David Belk Reddit AMA

[Yadster101]

David Belk's AMA is on the front page of reddit. I haven't read his work, but according to many of the comments he actually lists physician incomes as one of the contributors to the outrageous costs of our healthcare system. Although, I might be misunderstanding it because some commenters said that he was trying to suggest that physician income is a very small contributor and not a large issue.

My question, as a student interested in FM, is:
1) Is it really possible/likely that FM/PC salaries will go down any further than where they are now?

FM docs in my area are making ~150k out of residency working full time. Could they really dip to below 100k?

---

Members don't see this ad.

 

[Warderino92]

I wouldn't read too much into it, Reddit's general audience is 20 something socialist leaning liberals that believe that we should switch to a government run healthcare model. Whether you believe in that system or not that entire thread is a big circlejerk about how bad doctors are in america and how they screw their patients and what not.

 

[Dires]

I tried to read and watch some of Belks pieces. it was frustrating rapidly swinging between agreement to disagreement. Overall he comes across as a know it all dbag.

His article on med mal was particularly frustrating. I almost made a post on here about it. It would be nice to hear everyone's opinion.

 

[Yadster101]

I wouldn't read too much into it, Reddit's general audience is 20 something socialist leaning liberals that believe that we should switch to a government run healthcare model. Whether you believe in that system or not that entire thread is a big circlejerk about how bad doctors are in america and how they screw their patients and what not.

Actually, the upvoted comments seem to appreciate the time/money needed to become a doctor. The top comments are saying that physician pay should stay the same.

 

[Brahnold Bloodaxe]

Let's do some simple math. There are between 900k-1m active physicians in the United States. Not all of them work full time by a long shot, but for the sake of simplicity and erring on the side of over-estimating the "doctor problem" let's say they're all full time.

Let's further say that the average compensation of "physician" is 350k per year. That's a gross overestimation, again. Still, we're now left with 1 million full time members of the 350k/year physician master race.

So how much money are those physicians pocketing each year? That would be $350 billion a year. Google says total healthcare spending is around 3.5 trillion a year, which means physician salaries, under my completely unfair-to physicians-calculations represents 10% of that spending.

And remember, not only did I over estimate the total number of physicians, not only did I make all physicians full time, but I also grossly over-estimated the average salary those physicians earn in order to arrive at that 10% figure. In real life, 10% is the absolute upper bound on the fraction of healthcare spending going to doctors and in fact is much less.

 

[Law2Doc]

David Belk's AMA is on the front page of reddit. I haven't read his work, but according to many of the comments he actually lists physician incomes as one of the contributors to the outrageous costs of our healthcare system. Although, I might be misunderstanding it because some commenters said that he was trying to suggest that physician income is a very small contributor and not a large issue.

My question, as a student interested in FM, is:
1) Is it really possible/likely that FM/PC salaries will go down any further than where they are now?

FM docs in my area are making ~150k out of residency working full time. Could they really dip to below 100k?

Yes it's possible salaries will go down. Or more likely will stay the same, which is really a form of salaries going down as they wont keep pace with inflation.

The typical member of the public has no clue about school and training. But there's a huge sentiment that it's more about privilege than hard work. Virtually every grocery bagger will tell you they could have been a doctor. And universally people think doctors get paid way too much. No politician ever lost votes saying he would cut doctors salaries to help the healthcare consumers. Yes doctors make up less than 5% of healthcare costs but they are the 5% the patients see (as overpaid) and the 5% that don't have the money to finance political campaigns. The real costs are things like insurance (who the government has decided it needs to manage healthcare), drugs (the manufacturers of which aren't even all US entities, so harder to address without making people lose their medications or making the US players in this industry noncompetitive), and to a lesser extent things like the US diet/obesity, lawsuits -- which frankly the voting public is for because they are the ones who get injured, and so on.

So yeah, as doctors we are the easy targets to nickel and dime on reimbursements so politicians can say they are doing something about health care, but no it won't make a real impact. So yes salaries might go down another 5-10% over time in the form of annually lowering reimbursements for various tasks, without much healthcare impact. It won't be fast and doctors will do what they always do and add another hour into the day or see more patients per hour to try and earn it back.

 

[kbeitz]

David Belk's AMA is on the front page of reddit. I haven't read his work, but according to many of the comments he actually lists physician incomes as one of the contributors to the outrageous costs of our healthcare system. Although, I might be misunderstanding it because some commenters said that he was trying to suggest that physician income is a very small contributor and not a large issue.

My question, as a student interested in FM, is:
1) Is it really possible/likely that FM/PC salaries will go down any further than where they are now?

FM docs in my area are making ~150k out of residency working full time. Could they really dip to below 100k?

Read his points here: http://truecostofhealthcare.net/conclusion/

FM has the option of DPC, which bypasses the need for them to take insurance at all, and therefore allows them to determine their own income. Psych is similar in that they mostly have cash businesses. Both of these specialties will continue to keep pace with other medical practices

I think the gist is that healthcare cost is due to everyone in it, not just a subset. Everyone, including nurses and the pharmacy tech at your local Walgreens is in the game for a cut. Insurance works when it has MORE people it can distribute to, so it can justify HIGHER premiums. Physician salaries will never decrease under this model because its in the best interest of insurance companies to keep physicians happy so they can continue their game. Belk wants all of those people and costs to be transparent so that insurance companies can't just hide the money in a massive shell game. He's not after physicians, pharmaceuticals, or anyone small--he's after big insurance:

The health insurance companies aren’t hiding any money— they know that would be stupid. Instead, they’re distributing the money to all providers so they can drive up their revenue by driving up their costs. This strategy helps to ensure that most providers will side with insurance companies in opposing health care reforms. They also know that the more everything costs in health care, the more everyone will rely on them to manage these costs. They’ve effectively rigged the game in a way that allows them to win every time they make things worse for everyone.

For the record, I don't think he's wrong. But I would like a physician on this forum to provide a counterpoint to his argument if they think he is wrong.

 

[Yadster101]

I tried to read and watch some of Belks pieces. it was frustrating rapidly swinging between agreement to disagreement. Overall he comes across as a know it all dbag.

His article on med mal was particularly frustrating. I almost made a post on here about it. It would be nice to here everyone's opinion.

So you're familiar with him? Do you know where he went to med school/did residency?

Read his points here: http://truecostofhealthcare.net/conclusion/

FM has the option of DPC, which bypasses the need for them to take insurance at all, and therefore allows them to determine their own income. Psych is similar in that they mostly have cash businesses. Both of these specialties will continue to keep pace with other medical practices

I think the gist is that healthcare cost is due to everyone in it, not just a subset. Everyone, including nurses and the pharmacy tech at your local Walgreens is in the game for a cut. Insurance works when it has MORE people it can distribute to, so it can justify HIGHER premiums. Physician salaries will never decrease under this model because its in the best interest of insurance companies to keep physicians happy so they can continue their game. Belk wants all of those people and costs to be transparent so that insurance companies can't just hide the money in a massive shell game. He's not after physicians, pharmaceuticals, or anyone small--he's after big insurance:


For the record, I don't think he's wrong. But I would like a physician on this forum to provide a counterpoint to his argument if they think he is wrong.

I skimmed through the conclusion. He doesn't actually mention DPC...right?

 

[Yadster101]

Yes it's possible salaries will go down. Or more likely will stay the same, which is really a form of salaries going down as they wont keep pace with inflation.

The typical member of the public has no clue about school and training. But there's a huge sentiment that it's more about privilege than hard work. Virtually every grocery bagger will tell you they could have been a doctor. And universally people think doctors get paid way too much. No politician ever lost votes saying he would cut doctors salaries to help the healthcare consumers. Yes doctors make up less than 5% of healthcare costs but they are the 5% the patients see (as overpaid) and the 5% that don't have the money to finance political campaigns. The real costs are things like insurance (who the government has decided it needs to manage healthcare), drugs (the manufacturers of which aren't even all US entities, so harder to address without making people lose their medications or making the US players in this industry noncompetitive), and to a lesser extent things like the US diet/obesity, lawsuits -- which frankly the voting public is for because they are the ones who get injured, and so on.

So yeah, as doctors we are the easy targets to nickel and dime on reimbursements so politicians can say they are doing something about health care, but no it won't make a real impact. So yes salaries might go down another 5-10% over time in the form of annually lowering reimbursements for various tasks, without much healthcare impact. It won't be fast and doctors will do what they always do and add another hour into the day or see more patients per hour to try and earn it back.

If his conclusion is correct, the craziest thing is we know the solution to this problem but insurance companies have a huge incentive to fight the solution. By having an NHS like the UK everything would be better off but insurance companies would be dismantled. As docs do we have an incentive to keep the current system the way it is? If things changed wouldn't we be paid less?

 

[Brahnold Bloodaxe]

If his conclusion is correct, the craziest thing is we know the solution to this problem but insurance companies have a huge incentive to fight the solution. By having an NHS like the UK everything would be better off but insurance companies would be dismantled. As docs do we have an incentive to keep the current system the way it is? If things changed wouldn't we be paid less?

The good thing about the NHS in the context of your question is that it exists, so you can take a look for yourself and see if docs would be better off if something similar was implemented here.

Btw, here's a spoiler: the answer is NO.

 

[jeffk805dent]

Yes it's possible salaries will go down. Or more likely will stay the same, which is really a form of salaries going down as they wont keep pace with inflation.

Maybe I am out of the loop on the US job market but arent most white collar jobs salaries staying the same and not keeping pace with inflation as well? I hear from some folks b!tching about minor raises on their salary.

 

[Brahnold Bloodaxe]

Maybe I am out of the loop on the US job market but arent most white collar jobs salaries staying the same and not keeping pace with inflation as well? I hear from some folks b!tching about minor raises on their salary.

Maybe, but medical school debt is growing at a ridiculous rate, and the length of training is only increasing, as are the requirements needed to get into medical school. And we're seeing more and more patients to make that same flat salary. The upshot is, effective lifetime earnings after tuition and interest are plunging despite growing workloads and growing demand for physicians. That's a pretty unique situation, as most other jobs that have witnessed salary stagnation have done so due to lack of work/demand.

 

[Law2Doc]

Maybe I am out of the loop on the US job market but arent most white collar jobs salaries staying the same and not keeping pace with inflation as well?...

Most people in most industries over time receive small "cost of living" adjustments each year that purport to keep pace with inflation. If you look at medscape surveys over the past decade, average Doctor salaries are extremely flat, so we are not keeping pace. If you look even further, you'll notice the average hours doctors work each year has slowly inched upward over this same period so we are really doing more for less.

You aren't going to see the same trend with, say, dentistry, or management at a Fortune 500 company. "White collar" is a loaded term to toss around though, because it's hard to neatly look at trends during a decade when certain fields (eg law, banking) have been in a bit of turmoil.

 

[kbeitz]

So you're familiar with him? Do you know where he went to med school/did residency?


I skimmed through the conclusion. He doesn't actually mention DPC...right?

He doesn't mention DPC because those practices aren't sending $70,000 bills for uncomplicated appendectomies. He's talking about physicians directly benefiting from the private insurance situation as it exists in the US in response to the question "why is my hospital bill so high?" FM docs have some options to fend off the insurance culture and protect their incomes.