Docs/Students saying it's "easier to make money elsewhere??"

[janV88]

Profit is not the only motivator.

Profit is not only monetary.

Everything is profit driven. Money, fame, votes, and even that nice feeling you get by helping someone out...all of that is "profit".

---

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[Mmm sprinkles]

Why yes, I do like ice cream and sprinkles... sunshine and daisies... puppy dogs and kittens...

...by the way (and since you brought it up), who came up with PCR? When did he first conceptualize it? Who was he working for at the time? In what country? Thanks -- this was not covered in any of my American history classes....

I love when people resort to sarcasm. What's next? Gonna call me a commie or tie me to some ridiculous Nazi reference?

Name some medical innovations that were driven by profit, not competition, profit.

 

[Mmm sprinkles]

Profit is not only monetary.

Everything is profit driven. Money, fame, votes, and even that nice feeling you get by helping someone out...all of that is "profit".

I love logical fallacies, especially equivocation. When I say the profit motive, I strictly mean the quest for monetary gains. If you read my entire post, you'll notice the distinction I make between monetay profit and the general nature of competition, which exists independently of the profit motive.

 

[Mmm sprinkles]

Profit is not only monetary.

Everything is profit driven. Money, fame, votes, and even that nice feeling you get by helping someone out...all of that is "profit".

I love logical fallacies, especially equivocation. When I say the profit motive, I strictly mean the quest for monetary gains. If you read my entire post, you'll notice the distinction I make between monetay profit and the general nature of competition, which exists independently of the profit motive.

 

[Mmm sprinkles]

Damn iPhone

 

[MOHS_01]

I love when people resort to sarcasm. What's next? Gonna call me a commie or tie me to some ridiculous Nazi reference?

Name some medical innovations that were driven by profit, not competition, profit.

Well, my day has been made just a little brighter knowing that I have made you happy.... and there is no more need in designating you a "commie" than there is in stating water is wet or stealing is immoral.

You did not answer the PCR question. If you need some help, Google "Cetus Corporation".

Oh, to address your latest unbelievably ignorant -- or naive -- question: look up the history of CT/MRI/any imaging modality you can think of. Pick up a book referred to colloquially as the PDR. Pick up a surgical instrument catalog and look at the names of the instruments sold. Read one of your precious university contracts and you will invariably find a clause claiming rights (to the patent and future remuneration) of any work, device, or good developed that remotely relates to any work performed while at the university... then look at the number of folks who flee that setting to escape this penalty prior to coming out with their good.

Your worldview is the one skewed, naive, and impractical my friend. Until you are able to solve the problem of scarcity, that will always be the case.

 

[MOHS_01]

...and even if the initial conceptualization of any of these things were not "profit motivated" -- which is a pretty anemic assertion (they were patented, right?) -- conceptualization is insufficient for realization.... and that phase of the process is clearly with the intent to profit (in one form or fashion, be it strictly monetary or some other advantage) from the endeavor.

Beyond that, you do realize that healthcare has an inherent social streak, correct?

 

[docB]

I'm interested in knowing what sort of profit is inherently evil. If I make money working is that profit evil? Is the evil kind of profit only when a company makes money? Does it have to be company with stockholders to make their profit evil?

 

[Mmm sprinkles]

MOHS, I did not read past immoral nor do I intend to. You have a religious adherence to a system that does not exist and can do little more to defend it than resorting to generalizations. I have nothing against the free market (I'd actually love to find one) or the profit motive. I do, however, strongly object to the concept of profiting from sickness. I object to turning human beings into commodities. I object to health care being administered not for the general health of society, but for the purpose of pleasing stockholders. You have no moral compass if you don't likewise object.

 

[Slack3r]

MOHS, I did not read past immoral nor do I intend to. You have a religious adherence to a system that does not exist and can do little more to defend it than resorting to generalizations. I have nothing against the free market (I'd actually love to find one) or the profit motive. I do, however, strongly object to the concept of profiting from sickness. I object to turning human beings into commodities. I object to health care being administered not for the general health of society, but for the purpose of pleasing stockholders. You have no moral compass if you don't likewise object.

Lol, speaking of logical fallacies....

 

[Mmm sprinkles]

Lol, speaking of logical fallacies....

What fallacy? These aspects of our healthcare system are intrinsically wrong.

 

[Mmm sprinkles]

I'm interested in knowing what sort of profit is inherently evil. If I make money working is that profit evil? Is the evil kind of profit only when a company makes money? Does it have to be company with stockholders to make their profit evil?

Profit is not an evil in itself, but certain actions motivated by money are. Turning people into commodities is evil. Exploiting illness for personal gain is evil. Putting the welfare of a corporation above the public welfare is evil.

Few things are inherently evil. It takes intent and outcome to make something so.

 

[morning]

I think it's worth having this argument because I think people need to realize what medicine is not. Medicine is not charity work. There are a surprising number of physicians who, I have noticed, seem to think it is socially and morally appropriate to consider themselves martyrs to their profession because they work long hours in exchange for (what I consider to be) a lot of money, respect, independence, and job security. That isn't charity, or anything close. It's not in any way wrong, but it is nothing more than a fair exchange and there are a few reasons I think that physicans need to realize that:

1) There is no better way to end every personal relationship you have outside of your country club than to bemoan the fact that you work 60 hours a week for a mere 200K/year. The easiest way to annoy everyone around you, in any circumstance, is not to realize how blessed you actually are.

2) When you repeat bad advice, particularly as a physician, there is a good chance that you might convince someone to act on it. I'm not sure any premed would go so far as to become a plumber, but if you (against all statistical evidence) tell everyone about the easy hours and great money they could make as a PhD you could absolutely convince some poor soul to confine themselve to a perpetual post-doc rather than pursuing a lucrative career in medicine.

3) I'm a very religious man, and I firmly believe that we have an obligation to do real, selfless work for those around us, and that one day we will need to answer to a higher power for what we have done and what we have failed to do. I cringe at the thought of these legions of physicians looking back over their lives and trying claim selflessness because worked 80 hours a week during 3 years of residency and only recieved hundreds of thousands of dollars (every year, for the rest of their lives) in exchange. When you delude yourself into thinking that you're getting a raw deal when you're not you will unjustly mitigate the obligation you feel to pass those blessings you've recieved on to others in need.

Anyway, I am now 12 hours from starting an Internal Medicine rotation, so I'm signing off SDN for the next 8 weeks and y'all can have the last word.

I very rarely agree with things you say, but I agree with almost everything you said in this thread. There's a real Master of the Universe Syndrome sometimes, making a doctor feel 100% qualified to pontificate about ANYTHING, including things that have nothing to do with medicine (like the salaries other people make) and that they almost certainly never studied while majoring in biology, cramming for the MCAT, slogging towards Step 1 and interviewing as an MS4. There's nothing wrong with not being an expert on everything under the sun, but at least admit it and don't use the MD degree to claim you are.

Enjoy IM!

Male porn stars get paid crap. Unless you're a big name guy, you probably only make a few hundred dollars per film. Not to say that they don't have a fairly exciting job...



My dad is an engineer. He's turning 50 next month and pulls in about $130k. He also hates his job and works 60+ hrs per week. He is constantly worried about losing his job, and up until last month he wasn't even sure his project would be renewed.

A lot of male porn actors doing straight porn are gay and do gay porn work also. Being gay helps create staying power when screwing the ladies...so they aren't actually enjoying it that much. Unless they're Ron Jeremy, then they wonder every day what on earth they did to get there and how to stay there as long as possible I don't work in the porn industry, this is just what I've heard.

My brother-in-law is an environmental engineer and he absolutely loves his job. Engineering is a broad field, and I guess it depends on what you do and where you go. Like medicine.

 

[Apollyon]

A lot of male porn actors doing straight porn are gay and do gay porn work also. Being gay helps create staying power when screwing the ladies...so they aren't actually enjoying it that much. Unless they're Ron Jeremy, then they wonder every day what on earth they did to get there and how to stay there as long as possible I don't work in the porn industry, this is just what I've heard.

I know a lot about the commercial sex industry, and I would like to know from whom you've heard this. There are NOT "a lot of male porn actors" making straight porn and gay porn. That doesn't happen. If someone comes up HIV (+), that guy might drift into gay porn or other niche areas, because the women won't work with him. In fact, there's a well-known phrase of "gay for pay" - guys who make gay porn (because there's more money in it for guys than guys in straight porn), but are straight when they're out of work (including guys who are married - to women).

Your statement is fallacious and unsubstantiated.

 

[avatarftw]

a

 

[morning]

I know a lot about the commercial sex industry, and I would like to know from whom you've heard this. There are NOT "a lot of male porn actors" making straight porn and gay porn. That doesn't happen. If someone comes up HIV (+), that guy might drift into gay porn or other niche areas, because the women won't work with him. In fact, there's a well-known phrase of "gay for pay" - guys who make gay porn (because there's more money in it for guys than guys in straight porn), but are straight when they're out of work (including guys who are married - to women).

Your statement is fallacious and unsubstantiated.

Of all the things I've ever gotten into a debate about on SDN, whether or not a lot of men doing straight porn are actually gay would definitely be the most stupid and pointless topic. Ever. Ever. Like I said, it's something I heard. It might be wrong. Personally, I don't care...and I don't see why you do

 

[MOHS_01]

MOHS, I did not read past immoral nor do I intend to. You have a religious adherence to a system that does not exist and can do little more to defend it than resorting to generalizations. I have nothing against the free market (I'd actually love to find one) or the profit motive. I do, however, strongly object to the concept of profiting from sickness. I object to turning human beings into commodities. I object to health care being administered not for the general health of society, but for the purpose of pleasing stockholders. You have no moral compass if you don't likewise object.

A tad intellectually weak, don't ya think? Tell me -- which comparison did you find so objectionable -- that water is wet or stealing is immoral?

You hold that I prescribe to "a religion"; if that be the case, then that religion is freedom from tyranny, freedom from coercion, and the protection of the individual's freedom to choose for self the relative merits and appropriate uses of his labor and person. What is yours?

I don't know... perhaps you are a kind hearted, well intentioned guy/gal/whatever who sees suffering, heartache, hardships, or any number of afflictions of the human condition and believe that something must be done. I can get that -- so you set out in your mind a hierarchical list of wants/needs that should be provided for all. Great -- the only problem is this constitutes a subjective list of priorities that will not be shared by all.... and one that cannot be accomplished without the imposition of your will upon others against that of their own -- that is, outside of the very limited condition of free and open exchange between two (or more) willing parties. Your preference, therefore, necessarily relies on force as the means employed to achieve its arguably noble ends; it cannot be accomplished in the absence of force and coercion. Worse yet, neither the ends of equality nor the elimination of the unsavory elements of our biological condition are ever reached -- despite the suffering imposed upon a great many in the process.

I trust that you do realize no man has the explicit right to another man's person? That ones labors are a direct extension of ones person? Please tell me that these concepts are not lost on you?

Your presumption to question the "moral compass" -- much less assume the moral high ground -- of those who would defend even your liberty is truly laughable. If you honestly hold this to be true, you understand little on the subject you fancy yourself a scholar in....

 

[MOHS_01]

Of all the things I've ever gotten into a debate about on SDN, whether or not a lot of men doing straight porn are actually gay would definitely be the most stupid and pointless topic. Ever. Ever. Like I said, it's something I heard. It might be wrong. Personally, I don't care...and I don't see why you do

I'm starting to like you. Your porn fixation leads me to believe that you would be fun to hang out with. Ever. Ever.

 

[Apollyon]

Of all the things I've ever gotten into a debate about on SDN, whether or not a lot of men doing straight porn are actually gay would definitely be the most stupid and pointless topic. Ever. Ever. Like I said, it's something I heard. It might be wrong. Personally, I don't care...and I don't see why you do

This post says a lot - first, you get defensive. Why? You'll deny it, but it's "something (you) heard", and you went out of your way to come back and comment. From whom did you hear this? Why? Why would you even talk about it? Ever? Ever? Also, for the people making money, from actors to producers to distributors, this is not chump change.

Now, as to the second part - "Personally, I don't care...and I don't see why you do." That is insulting. Why is your username "morning"? I don't care, and I don't see why you do.

Ask a vice cop why s/he does it. Ask a child abuse doctor why s/he does it (and, if you saw the stuff they had to, you would puke and/or cry). In my job as a doc in the emergency department, I see the seedier side of life. That doesn't mean I'm a part of it. I know about the commercial sex industry. That you "don't see why" I do makes me guess you are young - like, 20. You don't have perspective, and are still thinking concretely.

 

[janV88]

I love logical fallacies, especially equivocation. When I say the profit motive, I strictly mean the quest for monetary gains. If you read my entire post, you'll notice the distinction I make between monetay profit and the general nature of competition, which exists independently of the profit motive.

Exactly my point. All the evils associated with the "profit motive" is not only monetary profits but can be translated to every type of profit. And you don't seem to understand that.

 

[Caesar]

This post says a lot - first, you get defensive. Why? You'll deny it, but it's "something (you) heard", and you went out of your way to come back and comment. From whom did you hear this? Why? Why would you even talk about it? Ever? Ever? Also, for the people making money, from actors to producers to distributors, this is not chump change.

Now, as to the second part - "Personally, I don't care...and I don't see why you do." That is insulting. Why is your username "morning"? I don't care, and I don't see why you do.

Ask a vice cop why s/he does it. Ask a child abuse doctor why s/he does it (and, if you saw the stuff they had to, you would puke and/or cry). In my job as a doc in the emergency department, I see the seedier side of life. That doesn't mean I'm a part of it. I know about the commercial sex industry. That you "don't see why" I do makes me guess you are young - like, 20. You don't have perspective, and are still thinking concretely.

How does working in the ER make you an expert in the commercial sex industry? Are you implying that a large volume of patients are involved in it? I don't really think that they are related, at all.

 

[Slack3r]

How does working in the ER make you an expert in the commercial sex industry? Are you implying that a large volume of patients are involved in it? I don't really think that they are related, at all.

RC fail.

 

[Mmm sprinkles]

A tad intellectually weak, don't ya think? Tell me -- which comparison did you find so objectionable -- that water is wet or stealing is immoral?

You hold that I prescribe to "a religion"; if that be the case, then that religion is freedom from tyranny, freedom from coercion, and the protection of the individual's freedom to choose for self the relative merits and appropriate uses of his labor and person. What is yours?

I don't know... perhaps you are a kind hearted, well intentioned guy/gal/whatever who sees suffering, heartache, hardships, or any number of afflictions of the human condition and believe that something must be done. I can get that -- so you set out in your mind a hierarchical list of wants/needs that should be provided for all. Great -- the only problem is this constitutes a subjective list of priorities that will not be shared by all.... and one that cannot be accomplished without the imposition of your will upon others against that of their own -- that is, outside of the very limited condition of free and open exchange between two (or more) willing parties. Your preference, therefore, necessarily relies on force as the means employed to achieve its arguably noble ends; it cannot be accomplished in the absence of force and coercion. Worse yet, neither the ends of equality nor the elimination of the unsavory elements of our biological condition are ever reached -- despite the suffering imposed upon a great many in the process.

I trust that you do realize no man has the explicit right to another man's person? That ones labors are a direct extension of ones person? Please tell me that these concepts are not lost on you?

Your presumption to question the "moral compass" -- much less assume the moral high ground -- of those who would defend even your liberty is truly laughable. If you honestly hold this to be true, you understand little on the subject you fancy yourself a scholar in....

MOHS, there is nothing intellectually lazy about ignoring people with nothing to offer beyond rhetoric. You say absolutely nothing of substance. Your posts amount to a rehashing of the mindless drivel they subject us to straight from kindergarten through high school. You seem to believe that by dressing it up with a semi-intelligent vocabulary (similar to Dennis Miller's crappy act), you gain some sort of edge in a discussion. Sorry, but as the sophists pointed out (since you seem to like the greeks, but skipped the allegory of cave) that's hollow and simply a nectar for the nitwit mob. You live in a fantasy world where the USA has a free market economy, where liberty and individuality are actually valued and protected, and where people have a legitimate freedom of choice. These are excellent ideals, but they are as unrealistic in their implementation as your caricature of my position, and they amount to a reality that an objective view of history will quickly demonstrate has never existed at any point in the past, and will most likely never exist in the future.

I have no set of needs that I believe should be provided beyond an unstacked deck (think of Teddy's square deal), but I am steadfastly against the monetary profit motive (sad that I have to specify that, but someone with poor logical skills likes to resort to the fallacy of equivocation) in medicine. My original post stated a point that you have yet to address: the profit motive as an institution in medicine will always, and without exception, drive down the quality of care. If you can see a way to reconcile an insurance company's drive for profit with their supposed function of funding quality medical care for their customers, then I'm all ears. Anything else, don't even bother.

 

[morning]

I'm starting to like you. Your porn fixation leads me to believe that you would be fun to hang out with. Ever. Ever.

I've even got the perfect first line for an illicit movie.

"So, like...I've got this irregularly shaped mole...you want to...check it out...?"

 

[MOHS_01]

....You live in a fantasy world where the USA has a free market economy, where liberty and individuality are actually valued and protected, and where people have a legitimate freedom of choice. These are excellent ideals, but they are as unrealistic in their implementation as your caricature of my position, and they amount to a reality that an objective view of history will quickly demonstrate has never existed at any point in the past, and will most likely never exist in the future.

Pardon me if I edit out the most egregious literary nonsense.

You and your ilk never cease to amaze me. Here's a little helpful hint towards the end of understanding -- every argument on these matters is an argument of competing ideals. We are now, as always, in a disagreement of the ideals -- the overarching set of principles -- which should aid us in crafting the rules of the game in whatever system is being discussed. The "ideal" system is the end, while the legislative/regulatory rules are the means meant to achieve that end. Perfection may not ever be obtained, but that does not render it a goal unworthy of striving for. Beyond that, how in the **** would one really know your position as you have done nothing other than talk in circles and avoid any real discussion? Even when challenged on your BS "the profit motive did not bring us PCR.... or any advance in medicine", the best you can do is ignore the discussion altogether? How many of your beloved logical fallacies have been committed within the narrow confines of just this discourse?

I have no set of needs that I believe should be provided beyond an unstacked deck (think of Teddy's square deal),

Are you saying that you believe this is true now? At any point in the past? Or is this another example of "a fantasy world...that has never and likely will never exist"? A lofty set of ideals -- ones that may be just even -- but should likewise be abandoned or cast aside because, in reality, they do not exist?

but I am steadfastly against the monetary profit motive (sad that I have to specify that, but someone with poor logical skills likes to resort to the fallacy of equivocation) in medicine. My original post stated a point that you have yet to address: the profit motive as an institution in medicine will always, and without exception, drive down the quality of care. If you can see a way to reconcile an insurance company's drive for profit with their supposed function of funding quality medical care for their customers, then I'm all ears. Anything else, don't even bother.

You do not "have to specify" ****, man -- but it would help a little if you could hash out your argument better than you have. Your comment carries no more legitimacy than the following: "I think you are full of ****." Both, when left to stand on their individual merits, are opinions devoid of thought.

Since you seem to be struggling a little with this, let me guide you and jump start a more concrete discussion: if monetary profit is such a bad thing (which you state), yet doctors should not be viewed as compulsory charitable volunteers (which you also state) -- how are they to be compensated? Ah yes, a fair wage for their labors. OK, who is the authority who should determine what constitutes "a fair wage"? Please, give us something to work with -- otherwise you sound like an asshat with nothing to contribute other than "I hate the current system. You are too ignorant to understand. I am smarter than you. Just listen to us and things will be better. You'll see...." A better class of criminal, indeed.

Here is what I contend: you actually are FOS in this line of thinking. As I have tried to state over and over, I understand and empathize with your "ideals"; where the problem presents itself is in the implementation of this set of ideals and the transition from one system to another. There is nothing -- nothing wrong with a provider being paid for his services. Any payment for a service above and beyond the cost of providing that service is "profit", and without that, it would be impossible to provide that service at all. There is absolutely nothing immoral about this arrangement; the immorality enters when decisions are made to the patients detriment in lieu of financial factors -- but this very immoral incentive will persist in any method you devise. Rationing, in its various forms and flavors, is a prime example of this; until you are able to successfully cheat the law of scarcity some form of rationing must always exist.

Now how about you make an honest effort at constructing a coherent argument for your "ideal" healthcare system that removes any and all economic incentive / disincentive to all parties? The state payer, the provider, and the consumer alike?

 

[MOHS_01]

...and the competition between providers, pharmaceutical companies, etc in order to gain an advantage over their competition has always been -- and will always be -- motivated by some form of pecuniary gain, be that direct in the form of present profit or positioning for future "profits" in some fashion. When you remove any and all financial incentive, what incentives are left? Power? Prestige? Control? Do you honestly believe that a state salaried workforce will be as efficient, productive, motivated, or produce the same level of innovation as one fueled by competitive forces? All are serious questions.....

 

[Mmm sprinkles]

MOHS, let me start by apologizing. First, I was unaware that my time on SDN should be spent writing my philisolophical treatise. Second, I have apparently failed miserably to fit into a neat little box for you to generalize. God help all of your patients who don't fit textbook diagnostic and treatment criteria.

Please MOHS, come out of the cave. The real world is not as terrifying as you may think.

You and your ilk never cease to amaze me. Here's a little helpful hint towards the end of understanding -- every argument on these matters is an argument of competing ideals.

Who are me and my ilk? Are we the commies? The socialists? The bleeding heart liberals? Thanks for the hint, but this is more than a matter of ideals. Right and wrong are NOT ideals; they exist whether you like it or not. It is plain wrong to turn humans into commodities. It is plain wrong to exploit the sick for finaincal gain.

Even when challenged on your BS "the profit motive did not bring us PCR.... or any advance in medicine".

I never said that the profit motive never brought us any advance in medicine. I said that the greatest advances were not brought through the profit motive. I notice that in all of these discussions you've made a point in avoiding my reference to the Salk vaccine. Perhaps the elimination of Polio is not the greatest advance. Or perhaps the fact that Dr. Salk made not a dime from his vaccine conflicts with your ideals. With regards to PCR, I think you're missing a huge chunk of the PCR history when you say google Cetus (I looked at the rest of your garbage post). Last I checked, Dr. Mullis won the 1993 nobel prize for the invention of PCR. I looked hard, but I just couldn't find Cetus anywhere on the nobel website. Looking a little harder, I found that the actual inventor of PCR (who considered Cetus little more than a method of funding; one of many including government research grants) made a whole $10,000 bonus when Cetus sold the patent to Roche (who made over 100 billion since then). But this is solely the invention, which I will grant was influenced by the profit motive (at least in the Cetus management's viewpoint). The medical applications of PCR have almost universally been born of NIH grants. These patents are often sold to private corporations, but it is a fallacy to believe that it takes a private, for profit corporation to allow for the distribution of a medical breakthrough (again, think of the Salk vaccine).
There are numerous other examples of major medical breakthroughs being made not to line the pockets of stockholders, but to satisfy the curiosity of scientists and engineers. Most of the products that come from the profit driven sector are miniscule advances. Very rarely will anything of substance be entirely born of these businesses. Even in drug research the most difficult and time consuming portions are not done using private money. They're done using public funds. I speak of the primary research to identify targets, the identification of lead compounds, and even major portions of lead optimization. Even clinical trials are heavily subsidized by public funds, or through tax deductions.

Are you saying that you believe this is true now? At any point in the past? Or is this another example of "a fantasy world...that has never and likely will never exist"? A lofty set of ideals -- ones that may be just even -- but should likewise be abandoned or cast aside because, in reality, they do not exist?

If you read just a little closer, I never said this is true now; never even implied it. I said this is my ideal that I believe we should strive for.

You do not "have to specify" ****, man -- but it would help a little if you could hash out your argument better than you have. Your comment carries no more legitimacy than the following: "I think you are full of ****." Both, when left to stand on their individual merits, are opinions devoid of thought.

I wasn't specifying for you, but for another individual who takes my quotes out of context. Let's hash this out a little further: ALLOCATIONS OF SCARCE MEDICAL RESOURCES SHOULD NOT BE DEPEDENT ON THE INTERESTS OF INSURANCE COMPANIES. Clear enough for you? You pointed out at one point that scarcity is a major issue. Not just in medicine, but in all aspects of finite resources. So should we decide who gets what based on how it affects the bottom line of an insurance company, or should we attempt to apply the idea of fairness? Apparently you're of the school of thought that we should take people for all they're worth when they get sick; I guess I'm a little more compassionite.

if monetary profit is such a bad thing (which you state), yet doctors should not be viewed as compulsory charitable volunteers (which you also state) -- how are they to be compensated? Ah yes, a fair wage for their labors. OK, who is the authority who should determine what constitutes "a fair wage"? Please, give us something to work with -- otherwise you sound like an asshat with nothing to contribute other than "I hate the current system. You are too ignorant to understand. I am smarter than you. Just listen to us and things will be better. You'll see...." A better class of criminal, indeed.

What I'm having trouble understanding is where you see a contradiction (also where you see me stating that monetary profit is a bad thing). So according to your logic, doctors can either charge the maximum allowable amount driven solely by profit, or they can work for free? Please MOHS, come out of the world of black and white and enter the gray area. What doctors are paid for their services has little bearing on the discussion of institutionalized profit in medicine (unless doctors become administrators and policy makers, which doesn't seem like it's gonna happen any time soon). I'm all for fair wages; doctors should be compensated on par with their workload, training, and services provided. That's not even the issue that I was raising. I see no need for our current system of allocation, and I believe it can be done better, more ethically, and more efficiently.

I agree that we must have some form of rationing, but again, this form of rationing should not be based primarily on monetary gain. People are better than you seem to think. We are driven by far more than want of fancy cars and big houses. We cannot eliminate out competitive nature (we physically have left the jungle, but our minds are still deep inside). Nor can we eliminate the state of limited resources that provides the impetus for competition. What we can eliminate is the greed factor from medicine. Nonprofit insurance companies; the end of a monopolistic stranglehold on medications by the drug companies; elimination of greedy practitioners such as yourself.

You said it yourself, an ideal may not be achievable, but that's not a reason not to strive for it.

 

[MOHS_01]

No, Mr. Sprinkles, it is I who should apologize -- I have been rather inept at keeping up with your shifting targets.... I apparently missed the transition from a discussion on the relative merits of a high income afforded to the medical laborer to a rant and rail against insurance companies (who you have never heard me defend in either this thread or likely any other). I believe that you are mixing arguments here.... and if there were no value in the insurance industry, surely someone would have come up with a non-profit alternative that would make life hard for them, don't you think? I mean, that is, unless there has been some form of cooperation -- or collusion -- or regulatory burden instituted by the state that protects the insurance industry's interest..... Let's recap:

I never said that the profit motive never brought us any advance in medicine.

What I'm having trouble understanding is where you see a contradiction (also where you see me stating that monetary profit is a bad thing).

OK.

Profit based medicine will always, without exception, lower the quality of medical care.

Name some medical innovations that were driven by profit, not competition, profit.

I am steadfastly against the monetary profit motive in medicine. .... the profit motive as an institution in medicine will always, and without exception, drive down the quality of care.

I object to health care being administered not for the general health of society, but for the purpose of pleasing stockholders. You have no moral compass if you don't likewise object.

Putting the welfare of a corporation above the public welfare is evil.

You pointed out at one point that scarcity is a major issue. Not just in medicine, but in all aspects of finite resources. So should we decide who gets what based on how it affects the bottom line of an insurance company, or should we attempt to apply the idea of fairness? Apparently you're of the school of thought that we should take people for all they're worth when they get sick; I guess I'm a little more compassionite.

Nice -- two of your beloved fallacies back to back; as my two year would say, "Bravo, bravo."

What I'm having trouble understanding is where you see a contradiction (also where you see me stating that monetary profit is a bad thing). So according to your logic, doctors can either charge the maximum allowable amount driven solely by profit, or they can work for free? Please MOHS, come out of the world of black and white and enter the gray area. What doctors are paid for their services has little bearing on the discussion of institutionalized profit in medicine (unless doctors become administrators and policy makers, which doesn't seem like it's gonna happen any time soon). I'm all for fair wages; doctors should be compensated on par with their workload, training, and services provided. That's not even the issue that I was raising. I see no need for our current system of allocation, and I believe it can be done better, more ethically, and more efficiently.

I agree that we must have some form of rationing, but again, this form of rationing should not be based primarily on monetary gain. People are better than you seem to think. We are driven by far more than want of fancy cars and big houses. We cannot eliminate out competitive nature (we physically have left the jungle, but our minds are still deep inside). Nor can we eliminate the state of limited resources that provides the impetus for competition. What we can eliminate is the greed factor from medicine. Nonprofit insurance companies; the end of a monopolistic stranglehold on medications by the drug companies; elimination of greedy practitioners such as yourself.

You said it yourself, an ideal may not be achievable, but that's not a reason not to strive for it.

The "old" me would respond with something along the lines of "OK, now listen here you self righteous little ****." The "new" me is able to realize that everyone's views and perceptions are fluid (for the intelligent, anyway) and that most people truly believe whatever position they hold to be the proper, right, and just position. You are seemingly still mired in the young and dogmatic phase of life..... I have asked you, several times now, who this end arbitrator and judge of fairness will be. What "objective" criteria will he/she/it employ. How will it accomplish these lofty goals without commandeering, conscription, declaration of eminent domain, or some other use of force over certain members or minority classes to accomplish these ends. Do the means matter? On and on. If you can fashion a system that does not violate natural law, I am all ears. Until then can you at least be honest enough to cede that many of the views you seem to hold can only be accomplished via tyrannical means? That the tyrant is the majority group (affectionately referred to as society)? If you cannot, we'll finish this discussion when you have a little more life under your belt.......

 

[MOHS_01]

Who are me and my ilk? Are we the commies? The socialists?

Starting to get that impression, yes. As for the "profiteering from the sick" -- until we are guilty of giving them the illness so that we can gain more profits, we working providers are generally rendering labors in an effort to correct problems not of our doing. I see no problem in getting paid in an amount agreed upon between the two parties in the room; what I truly find remarkable is that you seem to hold that this payment level would be best determined by some uninvolved party and that both the consumer and the producer should STFU and be happy with their benevolent decision.

So according to your logic, doctors can either charge the maximum allowable amount driven solely by profit, or they can work for free?

To address this more specifically: LOL... wait, wut? Yes, in an ideal world providers would be able to charge what they wanted to charge -- and consumers were willing to pay -- that would be the most desirable condition. In order for this to occur, however, one would have to remove the artificial limitations on the number of potential providers.... and if you cared enough to research post history a little you would find that I have argued since joining that no semblance of a free market exists in the practice of medicine. Now, seeing as we do not have any semblance of a free market in health care provision, a whole set of problems arise that are quite difficult to address while adhering to the principles of any free market. In short, it cannot be done.... but that does not mean I agree with a system whereby the heavy hand of the state should work in conjunction with the deep pockets of the insurance industry in an effort to systematically stack the deck against both counterparties (the consumer and the producer).

 

[Mmm sprinkles]

MOHS, I'm having trouble posting this because my palm seems to stick to my face whenever I read your condescending drivel I have not the time nor patience to continue in a useless endeavor. We disagree, and that won't change. I'm sure you'll take this post as an opportunity to continue being the pompous ashole I've grown so fond of arguing with in these past few days, but you can be sure I will not return to read it. I've shifted no goal posts. My argument has always been against institutionalized profit and greed as a motivation for entering medicine. You've done absolutely nothing to argue against these points. Rather you seem to be of the opinion that reading Atlas Shrugged and some excerpts from Republic makes you a scholar. I can guarantee that the map of your life began with a silver spoon, and proceeded up straight through high school, college, medical school, and so forth with no real experience anywhere. You make assumptions, judgements, and observations that are blatantly wrong yet you think you can hide these facts with rhetoric (you're an articulate one, I'll give you that). In my years I've met enough people like you to know continuing this dialogue is pointless. But not just for me, for you as well. Your ideas hold little sway, as they've been tried and have failed miserably. They sound good in theory, but fail in practice. Farewell MOHS, I'm off to Europe for the next four weeks. You may have the last word. I'm sure you'll use it and continue to exude the same level of class and sophistication as you have thus far.

 

[janV88]

but I am steadfastly against the monetary profit motive (sad that I have to specify that, but someone with poor logical skills likes to resort to the fallacy of equivocation) in medicine.

You must really have a hard time with comprehension, don't you.

The fact that you constantly "attack" the "monetary profit motive" yet let other forms of profit go by unharmed shows that you don't really understand what you're talking about.

Let me spell it out for you.

Every bad thing about the "monetary profit motive" has nothing to do with the profit. It has everything to do with the intent of the individual. If you remove financial gain from the system, the evils of the profit motive will still exist. When someone takes advantage of the sick and makes money off of their illness, it is not the money that makes this "evil"...it is the intent of the person taking advantage. Money is the after effect, the profit. Remove financial gain and another form of profit will take its place.

 

[MOHS_01]

MOHS, I'm having trouble posting this because my palm seems to stick to my face whenever I read your condescending drivel I have not the time nor patience to continue in a useless endeavor. We disagree, and that won't change. I'm sure you'll take this post as an opportunity to continue being the pompous ashole I've grown so fond of arguing with in these past few days, but you can be sure I will not return to read it. I've shifted no goal posts. My argument has always been against institutionalized profit and greed as a motivation for entering medicine. You've done absolutely nothing to argue against these points. Rather you seem to be of the opinion that reading Atlas Shrugged and some excerpts from Republic makes you a scholar. I can guarantee that the map of your life began with a silver spoon, and proceeded up straight through high school, college, medical school, and so forth with no real experience anywhere. You make assumptions, judgements, and observations that are blatantly wrong yet you think you can hide these facts with rhetoric (you're an articulate one, I'll give you that). In my years I've met enough people like you to know continuing this dialogue is pointless. But not just for me, for you as well. Your ideas hold little sway, as they've been tried and have failed miserably. They sound good in theory, but fail in practice. Farewell MOHS, I'm off to Europe for the next four weeks. You may have the last word. I'm sure you'll use it and continue to exude the same level of class and sophistication as you have thus far.

Godspeed and safe travels... but before you go, know this: just as in the matters above, you could be absolutely no further from the truth on your assumptions of my upbringing and background, which I have reluctantly recounted on more than one occasion on this site. Truth be told, I have not read either of the two works mentioned, and have but cursory knowledge of their contents. We're probably not all that different, you and I, other than the fact that I probably worked more... for less (there damn sure was no $30/hr for our sawmill/timber/tobacco/cattle/hay operation -- my pay was the roof over my head and the food on my and my 5 bro/sis's plates).... and it is this very understanding of the nature of hard work for poor returns that shaped and fashioned my opinions on these matters. You see, I did not go without for years just to blame and curse others for their success; I chose to work smarter and seek out the job that would provide the best returns for my labors while allowing for some pride in the knowledge that my chosen profession was an honorable one, one that does provide a worthy and necessary service, one that allows me to bring a heretofore unrepresented but needed specialty back to my predominantly rural community.... all the while allowing me the luxury of having some control over my lifestyle and schedule (so that my kids could afford to play organized sports, or attend play dates, or any number of other often taken for granted activities of childhood should they so desire.... and that would, at least more often than not, afford me the possibility of watching them do so).

...and one last thought on MD pay: why should it not be impressive? We perform a necessary and vital task as you have stated. The road taken is long and arduous as you have stated. Typically remuneration is commensurate with the difficulty of obtaining the skills required to perform any given task, and as long as the members of society continue to value their health and that of those they love, the pay should be reflective of these inputs.

The thing is, people intuitively understand this. Whether MD pay drops -- or the pay of alternative choices rise -- the effects are the same: medical school admissions are reflective. Med school apps peaked in the year I applied; enter the dot-com boom and applications dropped. This is not just theory -- one can look at the med school applications trends and compare them to the greater economic picture and see that there exists a correlation; it would seem that economic conditions factor into the decision of whether to crawl into the cave that is medical education or to seek alternate paths to economic security based upon the current perception of the likelihood and ease of doing so.

 

[MOHS_01]

I've even got the perfect first line for an illicit movie.

"So, like...I've got this irregularly shaped mole...you want to...check it out...?"

I had the classic bow-chica-wow-wow start playing in my head as I read it.... oh yeahhhh....

 

[seelee]

Profit is not an evil in itself, but certain actions motivated by money are. Turning people into commodities is evil. Exploiting illness for personal gain is evil. Putting the welfare of a corporation above the public welfare is evil.

Few things are inherently evil. It takes intent and outcome to make something so.

How exactly does the medical industry turn people into commodities? Are they buying and selling the people? Are they trying to make them sick so as to maintain their customer base? Please clarify?

So do grocery stores exploit hunger for personal gain?

Do contractors exploit the need for shelter for personal gain?

Just out of curiosity, if you had to choose, would it be more evil to make no attempt to treat an illness, or to treat an illness in exchange for profit?

What would be an example of putting corporate welfare above public welfare? If I own a company that makes medicine, and I charge people money for that medicine, and they value the medicine enough to give me money for it, is that putting my corporate welfare above the public welfare? In order to be un-evil, am I ethically required to provide that medication at cost? What if I invested that profit into growing my business or into building a new business, or investing in a start-up. That would create jobs, and provide others with means to purchase other goods and services, which in turn would provide income for other businesses and industries who are also profit-driven.

You attacked MOHS for speaking in generalities, but you offer no specifics. You make the nebulous broad-sweeping statements like "placing corporate welfare above public welfare is evil". Do you not realize that such a statement can be interpreted in dramatically different ways.

So lets assume that you wave your magic wand and require the evil corporations to provide their goods and services at or below cost to people at low income levels. So now we have the corporate welfare being sacrificed at the expense of the public welfare. Is that right?

But wait, people work for the corporation, and because they are no longer able to make profit, the company cannot expand, and eventually begins to loose money. The people who work for the corporation are now laid off. That is ok though, because now that they are low income earners, they can get the lower cost goods from the corporation. Except now that there are more poor people who can't find jobs (because the existing companies can't grow) the demand on those goods is higher, and the goods become scarce. Eventually some of the corporations go out of business which decreases the supply of goods in the market even more. Forcing the poor, who can't get jobs, to go without those goods.

So, in the attempt to put the public welfare above the corporate welfare, you succeeded in doing greater damage to the public because you forgot one key thing. Corporations consist of people. They hire people, they pay people, they provide valuable goods and services to people. You curse the evil medical industries for trying to make a profit. But would things be better if they never existed in the first place, if their products and technologies were never invented? What you want is for these companies to expend their time, risk, money, effort, and ingenuity to develop new products and technologies, and then you want them to surrender those things to you with out any reward.

 

[Slack3r]

...I'm off to Europe for the next four weeks.

Ah yes, the socialist motherland.

 

[Caesar]

rc fail.

orly?

in my job as a doc in the emergency department, i see the seedier side of life. That doesn't mean i'm a part of it. i know about the commercial sex industry.

 

[medicinesux]

It kills me when premeds preach the quote mentioned in the headline of the thread! Do they have any frame of reference or iota of life experience to say such a thing? They are merely "mimicking" what they hear from attendings or residents who have actually been in the trenches. These premeds remind me of my uncle's seventy year old parrot who would shout expletives across the house not really comprehending what the hell they are saying (My uncle swears like a sailor).

 

[Apollyon]

orly?

OK, med student - doing EM does not make one an expert. However, sexually based trauma is something taught. One way people arrive at that is through actions from the commercial sex industry. The Spitz and Fisher book "The Medicolegal Investigation of Death" added to that. I also had vocational and avocational interest in the idea. I also find it interesting from the financial side.

However, I'm not the one who said I was an expert. You are the one who proffered that in an instigatory and provocative manner. However, were you to prod me more towards a confrontation, I would show you my resources and support my claims, still not claiming to be an expert, though.

 

[DOwnage]

I don't think it will be easier to make money elsewhere in the future either. Health care reform passed and there's risk of overall income going down; we never know how the future will pan out if the law even gets enforced. However, with the financial regulation passing, we in the health care field aren't the only ones getting hammered. If it's gonna be hard for docs to make "good money", it'll likely be harder for others to make a comparable amount, and everything will remain the same relatively. However, I could see the standard of living in our country change if we stay on the current path.

 

[ccfccp]

Eh... I plan on getting a cushy government job where I only have to do 20 hours of real work in a week (I'll be there for 40-50, but work is for suckers... I can look as busy as the next guy...) Sure, I'll only make 100K, but that's not bad for 20 hours. They won't be able to fire me, and I'll get to retire in 20 years with nice pension.

Heh... all those stupid people out there looking for a REAL job...
</sarcasm>

 

[Gfliptastic]

Wow.

IDK where or what to post anymore. Although I'm not new to forums, I am to SDN. When y'all are done w/ your piszzing match, there was an interesting topic being addressed.

I guess I like to point out that in the Forbes Top 50 wealthiest people, there is a dearth of physicians. If you are chasing a paycheck, yes there's so many other different occupations to pursue.

Edit: Didn't realize that almost every area of SDN has several simultaneous piszzing matches in each forum. So this is par for the course. LOL.

 

[476515678234896]

what do physicians on here think about dentistry? it seems much easier (training and day-to-day) to make money in that field.

 

[Nilf]

Geez.... you guys are ignoring the elephant in the room...

When you consider medicine vs alternatives, first and foremost you have to consider the tremendous OPPORTUNITY COST of career in medicine.

Think about it... if you don't go to medicine, you have decade+ of worth of money PLUS decade+ worth of time to start a new business, develop new connections, open up new opportunities, etc... THIS IS HUGE.

You are bitching about how bad job market is now for lawyers, MBAs, engineers or whatever... Well we are in a slump right now... but when you are my generation, then you have missed most of the booming economy sitting in medical school lecture hall... while your college buddies were working, making money, getting experience, making connections, starting businesses.

Dudes... if you join an army right after high school, by the age of thirtysomething you get retire, get a small pension (20-30K per year), and you are virtually guaranteed a government job, where you don't do squat, have zero responsibilities, no chance of getting fired, great benefits. And noone is stopping you form opening a small retail business on side. THAT'S WITH HIGH SCHOOL EDUCATION.

I know a guy who majored in communication and opened a dog-walking business after college, netting north of 100K the first year.

I won't even mention accountants, lawyers, wallstreeters. That's powerleveling.

But when you are in medschool, you are grinding.

 

[Nilf]

/deleted double post

 

[bronx43]

I don't think it will be easier to make money elsewhere in the future either. Health care reform passed and there's risk of overall income going down; we never know how the future will pan out if the law even gets enforced. However, with the financial regulation passing, we in the health care field aren't the only ones getting hammered. If it's gonna be hard for docs to make "good money", it'll likely be harder for others to make a comparable amount, and everything will remain the same relatively. However, I could see the standard of living in our country change if we stay on the current path.

*Thumbs up.
This is exactly right. Even if the absolute number of dollars made by physicians decreases over the next couple of years/decades, it would be foolish to believe that the rest of society won't see a similar decrease in adjusted income. If you think doctors are getting screwed over, the financial reform that just passed is poised to put a coffin in many of the high paying financial industries - not to mention the fact that buyout and venture capitalism have already been in the red for the last decade or so.

Consumption of this level by Western society can't be sustained. That part should be pretty self-evident. Everyone is gonna pay the price. When **** hits the fan, it'll be better to be a doctor than an entrepreneur or financier.

 

[morning]

Think about it... if you don't go to medicine, you have decade+ of worth of money PLUS decade+ worth of time to start a new business, develop new connections, open up new opportunities, etc... THIS IS HUGE.

Are we not counting the 4 years EVERYONE besides the small business owners goes through to earn their college degree?

I can't believe you even mentioned law. Do lawyers not spend 7 years in school? Do they not struggle under insane tuition amounts? Are you unaware of how horrible the job market is in law?

 

[Gfliptastic]

Are we not counting the 4 years EVERYONE besides the small business owners goes through to earn their college degree?

I can't believe you even mentioned law. Do lawyers not spend 7 years in school? Do they not struggle under insane tuition amounts? Are you unaware of how horrible the job market is in law?

Not to mention EVERY small business owner has a successful business, right?

Also the reality is, that being a physician is quite possibly the most "secure" job in the United States. Can't outsource it. Economy goes up, down, sideways, there's always going to be people who are sick.

Are there people who will make a whole heck of a lot more $ than me? For sure! Can I be laid off? Outsourced? Cut out of a budget? Unless I'm utterly incompetent and unable to be insured, nope.

Master tradesmen make a ton of $, and only have to do a blue collar apprenticeship, where they already make $. Fantastic! I'm from a blue collar neighborhood. Do you know how many of my union friends are unemployed? 3 out of 4 of them.

MBA's don't guarantee work. JD's don't guarantee work. Ph. D's don't always guarantee work. An MD (or DO) has a lot of peace of mind to it. And hence can add non-monetary value to it in the end!

If the term Return On Investment rings true for anyone reading this, then the ROI on obtaining an MD/DO pretty much trumps the "overhead" comparing it to any other degree.

To extend the ROI argument further, a NP or PA running a hospital or a medical group or becoming a Vice President for a pharmaceutical company or medical device company after a productive satisfying life in practice???? GOOD LUCK pitching your "cheaper to obtain" degree to a Board Of Directors.

 

[avatarftw]

Sadly, many do not consider opportunity cost.

Geez.... you guys are ignoring the elephant in the room...

When you consider medicine vs alternatives, first and foremost you have to consider the tremendous OPPORTUNITY COST of career in medicine.

Think about it... if you don't go to medicine, you have decade+ of worth of money PLUS decade+ worth of time to start a new business, develop new connections, open up new opportunities, etc... THIS IS HUGE.

You are bitching about how bad job market is now for lawyers, MBAs, engineers or whatever... Well we are in a slump right now... but when you are my generation, then you have missed most of the booming economy sitting in medical school lecture hall... while your college buddies were working, making money, getting experience, making connections, starting businesses.

Dudes... if you join an army right after high school, by the age of thirtysomething you get retire, get a small pension (20-30K per year), and you are virtually guaranteed a government job, where you don't do squat, have zero responsibilities, no chance of getting fired, great benefits. And noone is stopping you form opening a small retail business on side. THAT'S WITH HIGH SCHOOL EDUCATION.

I know a guy who majored in communication and opened a dog-walking business after college, netting north of 100K the first year.

I won't even mention accountants, lawyers, wallstreeters. That's powerleveling.

But when you are in medschool, you are grinding.

 

[tibor75]

I think that medicine is a relatively unique field in that most of its members will never need to learn to deal with any significant failure. 'Success' in medicine is surprisingly attainable. Except for a few positions in academic medicine there is no never ending series of promotions, no board room to strive for, no jackass bosses (after residency) to constantly remind you that you're not measuring up, and no real competition for customers because the demand for physicians is so much greater than the supply. You hit attending and you have peaked, automatically. Which means that every physician gets to be a superstar in his/her own mind, because most physicians have never encountered a hurdle that they couldn't clear.

The result is that most physicians I’ve met assume that they would have achieved the maximum level of success in any field. They would have been CEOs, or the top traders on Wall Street, or would have scored one of the few remaining tenure spots in an overcrowded academia. Or maybe they just would have relaxed and pulled in a few hundred thousand a year as an enterprising plumber, or started home businesses that they would then have sold for millions a year or two later. Compared to what they imagine they could have been, Medicine looks like a pretty raw deal.

Now these physicians know perfectly well that most graduate students end up in perpetual post-docs, that newly minted MBAs and lawyers often have trouble finding any work at all (let alone work that pays hundreds of thousands of dollars and has real job security). They know that plumbers average 35K/year and that most small business go bankrupt. However they firmly believe that they would have been the exception because they are just that F-ing good. When they tell you that you could be doing better they're not lying to try to disuade you from the field, they genuinely believe that pulling down 250K for 50 hours/week of work is so far beneath their potential that's it's charity work.

I maintain that most people with a similar intelligence and drive as the average medical school matriculant who pursues a different training path will end up working more hours for less money, and that someone who wants to maximize their likely earning potential should seriously consider medicine. The fact that it's good work from a moral perspective and is mostly cubilce free is gravy.

Excellent post.

Funny how clueless doctors forget that one of the perks of their job is that fact that they can rarely lose it.

Have yet to hear of a doctor who wasn't a crook that was unemployed or simply couldnt' find a job. Almost every city in the country is hard after doctors. There simply arne't enough to go around.

 

[Dr Oops]

Are we not counting the 4 years EVERYONE besides the small business owners goes through to earn their college degree?

I can't believe you even mentioned law. Do lawyers not spend 7 years in school? Do they not struggle under insane tuition amounts? Are you unaware of how horrible the job market is in law?

law school is 3 years. And most of them are not as competitive as med school (you also dont have to shadow or volunteer etc.). The job market is terrible for them because it is oversaturated.