Fascinating article posted on the surgery board

Started by powermd
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With the movie Sicko playing now, awareness of the current state of health care will increase. I don't think the current system will hold for too long. We, headed by the AMA, should help shape the future system. It's a shame that for profit companies are in control of the nation's health. My vote is for a non profit system, private or public, where physicians and patients are in control. Annual check ups for preventive care will be necessary in order to receive benefits(other than emergencies).
​
 
great article. thanks for posting it


The problem is that physicians cannot organize to fight the insurance companies. Congress should let us organize.. Nurses organize and look at how well they are paid now.
 
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What needs to happen is what is happening...public awareness. This is a capatalistic country. Capatalism is what made healthcare in the USA the best in the world. Let it keep working! Making public what the FAT CATS of Aetna, Cigna, Blue Cross, etc. are making and how they are controling healthcare is exactly what needs to happen. Dont let the government have a hand in it.

The more people know about it the more they will choose other avenues of providing health insurance for their family. Letting the government take control of healthcare like Michael Moore wants would be the absolute wrong thing to do. Do you really want our healthcare system to be like the UK or Canada? I think NOT. I dont know about you, but I dont want to wait 18 months for an IHR if I need one....or a knee scope. God forbit you get cancer...and have to go to Mexico for chemotherapy treatments...or just to see a specialist.

Keep the government out of it....we dont need a quick fix. Be patient and wait for capatalism do its job.
 
johankriek said:
great article. thanks for posting it


The problem is that physicians cannot organize to fight the insurance companies. Congress should let us organize.. Nurses organize and look at how well they are paid now.
Click to expand...

I agree -- why is it that doctors cannot unionize?
other professions can...that is the biggest rip off ever.
 
amyl said:
I agree -- why is it that doctors cannot unionize?
other professions can...that is the biggest rip off ever.
Click to expand...

Anti-trust laws, I would presume. Doctors who are employees of hospitals ought to be able to unionize to negotiate fees. Private practice guys all agreeing to set prices would be considered collusion. I don't see why medicine shouldn't be more like any other profession where you pay more for a service if it's provided by someone who is in greater demand. This already exists in medicine with practitioners who don't take insurance, because the don't have to, for one reason or another. The biggest names at Columbia rarely take insurance. In order to ensure access for the poor, the government would have to suck it up and pay more to doctors.

Or they could just legislate mid-levels into physician roles, cover everyone for a third of our fees, and put us out all out of work!
 
Forgive my inexperience -- why can doc's only unionize if they are hospital employees?
what would be wrong with being a hospital employee?
 
powermd said:
Private practice guys all agreeing to set prices would be considered collusion.
Click to expand...

how about not agreeing to set prices -- eliminate the doc's conferencing with each other...just set the price and let the market dictate who is busy and who is not...
that is how gas stations set prices...they put a price up and then the one down the street does better, banks on their location to justify higher prices or offers services the other one doesn't. gas stations don't collude, they just go about their business....why couldn't docs do that?
 
amyl said:
Forgive my inexperience -- why can doc's only unionize if they are hospital employees?
what would be wrong with being a hospital employee?
Click to expand...

You may not see it as a bad thing...but hospitals can be very controlling. IMO, it is much better to be a business partner with a hospital. That way they make you happy and you make them happy...as long as both of you have something to offer eachother (money). Otherwise, if you want to not worry about the business side of things, by all means be an employee. Again, it is not bad...It is just my opinion that it is better to have a partnership relationship.

Clear as mud?
 
amyl said:
how about not agreeing to set prices -- eliminate the doc's conferencing with each other...just set the price and let the market dictate who is busy and who is not...
that is how gas stations set prices...they put a price up and then the one down the street does better, banks on their location to justify higher prices or offers services the other one doesn't. gas stations don't collude, they just go about their business....why couldn't docs do that?
Click to expand...


They do. Like medicaid for example...for OB/GYN's. Most have to accept it (in our area anyway) to get started. It more or less is a supplement to the private insurance patients. When their patient load grows they can choose to no longer accept medicaid....or any other low paying insurance for that matter. As long as you stay in demand for the high paying insurance plans life is golden. LOCATION LOCATION LOCATION....and attitude attitude attitude....is what keeps people knocking on your door. Nobody knows what makes a good doctor because they have no clue what a doctor does....dont kill too many and be nice and all will be good (of course not as simple as that but you get my drift).

Now, anesthesia is very different because anesthesia doesnt attract patients (except for pain management). It gets sticky because the anesthesia group can be out of network for for some or even all insurance carriers even though the hospital and the surgeon are in-network. So the patient gets a whopping bill for 50% of the anesthesia cost. But its possible the 50% the insurance pays for being out of netwok is more than the 80% of the agreed in-network cost. However, if there are enough patients complaining to the insurance carriers about their bills the insurance carriers may increase the negotiated in-network price. yada yada yada.....

There are so many variables....but its still better than letting the government set the price on what THEY think you should get paid.

Its all a huge game to get a bigger chunk of the pie.
 
i was talkign to a FP resident about this. she was all for universal healthcare....

we went back and forth because I totally believe in capitalism and believe that competition breeds innovation.

She was saying say, however, that when it comes to getting reimbursements etc from say public aid they get most of what they bill. if they want something back from INSurance companies they have to overbill and usually this means they have to do a lot of pre-authorizations.

that's why she was for govt owned health care.🙄
 
In reading this article I was surprised that medicare paid better than some insurance companies. I thought that medicare was a bum deal.... this supports what your FP friend said.
 
amyl said:
In reading this article I was surprised that medicare paid better than some insurance companies. I thought that medicare was a bum deal.... this supports what your FP friend said.
Click to expand...

It really depends on how much power you have in the market. If there is an oversupply then the insurers can play one off another. I would say that part of their problem was they did a very poor job of negotiating insurance contracts. There are very few times that you should take less than medicare. Most of our contracts are 130-140% of medicare. In their way of looking at this anything over medicare is profit. I also find their reimbursement for hospital consults very low. I think they are probably miscoding those. Unfortunately for saturated areas you can be forced to take a percentage of medicare especially in areas like FP. Hence the rise of concierge medicine.

David Carpenter, PA-C
 
1) Many HMOs pay less than medicare - nothing new there

2) that makes them twice as painful because not only do they pay less but they also nit-pick everything and frequently deny care or delay/deny payment (even if they approved it initially) - you don't have those headaches with medicare

3) doctors can't unionize --- they will always lose... there is a classic example in Austin, Texas. Blue Cross decided to cut general surgeon's reimbursements by 20% a few years ago - so all the general surgeons got together and formed a new group (because in order to negotiate together they needed to be in the same group - otherwise it would have been price-fixing/collusion). They then dropped blue cross completely and brought blue cross to the negotiating table... they succeeded in actually getting a 20% raise in reimbursements. Blue Cross outsmarted them though by suing them under anti-trust laws and the reimbursements fell again AND they had to pay a fine of something like 1.4 million $

http://www.ftc.gov/opa/2000/04/texassurgeons.shtm

read this to get the governments (insurance company subsidized view) of things...

if more doctors dropped out of plans employers would be forced to choose better insurance companies --- the real reason you see these problems is because employers choose the cheapest crappiest plan out there because it makes their bottom line better --- if you were an employer you would do the same thing...
 
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A bit off topic:


Let's say we do an IV, we put local, get in on the first try, don't spill blood, and pt is happy- I think we should get a TIP

Or get a block on the first try= TIP, definetely

Or you give zofran, reglan, decadron to prevent PONV- you deserve a TIP

Anyone with ideas about how we can make this happen? Should we publish some propaganda on the NY Times stating that Anesthesiologists ought to be tipped?
​
 
We cant' work together to help actually bring market forces into the equation...

But the government can single us out, abuse us, and make us cogs in the socialized healthcare wheel..

I love it.

Cash only urgent care centers to cure the FP socialist. Well, at least to cure the FP's who are capitalist, and let the socialist rot!

For anesthesiologists? Just lobby to get less government control over medicine in general, for starters. In other words, vote Republican!
 
Coastie said:
vote Republican!
Click to expand...

Im not sure voting republican will do anything except increase the salary and bonus of united health care ceo one hundred million dollars. and your salary will go down 5 percent and the amount of your work will increase 7 percet.
 
rmh149 said:
Letting the government take control of healthcare like Michael Moore wants would be the absolute wrong thing to do. Do you really want our healthcare system to be like the UK or Canada? I think NOT. I dont know about you, but I dont want to wait 18 months for an IHR if I need one....or a knee scope. God forbit you get cancer...and have to go to Mexico for chemotherapy treatments...or just to see a specialist.

Keep the government out of it....we dont need a quick fix. Be patient and wait for capatalism do its job.
Click to expand...

Just out of curiousity, what's wrong with the healthcare system in the UK or Canada?

Doesn't the idea that someone can walk into a clinic or hospital and walk away not worrying how much it's gonna cost them sound intriguing?

Doesn't the idea that physicians and nurses work 39 hours/week with 8 weeks paid vacation sound intriguing? Plus, if you work over that, you get paid overtime? And the salaries aren't that bad either: $60-100 grand per year as residents, $200+ as attendings.

Doesn't the idea of no hassles with malpractice insurance or billing or collecting sound intriguing?

American patients are already going to Mexico and India to get things done, anything from plastic surgery to laser eye surgery to CABG's.

And in terms of waiting for capitalism to do it's job ... I don't even know where to start with this one ... Hey, how about the current regime in DC, which outlawed Medicare and Medicaid from negotiating with the pharm industry. Not being allowed to negotiate prices? ... I believe it's called communism. And it's happening in right in our US of A. I hate to break it to you, but capitalism isn't going to save us. It's just going to let our Congress continue to get richer, right along with the CEO's of insurance companies.

... And I haven't even seen Sicko, yet.
 
TIVA said:
Just out of curiousity, what's wrong with the healthcare system in the UK or Canada?

Doesn't the idea that someone can walk into a clinic or hospital and walk away not worrying how much it's gonna cost them sound intriguing?

Doesn't the idea that physicians and nurses work 39 hours/week with 8 weeks paid vacation sound intriguing? Plus, if you work over that, you get paid overtime? And the salaries aren't that bad either: $60-100 grand per year as residents, $200+ as attendings.

Doesn't the idea of no hassles with malpractice insurance or billing or collecting sound intriguing?

American patients are already going to Mexico and India to get things done, anything from plastic surgery to laser eye surgery to CABG's.

And in terms of waiting for capitalism to do it's job ... I don't even know where to start with this one ... Hey, how about the current regime in DC, which outlawed Medicare and Medicaid from negotiating with the pharm industry. Not being allowed to negotiate prices? ... I believe it's called communism. And it's happening in right in our US of A. I hate to break it to you, but capitalism isn't going to save us. It's just going to let our Congress continue to get richer, right along with the CEO's of insurance companies.

... And I haven't even seen Sicko, yet.
Click to expand...

Sorry...I have yet to see the government present anything that would make me feel anywhere close to being comfortable with them completely taking over our healthcare system. Trust me, I have an open mind. If I see something that looks as good as what you are presenting...I am game.
 
TIVA said:
Just out of curiousity, what's wrong with the healthcare system in the UK or Canada?

Doesn't the idea that someone can walk into a clinic or hospital and walk away not worrying how much it's gonna cost them sound intriguing?

Doesn't the idea that physicians and nurses work 39 hours/week with 8 weeks paid vacation sound intriguing? Plus, if you work over that, you get paid overtime? And the salaries aren't that bad either: $60-100 grand per year as residents, $200+ as attendings.

No overtime you are salaried. There is a suppliment for the amount of hours that you work over 40 and what they call "work carried out at unsocial times".

Doesn't the idea of no hassles with malpractice insurance or billing or collecting sound intriguing?

American patients are already going to Mexico and India to get things done, anything from plastic surgery to laser eye surgery to CABG's.

And in terms of waiting for capitalism to do it's job ... I don't even know where to start with this one ... Hey, how about the current regime in DC, which outlawed Medicare and Medicaid from negotiating with the pharm industry. Not being allowed to negotiate prices? ... I believe it's called communism. And it's happening in right in our US of A. I hate to break it to you, but capitalism isn't going to save us. It's just going to let our Congress continue to get richer, right along with the CEO's of insurance companies.

... And I haven't even seen Sicko, yet.
Click to expand...
I'll preface this by saying I have never practiced medicine in the UK. Most of what I know comes from working with the Scottish NHS in setting up trial PA programs there.

Here is a page on the pay scale:
http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553
Top pay for a consultant does approach $200k. Also a private GP in a good area that is forced to take their own call can approach that. I am guessing that most of the anesthesiologists in private practice are doing better than that.

You are right no billing or malpractice. Now the bad part. First of all if you want to specialize there are a limited number of positions. You have to progress through the ranks. Yes you make $100k in specialist training, but that is where you will sit for a potentially very long time. You also have to consider the cost of living.

The other issue that you don't talk about is rationing. Now the NHS claims there is no rationing, there is defacto rationing due to differing rules. Over 70 - no dialysis for you. BMI over 30 no total joints. Want to prescribe an expensive medication - trust won't pay for it. Need a CT or MRI - prepare to wait.

Its kind of the same reason that every physician in the US doesn't work for Kaiser. You can make the same money that you mentioned above with the same hours working for Kaiser - If you accept the limitations.

David Carpenter, PA-C
 
:laugh:

Yeah, massive government bureaucracy. I love it. Take our current system's bureaucracy, and multiply times 1,000,000.

TIVA said:
Just out of curiousity, what's wrong with the healthcare system in the UK or Canada?

Doesn't the idea that someone can walk into a clinic or hospital and walk away not worrying how much it's gonna cost them sound intriguing?

Doesn't the idea that physicians and nurses work 39 hours/week with 8 weeks paid vacation sound intriguing? Plus, if you work over that, you get paid overtime? And the salaries aren't that bad either: $60-100 grand per year as residents, $200+ as attendings.

Doesn't the idea of no hassles with malpractice insurance or billing or collecting sound intriguing?

American patients are already going to Mexico and India to get things done, anything from plastic surgery to laser eye surgery to CABG's.

And in terms of waiting for capitalism to do it's job ... I don't even know where to start with this one ... Hey, how about the current regime in DC, which outlawed Medicare and Medicaid from negotiating with the pharm industry. Not being allowed to negotiate prices? ... I believe it's called communism. And it's happening in right in our US of A. I hate to break it to you, but capitalism isn't going to save us. It's just going to let our Congress continue to get richer, right along with the CEO's of insurance companies.

... And I haven't even seen Sicko, yet.
Click to expand...
 
Voting dem will bring obama and hillarycare.

Voting republican will bring no obama and hillarycare. It may also bring lower taxes, increased access to HSA's, and if the real conservatives have anything to say about it, less government influence in our daily lives. Bush has dropped the ball on alot of these things...The base shouldn't let that happen again.

johankriek said:
Im not sure voting republican will do anything except increase the salary and bonus of united health care ceo one hundred million dollars. and your salary will go down 5 percent and the amount of your work will increase 7 percet.
Click to expand...
 
core0 said:
You are right no billing or malpractice. Now the bad part. First of all if you want to specialize there are a limited number of positions. You have to progress through the ranks. Yes you make $100k in specialist training, but that is where you will sit for a potentially very long time. You also have to consider the cost of living.

The other issue that you don't talk about is rationing. Now the NHS claims there is no rationing, there is defacto rationing due to differing rules. Over 70 - no dialysis for you. BMI over 30 no total joints. Want to prescribe an expensive medication - trust won't pay for it. Need a CT or MRI - prepare to wait.

Its kind of the same reason that every physician in the US doesn't work for Kaiser. You can make the same money that you mentioned above with the same hours working for Kaiser - If you accept the limitations.

David Carpenter, PA-C
Click to expand...


1. There are a limited number of positions in the US as well for subspecialization. It's just a natural law of the universe -- not everyone gets to be a cardiologist or a spine surgeon.

2. Yes, cost of living is higher in Europe, but comparable to any major US city like NYC, Chicago, SF.

3. Rationing is not a bad thing. Maybe 88 y.o. demented gramps doesn't need to spend his last 6 weeks in an ICU. And if you're BMI is over 30, I agree, no TKR's for you, unless you're willing to pay for it out of your own pocket. The other citizens don't need to suffer because of your bad lifestyle. A TKR is not a life-saving procedure.

4. CT's and MRI's, this is like the classic argument against government-sponsored health care. Believe you me, if you need to have the CT/MRI to look for a brain tumor or a dissection, you'll get it, but if you need it in order to evaluate chronic low back pain, well then yes, you're gonna have to wait, unless you are willing to pay for it out of your own pocket.

5. I don't know enough about Kaiser, so I can't comment on it, I'll just have to take your word for it for now.

TIVA
 
TIVA said:
1. There are a limited number of positions in the US as well for subspecialization. It's just a natural law of the universe -- not everyone gets to be a cardiologist or a spine surgeon.

Yes but everyone that is trained as a cardiologist can be a cardiologist. In the NHS you work as a staff grade or associate specialist until a position opens up or someone retires (kind of like being a senior fellow for extra years). Usually a position opens up when someone retires or dies.

2. Yes, cost of living is higher in Europe, but comparable to any major US city like NYC, Chicago, SF.

To some extent. The taxes are what really hit you. Top rate of over 40%. You also get hit with a lot of little taxes (got a TV - pay a tax). Overall almost anywhere in the UK is going to be more expensive outside of NYC. The universal comment from the PAs in Scotland is that they dramatically underestimated the taxes.

3. Rationing is not a bad thing. Maybe 88 y.o. demented gramps doesn't need to spend his last 6 weeks in an ICU. And if you're BMI is over 30, I agree, no TKR's for you, unless you're willing to pay for it out of your own pocket. The other citizens don't need to suffer because of your bad lifestyle. A TKR is not a life-saving procedure.

A TKR is necessary to prevent further morbidity. Your profile says that you are a resident. How often do you see someone stopping care on gramps? Doesn't happen. Try to do that without permission and see how well that goes over. That is the difference between rationing and our system.

Its all well and good to say that right up until its your loved one. Americans have not been terrifically good at rationing.

4. CT's and MRI's, this is like the classic argument against government-sponsored health care. Believe you me, if you need to have the CT/MRI to look for a brain tumor or a dissection, you'll get it, but if you need it in order to evaluate chronic low back pain, well then yes, you're gonna have to wait, unless you are willing to pay for it out of your own pocket.

Yes if you have a brain tumor you will get one if the hospital has one. Things that we consider routine are lacking in the NHS system.

5. I don't know enough about Kaiser, so I can't comment on it, I'll just have to take your word for it for now.

TIVA
Click to expand...

Kaiser is like the medicine that we had in the Army. Good if you aren't really sick (benign neglect). Pretty good if you have an acute illness. Pretty bad on everything else.

David Carpenter, PA-C
 
Coastie said:
Voting dem will bring obama and hillarycare.

Voting republican will bring no obama and hillarycare. It may also bring lower taxes, increased access to HSA's, and if the real conservatives have anything to say about it, less government influence in our daily lives. Bush has dropped the ball on alot of these things...The base shouldn't let that happen again.
Click to expand...

Bingo!
 
Note that is $200k in the land where petrol and burgers at heathrow's passenger lounge cost more than health insurance per month in this country.

Seriously, that pay scale stinks. OH yeah! :idea: It's a socialized system.

core0 said:
I'll preface this by saying I have never practiced medicine in the UK. Most of what I know comes from working with the Scottish NHS in setting up trial PA programs there.

Here is a page on the pay scale:
http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553
Top pay for a consultant does approach $200k. Also a private GP in a good area that is forced to take their own call can approach that. I am guessing that most of the anesthesiologists in private practice are doing better than that.

You are right no billing or malpractice. Now the bad part. First of all if you want to specialize there are a limited number of positions. You have to progress through the ranks. Yes you make $100k in specialist training, but that is where you will sit for a potentially very long time. You also have to consider the cost of living.

The other issue that you don't talk about is rationing. Now the NHS claims there is no rationing, there is defacto rationing due to differing rules. Over 70 - no dialysis for you. BMI over 30 no total joints. Want to prescribe an expensive medication - trust won't pay for it. Need a CT or MRI - prepare to wait.

Its kind of the same reason that every physician in the US doesn't work for Kaiser. You can make the same money that you mentioned above with the same hours working for Kaiser - If you accept the limitations.

David Carpenter, PA-C
Click to expand...
 
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