doctors on strike?

[PAgirl]

---

Members do not see this ad.

It seems like more and more, doctors are getting screwed. Malpractice insurance costs are continuing to rise, the cost of a medical education is increasing disproportionately, and apparently we may not be able to defer our loans through residency. I'm not complaining about the salaries doctors make (with the exception of GP's and pediatricians), but it's kind of ridiculous that I will have around $300,000 to pay back when I start residency and then might have to choose where I practice to avoid paying over $100,000 a year in malpractice insurance (not to mention that I wouldn't be able to afford loan payments if I went into family practice). So anyway, my question is, can doctor's go on strike? It seems like nothing's going to change unless something drastic happens. I don't really think they can strike, but why not? I mean, I guess there's really no union, and the whole hippocratic oath thing where we pledge to help people, but I was wondering what everyone else thinks.

 

[wanabdoc]

its illegal?

 

[NCF145]

It seems like more and more, doctors are getting screwed. Malpractice insurance costs are continuing to rise, the cost of a medical education is increasing disproportionately, and apparently we may not be able to defer our loans through residency. I'm not complaining about the salaries doctors make (with the exception of GP's and pediatricians), but it's kind of ridiculous that I will have around $300,000 to pay back when I start residency and then might have to choose where I practice to avoid paying over $100,000 a year in malpractice insurance (not to mention that I wouldn't be able to afford loan payments if I went into family practice). So anyway, my question is, can doctor's go on strike? It seems like nothing's going to change unless something drastic happens. I don't really think they can strike, but why not? I mean, I guess there's really no union, and the whole hippocratic oath thing where we pledge to help people, but I was wondering what everyone else thinks.

Of course we could strike. But we won't, because that would be wrong. As doctors we shouldn't care about ourselves, only everyone else. 🙄

 

[coldweatherblue]

I think striking would be a huge black eye for the medical profession in the eyes of the public. Nurses can get away with it because ultimately they are supervised, but since doctors are the ones who (traditionally) are supposed to have the most responsibility towards the patient it is unacceptable to strike.

The medical profession should, however, be more proactive in taking steps to protect itself. However since doctors go to school to heal people, and lawyers go to school to interpret the law; doctors often seem to be on the losing end of litigation and policy changes.

 

[ClockworkDoc]

I think it will be hard for doctors to lobby for higher/fair wages because they typically earn well above the average. It will come off as being greedy. It is hard to get people to realize that there are many hidden costs.

 

[Law2Doc]

I think it will be hard for doctors to lobby for higher/fair wages because they typically earn well above the average. It will come off as being greedy. It is hard to get people to realize that there are many hidden costs.

Agreed. They will get no sympathy. And they aren't that organized anyhow. And they risk giving up market share to ancillary professionals (people may actually see that a lot of their visits can be handled by PAs, NPs etc.).

 

[-Goose-]

i would strike if reimbursement continues to drop.

 

[NotAProgDirector]

Striking only helps if it hurts someone useful.

Let's say doc's go on strike by refusing to see patients unless they are "seriously ill" -- let's say you leave the ED open and close all the outpatient clinics, elective procedures, etc. What happens / who gets hurt?

The insurance companies certainly won't care. In fact, they'll make more money because you won't be billing them and they continue to collect insurance payments from patients.

The gov't is unlikely to care in any meaningful way.

If you're in private practice, you just hurt yourself. That's doesn't work.

If you work for a hospital, then you can seriously impact their bottom line. You could try to influence the hospital to pay you more. But since the hospital's income from your services is completely determined by the insurance company, the hospital has little leverage to make any meaningful change.

 

[-Goose-]

Striking only helps if it hurts someone useful.

Let's say doc's go on strike by refusing to see patients unless they are "seriously ill" -- let's say you leave the ED open and close all the outpatient clinics, elective procedures, etc. What happens / who gets hurt?

The insurance companies certainly won't care. In fact, they'll make more money because you won't be billing them and they continue to collect insurance payments from patients.

The gov't is unlikely to care in any meaningful way.

If you're in private practice, you just hurt yourself. That's doesn't work.

If you work for a hospital, then you can seriously impact their bottom line. You could try to influence the hospital to pay you more. But since the hospital's income from your services is completely determined by the insurance company, the hospital has little leverage to make any meaningful change.

What would be a constructive way to let insurance cos/medicare/aid that we've had enough?

 

[Law2Doc]

What would be a constructive way to let insurance cos/medicare/aid that we've had enough?

Insurance companies already know you've had enough - but they don't answer to you, they answer to shareholders, so they turn a deaf ear. Doctors need to (1) organize, (2) raise money, (3) lobby effectively and in a unified way, and (4) start donating huge sums of money to doctor-friendly senators' campaigns. It's the American way.
They are already many millions behind the insurance companies in doing this.

 

[MJB]

Or, go cash only. 🙂

Needless to say, I'm not a big fan of a bunch of business people making the decisions about healthcare (management of insurance companies).

 

[ColinHay]

Or, go cash only. 🙂.

check out this guy

http://www.patmosemergiclinic.com/

 

[chimichanga]

http://www.reviewjournal.com/lvrj_home/2002/Jul-03-Wed-2002/news/19108774.html

http://www.nevadalabor.com/barbwire/barb02/barb7-21-02.html

The trauma service closed for a while

 

[Faebinder]

The first way to battle third party payers is to establish what is "urgent" vs. "emergent", and if "emergent" then how long can it wait and does it turn "urgent" later. This way you can tell the non-payers in the ER, "I'm sorry sir, this is not an emergency". Otherwise, even missing your prescription over the weekend is an emergency.

The other thing is, physicians need to stop acting like indivisuals. Two groups of surgeons fighting in a city is like a pair of twins fighting over 1 plate of food. Your disagreement and lack of communication with the opposite group only makes the insurance company happy. You should all meet every now and even bargain with insurance companies together. AKA "union without being a union".. some people prefer to call it "polyopoly".

 

[buffdoc]

Although it is illegal for doctors to unionize, doctors can still go on strike in a way.

It is also illegal for doctors to price collude or collectively negotiate against insurance companies for reimbursement rates. Doctors are forced to negotiate in a box against large monopolistic insurance companies, who only pay "reasonable and customary fees". So in a sense, they are able to price collude while doctors are not.

However, doctors can get together and discuss which insurance companies are good -- have high reimbursement rates, easier paperwork, and less hassle versus those that are bad.

And doctors do have a right to not accept certain insurance carriers. Just say "no longer accepting new patients." If doctors understood as a group which are bad and which are good and refused to carry the bad insurance, then those insurance companies would be forced to get better.

 

[courtyard]

Hi,

This is a question for practicing doctors. I am a 4th year medical student and yet I have almost no idea how finance and medical economics go in real world. Yet, at least in my school we have to go through so many courses on bedside manners, ethics, etc etc. Now don't get me wrong, to become a great doc, students should be lectured on ideal manners. But you know, if you have 10 min to spend per patient, it is kinda hard to deal with patients at personal level.

You go to a dental school, and most places have as part of curriculum, billing courses, and other financial topics. Medical schools need to teach their future doctors how business is run.

Sorry for rambling.
The question I had for practicing doctors is this: why can't a doctor or a surgeon charge fee based on how much a patient can afford to pay? For example, let's say a Goldman Sachs executives who bring home 20+$million on bonus alone needs a fundoplication. and of course he has a nice health insurance which has set amount they will pay the surgeon to perform the service. What stops the surgeon from billing directly to the billionaire, say 50K$ for the procedure what they would ordinary get reimbursed like 5K$ from some average joe's insurance. So at the end, surgeon would be reimbursed the set amount from the billionaire's insurance, and the billionaire will have to pay the remaining balance.

Is it illegal? or is it that not all docs are qualified to charge that amount but some do?

Thanks for the insight. I am not out to get people with money or scam people. But truth is, I think medical care "ought to be" based on means to pay. Just like ivy league education - schools set really high ceiling and it is up to them to decide kids with rich parents pay the entire tuition, while poor kids will pay less as deemed by the school. A wall-street guy bringing home million dollars and spend 5000$ a night on a wild party can surely afford to pay 30K$ for an appendectomy.

CY.

 

[Amraam]

Sorry for rambling.
The question I had for practicing doctors is this: why can't a doctor or a surgeon charge fee based on how much a patient can afford to pay? For example, let's say a Goldman Sachs executives who bring home 20+$million on bonus alone needs a fundoplication. and of course he has a nice health insurance which has set amount they will pay the surgeon to perform the service. What stops the surgeon from billing directly to the billionaire, say 50K$ for the procedure what they would ordinary get reimbursed like 5K$ from some average joe's insurance. So at the end, surgeon would be reimbursed the set amount from the billionaire's insurance, and the billionaire will have to pay the remaining balance.

Is it illegal? or is it that not all docs are qualified to charge that amount but some do?

Thanks for the insight. I am not out to get people with money or scam people. But truth is, I think medical care "ought to be" based on means to pay. Just like ivy league education - schools set really high ceiling and it is up to them to decide kids with rich parents pay the entire tuition, while poor kids will pay less as deemed by the school. A wall-street guy bringing home million dollars and spend 5000$ a night on a wild party can surely afford to pay 30K$ for an appendectomy.

CY.

The main question that comes up is who will decide this? You leave the realm on a universal exchange of value with definite values to 'ability to pay'.


Think about this gray area and how this could work, ability- based on what???? I assume you talk about amout in the bank- savings. But that is not fair. For one, people have different discount rates. Some people forsaken current spending for future spending. You will penalize the 'ant' who stores for the winter, and reward the 'grasshopper'. Some people spend a lot of there paychecks and live outside their means with cars, girls, and stuff. The people who have carefully invested and made there monies grow thus who have savings will be forced to pay more because they simply have more in the bank.

So you must say we have o take other factors into account. The number of children? Debt (Perhaps from making bad choices (gambling))? Race? Vacations? Heritage? NUmber of cars, age of cars? Bathrooms in the house? Does the government decide this? The doctor? Maybe they will only accept the rich after all who wants to treat someone who only has 5 dollars to pay? Would you, after all of your years dedicate yurself to serve in a inner city? Imagine how people with money will try to inflence these parameters. This sures seems like an easy way to corrupt people.

Just some thoughts.

 

[Amraam]

http://www.reviewjournal.com/lvrj_home/2002/Jul-03-Wed-2002/news/19108774.html

http://www.nevadalabor.com/barbwire/barb02/barb7-21-02.html

The trauma service closed for a while

Horrible story, the greedy doctors must somehow find a way. They have a duty to the vunerable and must transcend piety concerns like there own livelihood. After all, doctors are some of our nations brightest and a lot to give society/the collective.

Or they can just shrugg

 

[buffdoc]

Horrible story, the greedy doctors must somehow find a way. They have a duty to the vunerable and must transcend piety concerns like there own livelihood. After all, doctors are some of our nations brightest and a lot to give society/the collective.

Or they can just shrugg

I don't understand what you are saying...

How are concerns for their own livelihoods and families pious?

It's not the doctors that are greedy...it's the lawyers. And some patients.

All doctors want to do is provide lifesaving medical care to the best of their abilities without fear that they will have their careers ruined, homes taken away, etc., if something goes wrong with one patient.

Even if a doctor (or pharmacist for that matter) provides top notch care with no "malpractice", something can still go wrong. That is the nature of working in a scientifically complex field where not every person responds in the same way to the same treatment. Particularly in an emergency situation where doctors don't have time or are unable to find patients' histories. Or they may have to make a difficult choice in order to save a life where there is no easy answer.

People think they are entitled to healthcare and should assume no risk when they receive it.

Know the facts

 

[AwesomO]

The question I had for practicing doctors is this: why can't a doctor or a surgeon charge fee based on how much a patient can afford to pay? For example, let's say a Goldman Sachs executives who bring home 20+$million on bonus alone needs a fundoplication. and of course he has a nice health insurance which has set amount they will pay the surgeon to perform the service. What stops the surgeon from billing directly to the billionaire, say 50K$ for the procedure what they would ordinary get reimbursed like 5K$ from some average joe's insurance. So at the end, surgeon would be reimbursed the set amount from the billionaire's insurance, and the billionaire will have to pay the remaining balance.

When you sign a contract with an insurance company (which you must do to get access to their patients) you are agreeing to provide your service at the same price across the board for their patient panel. No it is not illegal to do what you are proposing but it would probably result in the insurance company terminating your contract. Now if you were to tell the insurance company that you would take their 5K of insurance and charge ALL of their patients an extra 45K across the board that would be fine. But I can garuntee you that no insurance company would ever contract with you.

Thanks for the insight. I am not out to get people with money or scam people. But truth is, I think medical care "ought to be" based on means to pay. Just like ivy league education - schools set really high ceiling and it is up to them to decide kids with rich parents pay the entire tuition, while poor kids will pay less as deemed by the school. A wall-street guy bringing home million dollars and spend 5000$ a night on a wild party can surely afford to pay 30K$ for an appendectomy.

If you don't take insurance and are strictly cash based then you can do whatever you want. Now whether your practice is succesful or not is a whole other story. I can tell you that unless you are offering insane perks no one is going to pay you 30K for an appy. And that the most likely result from your pay scale model would be a practice with no higher pay scale patients, very few if any in the middle, and almost exclusively low end pay scale patients. You practice would most likely go under in a few years.

 

[Miami_med]

"Ability to pay" is meaningless and is a concept that originates from Marxist ideaology that has permeated modern socialism. "Ability to pay" is really based primarily on a mixture of factors that include the choices of those who have lost the ability because they "needed" an expensive car. It's impossible to determine this in any fair way. Individuals who earn more won't want to pay more. Why should they? Congratulations, you've worked hard and done well, now you have to pay 10x as much. We complain about wanting to be rewarded for our hard work. Deciding that we should punish other people for theirs seems a bit hippocritical.

 

[Faebinder]

"Ability to pay" is meaningless and is a concept that originates from Marxist ideaology that has permeated modern socialism. "Ability to pay" is really based primarily on a mixture of factors that include the choices of those who have lost the ability because they "needed" an expensive car. It's impossible to determine this in any fair way. Individuals who earn more won't want to pay more. Why should they? Congratulations, you've worked hard and done well, now you have to pay 10x as much. We complain about wanting to be rewarded for our hard work. Deciding that we should punish other people for theirs seems a bit hippocritical.

Agreed. We're screwed cause everyone feels its their right to have the perfect healthcare yet they dont want to pay for it. This is known as EMTALA. End of story.