of pocket."



As a doctor trying to earn a living, I am not attacking doctor salary. I am merely pointing out why the 6% figure isn't as insignificant as some make it, given the dominant reimbursement model in this country.



Feel better?



Uh, yeah, but that 6% also reflects a particular dollar amount that, divided by the number of practicing physicians, reflects average salary. And if you think we, collectively, don't do questionable things to bring in extra dollars, I would ask that you read The Cost Conundrum.



The relationship of work/expenditure to health outcomes is anything but clear and linear. See linked article in reference to McAllen vs. El Paso.

All of this has been covered :rolleyes:. Also there has not been any determination as to what said websites defined as "salary" - whether with benefits or without. Since you are simply restating my originally proposed figure, do you have ANY idea how silly it is to retrospectively restrict the definition without having looked up the numbers yourself? All I said is I can't remember if they included benefits and I feel like they did ;)
 
Now that I am not on my phone I just wanted to respond a little more clearly
Really? I thought the equation was [(number of physicians) x (average salary)] / (total health care spending), which would not account for benefits. Malpractice is paid for indirectly, and only very rarely comes "out of pocket."
responded to above. Also, are you academic or employed by a university hospital? From my understanding private is very often paid directly out of pocket. Maybe this is only true of owners/partners in the practice. either way I dont see this distinction as being overwhelmingly significant since bookkeeping can shuffle numbers around in all sorts of fun ways. If it is indirect in the majority of cases, fine. And if these figures were not including benefits, fine. That doesnt really change any of the points that were made.
As a doctor trying to earn a living, I am not attacking doctor salary. I am merely pointing out why the 6% figure isn't as insignificant as some make it, given the dominant reimbursement model in this country.
We have already discussed how salary padding can result in increased overall costs. That was never the point and was never in question. The argument of "Doctors make too much and that is why healthcare is out of control" is akin to saying "OMGourd! I just Love Franks Red Hot!, but it makes me fat!"
No... the fact that your fat ass puts it on 7 lbs of deep fried chicken chunks is what does it. Sure your drive to eat a crap ton of the sauce contributes, but it is not the sauce itself that does it to you, so cutting out the sauce will not really net you the dietary effect you want. Savvy?
Feel better?
As compared to what? I didnt say that as some greater altruistic reminder to SDN. If you follow my posts at all you will know that I think altruism is over-rated, and that it is a mistake to equate compassion and empathy with making "nicey-nice" i.e. a d-bag can still care ;)
I was 1) making a pathos argument to the SDN locals 2) stating that I honestly think this is a "be careful what you wish for" scenario for patients and that things will not swing in their favor if they directly attack doctor salary.
Uh, yeah, but that 6% also reflects a particular dollar amount that, divided by the number of practicing physicians, reflects average salary. And if you think we, collectively, don't do questionable things to bring in extra dollars, I would ask that you read The Cost Conundrum.



The relationship of work/expenditure to health outcomes is anything but clear and linear. See linked article in reference to McAllen vs. El Paso.

:laugh: that is what I have been saying. The attack by some lay people on physician salaries is overly simplistic and implies a clear and linear mechanism. I do not deny and have not argued against the idea that doctors pad their salaries (see the buffalo chicken defense above). I think a better solution is out there which maintains doctor salaries and even maintains a fee-for-service model. It will be hard to convince me that doctor availability will not drop if we remove this. I think a better solution (or at least a step in the right direction) is to reign back insurance coverage for superfluous treatments, and take steps to make reimbursement less of a battle. I would also suggest we do something about malpractice because I have seen plenty of doctors frustrated about providing unnecessary treatments or ordering unnecessary tests in order to appease a patient for fear of being sued if the patient doesnt get what they want.
 
I would also suggest we do something about malpractice because I have seen plenty of doctors frustrated about providing unnecessary treatments or ordering unnecessary tests in order to appease a patient for fear of being sued if the patient doesnt get what they want.

I support malpractice reform because it's the right thing to do but I haven't seen any data at all that malpractice reform results in that much reduction in terms of tests. You can look at before and after in states that have malpractice reform - it has barely had any impact on that at all.
 
Also, are you academic or employed by a university hospital?

Private.

SpecterGT260 said:
From my understanding private is very often paid directly out of pocket.

Perhaps in sole proprietorships or solo LLCs, which are uncommon. In group practices it makes more sense for the practice to pay benefits directly and write them off as business expenses. The salary surveys I receive query just that: salary, as in a periodic payment from employer to employee.

SpecterGT260 said:
That doesnt really change any of the points that were made.

I do think it would alter the discussion if 6% went to 10%. Or 12%.

SpecterGT260 said:
We have already discussed how salary padding can result in increased overall costs. That was never the point and was never in question.

So why did you say this back in post #105?

SpecterGT260 said:
at 6%, the salaries really cannot be argued to be driving up costs.

SpecterGT260 said:
As compared to what?

I dunno, it seems like you have a lot to get off your chest.
 
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