Developing story: Sunshine Act Data Released...

Discussion in 'Medical Students - MD' started by @JackShephard, Sep 30, 2014.

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  1. @JackShephard

    @JackShephard

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    CMS payments data:
    http://www.cms.gov/openpayments/

    Expect to see some Op Eds from NYT and The Washington Post in the next 24-48 hrs.

    We also know there are a small minority of physicians cleaning up with millions in kickbacks. Those individuals should get some time in the spotlight.

    AMA statement
    http://www.ama-assn.org/ama/pub/news/news/2014/2014-09-30-statement-sunshine-act-data-release.page

     
    Last edited: Sep 30, 2014
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  3. Successful BM

    Successful BM 2+ Year Member

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    Jul 17, 2013
    Who could have seen that coming? The feds only have good history launching healthcare related websites.

    This seems like a federally-funded website for naming and shaming. Is that really an appropriate was to spend our tax dollars? Seems a bit immature to me. Maybe a little name-and-shame is what we need, but what the 'public' could do with this information is troublesome. This is especially true given the witch-hunty nature of the website and the way individuals tend to misuse information to further their own agendas. Not only do physicians have to worry about taking care of their patients and practices, but now they have to worry about defending themselves in a public forum against the droves of uninformed masses.
     
    pathologyDO likes this.
  4. DermViser

    DermViser 5+ Year Member

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    pathologyDO and evilbooyaa like this.
  5. calvnandhobbs68

    calvnandhobbs68 I KNOW NOTHING 7+ Year Member

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    " The database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding AG's Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin. Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research."

    How the is this not legitimate and how is that an "eye popping total"? Should they NOT get paid for research helping develop some drug treatment? Do we not live in the US where people get paid for licensing patents?

     
    Last edited: Oct 2, 2014
  6. @JackShephard

    @JackShephard

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    Feb 6, 2014
  7. evilbooyaa

    evilbooyaa 5+ Year Member

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  8. pathologyDO

    pathologyDO MS-3 2+ Year Member

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    ugh this makes me so unhappy!!! Freaking no privacy... Its ridiculous that they can make this kind of personal income information available to the public. Wanna know how much Dr. H makes up the road? Yeah! Just look it up online!

    Are there many other professions where you can look this type of information up?
     
  9. @JackShephard

    @JackShephard

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    I actually have no problem with it IF they didn't have double standards. For example, political campaigns are given money from hidden sources by setting up Super PACs alongside the other BS and corruption in political fund raising.

    The government cares about transparency as far as it doesn't hurt their ability to run for and retain office. They also care about transparency as far as it allows them to cut budgets (i.e. physician salaries). "Look, Dr. Joe made millions. We should therefore cut every physicians salary!" Expect this logic to follow by some politicians.

    There's a new book on this topic:

    Corruption in America: From Benjamin Franklin's Snuff Box to Citizens United
    http://www.amazon.com/Corruption-America-Benjamin-Franklins-Citizens/dp/067405040


    It's bad because it's not consistent.
    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
     
  10. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    It seems like a bunch of us enter medicine at the wrong time. The golden days are over! I read the comment section about this article on yahoo and some of these comments are beyond the pale. Do people really hate physicians that much? Do they really think we are responsible for most if not all of the healthcare problems America is confronting today? I hate to think that the public just see physicians as used car salesman i.e. we are crooks that are in it just for the money....
     
  11. darklabel

    darklabel MS3 5+ Year Member

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    Also realize absolutely no one has the physician's back. Besides the AMA, who advocates for physicians in any meaningful manner? The government, general public and nurse practitioner propaganda has put doctors in a vulnerable position of decreasing salaries and increasing debt. I don't know why physicians don't start taking more holidays off and working 9-5. Seriously, why do they have to put up with such crap, if I'm going to get a lower wage, then theres no way I don't deserve to be more relaxed like my European counterparts. After all, a single payer system is what the US is moving to right?
     
  12. DermViser

    DermViser 5+ Year Member

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    They already are. That's why they are becoming salaried.
     
  13. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    I don't understand why getting into med school is becoming more and more competitive when the tide is going against physicians... I guess they should have a 'US healthcare delivery 101' class taught by a physician in undergrad for people who are trying to go to med school so premeds know what they are getting themselves into...
     
  14. DermViser

    DermViser 5+ Year Member

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    Millenials are not the type to research these things fully. A majority of them support Obamacare even though they don't know what is in it. Ironic, as in order for Obamacare to work, it will require them to participate. That's why the plans that young people will be buying will be much more expensive than what they usually would get. Essentially young people (who won't use it much), will be paying for the sick care of the old and disabled.

    It's not the job of the med school to educate you on whether med school is right for you.
     
  15. darklabel

    darklabel MS3 5+ Year Member

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    Job market is still lagging, family pressure, something something help people

    I went to a lecture presentation and a surprising number of older individuals also supported Obamacare (but most of the doctors were FM). I voted for him because I expected some relief from my student loans, but instead I'm getting shafted as both a student and a future physician by the guy.
     
  16. Psai

    Psai Account on Hold Account on Hold 2+ Year Member

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    ヽ(´ー`)ノ
    Physician
    Everything else is worse. You don't get paid for hard work or intelligence. You make money by having money or knowing people who do
     
    W19 and DermViser like this.
  17. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    I know that, but when you see some of the posts in the premed forum, I think it will be good for premeds to have at least and idea what they want to get out of medicine... I, myself, had a good idea of what I was getting myself into...
     
  18. type12

    type12 2+ Year Member

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    The problem is, the tide is going against every field, but medicine has been very immune to the depression and job losses, so, in essence, becoming a physician continues to becomes a more logical choice. We're acutely aware of what happens in this field, but we forget to compare it to others sometimes. Here's a small rundown:

    http://www.oecd.org/unitedstates/49084355.pdf (the money in the US healthcare is attractive)

    http://content.healthaffairs.org/content/32/5/835.abstract (HYPERinflation, a streak and feat only achieved by the US healthcare field - outdoing Comp Sci and IT and Silicon Valley - has ended, but it still beats dollar inflation, meaning the value of being a physician continues to rise)
    http://content.healthaffairs.org/content/33/8/1399.abstract?=right (similar study to above)

    http://cbo.gov/sites/default/files/cbofiles/attachments/44513_MedicareSpendingGrowth-8-22.pdf (Obamacare is NOT to blame for the death of hyperinflation; causes uncertain)
     
  19. DermViser

    DermViser 5+ Year Member

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    Many of those doctors are close to Medicare age and are close to retiring. Also many of them truly believe that Obamacare will bring primary care salaries up to those of specialists (wrong). Not at all surprised that the Baby Boomer generation wants entitlements for everyone. The last thing you'll be getting is student loan relief for med school from this administration which considers your care too expensive.
     
    Silent Cool likes this.
  20. DermViser

    DermViser 5+ Year Member

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    The reason medicine is immune to depression and job losses is bc people are ALWAYS sick. It never ends.
     
    type12 likes this.
  21. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    I don't know if everything else is worse... It seems like NP are doing quite well... They can start working as RN making 50-70k while going to school part time to become NP , then they start making 6 figures salary in less time than physician with almost ZERO student debt...
     
    Silent Cool likes this.
  22. DermViser

    DermViser 5+ Year Member

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    You think those in Pre-Allo will listen? There are med students in Allo who STILL don't listen to **** that residents/attendings tell them.
     
    W19 likes this.
  23. DermViser

    DermViser 5+ Year Member

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    Correct. The problem is that OTHER JOBS have largely evaporated. So people are doing medicine bc it's largely recession proof (a very bad reason to do medicine in my opinion).
     
  24. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    @DermViser ,

    Do you think that PC incomes will go up at all or stay flat (relative to inflation)? Will they go down relative to inflation?
     
  25. DermViser

    DermViser 5+ Year Member

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    Specialists salaries won't go down, if anything they'll likely go up pardoxically bc there will be fewer and fewer specialists who can then demand a higher salary bc you can't recruit anyone for miles. PC incomes will probably stay stable. In order for PC incomes to go up higher, it would need to be a complete overhaul of reimbursement which will never happen. Not to mention, a lot of people are not going into PC not bc of income concerns, but bc of lifestyle concerns.
     
  26. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Do you think this will simply result in more midlevel specialists? Already we have NPs doing scopes, for instance. I could potentially see a Cards NP or PA. I could definitely see a Rheum NP. I know that Derm PAs can make a very nice living.
     
  27. DermViser

    DermViser 5+ Year Member

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    Derm PAs work under Dermatologists though.

    But yes, PAs and NPs have had a boom in enrollment: http://www.nytimes.com/2014/08/03/education/edlife/the-physician-assistant-will-see-you.html?_r=0

    Why go thru the **** of 4 years of med school or residency when there is a shorter and less hassle of a route?
     
  28. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Yeah, that's what I see happening. Milton Friedman predicted this decades ago--he said that if you restrict supply, then someone with different training will find a way to do your job (or some of it, anyway) in time.
     
  29. jw3600

    jw3600 2+ Year Member

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    This. I usually have pretty good connect with most of my friends and even family but I think either no one wants to acknowledge this point or they don't understand it. We have become/are becoming more of a place when capital begets capital. AND THAT IS IT (with the caveat of nepotism but that applies to very few people). Either you have capital and you make more capital or all your hark work an ingenuity is used to make more capital for someone else. Part of the reason for this is nothing is truly unique anymore. Any product, practice, or technique will eventually be replicated and optimized by someone with the resources to do it and make a profit. The whole concept of VC firms perfectly describes this phenomenon. You can have the greatest idea in the world (speaking hyperbolically) but for 99.99% of the population it is impossible to implement it without VC money. So you recruit their support and you become wealthy but it doesn't change the game. One guy makes $50M, but the VC makes $950M. So 1 dude may get rich but really you are just strengthening a system that will eventually lead to economic collapse or some sort of non violent revolution. The timeline is inevitable. The question is when and what is the tipping point.
     
  30. mysdnhandle

    mysdnhandle Joe the Plumber Banned

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    LOL this was released and nobody really could come up with any juicy stories from it as far as I can tell.

    I wish someone could release at will detailed financial information about corporate tax evasion, conflicts of interest in SEC/stock market regulation, insider trading amongst corporate scallions and the revolving door between government and industry down to a personal level.
     
    Last edited: Oct 6, 2014
    pathologyDO likes this.
  31. Señor S

    Señor S 2+ Year Member

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    Jul 28, 2014
    How do physicians even get in on these multi-million dollar kickback schemes? Asking for a friend :naughty:
     
  32. wjs010

    wjs010 5+ Year Member

    2,047
    479
    Apr 4, 2012
    I still don't understand why it's important that the public see what doctor x makes. Such an invasion of privacy. Does it have a list for all nurses as well?
     
  33. MrChance2

    MrChance2 2+ Year Member

    534
    424
    Sep 25, 2012
    Yahoo comments just hates everyone, don't worry.
     
    kirbymiester likes this.
  34. DermViser

    DermViser 5+ Year Member

    17,619
    12,859
    Apr 4, 2009
    This has nothing to do with what a doctor makes in salary.
     
  35. jakeislove

    jakeislove MS IV 2+ Year Member

    1,182
    534
    Oct 29, 2012
    Upstate, New York
    Some of my friends were drug reps when it was the wild wild west. They used to have a blast with dinners, ski trips (with spouses), buying books, and freebies. Now it sucks because every dime has to be tracked and only people really skilled at sales can make any money.

    It also sucks for students because we can't get pens, meals, books, etc...

    Bring back the old days!!
     

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