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Great post. All you residents preparing for graduation should read this and take a copy where ever you go.

Spread the word. Its time to start getting our profession back from the insurance companies.
 
that was a great article; very sad and discouraging though. big business is a beast.

i think this is a good case for medical schools to begin to teach medical economics. there is a need to change the "culture" we currently have. there seem to be a couple of wistle blowers, but its obvious there are so many that are still of the "please let me just operate" mentality. i too just want to operate and i'm math illiterate. however, it appears i will have to do something, because a 95% drop in pay over the last 15 years is just down right disrespectful.

i will only be begining my journey in july, i hope this will be addressed before i get out.
 
I think this is a great article, every surgeon i have talked to has expressed the same ideas to me over the past 2 years, but its good to see a published example. i think the major problem ,as stated in the article, is getting the masses to join in. One or two surgeons dropping the HMO's wont make a difference. Unfortunately the insurance companies have somehow convinced Dr's that they must take part in order to get paid. I have seen many physicians drop the HMO's and have patients pay upfront and later get reimbursed by their insurance companies. although this isn't the perfect solution, it does take the headache away from the physician, and in the end, their practices are still surviving.

I think that every program director should be printing a copy of this paper for their residents no matter what field they are in. the only way we are going to take the profession back is if significant numbers fight for a change, unfortunately with physicians this has yet to be the case. because of time constraints/ lack of knowledge, physicians have sat back and watched the profession be swept out from underneath them only to complain about it after the fact. Hopefully enough young physicians will read this article, and the others like it, and be inspired to take a stand against the insurance companies, otherwise in a few years we'll be nothing more than technicians following the orders of someone with no medical training.
 
Kimberli Cox, can we sticky this thread, or at least the link to the article,seems the more people who read this the better.
 
Thanks for posting that link. It's an awesome, much-anticipated answer to the miserable downturn the career of a surgeon has taken since the induction of HMO's.

My uncle practiced as an ortho surgeon and the peak of his career was the 1960's and 1970's and early 80's. He vehemently warned me again and again about how terrible things are now (compared to then).

I pretty much tossed aside his viewpoints and proceeded on pursuing my dream, as a doc, and now to be a surgeon. I'm staying the course. I plan on enjoying my career.
 
Wow. It's so refreshing to see that the as doctors we don't just have to take it lying down. As I've been watching the current financial situation in medicine, the thing that has frustrated me the most is how powerless the doctors seem to be to do anything about it. The doctors are the only ones with principles working in the health care market, the only one's who aren't completely driven by profit and that makes them get taken advantage of. It's nice to see that we can fight back, and that's what going to have to happen before doctors keep getting raped on reimbursements. I guess we just have to remember that they need us and our support to keep their little scams going.

Justin
 
While the results of his experiment are interesting, it's unclear how this would be sustainable if practiced widely. The bulk of his payments come from reimbursement for out-of-network care from those with HMOs. This out-of-network coverage typically pays more for the same procedure than in-network coverage. The higher reimbursement allows the surgeon to see less patients and deliver better care, but this won't last. Already there is a move from HMOs to lower reimbursement for out-of-network coverage, in order to reduce the number of patients going outside their network. In essence, this type of practice is exploiting a loophole in the HMO policies that pay more for the same service.

Then there's an issue about patients paying a premium to see certain doctors, on top of the higher reimbursement by HMOs. The physician in the article has been practicing greater than 25 years and probably has built up a solid reputation in the community. He is a clinical professor at the local medical school. He was also voted to be one of the best surgeons in America by New York magazine. Can his results really be reproduced widely, or is his success only typical of the upper crust surgeons? What are the implications if the upper crust surgeons defect? Where does that leave other surgeons, the majority of patients, and HMO coverage?

Another point is that it is only the surgeon's fees that are paid out of pocket. While a surgeon's fee for a AAA or Whipple only reaches several thousand dollars, hospital and other fees can be much much higher. These costs are paid by HMOs. If more and more surgeons were to drop HMO coverage, patients would commonly have to pay their premiums AND out of pocket to individual surgeons. That type of system is not sustainable unless premiums drop significantly and coverage is radically altered to only include hospital/nursing/ancillary/medical fees. In essence there needs to be a massive overhaul of HMO policies.

Again, the results of this surgeon's experiment is very promising, but it is hardly a blueprint for wide-scale adoption. It raises many questions. The biggest drawback to this type of practice is that it exploits a small, but highly profitable niche, which might not be widely reproducible. In this sense it is somewhat similar to boutique medicine. Before we hail these achievements, we have to ask ourselves what the real implications are. If your goal is to stratify surgeon reimbursement for the chance to make more for yourself, then this is clearly exciting. If your goal is better patient care, you should be encouraged but highly skeptical.
 
double post.
 
dr. cox, and anyone else with knowledge in this matter,

do you think sugery reinbursements will see brighter days or more of the same?
is there a united front of surgeons, or are there still too many who are not concerned?
 
filter07 said:
filter07 said:
Then there's an issue about patients paying a premium to see certain doctors, on top of the higher reimbursement by HMOs. The physician in the article has been practicing greater than 25 years and probably has built up a solid reputation in the community. He is a clinical professor at the local medical school. He was also voted to be one of the best surgeons in America by New York magazine. Can his results really be reproduced widely, or is his success only typical of the upper crust surgeons? What are the implications if the upper crust surgeons defect? Where does that leave other surgeons, the majority of patients, and HMO coverage?
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This would be a good thing. Too often I've noticed examples of physicians letting the government, and corporations, dictate the environment in which we practice. Let the market drive practice patterns, and not insurance companies or HMOs. Good doctors will be successful, and bad doctors will not be successful. We should all strive to be excellent physicians.

filter07 said:
Another point is that it is only the surgeon's fees that are paid out of pocket. While a surgeon's fee for a AAA or Whipple only reaches several thousand dollars, hospital and other fees can be much much higher. These costs are paid by HMOs. If more and more surgeons were to drop HMO coverage, patients would commonly have to pay their premiums AND out of pocket to individual surgeons. That type of system is not sustainable unless premiums drop significantly and coverage is radically altered to only include hospital/nursing/ancillary/medical fees. In essence there needs to be a massive overhaul of HMO policies.
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The point of the paper is to abandon unfavorable HMOs/insurance companies. Surgeon's fees may be separated from hospital charges. One does not need to accept unfavorable payments from HMOs or insurance companies. Further, if hospitals begin to have difficulty finding surgeons to operate in their hospitals, then they will get more involved in this growing problem. Already many rural hospitals are offerring greater compensation (in the form of salaried positions) than most urban centers.

filter07 said:
Again, the results of this surgeon's experiment is very promising, but it is hardly a blueprint for wide-scale adoption. It raises many questions. The biggest drawback to this type of practice is that it exploits a small, but highly profitable niche, which might not be widely reproducible. In this sense it is somewhat similar to boutique medicine. Before we hail these achievements, we have to ask ourselves what the real implications are. If your goal is to stratify surgeon reimbursement for the chance to make more for yourself, then this is clearly exciting. If your goal is better patient care, you should be encouraged but highly skeptical.
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There is no loophole that is being exploited. There is simply a choice not to accept unfavorable contracts with HMOs or insurance companies.

As far as compromising patient care by increasing physician revenue.... I don't think the point of the paper is to show physicians how to make more money per se. The point is that if you don't generate more collections than expenses, you can provide NO care. There is no business model that can succeed with a negative cash flow. This physician needed to increase revenue to continue providing any care. True, he will see less patients now, but at least he is able to see patients.
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I see this discussion often with the general surgeons, but not as much as internal medicine. Is there a reason? Are they not getting the massive hacking as the surgeons are?
 
NDESTRUKT said:
I see this discussion often with the general surgeons, but not as much as internal medicine. Is there a reason? Are they not getting the massive hacking as the surgeons are?
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Yes. While the cognitive specialties have always been reimbursed less than the more procedural ones, inflation adjusted pay for the most common surgical procedures has decreased between 25 and 70% over the last 15 years. In many cases, salaries and reimbursement for surgeons has decreased at a greater rate than changes seen in IM or other fields.
 
The author is right about one thing, that the insurance companies are living of the skills of the physician and surgeons in the US.

What is being done about this. ARe there any organization fighting against this robbery.

Why can't all the Doctors and pHysicians just make there own insurance company that deals with only paying the physician? AFter all without the MDs/DOs, what do they have.


This thread needs more discussion.
 
mrgq912 said:
What is being done about this. ARe there any organization fighting against this robbery.
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There are several - the AMA, the American College of Surgeons and many other organizations have committees which deal directly with reimbursement issues and lobbying Congress for changes.

Why can't all the Doctors and pHysicians just make there own insurance company that deals with only paying the physician?
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You can. You can even do away with insurance totally - either by having a "boutique" practice and charge cash only or you can have patients pay whatever you charge up front and then THEY deal with the insurance company, submitting the claims. Perhaps if more practices did this, patients would start to see that getting 45% (or less) of what you bill, is a bit of a problem.
 
what would happen if all the physicians in the usa (about 900,000), stop accepting insurance, leave their HMO contracts and go back to the old system (what ever that was).

How was medicine practiced before the HMO fiasco? Was our healthcare system better or worse with this old system compared to the present day HMO system.
 
mrgq912 said:
what would happen if all the physicians in the usa (about 900,000), stop accepting insurance, leave their HMO contracts and go back to the old system (what ever that was).
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Trouble is, you can never get a large group to agree on anything. There will always be those who are too scared to change. Once you are used to a certain lifestyle, you become afraid of not being able to make the Porsche payment. They way our fathers and grandfathers practiced medicine was that patients generally had insurance, you submitted a bill and it would get paid...not at the full rate, but there was much less paperwork. Instead of bundling procedures, you got paid for every part you did...even down to the Foley insertion.

A Vascular surgeon (Surgeon A) and I were shooting the breeze today when he told me the following little story... Approximately 25 years ago one of his practice's (now) elder surgeons (Surgeon B) did a Aorto-bifem repair and Surgeon A looked up the billing slip - Surgeon B got $7500. Assuming an inflation rate of $160%, in current terms, the payment for the Ao-bifem would be $7500 + ($7500 x 1.6) = approximately $20,000.

Surgeon A takes patient back to the OR recently for aneurysms at the proximal and bilateral distal ends. This means 8 hrs of grueling superceliac clamping, patient practically dying on table because she's a thousand years old now, etc. A hard case essentially. What is he allowed to bill for this? $1400. We'll see how much he actually receives from the insurance company.
 
This is a GREAT article! I'll e-mail it to all my friends. Thanks for the link!
 
surgical06 said:
that was a great article; very sad and discouraging though. big business is a beast.

i think this is a good case for medical schools to begin to teach medical economics. there is a need to change the "culture" we currently have.

i will only be begining my journey in july, i hope this will be addressed before i get out.
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yes, business is a beast, and it's ruthless and operates (no pun intended) as a culture with values and philosophies completely opposite from ours. that's why the relationship between medicine and business is so antagonistic, and many MDs are choosing to fight the system, leave it altogether, or accept that things are different and try to adapt by getting an MBA degree. but did any of you who are graduating or in residency not know this before you started med school? we were all given fair and extensive warning before we ever applied to med school that it's not what it used to be like and if you wanted to make lots of money, medicine is not the right career to choose. so are any of you really surprised?

i don't think this article or the subject matter in general is a reason to start teaching medical economics in med school. i don't think economics should ever be part of a medical student's education...the way we learn and practice the art of medicine is what makes our "culture" so revered and noble...the integrity of our profession would be threatened and we'd risk losing the trust and faith of our patients if they knew we were being schooled in fiduciary matters pertaining to their care--would you want to be cared for by someone who you aren't sure is making choices based on what's in your best interest or what's in his financial best interest? our decisions, motives, and choices would suddenly be met with skepticism, and the image of the doctor will be blurred with that of the profit-seeking businessman, and i think this would cost us far more in the long run than anything we could expect to gain from learning about economics in med school. i am not a businessman and i enjoy that i'm not perceived as such when it comes to my relationships with patients. i'd like to keep it that way and never have patients second-guess my judgment based on any concerns that i may be unduly influenced by financial matters when it comes to their care...once that happens, the trust is gone and so is our "culture".

i hope you don't expect much to happen after you're finished with your journey through training...presuming you went into this field with the right intentions, you wanted to take care of patients and there will always be patients to take care of. how much you'll be compensated for doing that remains unknown...it could get better or worse...but you won't have the time to fight the system. i think we all have to just stomach the reality that we're not going to become wealthy from practicing medicine and complaining isn't going to change that. i'm just as disappointed as everyone else is to read articles like this one, but i'd by lying if i said that no one warned me long before i ever took the MCAT about this problem. it's nothing new and we all chose to proceed with med school despite knowing this, as well as the cost of tuition, the debts we would accrue, the pathetic salaries for residents, and the obscene number of hours we'd be working. despite all of this, we still felt it was worth it, and i still do, and i just regard this as one more sacrifice we have to make in exchange for the privilege of getting to do what we worked so hard for.

i know i'm going to be struggling financially for a long time, and there will be a lot of people working in the HMO industry making way more money than us and working far fewer hours each week than we'll ever get to, but regardless, at the end of the day we'll get to think about how many people we helped and cared for at work, while all they'll have to think about is how many people they screwed over and cheated instead. i much prefer service to others over selfishness and greed, and i'm sure you do too...in the end i think it'll all work out and we'll be compensated well, in some form of currency or another.
 
mcindoe said:
i don't think economics should ever be part of a medical student's education...the way we learn and practice the art of medicine is what makes our "culture" so revered and noble...the integrity of our profession would be threatened and we'd risk losing the trust and faith of our patients if they knew we were being schooled in fiduciary matters pertaining to their care--
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:clap: 😀 YOU HAVE DONE IT! You have typed out the stupidest post EVER in the history of SDN! Its amazing! I've been here awhile and seen some stupid posters come and go but you are the first to make a plea on behalf of ignorance...YAY IGNORANCE! And you do it with such rightous indignation too. Amazing. Im in awe. Lets all keep getting raped so we can be "revered and noble" and...no longer able to practice medicine.
I like your gumption too "we knew what we were getting into, we can't change it...lets just give up" Thats the spirit! Damn, you must work at kaiser.
 
mcindoe said:
at the end of the day we'll get to think about how many people we helped and cared for at work, while all they'll have to think about is how many people they screwed over and cheated instead.
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Problem is, the average patient who has the average HMO doesn't seem to care whether or not you "helped" them by giving them a medicine or doing a surgery that's going to help them lead a better life.

After you've helped and helped and helped for days on end, the thing they pay most attention to is the fact that the nurse didn't come right away when they rang their call bell or that their food tray was cold. Then they leave and go out and keep smoking or drinking or eating fat or not take the great medicine you prescribed because it makes them feel "funny" and then they come back to the ER with the complaint you already wasted 80 hours of your life treating them for.

You could have spent more time helping them understand the importance of their disease, but business dictates that there's no time for that, and you have to get the work done quickly so you can move on to the next poor SOB who's already been waiting too long and hasn't been paid attention to due to the fact that the hospital can't afford to hire one more nurse to pay attention to them because the HMO says "1 dollar for you, a thousand for me".

We all care. But this is not what we signed up for. /end intern rant.
 
"but did any of you who are graduating or in residency not know this before you started med school? we were all given fair and extensive warning before we ever applied to med school that it's not what it used to be like and if you wanted to make lots of money, medicine is not the right career to choose. so are any of you really surprised?"😡


It is impossible to know what you are getting yourself into ahead of time, financially and otherwsie. Period. You can think you understand, but you won't until you shoulder deep in it. Same way you can think you know what it will be like to be on call, but you won't be able to actually comprehend what it's like until you are awake for "30 hours" with your pager simulating your heartbeat and hours of work left before you can sleep.

I am the son of two physicians (who, by the way, have done OK financially, but by no means make the stereotypical physician salary...) . I spent every moment of medical school I could working with a private practice surgeon, in all aspects of his practice. I feel like I had a pretty good handle on the current state of medical economics, residency training, and what it's like to be a physician.

However, I was wrong, particularly about economic issues. This is not meant to be conceited, but, if I can have the exposure that I detailed above and miss the boat, imagine the naive junior in college with no medical training/background at all who is applying for medical school because he/she "just wants to help people". Pretty soon, they will question "what the hell did I get myself into? It's not supposed to be like this! Why do I OWE medicaid money for perfomring a life-saving operation on a patient who hasn't seen a doctor since the cord was cut?"

That is reality and it takes articles like this one to provide detailed analysis of what is actually going on here. If my medical school can mandate sensitivity training so we can learn how to "better treat" our patient's who just want to sue us, why can't they mix in some practice management, medical economics, and general business coursework? Guaranteed to use that more than knowing the structure of certain g protein coupled receptors...

Also in response to that ridiculous post, physicians with your mentality are the one's responsible for physicians loosing control of their own practices/careers. The complacency of you and countless others, and the idea that we do noble work and nothing else should matter, is the reason we are where we are. The appropriate response is to take control, be aggressive, and take the initiative to do what's best for your practice for a change. Pretty soon, those fat HMOs, etc... described in the article will have patient's will rotten gallbladder's calling them on the phone asking for help because nobody will treat them. All of a sudden, they will have to change their policies. I'm not advocating ignoring sick patient's and letting their diseases go untreated, but a smart, methodical, realistic analysis of what's going on in individual practices could drastically improve the careers of countless surgeons.
 
I think most doctors enjoy doing a little charity work, giving something back, and helping out those in dire circumstances. Most probably would agree it makes them feel better than seeing a fat paycheck. But gone are the days when you can just go out and work hard and be overjoyed with your pay check at the end of the month. I didn't think that this article said that we need to unite, strike, and take back the luxurious lifestyle we deserve, but that we need to be AWARE of our costs and our revenues and practice accordingly. Advocating ignorance is the most idiotic thing ever.

I think the admiration of our profession is wearing out. We aren't as revered as we used to be. Part of it may be letting ourselves get backed into an economic corner to where we have to be rushed and hurried with our patients so that we can have money to pay our office staff at the end of the month.
doctors.JPG





If we don't know what money is coming in and going out, then we can't respond to it and things will get inevitably worse. Charity work isn't charity work when someone is making millions off it. It's called slave labor! We have to realize that we are practicing in a field driven by economic principles. Supply and demand, as well as costs, revenues, and profits drive all the other entities at play(insurance companies, drug companies, tech companies, administration). If we keep providing an infinite supply of cheap labor(working ourselves ragged for no pay and not even realizing it) then the demand (our compensation for the exhausting work we do) will continue to worsen. Once we are aware and prioritizing our practices to the work that gives us the most pay for the least amount of headache then hopefully the market will respond by increasing compensation for the work that sucks. Well that's my hope anyways. I guess they kind of have us because we HAVE to treat sick patients. But atleast being aware is the first step. I've been sending that article to everyone I know.

Justin
 
With all this going on, are surgeons just going to be making peanuts? I mean I couldn't imagine surgeons making less than 100K a year...
 
If I work for free or a nominal cost, I want it to be on my terms and by choice. And I certainly don't want to line the pockets of corporations who contribute nothing to patient care. At least some corporations manufacture goods; what has the insurance company ever produced?

My biggest complaint is not the salary. I knew that being a doctor was not as lucrative as it had been in the past. I did it because, among several other factors, helping people/society and making this world a better place was one of my goals. Making more or less money is not terribly important to me, in the grand scheme of things.

What makes me angry, regretful, and resentful is the fact that other people, who contribute nothing to healthcare, don't take care of the single patient, and certainly do not make this world a better place, are essentially stealing money from healthcare. Health insurance premiums are rising, patients are denied coverage retroactively, malpractice insurance is high, the doctor-patient relationship is strained, and throughout all of this, insurance companies are making record profits and their CEOs earn ungodly amounts of money.

This unjust situation is what angers me. If it was necessary, I honestly would not mind working for peanuts. I think many would agree, as they go on charity missions often. Medicine to me has never been about making myself rich. Medicine is a noble profession, and if we were all in this together, helping others would be enough for me. But we're not all in this together; the current situation is due to people stealing from our system and exploiting our humanitarian vows for their own selfish purposes. How many private practices are forced to hire someone just to call the insurance companies daily and demand reimbursement, or to make sure the billing codes are exactly right? That's at least 30k a year of waste because of the insurance company. How can we accept drastic cuts in our salary for the sake of universal coverage while others continue to get rich off the sweat off our backs? If our nation were poor, and truly in need, I would volunteer without question. But our nation is a nation of debt, of uncontrolled spending, mistaken priorities, and lavishness. CEOs are making tons of money. Politicians have no problem raising their own salaries and accepting financial contributions, but they are willing to cut reimbursements in Medicare or tax our gross salaries (Governator). These people have no right to ask us to sacrifice.

I am all for humanitarianism... on my terms. I will not let others exploit my good intentions while others continue to eat away at our income and dignity like parasites. Everyone in medical school should be educated on the healthcare system and finances, whether they want to be rich or not. It is a travesty that medical schools don't address this issue. We already waste so much of M4 year when we could be taught how to take back dignity to our noble profession. The road back to dignity is not by sticking our heads in the sand; it's by getting educated, searching for solutions, and gathering the will for reform.
 
filter07 said:
If I work for free or a nominal cost, I want it to be on my terms and by choice. And I certainly don't want to line the pockets of corporations who contribute nothing to patient care. At least some corporations manufacture goods; what has the insurance company ever produced?

My biggest complaint is not the salary. I knew that being a doctor was not as lucrative as it had been in the past. I did it because, among several other factors, helping people/society and making this world a better place was one of my goals. Making more or less money is not terribly important to me, in the grand scheme of things.

What makes me angry, regretful, and resentful is the fact that other people, who contribute nothing to healthcare, don't take care of the single patient, and certainly do not make this world a better place, are essentially stealing money from healthcare. Health insurance premiums are rising, patients are denied coverage retroactively, malpractice insurance is high, the doctor-patient relationship is strained, and throughout all of this, insurance companies are making record profits and their CEOs earn ungodly amounts of money.

This unjust situation is what angers me. If it was necessary, I honestly would not mind working for peanuts. I think many would agree, as they go on charity missions often. Medicine to me has never been about making myself rich. Medicine is a noble profession, and if we were all in this together, helping others would be enough for me. But we're not all in this together; the current situation is due to people stealing from our system and exploiting our humanitarian vows for their own selfish purposes. How many private practices are forced to hire someone just to call the insurance companies daily and demand reimbursement, or to make sure the billing codes are exactly right? That's at least 30k a year of waste because of the insurance company. How can we accept drastic cuts in our salary for the sake of universal coverage while others continue to get rich off the sweat off our backs? If our nation were poor, and truly in need, I would volunteer without question. But our nation is a nation of debt, of uncontrolled spending, mistaken priorities, and lavishness. CEOs are making tons of money. Politicians have no problem raising their own salaries and accepting financial contributions, but they are willing to cut reimbursements in Medicare or tax our gross salaries (Governator). These people have no right to ask us to sacrifice.

I am all for humanitarianism... on my terms. I will not let others exploit my good intentions while others continue to eat away at our income and dignity like parasites. Everyone in medical school should be educated on the healthcare system and finances, whether they want to be rich or not. It is a travesty that medical schools don't address this issue. We already waste so much of M4 year when we could be taught how to take back dignity to our noble profession. The road back to dignity is not by sticking our heads in the sand; it's by getting educated, searching for solutions, and gathering the will for reform.
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We as young surgeons-in-training and surgeons out in private practice need to go to the media, hospitals, and insurance companies with this message; well articled by this post.

Before it is too late.
 
Referring to the above: there are plenty of patients who will sue somebody who's done nothing but try and save or prolong their lives. There are lots of people who've literally just chosen to do nothing with their lives; to feed off of the government, social programs, our taxes, etc., so they won't have to do anything but sit around and drink malt liquor. Our "free, capitalist" country now allows this routinely. These same patients will treat us hard-working, educated, well-intentioned people as if we were slaves and absolutely obligated to keep them alive and healthy, however useless and destructive they are. The insurance companies and medicare/medicaid are developing a monopoly over physician payment, which is theoretically impossible in a free society (a futile point because, well, we're well on our way to communism).

Insurance companies serve no vital purpose and take full advantage of us, and *patients who are able to afford care often aren't willing to fork over respectable payment to have their lives saved, prolonged, or improved.* The typical person is willing to spend more money on a new purse or cell phone. The vast majority of people who can't afford services, I'm sorry to say, don't deserve them. We made our way from bacteria to complex beings via competion and survival. Who's now come up with the ingenious idea that thwarting that process will do anything but destroy us or, at the least, set us back from whence we came? I'll say it: if someone hasn't done enough with his or her life to afford 3,000/year for health insurance, then they may not deserve health care. Giving it to them defies every vital process of life and progression.

Patients who take our care, want it free, and then sue us when we fail to perform a miracle? F**k those patients! I personally will have that list of plaintiffs taped to my desk so I'll know who to turn away. Doctors are taken advantage of because...well...they're nerds. They're science guys. They don't stand a chance when it comes to the nitty gritty with lawyers and businessmen. As has been said above, we need to get tough and start standing up for ourselves, or we'll continue to be shafted by the very same people we care so much about helping.
 
Don't forget those patients who only value/insure their life at 10,000 dollars on their life insurance policy, but after an injury their life is suddenly worth millions in the eyes of a jury. Or the patients that are willing to pay thousands of dollars for cosmetic procedures and then whine about their 10 dollar co-pay on cardiac meds. Then there are the patients who get pissed that you turned them into collections for not paying their bill, or not filing for gov't aid. They aren't willing to spend an hour sitting down with a social working filling out paper work so you can atleast cover the costs of not to mention compensation for your time spent in the middle of the night taking care of them, or help you pay off the debt that you incurred as you payed to go into work at 5 in the morning for 4 years.

The american people have grown to feel entitled to healthcare, I think it's getting too late to change that. Maybe if the oncoming shortage is really bad it may be able to reverse things, provided that we don't just work ourselves unconscious for the same pay we always get to make up for the deficit of other laborers.

Although it's an easy thing to whine about, I don't think lawsuits are as common as they sound. It's actually pretty hard to win a case against a doctor who didn't totally drop the ball.

Justin
 
Unfortunately the average consumer already thinks doctors make too much money.

Is the medical field powerful enough on its own to implement change?

We have lawyers, media outlets and a general attitude of the populous all working against us.

When people think universal healthcare is a right and that anyone driving a nicer car than them is showboating...I dont think you can work against that.
 
i am glad to see this being put out there. this is something that many who have been in practice have been noticing over the past 10-15 years. it use to be that medicare was a bad payor. in today's market, it is one of the better payors. understand that today many insurance companies give you their contract payments based on a % of medicare. (90% of medicare rates, 110% medicare rates). so medicare is the only insurer that always gives you 100% of medicare rates.

talk to older physicians who have been out in their private practices for a while. they will tell you that they have to do twice as many cases to make the same money as they did 10 years ago.

i think this is an important article to be placed in these forums because i see a lot of posts on what salary you will make when you get don. there is no salary unless you a true "employee" like kaiser permanente. most of the salaries you may see posted are "guarantees" and in the contract there will be a stipulation on how much you are suppose to bring in or earn. as they say, "you eat what you kill." the problem with today's market there are no more fat chickens and turkeys, they are all cornish hens.
 
I am shocked no retiring surgeons and chairmen/chairwomen of surgery are helping us in this fight.
 
mcindoe said:
yes, business is a beast, and it's ruthless and operates (no pun intended) as a culture with values and philosophies completely opposite from ours. that's why the relationship between medicine and business is so antagonistic, and many MDs are choosing to fight the system, leave it altogether, or accept that things are different and try to adapt by getting an MBA degree. but did any of you who are graduating or in residency not know this before you started med school? we were all given fair and extensive warning before we ever applied to med school that it's not what it used to be like and if you wanted to make lots of money, medicine is not the right career to choose. so are any of you really surprised?

i don't think this article or the subject matter in general is a reason to start teaching medical economics in med school. i don't think economics should ever be part of a medical student's education...the way we learn and practice the art of medicine is what makes our "culture" so revered and noble...the integrity of our profession would be threatened and we'd risk losing the trust and faith of our patients if they knew we were being schooled in fiduciary matters pertaining to their care--would you want to be cared for by someone who you aren't sure is making choices based on what's in your best interest or what's in his financial best interest? our decisions, motives, and choices would suddenly be met with skepticism, and the image of the doctor will be blurred with that of the profit-seeking businessman, and i think this would cost us far more in the long run than anything we could expect to gain from learning about economics in med school. i am not a businessman and i enjoy that i'm not perceived as such when it comes to my relationships with patients. i'd like to keep it that way and never have patients second-guess my judgment based on any concerns that i may be unduly influenced by financial matters when it comes to their care...once that happens, the trust is gone and so is our "culture".

i hope you don't expect much to happen after you're finished with your journey through training...presuming you went into this field with the right intentions, you wanted to take care of patients and there will always be patients to take care of. how much you'll be compensated for doing that remains unknown...it could get better or worse...but you won't have the time to fight the system. i think we all have to just stomach the reality that we're not going to become wealthy from practicing medicine and complaining isn't going to change that. i'm just as disappointed as everyone else is to read articles like this one, but i'd by lying if i said that no one warned me long before i ever took the MCAT about this problem. it's nothing new and we all chose to proceed with med school despite knowing this, as well as the cost of tuition, the debts we would accrue, the pathetic salaries for residents, and the obscene number of hours we'd be working. despite all of this, we still felt it was worth it, and i still do, and i just regard this as one more sacrifice we have to make in exchange for the privilege of getting to do what we worked so hard for.

i know i'm going to be struggling financially for a long time, and there will be a lot of people working in the HMO industry making way more money than us and working far fewer hours each week than we'll ever get to, but regardless, at the end of the day we'll get to think about how many people we helped and cared for at work, while all they'll have to think about is how many people they screwed over and cheated instead. i much prefer service to others over selfishness and greed, and i'm sure you do too...in the end i think it'll all work out and we'll be compensated well, in some form of currency or another.
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Get off your high horse.

Of course we all knew that the glory days of medicine were over. We just want to be fairly compensated for our hard years of training and to not be screwed by HMOs, insurance companies, etc.

Why should we sit back and let HMOs take advantage of this "it'll all work out" mentality that some physicians have on this matter?
 
filter07 said:
If I work for free or a nominal cost, I want it to be on my terms and by choice. And I certainly don't want to line the pockets of corporations who contribute nothing to patient care. At least some corporations manufacture goods; what has the insurance company ever produced?

My biggest complaint is not the salary. I knew that being a doctor was not as lucrative as it had been in the past. I did it because, among several other factors, helping people/society and making this world a better place was one of my goals. Making more or less money is not terribly important to me, in the grand scheme of things.

What makes me angry, regretful, and resentful is the fact that other people, who contribute nothing to healthcare, don't take care of the single patient, and certainly do not make this world a better place, are essentially stealing money from healthcare. Health insurance premiums are rising, patients are denied coverage retroactively, malpractice insurance is high, the doctor-patient relationship is strained, and throughout all of this, insurance companies are making record profits and their CEOs earn ungodly amounts of money.

This unjust situation is what angers me. If it was necessary, I honestly would not mind working for peanuts. I think many would agree, as they go on charity missions often. Medicine to me has never been about making myself rich. Medicine is a noble profession, and if we were all in this together, helping others would be enough for me. But we're not all in this together; the current situation is due to people stealing from our system and exploiting our humanitarian vows for their own selfish purposes. How many private practices are forced to hire someone just to call the insurance companies daily and demand reimbursement, or to make sure the billing codes are exactly right? That's at least 30k a year of waste because of the insurance company. How can we accept drastic cuts in our salary for the sake of universal coverage while others continue to get rich off the sweat off our backs? If our nation were poor, and truly in need, I would volunteer without question. But our nation is a nation of debt, of uncontrolled spending, mistaken priorities, and lavishness. CEOs are making tons of money. Politicians have no problem raising their own salaries and accepting financial contributions, but they are willing to cut reimbursements in Medicare or tax our gross salaries (Governator). These people have no right to ask us to sacrifice.

I am all for humanitarianism... on my terms. I will not let others exploit my good intentions while others continue to eat away at our income and dignity like parasites. Everyone in medical school should be educated on the healthcare system and finances, whether they want to be rich or not. It is a travesty that medical schools don't address this issue. We already waste so much of M4 year when we could be taught how to take back dignity to our noble profession. The road back to dignity is not by sticking our heads in the sand; it's by getting educated, searching for solutions, and gathering the will for reform.
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Well said. 👍 I came across this thread recently and have read through all of the posts. There have been some great issues brought up. As a medical student, I feel helpless that I can't do anything to fix the system. I know it is the $64k question, is there really anything we can do? Or are our hands tied so tight behind our backs that we can't do anything. Will we always be at the mercy of the HMO's? If only a small aspect of the medical community could come together and start a united front. Maybe that would lead to a cascade of other events?

After reading the article, which was very interesting, does anyone have an idea of the % of money that an HMO takes in vs. gives out for reimbursement? I wonder if it is close to 50/50? Would be a very interesting statistic to know.
 
An obvious answer - as someone said above - is to enter the insurance market as a collective as has happened in lots of places with malpractice insurance. Have an insurance company owned by the care givers themselves, where there is no profit motive for the company that takes funds away from patient care, reimbursement, and lowering premiums. Give these insurance companies some competition.

If insurance company profit taking really is the problem (and I agree that it is), then a collective insurance company that saves this middle man's profits should be able to reimburse at much higher rates while still charging lower premiums to patients.

The problem/difficulty, and the reason there is less "press" on our side on this is that most folks seem to think the only alternative to insurance companies is socialized medicine... or, in other words, "out of the frying pan - into the fire".
 
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