Amazing: US Doctors Starting to Get Outsourced to India

[LizzyM]

If you look at the recession graph, you'll see a long recession near 1980. Look at the applications graph and you'll see that applications declined from 1980 all the way top 1990.

The baby boom peaked in 1957. Those babies graduated college in 1979 and 1980. After that, the pool of first time, traditional applicants declined as the pool of 22 year olds declined.

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[medseek1]

This sort of ridiculousness never ceases to amaze me. Why, exactly, should doctors not be worried about their paychecks? Do you think the insurance companies are sitting there trying to create higher quality healthcare, profits be damned? No. And yet, when they hurt doctors over and over again with paycuts and ridiculous schemes like these, there's at least a few people shouting that we should be martyrs. No. I'm not a martyr. I am a professional who wants to help heal people, but I damn well am not going to accept paycuts smilingly so that some parasitic insurance company can give its board of directors another five-million dollar bonus for Christmas.

Pull your head out of your ass and protect your own interests.

I think you should be more concrete when posting. I agree doctors have every right to exect $200k range. But what I see increasing number of jerks entering medicine whose sole purpose is to milk the insurance system and make $500K or more.

 

[medseek1]

I appreciate your opinion as you've obviously experienced more of the medical field than a "*****" such as myself. But my god, I hope I'm not this tainted when I get to your position. From my humble, SDN starry-eyed point of view, you're dangerously pessimistic.

Linguini, I am with you on this one. After spending over 10 yrs in education and accumulating tons of debt, we have every right to expect being in upper echelon of society and make decent living. But I see an increasing number of jerks who wants to make quick millions leaving their conscience at bay. Soon they will be crushed b forces of free market.

 

[Narmerguy]

There's nothing wrong with expecting fair compensation for your trade. Being a physician is a job/career like any other and there's no reason to be denied (or for some reason, to refuse) payment for what you're worth. While everyone appreciates a healthy humanitarian outlook, a touch of practicality is severely lacking in too many premeds.

Honestly, if you really want to give up your money, give it up to those who need it, not the insurance companies. By that I mean, take your full pay check and dole out what you feel necessary and proper to those in need of help and aid instead of foolishly expecting some insurance executive to use your decreased compensation for something altruistic. It won't happen.

 

[Legato]

Maybe some of you guys haven't been to India, but although small hospitals for the local population may not be up to the mark, the hospitals where procedures like these may be performed are advanced (in response to one of the earlier comments).

 

[8744]

I appreciate your opinion as you've obviously experienced more of the medical field than a "*****" such as myself. But my god, I hope I'm not this tainted when I get to your position. From my humble, SDN starry-eyed point of view, you're dangerously pessimistic.

"Tainted?" "Dangerously pessimistic?" In other words, when your hospital administrators, the government, or the insurance company that pays you decide to cut your reimbursement to levels that make a career in plumbing mighty attractive you are going to just suck it up and take one for the non-existent team because you have bought into the notion that by martyring yourself, you are improving medical care for the Holy and Bloated Underserved.

Good Lord. The aforementioned "Third Party Payers" have absolutely zero interest in the health of your patients. The CEO looks at his bottom line and the politician looks at his chances of reelection and advancement to an even more influential position. Everything in this bad old world of ours is either about money or power. The sooner doctors realize it the sooner we can pull our heads out of our collective asses.

 

[Excelsius]

The baby boom peaked in 1957. Those babies graduated college in 1979 and 1980. After that, the pool of first time, traditional applicants declined as the pool of 22 year olds declined.

Well, that makes the data even harder to interpret. I would need another graph showing the number of 20-26 year olds in the country from 1960-2007 to get any real correlation. Lizzy, since you're an adcom, what is your personal take on this? Have you noticed a strong correlation between recession and the number of applications? If so, I'd be interested to know what the lag time is and how long does the augmentation last. It will give some general idea, but to prove any correlation, we'd need to look at all medschools, not just one.

 

[cbrons]

Do you expect matriculation to climb even higher in the next few years?

 

[LizzyM]

It is an old saying that graduate school admissions rise when the economy tanks. Basically, if it is going to be tough to find a job, then people will decide to stay in school.

Another situation when business turns bad is that post-bac programs see a bump in admisions followed by a blip in med school admissions of non-trads. I expected to see this in 2003 and 2004 after 9/11/01 and that did happen a little bit.

 

[NonTradMed]

Do you expect matriculation to climb even higher in the next few years?

I expect that matriculation will see a slight bump, but given that there are now other high profile medical jobs out there, some of those people that would have gone to medical school may opt to train as PAs, nursing, or other types of ancillary medical jobs. "Doctor" is the first thing people think about when looking at health care jobs, but medicine now offer a variety of well paying jobs. However, I still believe medical school will continue to see high caliber applicants. It still pays better than many other jobs so people are willing to worker harder to get in.


As for medical tourism----was anyone surprised? It's a global economy we live in! Medicine was eventually going to join the rest of the nation in outsourcing itself. Medical and dental tourism has been around the Mexican/US border for years. India is merely following in Mexico's footsteps. And given the raising cost of health care, it was only a matter of time before some people are willing to sacrifice quality for cost (not to say India is very bad, but generally speaking, it isn't the first place people go to for top of the line care).

The US provides top notch health care. I've seen poor medicaid patients receive better quality care than middle-incomed people in developing nations. But that quality comes with an expensive price tag and not everyone want/need that level of care.

Just as some people would rather shop at Walmart for similar items at lower prices, some people are willing to go to developing nations and get decent care for a fraction of the cost. It's not the end of the world. The medical industry will adjust and life will go on.

 

[45408]

If there is a surgery that you can either have in India or not have at all (because of the cost), then India might win. Someone can also have a surgery in India and recuperation in the US.

Not if you can't find a surgeon to take the risk of having you as a patient. If your replacement knee got infected, nobody else is going to touch it, because even if the doctor that screwed you up is in Mumbai and the US doctor partially fixed it, I can still see a US lawsuit growing.

 

[45408]

I think you should be more concrete when posting. I agree doctors have every right to exect $200k range. But what I see increasing number of jerks entering medicine whose sole purpose is to milk the insurance system and make $500K or more.

That's a very small portion of the pie. Focus on the rule, not the exceptions.

 

[Law2Doc]

I expect that matriculation will see a slight bump,

Careful -- matriculation and applications are not the same thing. Applications go up when the economy is bad, after a lag. Matriculation is set by the schools independent of applications or the economy. Matriculation is rising now at the request of the AAMC for med schools to increase their enrollment by 15%, as well as due to the addition of a few new schools in the coming years. Application are what probably will see a bump (probably not so slight) in the coming years.

 

[Instatewaiter]

If there is a surgery that you can either have in India or not have at all (because of the cost), then India might win. Someone can also have a surgery in India and recuperation in the US. The inability to sue is a major drawback, but as the article notes, you'd need a major mistake to make into the news and scare any future medical travels. Still, people can get desperate. I am also wondering if a patient will even be given a choice. If the employer requires an overseas treatment, I am not sure how much leverage you can have as an employee, besides quitting.

With the litigious society that we live in, i cannot believe people would flock in mass to india to have surgery by a non-boarded, non-US trained surgeon who they have never met.

I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients. From the point of view of a patient, this seems like a worthy option to consider. It costs significantly less, a patient can get certain surgeries easier/sooner there, and (believe it or not!) India has many talented physicians, up-to-date technologies and procedures, and hygenic facilities.

Besides paycheck, there are a host of other issues. The idea of medical tourism is dangerously close to a slippery slope. If the quality of care is the same, then there isnt any issue, but you must realize that the only reason that insurance companies are pushing for this is because it saves them money- not because it is better for the patient.

I would be worried about major spike in DVT- the long flight over there, the surgery and then the flight shortly after the surgery. Expect a jump in PE rate from medical tourism.

If it helps foreign doctors decide that it's economically a good choice to remain in-country to practice, I see that as a good thing.

In what way is that a good thing if they are not taking care of their native people? It is no different than if they came to the US.

This sort of ridiculousness never ceases to amaze me. Why, exactly, should doctors not be worried about their paychecks? Do you think the insurance companies are sitting there trying to create higher quality healthcare, profits be damned? No. And yet, when they hurt doctors over and over again with paycuts and ridiculous schemes like these, there's at least a few people shouting that we should be martyrs. No. I'm not a martyr. I am a professional who wants to help heal people, but I damn well am not going to accept paycuts smilingly so that some parasitic insurance company can give its board of directors another five-million dollar bonus for Christmas.

Pull your head out of your ass and protect your own interests.

QFT.

The gov't and insurance companies will walk all over you if you dont stand up for yourself and you patients. Their interests are very different from yours or your patients.

Do you somehow believe that by decreasing your pay the surplus is going to be passed on to the patient (because it is not)

Linguini, I am with you on this one. After spending over 10 yrs in education and accumulating tons of debt, we have every right to expect being in upper echelon of society and make decent living. But I see an increasing number of jerks who wants to make quick millions leaving their conscience at bay. Soon they will be crushed b forces of free market.

Unfortunately for your little rant, medicine does not obey strict free market forces. There are too many 3rd parties, too many hands in the pot and too far of a disconnect between what the consumer buys and the actual medical care they receive.

 

[LizzyM]

With the litigious society that we live in, i cannot believe people would flock in mass to india to have surgery by a non-boarded, non-US trained surgeon who they have never met.

Why do you assume that these surgeons are not US-trained and boarded?

 

[Excelsius]

Do you expect matriculation to climb even higher in the next few years?

By 2015 there are going to be around 12 new medical schools in operation with an additional 786 new spots. For all the data, look here: Doctor Supply and Demand Statistics: Construing Misconceptions

But the increase in matriculation is not related to the number of applications because currently there are more than twice the number of applications than med school seats. So you can't judge anything using the matriculation number, which only depends on how many med schools open or expand their class.

 

[JokerMD]

u guys must be really nearsighted if you think indian healthcare is subpar. The facilities that these insurers use are on par with the top US healthcare centers (and btw, these facilities are popping up all over india), and the physicians are probably as good (usually better) than the top docs here in the US.

There are several reasons why the cost is FAR below the US cost. Most importantly, many indian hospitals are completely run by doctors and there is less bureacratic cost associated with running the hospital. also, malpractice is nearly nonexistant in india. of course there are several other reasons that costs are lower but these are the major ones.

i personally like this concept of outsourcing elective procedures to other countries

 

[cbrons]

This is the worst news I have heard about doctors and is the real aspect that can bring US doctor salaries way down: http://www.nytimes.com/2008/11/21/health/21abroad.html?ref=health The article discusses how one insurer allows elective surgeries to be performed in India with no out-of-pocket costs (airfare is covered too). Anyone worried about doctor reimbursements, should probably start worrying about a lot. I would like to hear some perspectives from med students, residents, and attendings. This is incredible and the future ramifications seem daunting.

What's so amazing about it? I mean, you didn't expect this to happen?

 

[wasteoftime]

woagh woagh woagh, you are supposed to be an altruistic human being that cares about all human beings, correct? All of a sudden, you only care about the socioeconomic status of citizens of the USA? you voted for redistribution of weath in november, right? so why are you so against its distribution globally?

 

[wasteoftime]

lol, i just read this quote from the article referenced from the nyt:

"Dr. Hashmi said it had actually been easier to evaluate the quality of medical care abroad than in the United States. 'There is a lot more willingness to share data about complication rates, the total number of procedures and the outcomes,' Dr. Hashmi said. 'We’re able to get detail per hospital and per physician.'"

I'm immediately reminded of lawyers in this country, and how great it would be if we followed shakespeare's advice and executed them all. Oh, and for good measure, we might as well execute their entire families to demonstrate how their greed is so malignant to us all, discouraging their avarice even further.