Did you see this IHT ordeal?

[Camel]

The International Herald Tribune (I actually read it sometimes because it's on my igoogle page but this reference was from the ASA members section) had some... well, I'll let you judge what it was and what it wasn't. Make sure you at least start reading the second page.

http://www.iht.com/articles/2007/04/08/news/letter.php?page=1

The response from Dr. Lema was posted on the members only section, so you'll probably have to log in to read this: http://www.asawebapps.org/docs/internationalheraldtribuneMJL.pdf

So, it has come to this. People suggest that doctors are unnecessary and they are the reason medical care is expensive. Yeah, makes sense. Doctors are a relatively new concept, and their appearance coincides with the skyrocket-type costs...

Not as if doctors take an oath to do what's best for the patient or anything. Because, you know, insurance companies, pharm. companies, politicians, and lawyers all take such oaths, yeah? Doctors saw that and figured it'd prolly be a dood idea to follow suit.

Ok enough sarcasm. This really irks me, though. It's not like journalism happens in a vacuum. People read this stuff. I should add journalists to the list above of people who act as though they take an oath for patient care. To be fair to the author, the question is an important one to raise if it has validity. What it comes down to is (from the way I read it) he asserts medical compensation is what drives up costs. I'm not an economist: anyone with more understanding want to comment on this issue? Is it really our greediness? He does mention that medical school wouldn't be worth it if there wasn't some benefit... to be frank, he's right. I wouldn't go into medicine if I didn't love it, but I also wouldn't go into medicine if I was going to be poor afterwards. Thoughts? I really would like to hear some discussion on this article because I think it is one of the BASIC things anesthesiologists face when competing with mid-levels.

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[dhb]

1400 seems a bit steep for pushing propofol for 20min... especially considering the GI only took 800
what he didn't say was how much he got paid for writing his article in the same amount of time...

 

[Camel]

1400 seems a bit steep for pushing propofol for 20min... especially considering the GI only took 800
what he didn't say was how much he got paid for writing his article in the same amount of time...

Something that is important to know (I, a mere medical student, have no idea how much procedures should cost Great comment)/

 

[rmh149]

I think people who write these articles should post their education and qualifications (I forgot....there are no qualifications to be a journalist). What really gets me is the fact that people will read that and say "yeah, why the hell do I have to pay so much". Again, they will think that physicians are greedy little bastards......up untill they point when they are begging you to save their life.

Did he say a junior in college could be taught to do the anesthesia in about two weeks? I dont even want to comment.

Would you let a 21 y/o tech shove a huge tube deep into your colon while a junior college student gives you dangerous drugs and hope that you keep breathing?

We should offer this to the patients and see what they choose. I think they will go the $2,200 route. Not to mention...whats the point of a colonoscopy if you dont trust the tech to determine wheater or not you have cancer.

Of course journalists know how to fix the world....they are smarter than all of us.

 

[rmh149]

1400 seems a bit steep for pushing propofol for 20min... especially considering the GI only took 800
what he didn't say was how much he got paid for writing his article in the same amount of time...

Good point...isnt it more like $480.

 

[Bertelman]

Pretty short-sighted way to evaluate the medical system based on a single procedure. Don't even bother considering other variables such as declining reimbursements, or maybe the fact that his insurance was the only one that actually shelled out the $1400, while all others gave somewhere south of 1k. Ignore things like escalating malpractice premiums, overall litigiousness which leads to more tests ordered to CYA, and of course the deplorable health condition of the average American, which leads to ungodly numbers of invasive procedures and high-dollar meds.

Don't bother writing an article hoping to transform the U.S. healthcare system if you only intend to discuss one parameter of a multi-factorial problem.

 

[Camel]

Pretty short-sighted way to evaluate the medical system based on a single procedure. Don't even bother considering other variables such as declining reimbursements, or maybe the fact that his insurance was the only one that actually shelled out the $1400, while all others gave somewhere south of 1k. Ignore things like escalating malpractice premiums, overall litigiousness which leads to more tests ordered to CYA, and of course the deplorable health condition of the average American, which leads to ungodly numbers of invasive procedures and high-dollar meds.

Don't bother writing an article hoping to transform the U.S. healthcare system if you only intend to discuss one parameter of a multi-factorial problem.

That's another huge point. I'm no expert on stats, but I would venture that comparing the medical system in the US to those of Europe is apples to oranges... It's like comparing Windows with OS X for Mac. Apple has the "diffiult" charge of making an operating system that is stable on machines that are built entirely by them, not upgradable, and with no non-proprietary parts. Microsoft has to make Windows work with everything that any person puts together... I can build a modem in my garage and make drivers for Windows and Microsoft's got to keep it stable. I'm not a huge fan of Microsoft in general, but criticism needs to be constructive AND logical.

 

[militarymd]

How many times have you guys seen me write "it's all about the money".

Doctors are GREEDY....no 2 ways around it.

I'm embarrassed sometimes to hear how some of the doctors talk about money in the doctors' lounge.

Yes, yes, and YES....doctors are greedy....

however, and fortunately, physician fees are not what's causing the rising healthcare costs.

 

[Camel]

How many times have you guys seen me write "it's all about the money".

Doctors are GREEDY....no 2 ways around it.

I'm embarrassed sometimes to hear how some of the doctors talk about money in the doctors' lounge.

Yes, yes, and YES....doctors are greedy....

however, and fortunately, physician fees are not what's causing the rising healthcare costs.

I couldn't agree more. I would never assert that any group of people is above being human. Some element of greed drives the principles behind the U.S. market and society. It's important to note that physician greed would need to have changed a whole lot in the last few decades to drive the changes in the medical system costs.

 

[bigeyedfish]

That guy is a *****.

1. Colonoscopies are every 10 years in average risk individuals.

2. Cost of healthcare and physician salaries have and an inverse relationship over time.

3. Anyone who will let a 21 yo with a week of training go poking around their cecum deserves what happens to them.

 

[core0]

That guy is a *****.

1. Colonoscopies are every 10 years in average risk individuals.

2. Cost of healthcare and physician salaries have and an inverse relationship over time.

3. Anyone who will let a 21 yo with a week of training go poking around their cecum deserves what happens to them.

Even better let that 21 year old figure out what to do with the complications (if he even recognizes them). These happen at a rate of 1/1000 in experienced hands. Much more in inexperienced hands. Box a few people and it doesn't look so good.

David Carpenter, PA-C

 

[Camel]

2. Cost of healthcare and physician salaries have and an inverse relationship over time.

Do you, by any chance, have a source on this? I ask not out of mistrust, but because it's definitely something I'm sure I'd use in discussions and I'd like to be able to say where it's from. Although, in theory, just saying "bigeyedfish told me on GasForms" should be plenty for anyone ;-) Everyone knows bigeyedfish pwns n00bs.

 

[johankriek]

How many times have you guys seen me write "it's all about the money".

Doctors are GREEDY....no 2 ways around it.

I'm embarrassed sometimes to hear how some of the doctors talk about money in the doctors' lounge.

Yes, yes, and YES....doctors are greedy....

however, and fortunately, physician fees are not what's causing the rising healthcare costs.

hey military,,

guess what?

EVERYONE IS GREEDY....

THE PLumber, the gardener, the lawyers, the politicians, the guy fixing your car, the guy selling you your car, the guy preaching at the church, the ceos administering health maintenance organizations, the ceo of your hospital,...... get the picture military.... EVERYONE IS GREEDY.. so your statement, does not say much.

we're all animals; we go where the most food is.

 

[fval28]

I was pretty amazed that this guy Dr. Berwick would denigrate 2 other medical professions in such a public way. Maybe this is his way of getting back at GI and gas docs for making 5-10X his salary (as a pediatrician). More to the point, this guy has been knighted for his views on healthcare- I am sure he believes his own press clippings and feels that nothing he can say is too outrageous. I wonder if he would let a pediatric technician take care of his sick kid...

 

[fval28]

hey military,,

guess what?

EVERYONE IS GREEDY....

THE PLumber, the gardener, the lawyers, the politicians, the guy fixing your car, the guy selling you your car, the guy preaching at the church, the ceos administering health maintenance organizations, the ceo of your hospital,...... get the picture military.... EVERYONE IS GREEDY.. so your statement, does not say much.

we're all animals; we go where the most food is.

but docs are held to a higher standard than all those you mentioned- besides it is very offputting to hear a healthcare professional whine about how much they aren't getting paid for taking care of a sick person. I understand where you are coming from- but the general public thinks that docs are rich and they (the public) are entitled to the BEST care possible regardless of ability to pay. Mil's point is well taken.

 

[johankriek]

but docs are held to a higher standard .

what? we shouldnt get paid for our hard work and labor? we should allow others to profit on our backs. because we are held to a higher standard?Look dude, i am a human being with student loans to pay back, taxes every month, a car lease, mortgage, etc.. get the picture. I enjoy taking care of patients.. Mils point is well taken however he is just pointing out the obvious. similar to stating, the sky is blue,

 

[Bertelman]

How many times have you guys seen me write "it's all about the money".

Doctors are GREEDY....no 2 ways around it.

...from the Times...

Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.

..more...

http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&th&emc=th&oref=slogin

 

[Camel]

Yeah my med school just recently started banning "free lunches" from pharm reps and such unless there's a very specific educational component that isn't just propoganda. Hopefully it helps.

 

[fval28]

what? we shouldnt get paid for our hard work and labor? we should allow others to profit on our backs. because we are held to a higher standard?Look dude, i am a human being with student loans to pay back, taxes every month, a car lease, mortgage, etc.. get the picture. I enjoy taking care of patients.. Mils point is well taken however he is just pointing out the obvious. similar to stating, the sky is blue,

never said you shouldn't get paid, only pointing out to you that public perception is what it is and crying poor is not going to win anyone's sympathies. not wanting to get into a ****ing contest, and i think you are right- you should make what you earn- i am just pointing out that public perception is not usually based on all the facts- and unless the public values medical services more than they do now, reimbursement is only going to be less and less over time.

 

[Camel]

never said you shouldn't get paid, only pointing out to you that public perception is what it is and crying poor is not going to win anyone's sympathies. not wanting to get into a ****ing contest, and i think you are right- you should make what you earn- i am just pointing out that public perception is not usually based on all the facts- and unless the public values medical services more than they do now, reimbursement is only going to be less and less over time. right now the public sees what you do as a RIGHT and not a privilege, ie there is no value in it to them- until they need it OR until you make a mistake...

Some excellent points. I also don't think many laypeople actually realize how expensive the medical track is (undergrad, med school, and the lack of much salary during residency to the point that you can claim financial hardship due to your debt/income ratio).

I do think it is important that we have thoughtful discource, not contests.

 

[militarymd]

The greedy folks I'm referring to:

1) are OUT of debt
2) drives 6 figure cars
3) live in houses that could function as hotels
4) own airplanes
5) own surgery centers ...etc...
6) blah, blah, blah,...etc..etc.etc...

Doctors are greedy...........doctors are in the top 1% income of U.S.

The public really doesn't care about your debt/whatever ratio.

When you whine about money, you just LOOOK bad in front of the public.

I would recommend leaving Money out of any arguements with ANYBODY.

 

[Planktonmd]

The greedy folks I'm referring to:

1) are OUT of debt
2) drives 6 figure cars
3) live in houses that could function as hotels
4) own airplanes
5) own surgery centers ...etc...
6) blah, blah, blah,...etc..etc.etc...

Doctors are greedy...........doctors are in the top 1% income of U.S.

The public really doesn't care about your debt/whatever ratio.

When you whine about money, you just LOOOK bad in front of the public.

I would recommend leaving Money out of any arguements with ANYBODY.

For once I have to say I AGREE 100 % With militarymd !

 

[Camel]

The public really doesn't care about your debt/whatever ratio.

Yeah, I agree with everything you said. I just mentioned that as support: the public doesn't know about that stuff, and they don't care because of the situation most docs are in economically.

 

[Broken Ankles]

The greedy folks I'm referring to:

1) are OUT of debt
2) drives 6 figure cars
3) live in houses that could function as hotels
4) own airplanes
5) own surgery centers ...etc...
6) blah, blah, blah,...etc..etc.etc...

Doctors are greedy...........doctors are in the top 1% income of U.S.

The public really doesn't care about your debt/whatever ratio.

When you whine about money, you just LOOOK bad in front of the public.

I would recommend leaving Money out of any arguements with ANYBODY.

most doctors used to be in the top one percent of income earners as recently as the late 1990s, but not anymore. nowadays, to be in the top 1%, you have to make more than $300,000, which is beyond most primary care physicians and even many specialists, if the salary surveys are accurate. since bush has been in office, the rich has gotten richer, but physicians as a whole are not among them.

 

[yapstev]

We could look at it this way:

For its standard calculations, the US government assigns what a human life costs at $1.6 million. So if we're considering whether to mandate a new safety belt or not, chances are it has to save at least 1 life for every 1.6 million spent.

Now if we can take this from a medical point of view. Given a concious sedation complication rate of 1/1000, anesthesiologists can "reasonably" get paid $1,600 per colonoscopy if they can in fact save an average of 1 life out of 1000 procedures (they probably save a significant #, but not necessarily 1). And an anesthesiologist can definitely prevent many more deaths/complications than a 21 yr old tech and should definitely be reimbursed significantly more than $60 per procedure (although $1,400 is quite a bit of $$).

And by the way, the 21 yr old pilot who crashes his plane while landing kills himself, but the anesthesiologist who crashes his patients kills others.

 

[Camel]

We could look at it this way:

For its standard calculations, the US government assigns what a human life costs at $1.6 million. So if we're considering whether to mandate a new safety belt or not, chances are it has to save at least 1 life for every 1.6 million spent.

Whoa, really? There's a value? One that they adjust for inflation and all that even? Interesting to see what other countries value a human life as, then...

 

[Stimulate]

The problem with healthcare costs is for-profit insurance and drug companies whose goal is to spend only 60% of premiums on actually providing healthcare. At least 50 insurance and drug companies are in the fortune 500. The CEO of Pfizer made like $180 million when he retired, and the CEO of UnitedHealthcare makes over $100 million a year. If this is what the CEO is making think of all the VPs, Regional directors, etc and all the way down the list! Medicare only soaks up 3.5% in admin costs so why do private insurers take 20-40% off the top? These are the guys driving the Bentleys and Maybachs, not your local PCP.

Also, setting aside the cost of a patient life, you can't pay someone $60 for a procedure that could end up in a $10 million lawsuit. It makes no sense.

Lastly, the patients want the latest-and-greatest healthcare options but nobody wants to pay for it or take responsibility for maintaining their own health. We have 93 year-old patients getting their aortas stented and hips replaced.

Everyone needs a dose of reality and unfortunately shifting the cost of healthcare onto patients (in the form of higher premiums, co-pays, etc) may be the only way to get people to exercise and stop smoking.

 

[VolatileAgent]

I would recommend leaving Money out of any arguements with ANYBODY.

i could not agree more.

at a recent function where i got to hear our governor speak, he made a point of chastising an activist group of doctors in our state for picketing in front of the capital building about the state's mandatory tort coverage. the only point he focused on was that it was hard for lay people in attendance to be sympathetic when they were looking around at so many bentleys and porsches parked on the side streets.

 

[bigeyedfish]

Do you, by any chance, have a source on this? I ask not out of mistrust, but because it's definitely something I'm sure I'd use in discussions and I'd like to be able to say where it's from. Although, in theory, just saying "bigeyedfish told me on GasForms" should be plenty for anyone ;-) Everyone knows bigeyedfish pwns n00bs.

Most of my evidence is anecdotal, so you'll just have to drop my name.

But a quick google picked up a few hits. I'm sure there's better sources out there.

Physician's salaries, adjusted for inflation, dropped by 7% on average 1995-2003. http://www.hschange.org/CONTENT/851/

Premiums increased by 30% 1996-200.
http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb10/cb10.shtml