"Golden days of the 80's"?

[NonTradMed]

I was perusing the boards and I noticed a common theme of premeds/med students talking about the 'golden 80's'. Just curious as to what this is.

Do they mean the pre-HMO days? Because wouldn't that mean time before the 90's in general? What made the 80's so golden that people on these boards talk so wisfully about them anyway?

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[Spitting Camel]

I was born in '81... could that have anything to do with it?

 

[OldLady]

I was born in the 70s. My Dad is a Physician. I can track his success by his cars and how many hospitals where he was on staff. In the 80's and prior to HMOs/managed care, medicine was largely fee-for-service meaning you paid the Dr office when you visited and then submitted to insurance (if covered). Doc's set their own rates. Many people's insurance only covered hospital visits and major medical events, not Primary Care visits and every prescription. Those things came about in the late 80's and 90's.

 

[NonTradMed]

Originally posted by OldLady
I was born in the 70s. My Dad is a Physician. I can track his success by his cars and how many hospitals where he was on staff. In the 80's and prior to HMOs/managed care, medicine was largely fee-for-service meaning you paid the Dr office when you visited and then submitted to insurance (if covered). Doc's set their own rates. Many people's insurance only covered hospital visits and major medical events, not Primary Care visits and every prescription. Those things came about in the late 80's and 90's.

Right, I understand that...but isn't that true of medicine for most part of the latter 20th century? What made the 80's so special that it deserves to be called 'golden'?

Was it the last hoorah before managed care? Or was it a time when doctors felt they were at the pinnicle financially and professionally (i.e before allied health intruded on their turf)?

 

[OldLady]

prolly a last hurrah. I'll ask my Dad. He'll prolly say socialized medicine would be better now, but he's mellowed significantly over the years. I think that once HMOs and Managed Care came in (which started in the 80s, not the 90s) Docs couldn't set their rates anymore and saw their incomes drop significantly. I don't know the history of fee-for-service insurance, but suspect in the olden days people went without insurance altogether. Does anyone know? Anyways, starting in the 90s my Dad had to get on staff at many more places, and put up with capitated insurance plans and such to make the same income he had made with less hours, staff, etc. So prolly the end of medicine = money. Having said that, being an OB-GYN in a college town like Champaign, IL where it's sort of a closed market of professors' babies etc I have heard can be quite lucrative.

 

[Sharky]

The 80s had some great rock music.

 

[SoulRFlare]

i get the impression from my dad that the 60's and 70's were the "golden age" (well probably the entire period of time from the end of ww2 to the early 80's.) It has to do with physician autonomy, lack of managed care...people routinely spent two or three weeks in the hosiptal for procedures which are practically outpatient now (of course our methods have gotten better, speeding recovery time), and every test or procedure the doctor ordered was carried out. also, I'm sure doctors were not sued quite as often, so malpractice premiums were much lower. there was probably still that mystique surrounding doctors--not a great thing, but my guess is it wasn't entirely bad either. finally (a reason linked to the whole managed care issue), there just wasn't the voluminous paperwork there is now...they weren't choked by government regulations. more and more, doctors are getting the sense that they are not much more than technicians.

 

[GregsAnatomy]

The "Golden Age of American Medicine" occurred in the 1950's and early 1960's. The research on this was published in Science in 1982 by John Burnham, who was my professor for History of American Medicine. The reference for this paper, if you are interested is:

Science. 1982 Mar 19;215(4539):1474-9

Here is the abstract, taken from PubMed:

American medicine's golden age: what happened to it?

"In the first half of the 20th century, American physicians enjoyed relative freedom from adverse comment in mass and highbrow media. In unexpected ways the physicians' high ideals and the campaigns against socialized medicine brought criticism not only of the priestly but also of the technical functions of the medical profession. In the late 1950's this led to a campaign to modify the elevated position of physicians in American society."

 

[lindyloohoo]

Funny you guys are talking about this. I was talking to my mom about it last weekend. She works for one of the major insurance companies. We were talking about how hospitals/doctors are signing contracts with the insurance companies so the insurance companies get better rates and docs/hospitals are assured a good base. Apparently back in the good old days, hospitals could charge whatever they wanted and the insurance company would pay it...all of it. Same for docs. Now, the insurance companies don't have the money to do that. Why that happened I'm not too sure.

Now the hospitals/docs can still charge whatever they want, but they only get the set rate for signing the contract. So you can charge $200 for an office visit, but you're only gonna get $60. The patient also sufferes a bit. If you go to an out of contract hospital, the insurance company is going to get you moved ASAP. You might not get the best doc for the procedure/surgery, etc, because they may not be in contract. Sure you can still do it, but you're going to end up paying ~80% of the bill and you aren't going to get to pay the $60 fee. You'll be paying the $200 fee.

The insurance companies got this ingenius idea from Medicare. We can also thank Medicare for those great little ICD-9 codes that make our work a pain in the butt. It seems like insurance companies are making off like bandits (the company my mom works for only make ~2 billion instead of the 4 billion it made during the late 90s). Docs aren't making the money they used to, and if you've noticed, we're down a significant number of hospitals in this country since the 80s because they couldn't afford to stay open.

Looks like we're in a crisis folks! and it's not likely to be resolved anytime soon. If left to the government alone, (like the malpractice crisis) we're gonna be in trouble. If you're looking for money, better work it Anna Nicole style and marry an old guy who invested well.

lindyloohoo

 

[W222]

WHEN TALKING ABOUT THE GOLDEN 80'S THEY COULD MEAN TWO THINGS. One being the fact that you fairly easily get into a med school with a 3.5 and a 28 MCAT. It wasn't extremely competitive numbers wise. I am not sure what this really reflects. Did the MCAT suddenly get harder or were there just fewer serious applicants? Not sure. This is one thing I have heard the term Golden 80's applied to. Another thing it is meant to show is that during the 80's the AGE OF EXCESS mentality also spread to the medical profession. Doctors could make a killing and really rake in money. Its sorta sad that the profession was concerned with money, or still is.

 

[MErc44]

I was under the impression that it was harder to get in awhile back because MD's made more money. I think it is less competitive now than in the past.

 

[pathstudent]

Supposedly docs made twice the money (in today's dollars even) in the 80s, plus they have to work even harder to make half as much.

 

[carrigallen]

Some people attribute the high increase in applications between 1996-1998 to the television show ER.

 

[MErc44]

Originally posted by Mr Reddly
However, if you look at the GPA/MCATs of matriculants, those have been on a constant climb.

Yea but look at SAT scores in the early 90's, the average has changed a lot since then. Wasn't a 1000 not that bad 10-15 years ago. Now you would get laughed at trying to apply to a UC, unless it's Berkeley

 

[OldLady]

The SAT has changed many times since the 80s. If you took it before a certain time (mid 90s?) you can't directly compare scores. They shifted the mean a bunch of times by 100 or 200 points. In part because scores stunk. A lot of people get 1600s now because the test is EASIER, it used to be only a few people in the country would get a perfect score. I have been on the admissions interviewing committee for MIT so I know this is the case. I have also noticed the SAT scores have climbed in numerical value over the years, in part due to the mean recentering that has gone on.