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Giovanotto

Giovanotto

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How-government-killed-medical-profession

http://www.cato.org/publications/commentary/how-government-killed-medical-profession

<<In 2011, The New England Journal of Medicine reported that fully 50 percent of the nation’s doctors had become employees—either of hospitals, corporations, insurance companies, or the government. Just six years earlier, in 2005, more than two-thirds of doctors were in private practice. As economic pressures on the sustainability of private clinical practice continue to mount, we can expect this trend to continue.>>
 
The author is just babbling. He doesn't make a coherent argument. He doesn't like EMRs. He doesn't like HMOs. He doesn't like the fact that lots of doctors are going to work for hospitals and HMOS. He's generally unhappy. He also has been in practice for over 30 years, so he's probably burned out and ready to retire. He quotes Ayn Rand. That alone should prevent anyone from taking him seriously. He's probably just depressed.
( He cites Atlas Shrugged, in which the geniuses of society all drop out. How absurd! In the real world geniuses start companies and make billions. )

Look, maybe eventually we'll have a single payer system, and that will probably lower physician salaries. But so far, Medicare has been a plus for doctors, because before Medicare, old and poor people were treated for free. Now, they are covered by insurance. Yes, Medicare pays very little, but very little is a lot more than nothing.

Doctors are becoming employees for the same reason that mom and pop stores are replaced by Walmarts and Home Depots. Economies of scale. But I think doctors are overall living better and are higher on the socio-economic scale now than they were before Medicare and Medicaid, and doctors are selling their practices because they want to, because they're getting better deals. No one is forcing them to do it. Maybe the author of that article is upset because no one offered him a job.
 
bc65 said:
The author is just babbling. He doesn't make a coherent argument. He doesn't like EMRs. He doesn't like HMOs. He doesn't like the fact that lots of doctors are going to work for hospitals and HMOS. He's generally unhappy. He also has been in practice for over 30 years, so he's probably burned out and ready to retire. He quotes Ayn Rand. That alone should prevent anyone from taking him seriously. He's probably just depressed.
( He cites Atlas Shrugged, in which the geniuses of society all drop out. How absurd! In the real world geniuses start companies and make billions. )

Look, maybe eventually we'll have a single payer system, and that will probably lower physician salaries. But so far, Medicare has been a plus for doctors, because before Medicare, old and poor people were treated for free. Now, they are covered by insurance. Yes, Medicare pays very little, but very little is a lot more than nothing.

Doctors are becoming employees for the same reason that mom and pop stores are replaced by Walmarts and Home Depots. Economies of scale. But I think doctors are overall living better and are higher on the socio-economic scale now than they were before Medicare and Medicaid, and doctors are selling their practices because they want to, because they're getting better deals. No one is forcing them to do it. Maybe the author of that article is upset because no one offered him a job.
Click to expand...
ummm no. physician real salaries have dropped over the last 10-15 yrs.

Sent from my VS986 using Tapatalk
 
bc65 said:
The author is just babbling. He doesn't make a coherent argument. He doesn't like EMRs. He doesn't like HMOs. He doesn't like the fact that lots of doctors are going to work for hospitals and HMOS. He's generally unhappy. He also has been in practice for over 30 years, so he's probably burned out and ready to retire. He quotes Ayn Rand. That alone should prevent anyone from taking him seriously. He's probably just depressed.
( He cites Atlas Shrugged, in which the geniuses of society all drop out. How absurd! In the real world geniuses start companies and make billions. )

Look, maybe eventually we'll have a single payer system, and that will probably lower physician salaries. But so far, Medicare has been a plus for doctors, because before Medicare, old and poor people were treated for free. Now, they are covered by insurance. Yes, Medicare pays very little, but very little is a lot more than nothing.

Doctors are becoming employees for the same reason that mom and pop stores are replaced by Walmarts and Home Depots. Economies of scale. But I think doctors are overall living better and are higher on the socio-economic scale now than they were before Medicare and Medicaid, and doctors are selling their practices because they want to, because they're getting better deals. No one is forcing them to do it. Maybe the author of that article is upset because no one offered him a job.
Click to expand...
So much wrong in this...

Doctors aren't selling their practices because they want to. They are doing it for basically 2 reasons. 1) Nearing retirement and can't find a young doctor who wants to buy their practice so they sell out to the hospital, work a few more years as contracted, then retire. 2) The private practice owners look at all the new mandates (EMR, meaningful use, the new MACRA, ICD-10) and realize that they can't afford to implement all of those things so they sell out to a hospital system that can. Technically both are voluntary, but in truth #2 especially isn't really voluntary its the choice between bankruptcy and not.

One of the brightest innovators in medicine today is a huge follower of Ayn Rand, and I find your contempt for those who appreciate her work to be troubling at best.

Of course he doesn't like HMOs. Anyone in medicine with even the slightest understanding of history won't like them either. There is a reason they were super-popular in the 90s and then became incredibly unpopular very quickly. Hint: its not because they were doing good work.
 
shoal said:
physician real salaries have dropped over the last 10-15 yrs.
Click to expand...

Maybe. I've seen some data that they peaked in the late 90's. But HMOs are around a lot longer than the past 10-15 years. Meanwhile, the "good old days" that everyone yearns for were in the 50's, 60's 70's, 80's. Doctors are way better off now than they were then. Don't cherry pick the data.

It's like med students who want loans at 3% like "in the good old days" of 10 years ago. But they don't want the rates of 9%, 10%, or 12% from the 80's. Or the good old days from earlier, when there were no loans at all.

VA Hopeful Dr said:
Technically both are voluntary
Click to expand...

What does "technically" mean in this context? Nothing.
What you're saying is that some doctors can't keep up with modern medicine and can't make money due poor business skills and poor economies of scale. They can't afford to modernize their record systems. Too bad. No one promised you that you could do what you want and have the world support you. Lots of businesses have to sell or merge or go out of business because they can't keep up with competition or innovation. You feel bad for him? Then send him some money. I won't.

VA Hopeful Dr said:
One of the brightest innovators in medicine today is a huge follower of Ayn Rand,
Click to expand...

Well, that's compelling evidence.
Lots of doctors believe lots of things that are wrong. Just look at how many different religions they believe in, yet no more than one can be correct.
The only reason I have contempt for her is that I read her books.
They have great appeal to adolescents and college students. "The world doesn't appreciate me. I'm taking my ball and going home".
 
VA Hopeful Dr said:
How on earth did you get that from what I said?
Click to expand...
By using the quote function to quote what you said.

There's a reason the few of those who study Ayn Rand's work in academia do so more out of morbid curiosity. There's a reason why Paul Ryan's Ayn Rand obsession contributed (albeit minor) to Romney not being elected.
 
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Walter Lance said:
By using the quote function to quote what you said.

There's a reason the few of those who study Ayn Rand's work in academia do so more out of morbid curiosity. There's a reason why Paul Ryan's Ayn Rand obsession contributed (albeit minor) to Romney not being elected.
Click to expand...
Your reading comprehension is just awful. My only point was that judging someone's worth on whether or nor they place value in what Ayn Rand wrote is stupid.

Let's actually look at what I said...

"One of the brightest innovators in medicine today is a huge follower of Ayn Rand, and I find your contempt for those who appreciate her work to be troubling at best."

Did I say anything about whether or not I like or believe in her writings? No, I did not. Here is what I said: there's a guy in medicine who is both very bright and leading a big wave of innovation in medicine. He puts a lot of stock in Any Rand's writings. It troubles me that you would judge someone merely based on their liking of a particular philosophy. That's it. Anything else you got from that is an assumption on your part.
 
I will say that whether or not Ayn Rand is wrong in her politics (I think she is), I've noticed that her books are exactly the type of pop-philosophy that serves as a good marker for identifying people who don't know what the hell they're talking about.

In college, the first person I met who really liked Ayn Rand spent all afternoon every day smoking weed in the dorm building quad and literally thought that Nietzsche was a Nazi (not, like, thought that Zarathustra had some nazi-seque messages, which itself would be wrong for so many philosophical and historical reasons . . . literally thought Nietzsche was part of the Nazi Party).
 
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VA Hopeful Dr said:
So much wrong in this...

Doctors aren't selling their practices because they want to. They are doing it for basically 2 reasons. 1) Nearing retirement and can't find a young doctor who wants to buy their practice so they sell out to the hospital, work a few more years as contracted, then retire. 2) The private practice owners look at all the new mandates (EMR, meaningful use, the new MACRA, ICD-10) and realize that they can't afford to implement all of those things so they sell out to a hospital system that can. Technically both are voluntary, but in truth #2 especially isn't really voluntary its the choice between bankruptcy and not.

One of the brightest innovators in medicine today is a huge follower of Ayn Rand, and I find your contempt for those who appreciate her work to be troubling at best.

Of course he doesn't like HMOs. Anyone in medicine with even the slightest understanding of history won't like them either. There is a reason they were super-popular in the 90s and then became incredibly unpopular very quickly. Hint: its not because they were doing good work.
Click to expand...

What exactly is included when "selling a practice"? Are you just selling the framework for one? Because the provider who is providing the service, arguably the only part of the practice generating profit, is leaving when the practice is sold. So what exactly would someone be paying for? And how is that number determined? Just curious questions.
 
sloop said:
I will say that whether or not Ayn Rand is wrong in her politics (I think she is), I've noticed that her books are exactly the type of pop-philosophy that serves as a good marker for identifying people who don't know what the hell they're talking about
Click to expand...

Ah yes, this phenomenon is also known as "Malcolm Gladwell sign".
 
bc65 said:
What does "technically" mean in this context? Nothing.
What you're saying is that some doctors can't keep up with modern medicine and can't make money due poor business skills and poor economies of scale. They can't afford to modernize their record systems. Too bad. No one promised you that you could do what you want and have the world support you. Lots of businesses have to sell or merge or go out of business because they can't keep up with competition or innovation. You feel bad for him? Then send him some money. I won't.
Click to expand...
That's the thing though, its not innovation or competition in the usual sense. Its the government, that pays for over half of healthcare claims, saying "if you don't fork over the money to upgrade to this system which doesn't actually improve outcomes or patient care, we're going to pay you even less than we do now... and oh by the way, even if you do upgrade we're not going to pay you enough to make up for what you're having to spend to comply with our rules... and oh yes, after you've spend huge amounts of money complying with meaningful use, we're going to scrap the program and start a new one with a whole new set of rules...". This has nothing to do with poor business skills, its entirely government intervention killing off smaller practices.


bc65 said:
Well, that's compelling evidence.
Lots of doctors believe lots of things that are wrong. Just look at how many different religions they believe in, yet no more than one can be correct.
The only reason I have contempt for her is that I read her books.
They have great appeal to adolescents and college students. "The world doesn't appreciate me. I'm taking my ball and going home".
Click to expand...
They also have great appeal to innovators.
 
coffee-doc said:
What exactly is included when "selling a practice"? Are you just selling the framework for one? Because the provider who is providing the service, arguably the only part of the practice generating profit, is leaving when the practice is sold. So what exactly would someone be paying for? And how is that number determined? Just curious questions.
Click to expand...
Equipment, premises (if you own them, the remainer of the lease if you don't), and patient records. You can also include a value for accounts receivable. The first 2 are easy to calculate as they have known value. The 2nd two are trickier and I don't know the specifics of how you determine that, although you usually calculate the practice's total collections and factor that in. For example: if my practice brings in 750k every year then all other things being equal I can ask for more money at sale than a practice bringing in 500k.
 
VA Hopeful Dr said:
Did I say anything about whether or not I like or believe in her writings?
Click to expand...
You can attack my reading comprehension if it makes you feel better. But as written, and without any additional info or insight, your post that I quoted, the fact that you felt the need to call that user out for the way he/she criticized Ayn Rand, and your level of defensiveness strongly implied that you did like/believe her writings. If you truly feel otherwise and don't want your comments being misconstrued on an internet forum, think about phrasing.
 
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Walter Lance said:
You can attack my reading comprehension if it makes you feel better. But as written, and without any additional info or insight, your post that I quoted definitely implied that you did like/believe her writings.
Click to expand...
I think you're confusing an assumption on your part with an implication on mine. My post implied nothing, except that a physician I respect likes Ayn Rand's work and I think its foolish to judge someone harshly for that. That was the entire point of my post, and since I'm the guy who wrote it I can state with 100% accuracy that I meant nothing else. If you read more into it than that, its on you.
 
VA Hopeful Dr said:
Equipment, premises (if you own them, the remainer of the lease if you don't), and patient records. You can also include a value for accounts receivable. The first 2 are easy to calculate as they have known value. The 2nd two are trickier and I don't know the specifics of how you determine that, although you usually calculate the practice's total collections and factor that in. For example: if my practice brings in 750k every year then all other things being equal I can ask for more money at sale than a practice bringing in 500k.
Click to expand...

Sometimes the practice will come with insurance contracts- For example Doc A buys Lakeside Family Practice from Doc B and the Lakeside FAmily practice adds Doc B to its Blue cross Blue Shield policy and then Doc A, who now owns Lakeside Family Practice, can bill for his services thr0ugh that insurance contract.
 
michaelrack said:
Sometimes the practice will come with insurance contracts- For example Doc A buys Lakeside Family Practice from Doc B and the Lakeside FAmily practice adds Doc B to its Blue cross Blue Shield policy and then Doc A, who now owns Lakeside Family Practice, can bill for his services thr0ugh that insurance contract.
Click to expand...
That I didn't know about, but it makes sense.
 
Having been part of a very successful private practice, I disagree with the original author in many of his assertions, but his biggest logical hole is that he ignores the fact that doctors in private practice are business owners first and the principle employee second. They are usually good at being the principle employee, but stink as the business owner.


As for Ayn Rand’s references, like ALL other uber philosophers Ayn Rand’s philosophy makes less or more sense depending on the time and place of its application. Ayn Rand only relevance to this topic is her disdain for governmental interventions. Business owners typically hate regulations and prefer predictable landscapes vs. unknown changes. In my opinion, the reason author hates the change is because he does not want to take the time (and make less money for some period of time) to learn and implement the changes. It’s in human nature to want to just do the same thing with small and self-directed changes. For one person with no competitions this would be great, but in a competitive market this is far from ideal because changes come at large, uncontrolled and disruptive waves (governmental or not). The longer one is in business the more one hates the disruptive changes and that is only human. However, as someone who just arrived in the market, you start with a clean slate and the new rules are not new to you they are simply the rules of game and hence no change-accompanied frustration.


The top 30 income earning professionals in the US all are doctors. Surgeons can make up to $700,000 income. I am on my way to become a doctor, but I don’t believe any amount of education should justify this kind of salary. Their salary is determined by the demand for their work and the chokehold on the residency spots that limits supply (not their years of education). Nevertheless, if they only agreed to perform half the number of surgeries they would have plenty of time to make their business side more successful and still make $350,000 a year. Now someone can argue that the inflation adjusted salaries were higher 20 years ago, but that does not mean the current salaries are unfair, it only means 20 years ago was an unusually good time for doctors in terms of finances.
 
Dr. Adam said:
I am on my way to become a doctor, but I don’t believe any amount of education should justify this kind of salary. Their salary is determined by the demand for their work and the chokehold on the residency spots that limits supply (not their years of education).
Click to expand...

I'm pretty much in agreement with the rest of your post, but it should be noted that the salary is not just a function of length of education. You also have to factor in the ability/aptitude required, the expense of the education and it's opportunity cost, the value of the work done, the difficulty of the work and correlation of skill and results, and other factors. There's a lot of justification for high salary, though quite how high could be a matter of debate.
 
all I feel comfortable saying is that whatever factors are taking place to make it so difficult to maintain/start a private practice is a shame - a sentiment echoed by many docs, because whether or not you argue how much Medicare and HMOs have limited autonomy, certainly not being able to be a solo practitioner does so as well

I think the issues for this go beyond just coding or Medicare

part of it, as I understand it, relates to malpractice, and that a hospital paying millions a year for such insurance are better able to negotiate price than the solo practitioner (yes, this goes into economies of scale as mentioned, just pointing out med mal, and there's more than one way to reform that area)

I do appreciate the spirit of what this guy is saying about over-reliance on protocols in dx & tx, and dwindling autonomy of docs in clinical decision making, I just don't entirely blame the government

plenty of hospitals are, independent of government regulation, instituting doctor-autonomy-gutting & patient-benefit-questionable-at-best policies for the sake of money
 
sloop said:
I will say that whether or not Ayn Rand is wrong in her politics (I think she is), I've noticed that her books are exactly the type of pop-philosophy that serves as a good marker for identifying people who don't know what the hell they're talking about.
Click to expand...

Funny, if you replace the words "Ayn Rand" with "Bernie Sanders" and "books" with "speeches/interviews" then our experiences have been identical.

Sent from my SM-N910P using SDN mobile
 
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