Interesting WaPo article on physician pay

[medgator]

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I suspect that many displaying sympathies to some (or all) tenets of socialism have not owned a small business before. Which is fine.

 

[OTN]

Medicare and Social Security have always been Ponzi schemes, and the gig is almost up. I can't imagine The Boomers doing anything but robbing our grandchildren as much as possible, so I do agree: money printing it will be, as we have $161 trillion (!) of unfunded obligations. Means-testing Medicare or Social Security is not politically feasible in the gerontocracy under which we all live.

One solution could be to rapidly -as quickly and dramatically as possible- increase legal immigration so that productivity of US workers can rise, thus possibly giving us a chance to pay for The Boomers.

Edit: I should have said "their grandchildren" but everyone gets the gist

 

[Mandelin Rain]

I can't imagine The Boomers doing anything but robbing our grandchildren as much as possible

On this, we can all agree.

 

[medgator]

Like, apparently we have all the cherry picked examples of how bad western europe is rolled into one dysfunctional country.

Nordic countries are capitalist. But they have a robust funding of socialist programs. Inconvenient truth to those on both sides

Sorry Bernie Bros But Nordic Countries Are Not Socialist

As much as liberals like to use Nordic countries as examples that socialism and successful societies can co-exist, the reality is that these countries are not socialist, or even farther along the spectrum toward socialism than most other developed countries.

www.forbes.com

 

[deleted1168505]

Open borders? We have such a labor shortage it's ridiculous yet one side just loves to throw that buzzword around while acting like an ostrich in the sand when it comes to immigration reform

People that are coming across the border unchecked and remaining in the country are not taking legitimate jobs and contributing to the tax base. They are either not working or participating in an underground economy either as victims or criminals. This is the entire point and a humanitarian issue and I really think everybody understands that at the basic level. But I don't understand the problem of calling a spade a spade. But the frustration at terms like "open borders" also tend to believe that the tent cities in coastal urban areas are not something we should do anything about either as that would be infringing on the freedoms of people to live like that. So, well... at some point you just give up because it's like arguing against a wall -- they are never gonna see it. People don't want to comment on these problems because they are afraid of being pigeonholed along with Mr. Build-a-wall, and that's really what it's come to.

 

[temujim]

Open borders?

We have such a labor shortage it's ridiculous yet one side just loves to throw that buzzword around while acting like an ostrich in the sand when it comes to immigration reform.

Good to know. Will stop worrying about the rad onc job market and the number of IMGs let in for training/ABR alternative pathways.

 

[communitydoc13]

If he "owns it," it'll certainly cross over to "Dare you to reply" territory, which is likely where we already are.

Clearly physician pay is a touchy subject, as is the posting of this particular article by the future leader of ASTRO.

That this would devolve like it has is, I guess, not surprising. The best defense of one's salary is always, "it's what the market dictates". If you subscribe to the notion that healthcare is a right, then provision of healthcare becomes a collective social obligation and yes, docs become servants (as in civil). There is an inherent tension.

We are in a tough spot. That the future leader of ASTRO is also a MAYO physician (pay structure for MAYO radoncs is available on-line) is important. I believe that most academic physicians (obviously not the Lou Potters crowd) believe that they have forgone maximum market value to do good. They also believe in the value of their (typically large) institutions (drivers of innovation, providers of equitable care). I do not think this is wrong. I even think it is noble. (I wonder what Goethe would think).

My concern is that these large institutions are really very corporatist at this point, and in our field, which is both historically very lucrative and desperate to maintain or increase relevance, incentives have been to invest in highly lucrative, high capital interventions with limited evidence of superiority (and a ceiling regarding differential clinical value that is small) and then look to protect these interventions preferentially.

These large institutions are not looking to pay their doctors more. They are looking to grow and capture market share. I'm sorry, but if you work for MAYO or JHH or MSKCC or MDA, you are functionally working for a corporation at this point. They are not the solution to runaway oncology costs.

As a counterpoint, community hospitals typically provide cancer care at a relative discount. Pay their doctors more, (calculation more murky than just comparing annual salary and usually closer in terms of real compensation than many think) and often serve poorer patients. There are limited opportunities for research or national leadership at the community physician level. You also should pay doctors more to move to communities that don't produce a lot of them (some market forces there).

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance - PMC

Are there differences in insurer spending and care utilization for patients with private insurance undergoing cancer surgery at National Cancer Institute (NCI) centers vs community hospitals? In this cross-sectional study of 66 878 patients with ...

www.ncbi.nlm.nih.gov

Get rid of the carve outs. Get rid of preferential payment. Of course, reduce training spots. You'll be surprised how many people will be on board.

As an aside regarding obesity? Nobody is diminishing this as a health issue. It is at the forefront of most preventative health measures, including in oncology.

Now if you think Michelle Obama is fat, you are wrong....and there is nothing wrong with being thicc.

Regarding undocumented immigrants...yes they are vulnerable....they are also typically major economic contributors in mostly non-seedy industries. Still, legal immigration is better (but not needed for radonc spots!)

 

[deleted1168505]

Now if you think Michelle Obama is fat, you are wrong....and there is nothing wrong with being thicc.

Oh, so that's where you were trying to go with that (I thought it was somewhere else). I'm not sure why that triggered that response, and that was not my intent, but makes sense now. Weight and body image are sensitive issues we all deal with to some degree.

Obviously people have evolved different body shapes from different cultures and the concept of beauty is subjective. Japanese people tend to be small framed whereas Polynesians are quite large. Are there morbidly obese Japanese and ultra-lean body-builder Samoans? Of course. Obesity is about how much body fat you are carrying on your frame resulting from consuming too many calories. Dwyane Johnson is 270 lbs. He is not fat. Women naturally have more than men do, and this is normal. I had a girlfriend once long ago with an eating disorder aspiring for zero percent body fat so I'm aware of the problems there and that's not healthy either. The issue is normalizing 300 lbs. with 40% body fat as normal and making them swimsuit models with the implication that this is beautiful and healthy (which absolutely is a thing). Hard no. I draw the line at telling outright lies. I do believe that there is a physical ideal we should all strive towards, even if not achieved but an ideal to motivate us to be healthy and make good choices within reason. Hopefully we can agree on that, but maybe not as many would come after me for saying that.

That this would devolve like it has is, I guess, not surprising.

I don't know why you think it devolved. Overall I think it was a healthy discussion with the exception of the unpleasant implication of "owning" some idea you wanted to attribute.

 

[medgator]

Good to know. Will stop worrying about the rad onc job market and the number of IMGs let in for training/ABR alternative pathways.

That's pretty much rad onc returning to its roots if you want to go in that direction, but at least try to come up with a better strawman. It was not a comment on the rad onc labor market, we both know better than that

 

[medgator]

People that are coming across the border unchecked and remaining in the country are not taking legitimate jobs and contributing to the tax base. They are either not working or participating in an underground economy either as victims or criminals. This is the entire point and a humanitarian issue and I really think everybody understands that at the basic level. But I don't understand the problem of calling a spade a spade. But the frustration at terms like "open borders" also tend to believe that the tent cities in coastal urban areas are not something we should do anything about either as that would be infringing on the freedoms of people to live like that. So, well... at some point you just give up because it's like arguing against a wall -- they are never gonna see it. People don't want to comment on these problems because they are afraid of being pigeonholed along with Mr. Build-a-wall, and that's really what it's come to.

Any data to support your narrative? Because our birth rates are falling and the labor crunch is real

 

[Chartreuse Wombat]

As an aside regarding obesity? Nobody is diminishing this as a health issue. It is at the forefront of most preventative health measures, including in oncology.

Please stop the fat shaming. Some are denying that obesity is a health issue. In fact there is at least one journal devoted to fat studies

https://www.tandfonline.com/journals/ufts20

Of course all deserve dignity and respect.

FYI I am overweight approaching obesity based on BMI

 

[deleted1168505]

View attachment 375373

Sadly, I am very aware of depositing into SS as a small business owner for a long time with the double hit on FICA deposits once a month.
A SS check into my bank account? That would a pleasant surprise. I have little faith I will ever see this money back again.
The history of SS and medicare is interesting. A third rail political issue. I don't know the answer. Making immigrants legal and paying into the system certainly wouldn't be a bad start. I also have no problem with some wealth tax on the ultra-billionaires. However, the reality is that most of the tax (in absolute dollars) in America is already paid by those at the top and at some point they just leave and pay taxes elsewhere. More good will be done by cutting spending and not getting entangled in costly foreign wars (what's defense spending? The military industrial behemoth is unstoppable in reality -- they will get their money, always).

 

[communitydoc13]

I don't know why you think it devolved.

We moved to tangential topics relative to the original post. European health care systems.....fair game. Europe as a dangerous place to travel with mentions of cultural homogeneity and casting health care expenses as mostly a function of personal choices...not clear how it helps us protect our salaries.

o that's where you were trying to go with that

I thought you were alluding to transgenderism and homosexuality. I guess you were not.

But, I'm also not discriminating against a fat person regarding hiring...and a 300 lb swimsuit model is fine for the right audience (just not you). A supportive, non-shaming environment to try to emphasize health for that person is probably best (as well has helping their significant other get to a point where they are helping them be healthy). An ideal?....who knows....might be 220 lb for that person, but if their LDL, cardio and strength are good...I'd be happy for them if I were their doc.

All good.

 

[deleted1168505]

Any data to support your narrative? Because our birth rates are falling and the labor bl crunch is real

What narrative? I agree with you.

 

[deleted1168505]

But, I'm also not discriminating against a fat person regarding hiring...and a 300 lb swimsuit model is fine for the right audience (just not you). A supportive, non-shaming environment to try to emphasize health for that person is probably best

There is currently a lawsuit about an EM resident who was physically unable to do her job because of being obese:

Texas Top Court To Hear Obese Doctor’s Wrongful Termination Suit

The Texas Supreme Court agreed on Friday to review a discrimination suit stemming from a first-year resident who alleges she was fired because of her obesity.

news.bloomberglaw.com

If you are United airlines, are you going to hire a 400 lbs. pilot who can't fly the 737 because it doesn't have a side stick? Is the flight physical discriminatory? What are the risks of having a medical event during flight? There is always nuance to this and everything just doesn't boil down to straight bigotry.

I thought you were alluding to transgenderism and homosexuality. I guess you were not.

Well I do believe there are unhealthy sexual behaviors that have nothing to do with which sex you are attracted to (as opposed to this idea that when it comes to sex literally anything goes if it makes YOU feel good then it must be healthy). The normalization of the porn industry is bad enough, but when the AI sex robots show up (and they will) I think you'll see that play out not so great for society. We're getting off in the weeds here, and I don't have an interest in going down this path on a separate touchy subject. Fat-shame, sex-shame, etc. Shame is not necessarily a bad thing as it encourages people to be better versions of themselves. It's a natural human emotion that we evolved for a reason. When you treat things like morbid obesity and pathologic hypersexuality with kid gloves because you don't want to be judgy or seem shameful, then really are you hurting or helping? There is a difference between being truthful with someone and berating them for being what you consider morally inferior or weak. You can do the former while still being compassionate, at least I believe that anyway.

The funny thing is, in society, shaming someone for smoking (tobacco only curiously enough) is totally fine now. You can be as rude and nasty to smokers as you want and nobody will cancel you or call you out on social media. A bit hypocritical I think that some self-destructive behaviors are ok to outright ridicule while others you can't even gently try and address.

 

[communitydoc13]

Dude...

 

[elementaryschooleconomics]

*clicks on new post notification for this thread*

 

[Mandelin Rain]

We're one step away from discussing the Green M&M at this point. Have fun y'all.

 

[Mandelin Rain]

I'm sorry that happened to you.

 

[thecarbonionangle]

Nobody "hates" UHC for being rich, but they sure do hate on Doctors making a good living.

You better believe those megacorp's are happy to fuel that notion - the poor fight against the middle class while the rich smile and laugh behind closed doors.

Absolutely. This is the way.

 

[LostResident1]

Medicare and Social Security have always been Ponzi schemes, and the gig is almost up. I can't imagine The Boomers doing anything but robbing our grandchildren as much as possible, so I do agree: money printing it will be, as we have $161 trillion (!) of unfunded obligations. Means-testing Medicare or Social Security is not politically feasible in the gerontocracy under which we all live.

One solution could be to rapidly -as quickly and dramatically as possible- increase legal immigration so that productivity of US workers can rise, thus possibly giving us a chance to pay for The Boomers.

Edit: I should have said "their grandchildren" but everyone gets the gist

Well of course. How else will people buy the Boomer's multimillion dollar homes? How else will people buy a Boomer's stocks at 30-40X earnings? Whatever it takes to preserve their wealth.

 

[Neuronix]