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I was curious as to what kind of job security in the future is there with anesthesiology?
Job Security
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None. In fact, don't even go to medical school. You'll be hounded by patients who don't really want to get better, squeezed by insurance companies who would pay you $4 for your efforts if they could, sued by disgruntled patients, and lose your soul over the next 7-10 years while your being expected to work 80+ hours a week (I don't care what the regs say... they're not there to protect you, trust me), jump through a bunch of stupid hoops, have no meaningful semblance of a social life, and chart the new depths of what it means to be exhausted.
Me? I should've gone to business or law school instead. Somehow part of me thought - my ego, I admit it - that by going to med school I'd be looked up to and respected and hold some sort of special standing in the community.
Yeah, that bubble has been burst a long time ago. (The only doctors I see now who still actually believe that are the ones where there is a clear consensus on being regarded as the "dinguses" of the hospital.)By now, I'd instead be making huge bucks screwing over physicians, who are more interested in fighting with each other and trying to prove to the people who are supposed to be their "colleagues" how much smarter they are. The in-fighting, oh!, the in-fighting. So, instead I'm a member of an "elite" group who are openly prone to being taken advantage of by the FTC, the Association of Trial Lawyers, politicians, insurance companies, patients, the government, nursing organizations... and just about anyone else who purports to both implicitly hate and yet still need us at the same time.
Check your ego. About 90% of people say they want to go into medicine to "help" people. The reality is that most of those same people think there is something special about being called "doctor". There isn't.
Me? I'm going to get in the game - now that I can't get out - make as much money as possible while that's still possible, invest wisely, and then cash out before 50. And, then I'm going to sit on some tropical island and laugh as I watch the entire healthcare system in the U.S. crash in on itself. Why? Because the politicians, the insurance companies, and the general public don't really want our help to fix it, despite the fact that we work in it everyday. Why? Because, they perceive us as the biggest part of the problem. Yet, we are put under so many ridiculous and unimplementable "goals", under the pseudo-authority of agencies that don't really have authority such as JCAHO, that we can't possibly do our job in a cost-effective, patient-centered way.
So, the fox is already in the henhouse. Might as well make hay while the sun shines, get out of Dodge, and laugh 'til your blue in the face. That's my plan, as well as digging up as many trite metaphors as possible to show my disdain with how f**ked up the healthcare system is right now, as well as the fact that no one is talking about the real fixes that are needed.
Or, I can always go the Barry Friedberg way, sell my soul to the devil, and do boob jobs for the rest of my career demanding cash payment up front and a waiver that says you can't sue me. Hey, Zippy, any openings?
-copro
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Copro!!!!!!! Stop it!!!!!
O.k., you make some very, very valid points. But, the BS is NOT the sole domain of medicine. The crap, dog eat dog mentality, and politics is common to working life in general. And, it's not the case that the only careers in which there is significant sacrifice and prolonged "gratification" is medicine.
To be successful in ANY field, you'll be working many hours. You're not likely to come right out of undergrad raking in the big bucks (a relative expression)regardless of your chosen career path. Sure, you can point to a very small minority of dudes that go into IB etc. Even with their own sacrifices, they can still hit some high numbers earlier on than in most other fields. But, these people are for sure the minority of finance/business grads, and most need to obtain an MBA from a very reputable institution.
Here's my take. Many doctors DID go into medicine because they're generally a good bunch of people. They DO care. And that may be part of the problem. When you care TOO much, you're likely to become jaded, because the realities of anything come down to the all mighty dollar. This is a law, not even a theory. Also, human nature is such that it's true that many people will sell you out regardless of your best of intentions. Again, this is simply a fact, so don't be shocked when it happens. It will.
So, if you do medicine, do it with a realistic expectation of what it truly can offer you (yes, YOU, no martyrdom here). Realize that there are major challenges and changes coming to a theatre near you. But, also realize that it can still be a rewarding way to make a living. Will you get rich? Probably not, for the average physician. But, you can still make a decent living, and find it to be rewarding to boot. This is my very humble opinion as a lowly MSII.
O.k., you make some very, very valid points. But, the BS is NOT the sole domain of medicine. The crap, dog eat dog mentality, and politics is common to working life in general. And, it's not the case that the only careers in which there is significant sacrifice and prolonged "gratification" is medicine.
To be successful in ANY field, you'll be working many hours. You're not likely to come right out of undergrad raking in the big bucks (a relative expression)regardless of your chosen career path. Sure, you can point to a very small minority of dudes that go into IB etc. Even with their own sacrifices, they can still hit some high numbers earlier on than in most other fields. But, these people are for sure the minority of finance/business grads, and most need to obtain an MBA from a very reputable institution.
Here's my take. Many doctors DID go into medicine because they're generally a good bunch of people. They DO care. And that may be part of the problem. When you care TOO much, you're likely to become jaded, because the realities of anything come down to the all mighty dollar. This is a law, not even a theory. Also, human nature is such that it's true that many people will sell you out regardless of your best of intentions. Again, this is simply a fact, so don't be shocked when it happens. It will.
So, if you do medicine, do it with a realistic expectation of what it truly can offer you (yes, YOU, no martyrdom here). Realize that there are major challenges and changes coming to a theatre near you. But, also realize that it can still be a rewarding way to make a living. Will you get rich? Probably not, for the average physician. But, you can still make a decent living, and find it to be rewarding to boot. This is my very humble opinion as a lowly MSII.
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Just wait... you think it gets better when you finish med school... you're still in the idyllic phase, like most of us were when we were MS2's...
And, by the way, I've worked in private industry before I went to med school, and I now regret the fact that I made the switch. But, I'm in too deep. The BS in healthcare administration is far deeper and stinkier than it is in ANY other domain. Here are the facts:
(1) We are mandated to do certain things by JCAHO. JCAHO is not a governtmental agency, it is a private organization that is supported by insurance companies. It has to justify it's own existence, or it will cease to exist. The result? The have self-directed "initiatives" that have little bearing on what we do on a day-to-day basis. For example, just telling people that "JCAHO is coming" suddenly means no coffee cups around the work areas, all the litters in the hallways disappearing, and no medical records being left out. Does this happen without the fear/threat of some all-powerful organization coming to "audit" you and potentially make you lose part of your funding (as a result of collusion with CMS and private insurance companies)?
(2) We are not allowed to engage in collective bargaining by the FTC. Insurance companies, for all intents and purposes, are. The result? We can get f**ked by anyone who claim they are offering "fair market reimbursement" for a procedure, test, office visit, etc. There was talk in the late 1990's and early 2000's about loosening the noose around physician's necks with regards to this issue, and as a result we were allowed (in some states) to form Independent Practice Associations. But, don't try to collectively bargain... unless you want to get in legal trouble. It was, essentially, tried in Laredo, TX when surgeons formed an IPA and across the area encouraged practitioners in their IPA to refuse to accept the pitifully low reimbursement insurance carriers, who have the knowledge of who is getting what, were offering. The result? The physicians were sued, lost the subsequent anti-trust lawsuit, and were fined collectively.
http://www.ftc.gov/opa/2006/02/laredo.shtm
(3) Lawyers represent the largest contingency of elected officials. The legal lobby is not interested in tort reform, and lawyers who become politicians are less likely to vote against it. Contingency fees provide an incentive to sue doctors, whether or not any malpractice was done. The result? We have a "BINGO"-type legal tort system that encourages scum-sucking plaintiffs attorneys to start legal proceedings, without any real repercussions on the merits or frivolity of a particular suit, and hopefully settle for large amounts of money. This is unlikely to meaningfully change, and it is a constant threat in the background that will dictate how you practice (like it or not). Anybody who disagrees, well, they haven't been sued yet and had the "wish I'd said that back then" or "if I'd only made that clear when I had the chance" or "I really didn't need to do that, did I?".
(4) Mid-levels want your job, and will have your job. Eventually. There will be no more primary care providers who are MD/DO trained. Most ICUs will be run by PAs and CRNPs under the direction of the treating team. CRNAs will continue to grow in force and numbers, and will drive the overall cost of anesthesia reimbursement down. And, they are nurses. They are allowed to unionize. They are allowed to collectively bargain. They do not have the same legal exposure (yet) as we as physicians do. You are and will compete with them, like it or not, depending on what career path you choose in medicine.
(5) Governmental agencies want to encourage supplemental "taxes" for healthcare workers, because (you know) we make so much more money than everyone else and are actually the biggest part of problem of the current healthcare crisis. Their solutions are ludicrous. They have no idea what actually goes on in a hospital, yet they claim they can fix it with taxes and legislation... aimed at the people who are actually doing the work! (Talk about creating even more of a disincentive for people to go into the medical field).
(6) I'd argue that anyone who thinks that they can make an impact on people's lives has not spent enough time on the internal medicine wards. Take care of a 700+ pound diabetic patient with now presents with a necrotizing peri-rectal abscess who you've admitted 12 times over the past 2 years, has actually gained weight, has been collecting disability (because, God knows, he shouldn't be expected to take responsibility for his own condition and actually get a job), has accumulated over a million dollars of medical charges, and is unlikely to make it out of the hospital this time despite the fact that you've been tasked to take him to the OR - every day - for a washout and VAC replacement. Who's paying for this? And, what resources is he stealing from someone else who actually might get better? I'll give you a hint: you are, because you actually have a job and care about working and contributing to society.
We gotta get a lot tougher as a profession, boys and girls. We are soon getting to the point where healthcare is going to have to be rationed, or it's going to bankrupt this country. We've gotta change the rules and start refusing multiple offenders and abusers of the healthcare system, people who've repeatedly demonstrated that they have the capacity to get better but don't really want to.
We're going to have to start drawing the line. And, it starts by (1) stopping the in-fighting and blaiming between disciplines, (2) organizing ourselves, and (3) not letting lawyers and bureacrats continue to dictate how we do our job. Until those things happen, we are f***ed. And, unless you're willing to take on that fight - something every 22-year-old should know and understand before they consider attending med school - I would choose another career. I'd heard the rumors before I did, but I never realized it was this bad. And, any med school not preparing you for this reality in some way, shape, or form is doing you a huge injustice.
-copro
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So what you guys are saying is, it gets way better after second year?! Awesome. Ok, back to studying respiratory pathophysiology and blatantly ignoring the true nature of my chosen profession because I have no other options given my debt load...
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Thats the spirit!
DOn't forget to pound that KREBS cycle in DEEP. YOu'll need that bad boy often to bail you out of tough clinical situations. And on the stand.
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I'm saying it can if you are willing to work cohesively with your colleagues (instead of arguing/blaming them), are motivated to practice in specialty hospitals that treat specific diseases/patients/conditions and mandate at least a portion of the anticipated bill is paid before services are rendered, you work towards meaningful tort reform by refusing to provide care to certain patient populations, and strive to create a professional environment where doctors are again actually in charge of patient care. This is going to happen anyway, folks. If "universal healthcare" comes, it's going to be the VA model all over the country. Those who can afford to pay will go to specialty hospitals. The rest will have to stand in line. And, you'll either have a job in one of those specialty hospitals (if you play your cards right), or you're essentially going to be a government employee.
-copro
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I would add this bit of advice to everyone: (4) If you're not politically-inclined, like most doctors, at least put your money where you mouth is. Instead of complaining about CRNAs/SRNAs, i urge everyone to contribute to ASAPAC; the MINIMUM contribution for a resident is $20 - i spend more than that for lunch each week. This is to protect OUR future and compared to an anesthesia resident's earning potential, $20 should be nothing.
Copro, please don't become jaded by the system. You sound like a very level-headed person. I hope you are at least attempting or are actively involved in trying to protect our futures, instead of dreaming about purchasing your own island someday.
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Wait, we have to remember stuff we learned first year too? Oh man. All kidding aside, I think copro makes some great points, it's just difficult to learn all the basic sciences and learn the ins and outs of the failing system of health care in this country and know what to do about it as a student, so I appreciate the input from less than optimistic perspectives. I don't have any interest in anything other than medicine either, so I guess we'll see what happens.
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Congrats Copro, I think you have arrived! Don't forget the bumper sticker: "Cash, Check or Credit Card-- nobody rides for free." Psst, make it complete and drop that dirty lil' ASA membership. Regards, ----Zip
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Vent, you did NOT just compare the TCA cycle with Respiratory Pathophys did you????????😀
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I'm glad you're not studying either. Maybe all I have to remember is to administer the propofol before the ketamine. Seems simple enough. Has anyone else ever heard of that technique?😍
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All I have to say is if John Edwards gets elected, I'm moving to Norway. Or, Dubai.
-copro
-copro
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Actually, they're looking for U.S. doctors in Dubai.... Check out the job ads in the back of JAMA. It'll be interesting to see how Dubai turns out in the next decade or so.
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I think there could be a worse place to practice medicine. I know of a country in Europe that anasthesiologists went on strike recently cause they are making less then teachers.....I moved from that country here to US of A so I can make more then teachers 😀 (no offence to teachers) BTW, is it really that bad for you? You almost convinced me to quit med school....😉
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Little kid is walking down the dirt road, and he passes a barn and an old farmhouse with an equally old farmer sitting on the front porch. The farmer notices the little kid is dragging something behind him.
"Boy," he yells out, "what you got there dragging behind you?"
"This here's chickenwire, mister. I'm fixing to go catch me some chickens," he yells back.
"Boy, don't you know that ain't what chickenwire's for? You can't catch no chickens like that." And, he shakes his head.
Couple of hours later, sure enough that kid comes walking the other way back up the dirt road with a bunch of chickens all tangled up in the wire he's dragging behind him.
Next day, same kid walks by the farm, except this time he's got a big roll of tape in his hands.
"Boy," the farmer says, "where you going with that there tape?"
"Well, mister," he yells back, "this here ain't no normal tape. This here's duct tape, and I'm fixing to go catch me some ducks."
"Son," the farmer shouts back, "you can't catch no ducks with 'duct' tape. Any fool knows that."
Sure enough, couple hours later that kid is walking the other way up the path with a bunch of Mallards quacking and flapping their wings all tangled up in a long strand of duct tape.
Again, the very next day the kid comes walking down the path. But, this time he's carrying a stick.
"Boy, where you going with that there stick?" the old man shouts.
The kid yells back, "Well, sir, this here ain't no normal stick. This here's pussywillow..."
"Hold on. Let me get my hat!"
-copro
(P.S. It's up to you to figure out the moral of the story in relation to this topic.)
"Boy," he yells out, "what you got there dragging behind you?"
"This here's chickenwire, mister. I'm fixing to go catch me some chickens," he yells back.
"Boy, don't you know that ain't what chickenwire's for? You can't catch no chickens like that." And, he shakes his head.
Couple of hours later, sure enough that kid comes walking the other way back up the dirt road with a bunch of chickens all tangled up in the wire he's dragging behind him.
Next day, same kid walks by the farm, except this time he's got a big roll of tape in his hands.
"Boy," the farmer says, "where you going with that there tape?"
"Well, mister," he yells back, "this here ain't no normal tape. This here's duct tape, and I'm fixing to go catch me some ducks."
"Son," the farmer shouts back, "you can't catch no ducks with 'duct' tape. Any fool knows that."
Sure enough, couple hours later that kid is walking the other way up the path with a bunch of Mallards quacking and flapping their wings all tangled up in a long strand of duct tape.
Again, the very next day the kid comes walking down the path. But, this time he's carrying a stick.
"Boy, where you going with that there stick?" the old man shouts.
The kid yells back, "Well, sir, this here ain't no normal stick. This here's pussywillow..."
"Hold on. Let me get my hat!"
-copro
(P.S. It's up to you to figure out the moral of the story in relation to this topic.)
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Thanks, Einstein. Maybe someone else can think of the bigger frame of reference that I was alluding to. 😕
-copro
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O.k., I'll take a shot. I'm assuming you mean that people are incorrectly looking to medicine (the tool) as a way to achieve their means and goals in life. From your previous few posts on this thread I'm assuming you think it's the wrong tool. While it's plausible to associate the stick with the real tool (like Teddy Roosevelt), I'm not sure about that one. Perhaps you think law carries the real weight, so to speak, and could therefore be the "right" tool, again due to your previous few posts.
You realize this is like asking us to read your mind..... (I may stick to my original synopsis...lol)
I REALLY need to get back to restrictive lung diseases, or my buddy and colleague PriorityMed is going to bury me on this exam...... AGAIN!
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I think it has to do that the farmer finally believed the boy after he saw the boy knew what he was doing.... right?
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Not quite. But the Glycolysis/Gluconeogenesis cycle does still keep me awake at night. Just pondering the sheer complexity of our own bodies....pfffhahaha
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DING DING DING DING DING!!! We have a winner.
The story is ludicrous, funny, but ludicrous. Obviously, the kid doesn't know what the hell he's doing and has a mistaken rationale for why he's doing it, but it's still working. The old man is wise and can see the error of the boy's thinking, but he's perplexed that the kid is still getting results.
I see this much like medicine. We, the physicians, are sitting on our high horses saying "it can't be done that way." The point of the story is that, as physicians, we have been notoriously unflexible in entertaing alternate ideas to solutions because it doesn't fit the current paradigm of the physician being the paramount keeper of medical knowledge. We (sometimes falsely) believe that you can't get results that way. The fact is, some of those alternate solutions are getting results.
The crux of the matter is that there seems to be no benefit to us if we try those alternate solutions, and that's the problem. If we stand to benefit from it, we'd be willing to try. Now, if the boy showed up on the third day with some skunk weed, I'm sure the old man would've stayed put on the porch. What the "alternate" solutions need to come up with is their own version of pussywillow. Until that happens, there won't be an incentive to take a risk and follow what appears to be a nonsensical new way of doing things.
That's the real challenge to those who purport to have the solution to the healthcare crisis: creating a win-win opportunity that makes it worth the risk of trying new ideas. Personally, I haven't seen too many creative thinkers that have been able to solve that problem.
-copro
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so do you have solution? or at least some ideas? Cause I don't see any good ones
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Yeah, I do. But they aren't going to fly with the politicians, trial lawyers lobby, and FTC. Simply these things:
(1) Legal tort reform including a professional, peer-review of the facts behind a medical malpractice claim before it can enter the legal process. Without approval from such a committee and determination of whether or not malpractice actually occurred, you can't proceed with a lawsuit. The physician and the patient would split the cost of this review.
(1a) Captitation of contingency fees to a maximum of $50,000 per verdict awarded to a plaintiff, with special considerations for billable time spent preparing the case, discovery, preparing exhibits (etc.) to a maximum of $150,000 per verdict.
(1b) Mandatory "pain and suffering" cap of $250,000.
(2) Right of physicians to collective bargain with insurance companies, including open access to what reimbursements are being paid to other physicians offering similar services in the same area.
(3) Eradication of JCAHO.
(4) Standardized insurance forms, coupled with a consensus on what always will/will not be covered across all carriers. This will streamline the pre-approval process and reduce overall paperwork (currently a huge bureaucratic cost to healthcare organizations).
(5) Uniform national healthcare provider licensure for all fifty states.
(6) Ability of emergency rooms to "opt-out" of EMTALA regulations and refuse care to patients who present not having an emergency before they are seen by a provider. Or, conversely requiring payment before they are seen.
(7) A national list of patients who abuse the healthcare system by demonstration of repeated failures to pay for care or follow prior recommendations. These patients may be refused additional care, or conversely would require payment before being seen and treated. This would be akin to a "three strikes" rule if (1) the presentation does not form the basis of a new medical complaint, (2) their reason for seeking evaluation is not part of their continuity of care, (3) the patient's lifestyle choices play the predominant role in the disease process, (4) there is clear, irrefutable evidence that they have not followed the prior prescribed treatment regimens.
(7a) Patients on such a list would be unable to sue physicians and nurses.
That's a start. I'm sure there are more. It all comes down to patients wanting to get something for nothing and their false belief that we can immediately fix all their problems with a medicine or surgery when they show up on our doorstep.
We've been promoting the "health maintenance" and "preventive medicine" schpiel for long enough now. Education isn't working. It's time for tough love.
-copro
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That sounds good. I was thinking more like what to do with people that can't get proper health care? Or those who can't afford any care so they go to ER for every stupid thing cause they can't be sent away from there. I guess I am still in the phase of helping people hehe
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Great suggestions, copro. But personally I'd settle for no longer watching doctors vote for a malpractice lawyer...
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There are two classes of people in this world:
(1) Those who take responsibility for their actions.
(2) Those who don't.
Try as you might, you're never going to change the second group by continuing the current paradigm and providing more access. Universal access to healthcare is a noble idea, but it just won't work the way it's envisioned. People can get low cost healthcare, low cost prescriptions, and ability to see people for their routine healthcare needs. They just simply choose not to do this, and many (as we all know) use the ER as their doctor's office. They mistakenly believe that we can fix whatever is wrong with them in one visit. They continue to smoke, overeat, avoid exercise, and drain the system at the same time.
This may sound like a war against the poor, but enough is enough. If you keep giving handouts, those handouts become expected. I'm not talking about the honest guy who's down on his luck. I'm talking about the entrenched "take care of me" culture we've engendered through decades of bad policy. Remember the old saying, "Give a man a fish, feed him for a day... teach a man to fish, feed him for a lifetime." We've got to make people responsible for the results of their own bad behavior. The only way you're going to do this is by stopping the handouts.
-copro
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This is huge, in my opinion. See copro, we ARE on the same side bro.
As far as the up and comers on this board are concerned, the key (again, IMHO) is to detach oneself emotionally from the challenges, but keep the intellectual awareness as well as reflecting your beliefs through behavior. This means supporting and contributing to PACs and, like many have pointed out, get involved in hospital policy groups and leadership when possible.
I take the optimistic approach in that the more awareness there is amongst doctors, residents, med students, and even pre-meds, the better chances that we'll succeed in our endeavors of advocating on behalf of our chosen profession(s). Guys, this can happen. These challenges are NOT unwinnable.
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Again, HUGE issues. Our formerly self-reliant, hard working, pull yourself up by your bootstraps culture has evolved into an entitlement society that expects the government to bail them out of poor decision making, including (and this is pitiful) their mortgage obligations. Everyone's a victim.....
This is a major problem, and just guess which political party tends to foster these notions....😎
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hmmm
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I agree that people make poor decision, people live off credit, and spend their money unwisely. They rather spend their money on a cell phone for their teenager then health insurance. But here is a problem. Health insurance is expensive if u are trying to get it not through work. You can get one for $150 a month per person with $ 5000 deductable, if you are under 30 and no major diseases. The problem comes when you get sick and you do have to spend that $5000. Not everyone is inteligent and is able to get a good job that offers them health insurance. There are fast food workers, and landscapers etc and they can't afford insurance even if its only 150 a month. And yes, everyone can go to school and everyone can get education etc, but is everyone created qual?? I don't think so. We are the lucky once that can easily look into future and see obvious things (like credit cards can be bad!) but not everyone is as smart. There are people that take responsibilty for their action and people who don't. I like to think that I take responsiblity for actions. But right now i am living on tight budget, so I chose the $150 insurance. I got sick, needed EGD, which with my deductible was $1500. I didn't have the money, I decided not to do it. I am still alive thank God. My other option was to pay $300 a month to get better insurance for more money. I looked into insurance for my parents, if they wanted to do it they would have to pay 600 a month each. Do you see my point? Even people that do care get screwed.
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These are valid points. Can't say I agree with ALL of your numbers, but nevertheless, some of those deductibles can be pretty formidable. I think the key is to offer additional tax incentives to encourage more people to be able to afford private insurance when they don't qualify for medicaid or medicare.
The only problem I see with this is that many people are clueless in terms of tax knowledge and those benefits aren't realized until years end, and thus requiring some fiscal planning - heaven forbid.... Maybe this concept could be streamlined though, where contributions are taken out of a paycheck automatically, pre-tax as opposed to having to claim this at years end. There would be a list of qualified/certified providers that the employee could choose from. This would facilitate the automaticity of this in terms of automatic pre-tax contributions. But, that would only work for the premium and not claims on any out of pocket medical expenses throughout the year.
Also, human beings all have at least a minimal level of intelligence. I don't buy into the notion that this stuff is simply too complicated for a non-mentally challenged (clinically) individual. Perhaps employers could run a small workshop through HR departments (for larger companies) or the government could supply educational pamphlets or something. It would have to be made easy and noncomplicated.
But the bottom line is that healthcare is not FREE (despite what Michael Moore might have us think). And, if more people had to pay into the system, there would be less of a disconnect between services rendered and decisions made by consumers of those services. Frankly, I think this type of system should be implemented throughout, and absolving companies from having to offer such "fringe" benefits. This would also help American companies compete in a global market where most other countries do NOT have employee sponsored healthcare, which is a competitive advantage to them.
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I definitely don't think government run healthcare is a good idea. The coutry I am originaly from has socialized "free" medicine, although it is slowly changing. And quality is really crappy, doctors don't make **** (hence Anesthesia strikes) and if people are 60 years or older they are not eligible for certain meds, and have to pay out of pocket if they want or can. I really don't know about perfect system. But I agree with what you said above.
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People that care also get screwed, this is true. Cost shifting to more wealthy members of society that actually pay for their care should cover these instances much more readily than the obese alcoholic diabetic smoker that needs dialysis twice weekly for the rest of their life. I agree that this isn't totally black and white, but as of right now, the American public has no incentive to take care of themselves. They can eat what they want, drink what they want, and just go to a doctor to "fix" them if something goes wrong. If the doctor can't fix it, they see another doctor, with the money they got from filing suit against the first doc. Also, I think health savings accounts would be better in the long run for a lot of people than insurance is, but obviously this wouldn't be ideal for those that can't even afford insurance. It's all about incentives, and what motivates people.
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Coprolalia for President!
I agree with just about everything you say. Now let's figure out how to get it done.
I agree with just about everything you say. Now let's figure out how to get it done.
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Have you ever asked yourself why?
Hospitals artificially inflate what they bill to patients knowing that they won't collect a large portion of what they charge.
Insurance companies can negotiate directly with healthcare organizations about what will get paid for and by whom (i.e., the insurance carrier and the patient in a percentage-wise basis). If a hospital charges $500 for a test, the insurance carrier might negotiate a reimbursement rate, via a mechanism that is akin to collective bargaining, that is, say $200. Of that $200, the insurance carrier might pay 80%, and the remaining amount, $40, is paid by the patient.
So, what the hospital is really saying is that this test can be done for $200, but they're going to charge $500 for it because that's the premium they think they should get.
The person with insurance, essentially, pays $40 (in addition to their monthly premiums) for a $500 test.
Problem is, if you don't have insurance, you are billed at that premium rate. You, as an individual, have no negotiating power. So, the numbers are artificially inflated and the uninsured is penalized. Someone without insurance comes in and is charged the full $500 for that test. They can't pay. The hospital goes into collection proceedings against the patient, and ultimately they write-off the loss.
It's all f'ed up. People should be paying cash - one charge - for a particular test, no matter who's paying. The insurance companies have completely screwed-up this process by being able to negotiate and bargain directly with the healthcare companies.
That's another thing I would change. Let me give you a hint: private insurance companies never lose money, despite what they might want you to think. Quite the contrary.
-copro
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I completely agree. Do you think there should be some kind of regulations for insurance companies? Seems like they do whatever they want. 😡
I also noticed something else. Scrub techs open bunch of gowns and gloves "just in case" so every case there are 3 extra gowns that are going to be thrown out. WHY? How hard is it to ask a nurse (or med student) to open a gown or gloves when needed. I don't know how much gowns cost but that is just an example. I would say that 1/3 of the supplies in surgery is wasted. Or one time I scrubed in and nurse is asking me what size gloves I wear, so I say whatever u have there it will do since I will be just standing there anyway. And she kept insisting that I tell her the size so she can open new ones. Too much wasting in our society. I am not sure if there should be some kind of rule that you can't open gowns, but it is just common sense.
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Yeah, that drives me crazy too.
I don't draw-up atropine or succinlcholine during my morning set-up for that reason, except in small peds cases. I can't remember the last time I had to use either of those in a non-emergent adult case. Yet, I have colleagues (and attendings) who insist that it is drawn-up and ready to use at the beginning of the day. Why can't you just have it out on top of your machine ready to go if you need it? I can draw up either of those meds in about 7 seconds. No one ever died in 7 seconds in the OR where you didn't see it coming well in advance.
I can only imagine how much of those two meds are thrown out every year, and billing a patient for a drug that isn't used is borderline billing fraud, in my humble opinion. Not to mention the fact that each syringe, each needle, each discarded drug just means more medical waste to deal with... which adds additional cost.
-copro
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I wonder if there is a way to stop this waste!?😕
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Just curious if there are some good, evidence based websites out there to get all of these facts for some debate-goodness.
I am actually a miserable nursing student who is going into my final semester for the BSN, and we have a lot of this community based stuff next semester and a lot of debates on health care, and I want to be ready to take on my militant professor.
Now, inherent to nursing school, all of the professors are blindly liberal in their opinions and dont always consider the ramifications of their suggestions to problem solving. Also, you all have seen nurses get militant-like on the units and in their union stuff, but you have no idea how bad it is in nursing school. They bash every health care profession, including respiratory therapy, physicians, lab techs, etc, it is unbelievable.
And yes, the NPs are out for your jobs and they think they can do primary care better for some reason. I was offered to take the graduate level pathophysiology courses during my BSN semesters and my academic advisor told me not to waste my time because the science underlying those courses is actually easier than the science I received in my biology minor (your basic 300 & 400 level undergradute bio/biochem/molecular courses). Now, is that someone you want treating your sick kid on a late weeknight? Not me.
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Not sure about how to apply evidence-based medicine in this context -- I tend to think of that more in the context of randomized studies. Insurers' negotiating with hospitals, however, is well documented by NY Times, Wall Street Journal, etc, as is the "full price" policy for those who pay cash. There was an excellent example in the WSJ a few weeks ago, if I remember correctly.
But a few thoughts. First, at the heart of it all, there are only two basic ways to ensure "universal" coverage:
1. Agree to pay for whatever care would benefit the patient, accepting that this involves enormous and unpredictable amounts of money.
2. Budget a set amount, and restrict care such that only the budgeted amount will be spent.
All socialized ("single payer") systems to date have used choice #2, although they don't generally come out and say that. Britain was exposed previously for making it extremely difficult for patients with rheumatoid arthritis to get drugs like Enbrel and Humira, because they're quite expensive. Instead of a formal "you won't get this," there is often a lot of bureaucracy to discourage its use.
(This http://www.rheumatology.org.uk/publ...J9UKpOj6nwpARs23Q&sig2=WnEHoqLempA9jb_usnDGjQ
is a link to a study in the British journal "Rheumatology" on that subject)
Studies like MRIs also tend to have a much longer lead time, again compared to cheaper alternatives. The result is rationing without a formal rationing policy, and the possibilities for abuse are unfortunately obvious.
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job security in anesthesia --- work for the government at either a VA and or in the military --- you will NOT be fired!!!
flip-side you will be woefully underpaid compared to the private sector
copro brings up good points and I agree with all of them --- however, we chose an industry that was going down-hill over the last 30 years. This hasn't just happened during the last 8-10 years....
then again, i have to admit that when i went to med school i was VERY ignorant of what it meant to be a physician --- i still remember showing up for orientation for surgical clerkship (1st rotation of my 3rd year) and being told I was going to be on call q2 for 1 month and then q3 for the 2nd month... I HAD NO IDEA WHAT THAT IMPLIED until I realized I hadn't fed my cat for 3 days cause i was at the hospital non-stop...
the biggest issue is the FTC issue --- and that WILL NEVER BE FIXED - the insurance companies will never allow that to happen --- and they control the legislature far better than do physicians... and the legislators are more likely to listen to an insurance company that has 4 million lives covered in their state versus a few doctors .... for example
so go into medicine because you enjoy helping people - and you will quickly realize that the people who need help the most are the ones we can't help... the disabled, the disenfranchised, the drug addicts, the obese... those are social issues that we can't fix with pills/injections/surgeries...
or do what copro suggests: find the best paying gig, sell your soul for as much cash as possible, and invest EVERY penny so that you can get out as soon as possible.... that means no fancy cars, no fur coats...
flip-side you will be woefully underpaid compared to the private sector
copro brings up good points and I agree with all of them --- however, we chose an industry that was going down-hill over the last 30 years. This hasn't just happened during the last 8-10 years....
then again, i have to admit that when i went to med school i was VERY ignorant of what it meant to be a physician --- i still remember showing up for orientation for surgical clerkship (1st rotation of my 3rd year) and being told I was going to be on call q2 for 1 month and then q3 for the 2nd month... I HAD NO IDEA WHAT THAT IMPLIED until I realized I hadn't fed my cat for 3 days cause i was at the hospital non-stop...
the biggest issue is the FTC issue --- and that WILL NEVER BE FIXED - the insurance companies will never allow that to happen --- and they control the legislature far better than do physicians... and the legislators are more likely to listen to an insurance company that has 4 million lives covered in their state versus a few doctors .... for example
so go into medicine because you enjoy helping people - and you will quickly realize that the people who need help the most are the ones we can't help... the disabled, the disenfranchised, the drug addicts, the obese... those are social issues that we can't fix with pills/injections/surgeries...
or do what copro suggests: find the best paying gig, sell your soul for as much cash as possible, and invest EVERY penny so that you can get out as soon as possible.... that means no fancy cars, no fur coats...
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Gotta agree. Wasting drugs is one my biggest pet-peeves. I see co-residents drawing up every freakin' drug at our disposal just to be "prepared" for any emergency. Of course, most of it gets thrown out. I've also seen vials of unopened, unexpired propofol, sux, and misc. thrown into the garbage b/c the resident was post-call and too lazy to return it to the pharmacy. People just don't care when "they're not paying."
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I think so
As an engineer in the manufacturing industry for the last 10 years, I have witnessed firsthand how the roles of uninsured people in America has risen so drastically.
In the past, corporations would generally employ everyone who did work for them on a continual basis...operators, technicians, engineers. But starting about six or seven years ago, these companies started hiring temporary workers who they did not have to offer benefits to. This trend has continued ever since to the point that now, when the temps are legally required to be hired by the corp (after 6 months in AZ depending on the type of worker), the corp just lets them go and hires new temps. This is done at the cost of compromised quality, efficiency, yields, etc., but it ends up being cheaper for the business. Why? These companies now pay around $1200 per month per employee just for their health insurance premium. Now, even engineers are being hired as temp workers in many cases.
And it seems to me that this is the main factor in the increasing number of uninsured. But I dont blame the corporations necessarily. Rising health care costs were cited as the number one reason for the bankruptcy of Delphi Corp. (largest bankruptcy in U.S. automotive history) and the near bankruptcy of GM.
But its not health care costs that are necessarily going up, its simply the cost of health insurance that is going up. And while health insurance companies reduce reimbursements to physicians and increase premiums on everyone, they have been turning record profit margins (I read this on an AAMC STAT report about two months ago, but cant find the link now). All the while, more and more people become uninsured as companies go out of business, companies hire temp workers, move offshore, etc.
And as more and more people go uninsured, the calls for universal healthcare get louder and louder. 👎
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The cost of anesthesia (IV) drugs is something like 2.5% of the cost of an operation all told. Vials of simple stuff like succinylcholine and glycopyrrolate cost a few cents.
Another issue is only sharp things go in the sharps bin. You see gloves, tourniquets, paper packaging, syringes going in there. Syringes themselves ain't sharp, and they ain't "sharps." Sharps disposal is actually quite pricey.
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Hey Fakin', Good point there about how it is a waste of money when gloves and wrappers go into the sharps bin. But, for you and the other MS-3s out there, NEVER take the needle off the syringe after its been used. You should also NEVER put the cap back on the needle esp. if you are holding the cap with your other hand. Both are ways that people get needle stick injuries.
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A better example cannot be found to illustrate this than the multi-billion dollar medicare fraud that has/is occuring in south Florida.
-copro
