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Doctors as businessmen

Discussion in 'Medical Students - DO' started by Plinko, Apr 9, 2004.

  1. Plinko

    Plinko Senior Member
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    I recently had a preceptorship with a FP doc that told me that many of his pharmaceutical sales reps make more than him (more than $85K/year). I couldn't believe this. He does work in a rather impoverished area and has many patients on Medicaid. But still, this struck me as ridiculous. I also read recently in the USA Today that in many states in the country Pediatricians can expect to make less than Vets. While I understand that the problem here (assuming you see this as a problem) is much larger that what a thread on SDN can hope to tackle, I was wondering if any of you other fellow med students out there felt that the idea of offering a business class in your curiculums might serve to remedy this problem in the future. I say this because it seems to me that the doctors out there who have preceded us have been ill equipped to handle the pressures being put upon them by lawyers, politicians, insurance companies, etc. to take away the standard of living they have earned and deserve.

    I see this as an osteopathic problem even more so than an allopathic one given the large numbers of PCPs DO schools produce.
     
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  3. Doctor Peloncito

    Doctor Peloncito Family Physician
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    I don't think it is primarily a DO problem. Even though we produce a higher percentage of primary care physicians, there are still many more MD PCPs out there.

    Anyway, UHS offers a dual DO-MBA degree in conjunction with Rockhurst University. I think that this program may be ok to help make docs a little more business savvy, but I don't think it will in any way make them businessment. I think it will allow them to communicate better with their accountants and lawyers, but I think that the business should be left to the businessmen and women.
     
  4. gioia

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    Interesting.

    In Business, you have bad business people and in Medicine, you have bad business people. It really depends on the person.

    I think if Business courses (oriented toward healthcare) should be taught anywhere, it should be in the undergrad curriculum. Then students would have a better idea of what they are getting into.
     
  5. DrDad

    DrDad DO Stud. '08
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    i agree with Gioia.... too true about bad business.....
     
  6. Dr JPH

    Dr JPH Membership Revoked
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    Follow-up...would you still have gone to medical school? Who maybe would NOT have?

    I, for one, would still have chosen this path.

    But I can be honest when I say it is tough to look at my roomates (all my age and graduating Pharmacy school this year...as I WOULD be if I stuck with that program from undergrad) getting $95,000+ offers to work retail pharmacy and not wish I had a piece of that.

    My girlfriend makes over 100K as a pharmacist and is quite happy and stable financially.

    Medicine needs to be a passion, but as a responsible physician you cannot lose sight of the business aspect of our chosen calling. to do so would be IRresponsible for ourselves and our families.

    Good thread...keep the conversation going.

    JP
     
  7. gioia

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    Oh definitely, JP. I would certainly stick with the decision I made!

    You're right about needing to know yourself well enough to choose the right career. I've been in business and even done those seemingly goofy personality assesments.. every bit helps.

    I couldn't be a pharm. I thought about it and almost applied (love chemicals and organic chem) but it did not embody what I love about medicine.... diagnosis. I also despise corporate management as my work-world...

    There are also a lot of write-offs and income restructuring you can do as a physician. You can even dicate your hours (depending on what your interests are).

    If you give me a job and tell me that I can't make a diagnosis, or problem solve then I'm miserable... I also need diversity and like working odd hours....

    These are all things people need to consider.

    Of course, you will always meet miserable individuals in every occupation. Listen, and decide: did they make the best decision for themselves. Is their misery toxic and out to poison other people's happiness?
     
  8. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    I suspect that if an FP is making the $85k figure you mention, it doesn't have much to do with poor business skills--either he's chosen the sort of altruistic work that doesn't pay much, in which case all the business skills in the world won't help as he'll primarily be getting standardized government reimbursements, or perhaps in the opposite scenario one's chosen a competitive area with an easy lifestyle (eg the classic suburban four-day-a-week FP.

    In other words, I can't think of too many scenarios in which an FP would be forced into an $85k a year job, and if he's chosen a position of that nature, business skills aren't going to make up the difference. There's a lot to be said for intelligent business decisions, but I don't think they're the sort of thing that can taught to any lasting effect in a med school program not incorporating an MBA.
     
  9. fishy424

    fishy424 Member
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    I agree with the last post.

    At this point in time, working as an FP in a rural area and making "only" $80,000 is a lifestyle choice and has little to do with business knowledge. ($80K still ain't shabby folks) In my eyes, someone with this type of practice knows (or should know) ahead of time that they are going to be making less that their suburban and city specialist counterparts.

    Perhaps courses in political-economy or healthcare inequality, etc. and most importantly political action/policy change are most important for physicians who want to address the inequalities in pay that arise due to specialty choice and geographic practice location. Letter writting and lobbying skills seem more important than business acumen when trying to address questions about fair compensation in the profession.

    Maybe someday, if state and federal reimbusement rates increase for medicaid/medicare pts., more doctors will be incented to practice in underserved areas.

    Good post. Any more thoughts?
     
  10. DrDad

    DrDad DO Stud. '08
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    It is our intention to serve as medical missionaries in rural OK fulling realizing that our intent may define for us that we make ~80-100K per year.... approx 20K less than average for the area... The money though is not where the importance lies.... The ability is so much more important.... further, if we do make more then we will be able to do more free care.... hopefully the case.... yet, It all comes back to the initial reason for going to med school.... To serve....
     
  11. gioia

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    I'm not convinced. Declared salary is relative. Imagine being the ONLY Doc in a rural town.... there are many undeclared benefits; cash payments being one of them...

    Check out other rural med threads, there are docs who do extremely well with a FRACTION of the overhead seen in urban/suburban settings.

    We must apply the same mentality to salary as we do med school admissions. How often to schools make themselves (or their applicants) look different on paper than they are in real life?

    If a legit. physician has an extremely low salary and can't understand it, then they need management training or better bedside manner.

    50 BILLION DOLLARS were spent last year alone - out of pocket- by patients looking for alternative health care... so I am sure a decent salary can be garnered.

    Of course, this is my $.02. Call me in ten years and ask me about my salary then ;)
     
  12. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    I agree that $80k is very low for rural work. If anything, rural med pays significantly higher than anywhere else. There are plenty of NHSC positions that will pay $150k out of the gate (and this without the hassle of owning or operating your own practice).

    The only docs making $80k, I'd think, are the ones doing that altruistic work, the ones in suburban/city areas where competition is higher and salary lower, or the ones in the first year or so of independent practice. Otherwise, it's HARD to make that little money, unless one is living a pretty relaxed lifestyle. I'd be interested to hear how many hours this doctor works, if you know offhand.

    I've got no particular experience in the matter, but from what I've seen any FP can expect around $120k baseline without having to do a whole lot but show up for work. Business skills surely can up this figure, but if someone's making a lot less than that, I doubt it's because of a lack of business acumen.
     
  13. Plinko

    Plinko Senior Member
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    The FP doc I spoke of works from 7-2PM (no lunch break) five days a week, and 9-12 on Saturdays. He supplements his practice by employing a Nurse Practitioner (mostly for the WWEs), who sees patients in the afternoon. He graduated KCOM in '63 and has been in practice in the same office (in North St. Louis) for the last forty years. I consider him, in my humble opinion based on two years experience in medical school, to be an excellent clinician with an even more impressive bed side manner. I simply chose him as an example to serve as a microcosm for a larger problem. I understand that he does not represent the norm. Perhaps I should have used the example of an otolaryngologist for whom I worked prior to med school who repeatedly told me that he has to perform three times the amount of surgeries today in order to make the same salary he made twenty years ago. I simply was trying to conjure up a discussion of possible remedies to what I see as a growing problem of improper reimbursement to the level of dedication, time, and skill that comprise most doctors' investment into their careers.

    While agree with a previous post that suggested that the primary motivating factors for one going into medicine should not inlcude a desire for money, I still have to argue that an inappropriate salary level is being afforded physicians, taking into account the context of what the labor market affords people of a simliar level of education and personal sacrifice. Somewhere in our history our altruisitc maxims we so chersih and live have become somewhat of an Achilles Heel. It has rendered us vulnerable to the sharks out there who endeavor to take away what we used to earn in years past. One solution, I have felt, is to somehow incorporate into the evolution of a doctor's career some of the tools that those on the other side of fence--lawyers, politicians, etc.--already have at their disposal.

    To put is simply, I don't think we as future doctors should have to sacrifice such a high degree of comfort in our future lifestyles in addition to all the sacrifices we have already made, and undoubtedly will make, in order to become physicians. After all, this is not a socialist state that we live in. A desire to be rewarded for all our efforts has to fit in somewhere on the long list of why we want to be doctors.

    I'll get my philosophical podium. Didn't mean to rant. Just pulled an all-nighter to take an 123 question Neuro test. My sympathetics are in overdrive.
     
  14. gioia

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    Did you ever stop to think that, maybe, there is a 'medical bubble' kind of like the current 'housing bubble' experienced in many parts of the US?

    Maybe we should be poorer. Maybe physicians have just been lucky the past 30 years because physicians certainly weren't in this position 100 years ago.

    As long as I can have my espresso and drink it too, I will be happy.
     
  15. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    Not of our own will have we been forced into the ?business? of medicine. Deep down inside I will ALWAYS believe that medicine and business are and should be separate entities. The reality of it all however is that society and government (and Ahole insurance companies) forced us to be businessmen and woman or risk certain failure.

    So let?s crunch some numbers.

    hmm, I?ll have $250,000 loans at the end of four years (about $200k med school, $50k undergrad). That's $2,083 dollars a month to have my student loans paid off in 10 years (by the time I turn 37).

    BUT lets not forget,

    PLAN A: most IM residencies barely pay $35,000 a year, forgetting about taxes that's about $2,916 a month you "earn" (not take home) your first 3-5 years out of school. $2,916-$2,083 = $833 per month for food, shelter, laundry, heat, electric. We all know most places just to RENT can be nearly $800. Well that doesn?t seem to work.

    OK so?

    PLAN B: DEFER $250,000 during 3 (i'll be generous) year residency at 4% interest rate (per year) putting our new total at something around $281,216 so over 10 years I would now have to pay $2,343 month (and not finish paying loans until I am over 40)

    Let's say by some miracle of god I manage to take home $100,000 after taxes, malpractice and other rediculous insurance BS. That'd be about $8,333 . So, $8,333-$2,343 = $5,990.

    Now let's say I purchase a modest middle class house of about $175-200k, mortgage payment ~ $2000. So $5,990-$2,000 = $3,990/month for food, family, other taxes, expenses, retirement account savings, maybe even a car payment (forget about vacations- who needs or deserves those?)

    I love medicine with all my heart and soul but the debt we accrue during and the massive problems (according to research hard data, average insurance reimbursement is at 63% on accounts receivable) collecting on any services anymore makes me angry and cynical and worrying about whether I'll have a pot to piss in, in 10 years is really aggravating.

    On a side note, I know people disagree, but I think it's hilarious that all these new expensive schools feel that there is a shortage of RURAL physicians that can be fixed by opening more schools when the real reason that graduates avoid the RURAL areas is because no one can get paid. EVEN if it's not true (but I firmly believe it is) it IS a VERY common perception that RURAL physicians can't make ends meet.

    my 2cents
     
  16. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    There seems to be a perception that rural medicine doesn't pay. As far as I can tell, the opposite is true. If you want to be a FP and make a lot of money, rural medicine is really the route to go. Obviously there are exceptions, but on the whole an FP working in an undesirable rural area is going to make much more than an FP working in a highly desirable, and therefore highly saturated, suburban/urban area.

    If more FP's knew this, perhaps the rural medicine shortage wouldn't be so short. I suspect, though, that most do, and the reason most FP's choose not to live and work in rural areas is the same most of the population at large doesn't--life on the farm isn't all that. For those that do dedicate themselves to that route, though, it's really not that tough to pull in more as a rural FP than many advanced specialties will in the city.
     
  17. Plinko

    Plinko Senior Member
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    To answer your question: No.

    I must say, with no offense intended, that you are the only adult person I have ever heard say, in my entire life, that he "should be poorer." Maybe I haven't been hanging around the missionary/Peace Corp crowd enough.
     
  18. gioia

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    Oh, PLINKO,

    I know, I know...

    I just read so many threads that all seem like they end up saying, "we're poor" , "we're broke". I was just being sarcastic.

    I like your thread.


    I have yet to see a shoeless physician, that's all. :eek:
     
  19. BostonSean

    BostonSean Junior Member
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    Homer,
    all your calculations of how much debt, and how long it will take to pay off are not taking into consideration interest on the loan you take out.

    250,000 dollars in loans paid over 10 years would be a lot more than 2,083/yr.

    but yeah good post I agree with your frustrations!! :mad:
     
  20. sophiejane

    sophiejane Exhausted
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    The problem is not that doctors are bad business people. The problem is that our entire system of providing medical care in the US is on the brink of imploding. It is more of a crisis than any of us understand.

    The insurance companies and drug companies are getting fatter, docs are making less, and the quality of patient care is decreasing. "Boutique" clinics for the rich are thriving. Medicare and Medicaid are overburdened. Taxpayers are pouring money into a system that is hemorrhaging dollars as fast as they are coming in.

    Now, what appears to be the problem here? I can tell you it has much less to do with business saavy of doctors than it does with a tragic flaw in the whole system.

    We are inheriting this mess. It is up to us to speak up and change it.

    One interesting development lately is cash-only practices. There was a recent piece on CNN.com about this. Docs can charge much less because they aren't paying a "billing specialist" $20/hour to harrass the insurance companies into paying, and they STILL take home more than the insurance payments would have given them. Think about it--for most middle class, relatively healthy people, why are their employers paying out the nose for insurance that they so rarely take advantage of? Why not offer people catastrophic and hospital coverage at much lower rates and use the money saved to pay cash when they see a doc? What this could do is cut out the middleman, allow docs to see few patients and deliver better care and make more money, and send a message to big managed care companies that hits them where it hurts.

    The safety net services will always be needed for the poor...but that is a different topic and one that is even more complicated.

    (It is interesting to note that THE ONLY thing in the medicare prescription drug plan that was entirely UNTOUCHABLE was the provision that cut out competition for drug manufacturers--allowing them to get a huge piece of the pie when it was all said and done. Now who do you think has the largest and best-funded lobby on capitol hill? Hmmm....coincidence? I think not. It would appear that Dubya has been keeping close company with those well-heeled pill-pushers...)
     
  21. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    And all this time I thought it was the AARP that had the largest and best-funded lobby on capitol hill. But on second thought, that's crazy...if that were true, there would probably already be some sort of massive government program geared towards providing them inefficient and obscenely bloated care while draining resources from the rest of the nation. Thank goodness there's no senior lobby!
     
  22. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    Boston, I don't really know exactly how interest works my point was merely to make a point that what is happening to us is sadistic and unacceptable.

    Sohphie, I agree we all need to be proactive but when you have a dictator... er I mean president in power that either does what the lobbies pay him to do or whatever his ******ed little mind wants to do regardless of what the majority wants in this country. For me, this is disillusioning and doesn't make me want to hop in my car, drive to D.C. and talk to anyone or waste my time trying to convince "senator kickback" that his voters will likely have no hospitals to go to in 10 years because people use ED's as primary care centers free of charge and bankrupt hospitals (I've seen it, and seen it often). Wasting my time. This country really scares me, I don't see how or who could ever fix this problem, it's just going to have to take a catastrophy to open eyes and so be it.

    Yep, I truly believe the system will collapse before any significant reform would happen...
     
  23. sophiejane

    sophiejane Exhausted
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    Luke,

    Drug companies have approximately 800 full time lobbyists on capitol hill, more than any other special interest group.

    I did mention that medicare and medicaid were overburdened and needed fixing, if you read my post. I do agree with you on that. I assume your tone was sarcasm, but it is sometimes hard to tell in writing.
     
  24. sophiejane

    sophiejane Exhausted
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    You only need to drive as far as your local polling place, and all you need to do is vote. Then get 10 more people to vote.

    Please don't feel like you can't make a difference because you can, but not if you don't vote!
     
  25. gioia

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    Any other patient- care/provider-resolution ideas?

    Has KAISER helped the current situation at all?
     
  26. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    AARP spent $20.9 million last year on lobbying activities, while the Pharmaceutical Research and Manufacturers of America (PhRMA) spent about $16 million, according to lobbying records released last week.

    http://www.hillnews.com/news/031704/costs.aspx

    Looks like those lobbyists are a bit more efficient with their 800 than the seniors, then!

    Really, it gets a little tiring to see people blaming the drug companies. If there is a "health care crisis," it exists mainly because seniors are being afforded an unsustainable level of care at the expense of others, and high drug prices are only a very indirect result of this. With an artificially low retirement age and a medicare program that grows ever more bloated, the blame rests squarely on the back of Grandma, who will vote against anyone who dares propose raising the retirement age by a few years or rationing health care for those who won't get full benefit from it.

    As for reforming medicaid, perhaps we need to do so, but not because it's like medicare. Rather, the monstrosity that is medicare has left little money for medicaid, which is a very efficient program. Too efficient--there are plenty of doctors making great livings treating medicare patients; not many making great livings treating medicaid kids. If all this relates in any way to doctors as businessmen, it's in that a conscientious doctor should be working to make health care for all a viable business model. This won't happen by beating down the pharmaceutical companies; it will happen by more equitably distributing health care dollars between well-off voting seniors and the kids and poor who can't or don't vote.
     
  27. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    And what form do you forsee this catastrophe taking?
     
  28. gioia

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    Great Post. Hey lukealfredwhite , is your avatar Miro?
     
  29. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Thanks gioia!

    The avatar's Kandinsky, though it does look very Miro-like; good call. I'm a particular fan of Miro's "Pygmies" and "Harlequin"...lovely stuff.
     
  30. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    A decrease in hospitals/capital that reaches levels where people ARE turned away from ED's, waitlists for procedures that dwarf those Canadian waitlists , log increases in bankrupt physicians, providers and most of all malpractice insurance companies.

    I think the perfect and most immediate threat to the healthcare system has already peaked out it's head- I forget which state it was but some mid-western state lost it's LAST malpractice insurer to bankruptcy and physicians, all of them, being without coverage just walked out. Luckily the state stepped in and did some temporary fix but it would not surprise me to see things like this happening in states like FL, OH, PA or NJ... Either hospitals will close, physicians will be unable to practice or everyone goes bankrupt. You pick, it's already happening afterall...

    I'd just like to see the face of a senator when he brings his hypertensive wife in for suspect subdural hematoma and there are 2 hours of criticals before him. Hand him a packet on tort reform, tell him to take two and call me in the morning...
     
  31. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    I find it interesting that you're mentioning these things and pinning the blame on a president you seem to consider both corrupt and incompetent. Tort reform seems to be your main concern, and it's common knowledge that the main obstacle to tort reform is the democratic party. Trial lawyers are overwhelmingly democratic, and contribute vast quantities to the party.

    Bush to AMA: Tort reform a must
    http://www.ama-assn.org/amednews/2003/03/17/gvl10317.htm

    Tort Reform Bill Roll Call
    http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=2&vote=00066

    I'll agree wholeheartedly that tort reform is a major issue, and the primary engine of unnecessarily high health care costs, not only because of premiums, but because of the appalling number of needless procedures and consultations doctors order to preserve themselves.

    Yet people still seem to be very comfortable making nasty ad hominems about whoever happens to be in the oval office and roundly condemning pharmaceutical companies. My personal theory is that it sounds a lot better to attack businesses and presidents than senior lobbies and democrats, so that's what people do. Frankly, though, I don't see how it's relevant--if we're going to start throwing blame around, let's put it where it belongs.
     
  32. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    Luke, are you an idealists? Of all specialities in this world medicine surely requires the most attention to detail and care for the best treatment of life however if you propose major reform on medical school education or further restrictions guidelines to elimiate all medical error you're dreaming. Physicians can do more than they could in the past and I would even go as far to say is on average they make fewer mistakes than before, what's the big difference? One word:

    LITIGATION

    I don't just blame the president (though he is shameful), I blame the senators, the lawyers, hospital administrators, insurance companies AND physicians. I can't do anything about other physicians being stupid and making mistakes, all I can do is study hard and not be on the wrong side of the statistics. I can vote and complain about/for whoever I want... welcome to America
     
  33. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    You certainly can vote for and complain about whomever you wish; I'm merely submitting that if you're going to complain about issues and politicans both, it's probably best to match up the politicans with the issues. Med students aren't known for being overly canny when it comes to politics, much to their credit. It's irresponsible, however, to rail against tort reform as the bane of medicine and then blame those not to blame for it.

    As for your comments about idealism and medical error, I'm afraid I don't follow your point, and so will with apologies avoid responding to that.
     
  34. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    I mentioned that because I thought thats what/where you meant "blame was due". Not at the wrong politician...

    And BTW if he can start a war on his own he can push some legislation through to help improve the health care of the country don't you think? I very squarely put blame on our "protector of freedoms and well-being" shoulders...
     
  35. gioia

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    lukealfredwhite, Thank you!

    Miro is incredible (Klee is good, but too depressing- talk about issues). WhenI saw your avatar, I thought, "Gee, that looks like Miro but I don't recognize it". ...Figures it would be Kandinsky. I can never quite place his art because his style seemed so fluid - always changing with his mood.
     
  36. Plinko

    Plinko Senior Member
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    LOL, gioia. I agree. I still think those shoes shouldn't have to have holes in them though. That's all I'm saying.
     
  37. gioia

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    Yeah, you're right PLINKO.

    I got it: Just in case everything falls through and physicians end up taking part time Walmart jobs to support their families, let's start networking with cobblers now so at least we won't have corns and bunions. :eek:
     
  38. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Cobblers! Any future doc who knows Kandinsky and uses the word cobblers is bound to meet with success. That's style.
     
  39. gioia

    10+ Year Member

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    Well, you see... my great great uncle was Geppetto and he was an art dealer before he opened up his quaint little wood shop and raised my bratty oldest cousin Pino.

    I gave you a Karma Point for that one! :)
     
  40. theags

    theags Junior Member
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    Here's a fact to chew on for awhile. My mom is the office manager for two general surgeons in the Salt Lake area. They gross $120k/yr. That's a fair amount of money, but not when conisider they are SURGEONS!!! :( On top of that they each pay around $110k/yr for malpractice insurance. At the end of this year they will be out of business because they can't afford the malpractice. Since we're all pointing fingers, I'd like to point mine at the idiots who sue docs over the smallest things and get $millions$ in return. :smuggrin: Anybody else got opinions or more fingers to point?
     
  41. gioia

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    How much do they pay your mom?
     
  42. fasciaLATA

    fasciaLATA Junior Member

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    Plinko,
    Does this physician's last name begin with a P? I am almost positive that he is the same doc that I did a preceptorship with last summer...what a coincidence. I think he is a great clinician and teacher. I would agree that most of his patients are on medicaid/medicare and I sensed that he does a lot "freebie" work. The Pharmaceutical reps love him because he takes the time to listen to them and is respectful, which in return benefits his pts. because he is able to give away large amounts of free "samples." My guess is that he has been in medicine for so long and seen all the changes, that he is happy to have maintained his own practice all these years and is still doing what he loves. I think it's pretty neat to say that you've been a family's doc for 2 or 3 successive generations. True $85,000 is on the low end for a physician's income, but I do know that he drives a mercedes, frequents the golf course quite often and has plenty of time to spend with his family. :thumbup: not bad if you ask me.
     
  43. Plinko

    Plinko Senior Member
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    Yeah, starts with a P and ends in a Z. Such a small world we live in.

    He was a great doc to do a preceptorship with. Very nice guy and very good at teaching pre-clinical students. I was amazed at the amount of pathology he saw for such a small family practice office. In the week that I was there I saw a number of CHD patients, Bergers Dz, SLE, alpha 1 antitrypsin deficiency, and a DVT patient, just to name a few. I wish I could do my three month family rotation there, but I have to stay in Texas for that.
     

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