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Why are psychiatrists in general so afraid or uncomfortable talking about income potential in the field? Is it the type of people who go into psychiatry or just that everybody thinks making a lot of money in psychiatry is just not possible? I'm interested in hearing what people think.
 

whopper

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I don't know specifically where you're getting that idea. I'm not saying you're wrong but in general, people don't want to give the exact dollar amount of how much they make.
 
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I feel like in general the desire or idea to make a lot of money in psychiatry is frowned upon or looked down upon. My feelings are based on my experience in psychiatry residency, the general public's opinion of psychiatry, and even the postings on this forum. I would like to hear some feedback on this issue.
 

loveoforganic

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I think it's not so much specific to psychiatry as general to medicine, or even health care, due to the nature of the fields.
 

digitlnoize

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Its not that hard to find data on this. It has actually been discussed here, if you dig...

Other than that, there are many salary aurveys, which show incomes in the 175-225k range, generally.

Aside from that, you can google psychiatrist fee schedules, and look at some websites of what psych docs are charging. Ive seen mostly in the $175-250 per hr range, although some charge more, some less.
 

OldPsychDoc

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I feel like in general the desire or idea to make a lot of money in psychiatry is frowned upon or looked down upon. My feelings are based on my experience in psychiatry residency, the general public's opinion of psychiatry, and even the postings on this forum. I would like to hear some feedback on this issue.
My opinion--and yes, it's just that, an opinion--would be that we hear a lot on this forum from people without much actual career experience talking about income expectations for cash-only private practices. Meanwhile, those of us who have been doing this for awhile know that the patients who truly have the biggest problems and the real Severe Persistent Mental Illnesses are going to inhabit the forgotten margins of society and are not exactly sought after for their ability to sustain a practice's revenue stream. I will say I make a darned good income, placing me safely within the upper middle class of this country. I also believe in something called a social contract--to not forget those who are not as fortunate as I.
 
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surftheiop

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Why are psychiatrists in general so afraid or uncomfortable talking about income potential in the field? Is it the type of people who go into psychiatry or just that everybody thinks making a lot of money in psychiatry is just not possible? I'm interested in hearing what people think.
As complete outsider to the field it would seem pretty obvious why people frown on excessively talking about how to maximize salaries.

To make more money you need to either work more hours or make more money per hour. And especially in a field like psychiatry, trying to make more income per hour would almost certainly lead to worse patient care at some point.

Everybody has a friend/relative who thinks all psychiatrists are money grubbing swindlers because they only get to see their psychiatrist for 10 minutes at a time. People on this forum probably don't want to encourage that sort of practice.
 

masterofmonkeys

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As an unabashed consequentialist libertarian, I am not against people making money. But, I think the problem most of us have with discussions about maximizing monetary potential with psych is that, unlike other professions and certain other specialties in medicine, it is hard to come up with a way to make a ton of money in psych while a) taking care of the truly sick or b) providing high-quality care.
 

billypilgrim37

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As an unabashed consequentialist libertarian, I am not against people making money. But, I think the problem most of us have with discussions about maximizing monetary potential with psych is that, unlike other professions and certain other specialties in medicine, it is hard to come up with a way to make a ton of money in psych while a) taking care of the truly sick or b) providing high-quality care.
You're sounding more Tyler Cowen-esque. Softening in your old age? ;)
 

michaelrack

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unlike other professions and certain other specialties in medicine, it is hard to come up with a way to make a ton of money in psych while a) taking care of the truly sick or b) providing high-quality care.
it's hard to make money in manymedical specialties while taking care of the truly sick and providing high quality care. Oncology was a possible exception, although I hear that profit margins are dropping on chemotx.
 

Sneezing

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My opinion--and yes, it's just that, an opinion--would be that we hear a lot on this forum from people without much actual career experience talking about income expectations for cash-only private practices. Meanwhile, those of us who have been doing this for awhile know that the patients who truly have the biggest problems and the real Severe Persistent Mental Illnesses are going to inhabit the forgotten margins of society and are not exactly sought after for their ability to sustain a practice's revenue stream. I will say I make a darned good income, placing me safely within the upper middle class of this country. I also believe in something called a social contract--to not forget those who are not as fortunate as I.
So far I have been noticing that often those who are truly sick in the grand scheme of things really don't need a psychiatrist as much they do other things. They really need some one to watch them like a parent for the rest of their lives. Also needed is intensive therapy to teach coping skills to lifes stressors. Then to top it off the miracle gift of insight. Otherwise we're doing nothing more than applying duct tape to pervasive behavioral issues to mitigate the harm an individual will cause to those around them.

The people who are going to make the biggest gains are those who already have fair coping skills and insight. By helping these people one could indirectly contribute more to society by helping this cohort return to baseline functioning quicker.

At what point do you stop and say to the borderline patient who is a suicidal swallower that their MasterCard (i.e. Medicaid) has run out? Do you wait for the 100th visit and EGD and 2.5million dollars later? Do you wait for the 200th swallow attempt?

Healthcare is on the fast track to rationing. You can only throw so many resources at a marginal gain. Insurance companies and medicaid are already starting to do it. How many patients have you seen no longer getting covered after x days of an inpatient stay? The patient really needs 2x days and now the hospital has to eat it. Eventually hospital budgets will lash back and discharge people, or not accept those with out certain insurance, or they will simply close down the units. The state hospitals will increase out of public outcry and eventually they will start to look like the asylums of old.

Public funds for our already strained system of halfway houses, group homes, day programs, etc. will collapse. As our economy tanks their will be more malingers seeking shelter and food competing against those who are afflicted. The overburdened system will hemmorhage to the point of collapse. And when you are bleeding out you apply pressure not suture the arterioles one by one.

I predict in psychiatry there will only be two real options available in the future. State institutions or private practice.
 

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How many patients have you seen no longer getting covered after x days of an inpatient stay?
I honestly hope you're wrong, but I can't argue with the quoted sentence. I've only been doing my new (inpatient) job for three weeks and I'm already tired of insurance companies telling me they know better than I do when patients are ready to go home.

I mean we all know how long antidepressants take to kick in, right? Let's say I titrate a patient to a therapeutic dose of an SSRI fairly quickly, but he's still suicidal and can't guarantee his safety outside the hospital. Next thing I know I have some insurance guy (a psychiatrist, no less) on the phone telling me he's not going to cover any further days because I haven't changed the patient's meds in a few days. "He's still suicidal," I say. "But you're not doing anything," he says. The patient's taking his meds and attending groups, but this doesn't count apparently. Even though we all know that anti-depressants don't work immediately.

Well, that's my rant for the evening. :)
 

Sneezing

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I'm sorry Sunlioness.

So far I've noticed from the perspective of the intern that depressed patients really only get 3-5 days to turn things around and if they happen to have some local variant of excrement insurance, they get just three days. It pisses me off to say people getting discharge faster than they should only to have them bounce back because the job wasn't done right the first time. The first day of "I'm not suicidal" and bam they're gone. They're not ready to function in society yet, but resource poor environment we're in dictates only the suicidal, psychotically dangerous, homicidal, or ADL incompetent get to be in the hospital. As a result substance abusers and over the top borderlines are over representing the suicidal category and pushing out some of the other categories including the newly mentally ill mood disorders.

I'm starting to get the impression that the only real function of hospitals now are to baby sit people to make sure they don't hurt themselve or others and the actual status of their disease improvement is of no concern. Its like kicking the CHF'ers out once they no longer look anoxic.

Some times I day dream about the notion of opening up my own inpatient unit once I'm in private practice to show insurance companies / large hospitals / government how its done, but its a fool's dream. Stark laws. Liability insurance. Basically, lawyers eliminating risk one dream at a time.
 

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Some times I day dream about the notion of opening up my own inpatient unit once I'm in private practice to show insurance companies / large hospitals / government how its done, but its a fool's dream. Stark laws. Liability insurance. Basically, lawyers eliminating risk one dream at a time.

It's called the VA.
 

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Sneezing,

I don't know if this will lend you any insight. By the time I finished residency, my opinions were much like the ones you expressed above. Many of them still are. Something that modified my views, but at the same time keeping the foundation the same was better exposure to psychotherapy from people outside of psychiatry.

What I noticed that tends to happen is several people wanting help go to a hospital. Several of these people didn't need hospitalization or mental health treatment that a psychiatrist typically gives. For better or worse, managed care has directed us to act as psychopharmacologists and treat those of the more severe mental health issues. (E.g. GAFs of 40 or below).

Some people are in need of mental health providers but not of the sort we usually provide (thanks to how managed care herded us.) Some people just need someone to listen to them and offer them validation. While this is not what a hospital should be providing, that's what is often happening.

If these people were to be directed to psychotherapists and not psychiatrists, it'd free up a lot of the issues you mentioned. Mind everyone that I am not against psychiatrists doing psychotherapy. In fact, I believe we should be strong in that area. I, however, also believe that we need to know our place and refer many of the cases we get to others. We should not be treating borderline PD if we do not know how to do DBT. We should likewise not be throwing a medication at every single problem. If we aren't going to medicate, we should be directing these people to other sources, or be doing the psychotherapy ourselves.

Where I did residency, no one knew how to do DBT. We did not have anyone we could refer our borderline patients. In effect, those patients, (among several other Axis II patients) didn't get the service they needed while the system billed the heck out of the government and those people were medicated that led to no real improvement and a lot of worsening (e.g. 100 lb weight gain).

After years of seeing it, I developed a resentment of borderline patients. It is after all easy to blame someone where they have a disorder but they are still in control of their faculties and therefore arguabley not excusable for their self-destructive behavior.

2 years later and seeing dozens of patients improve with DBT, my opinion is now that these people do need the right service and geez, it's the thing that the textbooks say we are supposed to do, but for some idiotic reason very few psychiatrists are doing it. Can I blame my program? Perhaps, after all anyone with half a brain in that program in the faculty should've realized our hospital was chock full of borderline patients, but none of them were making any steps to recruit a DBT therapist or learn it on their own. However, as much as I could blame them, this a problem I've seen in almost every area I've practiced in, seen, or when in discussion with my colleagues at other programs they say the same thing is happening in their neck of the woods too.

Some of those improvements have saved literally millions of dollars. Just for example one patient where I work, her symptoms were to the extreme where if she just walked down a flight of steps there was a likelihood she'd make herself fall. It wasn't suicidal behavior, it was parasuicidal. She was hospitalized for 5 straight years and each idiot psychiatrist diagnosed her as psychotic and tranqued her up on what have you (Haldol, Zyprexa, Depakote). A colleague of mine finally took over her case and took a new approach. If everyone (including the idiot psychiatrists that dosed her up on antipsychotics, mood stabilizers and benzos) thinks she's borderline and no one thinks she's psychotic, then why are we treating her as if she's psychotic and not as a borderline?

She was weaned off all her meds, was started on DBT and 6 months later she was discharged. The parasuicidal behavior stopped in the first two months of DBT treatment. The cost? About $750 a day and she was hospitalized for 5 years.

What is 1+1? It's two. right?

What's the treatment for borderline PD? It's DBT.

Ask a psychiatrist what the treatment for borderline PD is, they'll say DBT, but then they'll give the patient 5 meds and no DBT.

Now tell me where the sense is in that!?!?
 
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Sneezing

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What do we do about the frequent flyer borderline who refuses DBT on multiple occaisions? Continue to offer it until they move through the stages of contemplation?
 

whopper

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What do we do about the frequent flyer borderline who refuses DBT on multiple occaisions? Continue to offer it until they move through the stages of contemplation?
Wow, now that's a different problem. Where I did my training, many of the patient would've jumped at DBT if you told them it was the right treatment and why they haven't gotten better in years.

If they refuse DBT, then you got to set boundaries. If what they want is not therapeutic, you shouldn't offer it. E.g. Ativan, Xanax, etc.

If they meet commitment criteria and refuse DBT, and it's an extreme (I'm talking parasuicidal to the point where they truly are in danger of suicide), then you admit them. If you're hospital doesn't offer DBT, perhaps long term care does (but then again maybe not).

DBT, mind you, if done properly would offer 24 hour support services for the more extreme patients, and in several of those cases, the patients have been put in a situation where they don't have many other options. E.g. someone who is in mental health court has to get treatment or they could go to jail. Others may have been literally told several times that medication is not the appropriate treatment and if seen on the inpatient unit, they will be discharged immediately.

(Heh, reminds me of an attending I had in residency. The second he saw a borderline he discharged them. Most of the borderlines were hospitalized for less than 12 hours and when he showed up in the morning---OUT! As cruel as that sounds, that actually in many cases is not off with what DBT recommends. The problem was that the patients had no place to go to get DBT once they were discharged.)

But aside from DBT, my opinion stated above is for several patients who don't need what the hospital provides. E.g. welfare drug addicts who only go to the hospital because they've spent all their money on drugs for the month and they claim to be suicidal but are really seeking 3 hots and a cot, institutionalized former criminals who don't want to go to prison but want someone to take care of them, women who claim to be suicidal only because they wanted attention from their boyfriend, etc.

The program you are in needs to develop a strategy to deal with these people without them ripping off the system but at the same time, in a non-judgmental manner, direct them to what they really need. Unfortunately that direction may not exactly seem compassionate to the patient at that time.

The problem is that several programs label someone and medicate when that is often not the right answer.

The worst extreme case I had was a homosexual man who felt he was in man-heaven in the inpatient unit. This particular individual had histrionic personality disorder but was diagnosed with bipolar disorder and he did not have this disorder, or at least did not have a depressive, mixed, or manic episode while in the hospital for 2 months. I told him I was going to discharge him and he told me the second he'd get out of the hospital he was going to cause a public disturbance to get back in. Thankfully, being that I work in a forensic psychiatric unit, we had another forensic psychiatrist do an assessment corroborating my opinion and the guy was discharged against his will. The guy caused a scene (exposed his penis at the first mom and pop store he could get to), the prosecutor ordered his records from the hospital, they read my report and the other doctors report, and instead of being sent back to the hospital, he was sent to jail.

What most places would've done would've been to keep this guy in the hospital.......indefinitely, even though no one believed he had an Axis I disorder, but someone would've written down Mood DO NOS, or Psychosis NOS when they didn't even believe in that diagnosis.

That is by no means a salutation on myself. I was only able to get to this point by doing forensic fellowship, knowing the laws inside out, knowing how the mental health court works, and being able to have a forensic psychiatric consult available. Most places don't have these things available to them.
 
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carlosc1dbz

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Why are psychiatrists in general so afraid or uncomfortable talking about income potential in the field? Is it the type of people who go into psychiatry or just that everybody thinks making a lot of money in psychiatry is just not possible? I'm interested in hearing what people think.
When talking about making money in medicine, we should focus on how we can make money outside of medicine while being good doctors. I was recently thinking about the baby boomers and the services that they will need. I think the flash flood of consumers of senior services will rise in a way that has never been seen before. Any investment ideas? Any entrepreneurial ideas anyone?
 

masterofmonkeys

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Basically, lawyers eliminating risk one dream at a time.
That was incredibly poetic and may have made me fly into a brief destructive rage. Wanna make out?

Seriously, I agree with you that the system is broken. I personally have no intention of taking insurance if I can possibly pull it off. I have no belief in the current system. It's built on ******ed premises that make no sense epistemologically, economically, or ethically. So it can kiss my ass.
 

whopper

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Here's why the system is broken.

How much money does it make for a doctor to do a triple bypass?

How much money does it make for a doctor who sits with his patient and educate them on lifestyle modification, the importance of a statin, and quitting smoking?

Several doctors will gleefully do the bypass. Very very very few doctors do the education. What intervention saves the system more money and is much more cost effective?
 

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What was that British study that concluded preventive care costs more than people making poor decisions and dying early? They said preventive care had it's costs, and healthier people ended up getting old anyway (COPD, heart failure, cancer, etc) and required the intensive interventions and ICU stays that crank up medical spending. So it's cheaper if you have your first heart attack at 42 then die at 55. It costs more to stay alive until your 85 then die in the ICU. Sorry about the heartless tone of this post.

It seems if we're looking at the system and thinking how can we save money, we shouldn't counsel anyone, let everyone smoke/drink/get fat, and when they die earlier the system saves money.

But as physicians we have an ultimate responsibility to act in the best interest of the patient sitting in front of us, and that means we make poor financial decisions for the system to benefit the single patient. The system is inherently tied to these ethics, a paradox of saving money while providing optimal care for the individual patient.
 

Sneezing

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That was incredibly poetic and may have made me fly into a brief destructive rage. Wanna make out?
My BP still raises when I think about lawyers overall purpose.

Don't think the SO would appreciate that. Plus I think we're both sporting Y chromosomes. Two Y's is too many questions for me.
 

michaelrack

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When talking about making money in medicine, we should focus on how we can make money outside of medicine while being good doctors. I was recently thinking about the baby boomers and the services that they will need. I think the flash flood of consumers of senior services will rise in a way that has never been seen before. Any investment ideas? Any entrepreneurial ideas anyone?
It's hard to have time outside of medicine to make money if we are spending the time necessary to be good doctors.
 

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What was that British study that concluded preventive care costs more than people making poor decisions and dying early? They said preventive care had it's costs, and healthier people ended up getting old anyway (COPD, heart failure, cancer, etc) and required the intensive interventions and ICU stays that crank up medical spending. So it's cheaper if you have your first heart attack at 42 then die at 55. It costs more to stay alive until your 85 then die in the ICU. Sorry about the heartless tone of this post.

It seems if we're looking at the system and thinking how can we save money, we shouldn't counsel anyone, let everyone smoke/drink/get fat, and when they die earlier the system saves money.

But as physicians we have an ultimate responsibility to act in the best interest of the patient sitting in front of us, and that means we make poor financial decisions for the system to benefit the single patient. The system is inherently tied to these ethics, a paradox of saving money while providing optimal care for the individual patient.
Interesting point.
 

whopper

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What was that British study that concluded preventive care costs more than people making poor decisions and dying early?
There is data showing that dying early could actually cut costs to the healthcare system.

But this brings up a few questions. E.g. in European systems, someone dying often doesn't cost as much. In Europe, people culturally are more open to hospice and not the extreme interventions we do in the states where people have ICU interventions that cost more than everything that person has ever spent (or spent on him) for healthcare just to keep that person alive for a matter of a few hours to days.

Other factors: we do need to factor the ethics into this as well and not being healthy often does contribute to several costs to society other than healthcare costs. E.g. sick days from work, decreased productivity, etc.

Another big factor is, if people's health were improved, society could raise the retirement age. It only makes sense. That would save and make society plenty of more money.
 

whopper

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Getting back to the original post there's an interesting dynamic in terms of making money that's in my area and not in many others.

We have a private hospital/center phenomenon. Well they don't like to be called a hospital, but it has an inpatient unit, so in my mind they are one.

The Lindner Center opened up a few years ago in the Cincinnati area. It's run by some of the top doctors in the country and it's based on a premise of giving care that is top-quality and over the standard of care.

http://www.lindnercenterofhope.org/

The former PD in my forensic fellowship left his position to take over a high role in that hospital, oh well the guy who took over was even bigger in the forensic field (Guttmacher award winner--the top honor in the field) and he was a great teacher that gave about 4 hours a week of one-to-one time with me so it was win-win for me.

This place pays psychiatrists more than most places and they only want good psychiatrists working there.

None of the psychiatric bull$**** doctors that start a patient on 5 meds the first day or give out benzos like they're candy. They only want doctors with a good track record.

But the point is, is that in some places you can work in an institution and make more money without having to do private practice.
 

Ibid

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Another big factor is, if people's health were improved, society could raise the retirement age. It only makes sense. That would save and make society plenty of more money.

Whopper I will take it as read that you were being ironic. It seems to me that having a healthy healthcare industry is now the political imperative rather than a healthy population everywhere.

The French have always been able to see the merit in a better quality of life rather than increased productivity even if that means they are less well off.

France Riots over Retirement Age increase from 60 to 62
http://www.youtube.com/watch?v=CGRu0vhnxXk&feature=related
 

whopper

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I'm very aware of the French riots. I'm also very aware that several countries including this one are on the verge of bankruptcy and one of the problems are a population of people entering retirement age that are fully capable of working. The social security system in the U.S. is on the verge of collapse.

Of course someone that cannot work should not, but plenty of people are living longer because they are healthier.

The fiscal problems are of course more complicated than simply people's retirement. A problem with any retirement age is it cuts a line in the sand that must apply to everyone and that too is more complicated than that.
 

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The worst extreme case I had was a homosexual man who felt he was in man-heaven in the inpatient unit...the guy was discharged against his will. The guy caused a scene (exposed his penis at the first mom and pop store he could get to)...and instead of being sent back to the hospital, he was sent to jail.
*resisting tasteless joke*
 

Ibid

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one of the problems are a population of people entering retirement age that are fully capable of working.

Whopper, so true. I blame the baby boomers for nearly everything, surely one of the most smug, greedy, selfish generations for a long time. Borrowed heavily, and then inflated their way out of debt at the same time index linking their final salary pensions which they took far far to early. All the while benefiting from a never to be repeated property boom that allowed them to think they were somehow "clever".

Our children will have a lot to thank them for.
 

Sneezing

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There shouldn't be a retirement age. There shouldn't be social security. People should save for themselves. If you can retire at 30 go for it. If you retire at 70, congratulations, you made a choice and are retired. Where in the constitution did it ever say we the people are responsible for the fiscal wellbeing of neighbor? Having a standard retirement age encultures the concept of a finish line and entitlement that people should reach and obtain. Now as a result of this I see folks coming through who cite as a stressor that they never saved for retirement. We need to get rid of this and maybe it will sink in for people to start looking for jobs they like or striving to take steps inorder to get the jobs they like and then no one will want to retire. How often have you seen someone who just retired then they spend their days watching television? An idle mind is a dangerous thing.

The french are lazy idiots. Rioting over retirement age?
 

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Sneezing it gets worse.

The United States offers employees no statutory minimum holiday allowance but the typical average is 15 days 25 days total, the French in contrast do rather better with 40 days.

The French will be so envious of your zero employee benefit work until you are dead system its surprising they haven’t adopted it. Oh wait….looking at this table no one else thinks you plan is a good one either.

http://www.totallyexpat.memberlodge.com/resources/Documents/Mercer_Holidayentitlements_Globalcomparisontable.pdf

For the record my entitlement is 55 days. I must be really stupid.
 

OldPsychDoc

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Sneezing it gets worse.

The United States offers employees no statutory minimum holiday allowance but the typical average is 15 days 25 days total, the French in contrast do rather better with 40 days.

The French will be so envious of your zero employee benefit work until you are dead system its surprising they haven’t adopted it. Oh wait….looking at this table no one else thinks you plan is a good one either.

http://www.totallyexpat.memberlodge.com/resources/Documents/Mercer_Holidayentitlements_Globalcomparisontable.pdf

For the record my entitlement is 55 days. I must be really stupid.
I don't suppose this would be a good time to bring up France's mandatory government -funded universal health care, would it...? :D





(didn't think so... :oops:)
 

Sneezing

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Sneezing it gets worse.

The United States offers employees no statutory minimum holiday allowance but the typical average is 15 days 25 days total, the French in contrast do rather better with 40 days.

The French will be so envious of your zero employee benefit work until you are dead system its surprising they haven’t adopted it. Oh wait….looking at this table no one else thinks you plan is a good one either.

http://www.totallyexpat.memberlodge.com/resources/Documents/Mercer_Holidayentitlements_Globalcomparisontable.pdf

For the record my entitlement is 55 days. I must be really stupid.
Regarding your bolded you are putting words in my mouth. A person need not work until they are dead. I plan to, but people have a choice. People can save their own money and retire when appropriate for them. Most people in America live beyond their means. That is a cultural problem. You take away the nanny state mentalality and stop encouraging entitlement attitudes through the government and people will have no choice but to be adults and be personally responsible for themselves.

There are plenty of people who agree with me and are quite furious about the over extending government, increasing social programs, and rampant elimination of personal freedom.

I am choosing to interpret your saracasm as literal.
 

whopper

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I'm not trying to be judgmental or political but I think it's just darned common sense to not give entitlements to those that are capable of working especially given that the value of our dollar is plummeting, deficits are skyrocketing, and our current fiscal spending is not sustainable.

When WWII started, people in droves volunteered because it was the right thing to do. Today, our country is faced with a problem that could cause another great depression yet very few people seem to want to heed the call and make the tough actions needed. I figure it's a hell of a lot more work to join the military, put your neck on the line and fight in war for several months, even years than it is to merely may your own way and pay for what butt takes out of society.

The problem goes from those wanting entitlements that don't need them all the way to people in power screwing others for their own pockets.

But this post is a heck of a digression from the original question!
 

Ibid

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you're not stupid, your employer is

I don't think so. It is a contract both parties entered into freely. I could ask for more compensation in cash terms but I prefer longer holidays. I already do more work than I am obligated to do so my employer is doing the right thing. I can't see how from my employers point of view it would be smart for them to pay me more. Certainly I would demand more if my holiday entitlement was reduced.

If there is extra work to be done they can employ someone else to do it.

Old Psy Doc

I don't suppose this would be a good time to bring up France's mandatory government -funded universal health care, would it...?

lol Just to add insult to injury they live longer than just about everyone else as well.
Just don't bother sticking out your tonque when you want a pain killer, I expect you know their healthcare delivery systems differ in more ways than one.

Sneezing

Come on….you are happy to post "The French are lazy idiots" and then become indignant when you don't get a thoughtful nuanced response.

Most people in America live beyond their means. That is a cultural problem.

I agree and its not limited to the U.S.

You take away the nanny state mentalality and stop encouraging entitlement attitudes through the government and people will have no choice but to be adults and be personally responsible for themselves.

Fine. Does this apply equally to all the tax dodgers getting their income classed as capital gain? Does this apply to everyone getting tax credits? Every one who keeps money hidden offshore? All these perks and admittedly legal and illegal tax avoidance measures, greedily taken up in the same value free moral free vacum that exists in the financial sector have a cost and it all is being funded ultimately by government borrowing. Are all these "hard working" tax dodgers going to start pulling their weight as well? Are they happy for the nanny state to raise their taxes and stop going to the sovereign debt market on their behalf? Who is really addicted to sucking nanny states tit? The entitlement culture is not just about welfare. Why kick the most vulnerable when they are not the largest part of the problem?

There are plenty of people who agree with me and are quite furious about the over extending government, increasing social programs, and rampant elimination of personal freedom.

And all tea party supporters no doubt.

Almost comic if it were not tragic. You are cross about social programs?? Your supposed self reliance (as is mine) is dependent on cheap energy, and exploitation of the people and natural resources in the third world all given a nice kick start by the slave trade. Self reliance, that is just a sick slogan propagated by people who would have you run faster so they can sit back and take it easy bobbing around in the med sipping Champagne.

Again re: The French are lazy idiots. By all means work yourself into an early grave with the outside chance that you too might spend a few decrepit years living on dividend income. I choose to take my holidays now.

Whooper

As I am sure you know the second world war was caused by the rise of fascism which is what people turned to in Germany and Japan precisely because capitalism failed. That is what we have to fear now.
 
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whopper

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As I am sure you know the second world war was caused by the rise of fascism which is what people turned to in Germany and Japan precisely because capitalism failed. That is what we have to fear now.
IMHO what happened...

When people are pushed lower on Maslow's pyramid, they either stop thinking with their brains and/or they start making decisions out of anger. In Germany, a combination of the loss of WWI, dire economics, and cultural uniformity led to all of the problems. IMHO it was more than capitalism failing.

I mentioned this on the board before...Capitalism is not the free market. Capitalism is the act of competition between free agents so that a better product is given to the consumer for a cheaper price. Adam Smith, the founder of Capitalism, stated in his book several times that it is not simply the government leaving EVERYTHING alone.

If there were a completely free market, companies could lie about their product, pump cocaine in it to spike sales, put their competition out of business via methods that do not promote better products (e.g. burning it down or buying them out etc.). These things actually were going on without government intervention.

Smith argued that if the government were to get involved, it should only do so up to the point where it created the rules of fair play where competition would again be reinstituted. He mentioned that anti-trusts, regulations, etc. would actually be needed if people decided to not follow the rules of competition. That actually is game theory, but Smith mentioned these things in The Wealth of Nations

A problem is the talking heads have used the Big Lie Technique that Geobbels perfected. Speak a lie enough, people start believing it's the truth. Pretty much every right leaning talking head that gets ratings mentions Capitalism as something equating no government interference. That is not true. (I state the "ones that get ratings" because conservatives that are intellectually honest such as George Will do not resort to this bull.) Capitalism does, however, mean no interference so long as people work harder to make a better product for a cheaper price.

What's going on now is that IMHO is our country is on it's first steps of being tthat empire you read about (Rome, Spain, etc) that who's best days are now behind it. It's a problem that's of our own making. Our dependence on foreign oil, our skyrocketing deficits, people wanting entitlements that are perfectly capable of working, these are all things that if the country collectively as a whole wanted to solve we could.

(Apologize for writing OT.)
 

michaelrack

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As I am sure you know the second world war was caused by the rise of fascism which is what people turned to in Germany and Japan precisely because capitalism failed. That is what we have to fear now.
Perhaps you mean Italy instead of Japan? I don't think the failure of capitalism had much to do with Japan entering into WWII.
 

Ibid

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IMHO what happened...

When people are pushed lower on Maslow's pyramid, they either stop thinking with their brains and/or they start making decisions out of anger. In Germany, a combination of the loss of WWI, dire economics, and cultural uniformity led to all of the problems. IMHO it was more than capitalism failing.


Yes, I agree the Treaty of Treaty of Versaille being so harsh contributed in Germany but the common thread was the global depression of the 1930s. As you allude to when people felt insecure they turned to authoritarian and nationalistic leaders who appeared to offer certainty. Japan also had the difficulty that it was excluded from its natural neighbouring markets by colonial powers.

I mentioned this on the board before...Capitalism is not the free market. Capitalism is the act of competition between free agents so that a better product is given to the consumer for a cheaper price. Adam Smith, the founder of Capitalism, stated in his book several times that it is not simply the government leaving EVERYTHING alone.*

If there were a completely free market, companies could lie about their product, pump cocaine in it to spike sales, put their competition out of business via methods that do not promote better products (e.g. burning it down or buying them out etc.). These things actually were going on without government intervention.*


They still go on. Enron being the first example that springs to mind.

Smith argued that if the government were to get involved, it should only do so up to the point where it created the rules of fair play where competition would again be reinstituted. He mentioned that anti-trusts, regulations, etc. would actually be needed if people decided to not follow the rules of competition. That actually is game theory, but Smith mentioned these things in*The Wealth of Nations

A problem is the talking heads have used the*Big Lie Technique*that Geobbels perfected. Speak a lie enough, people start believing it's the truth. Pretty much every right leaning talking head that gets ratings mentions Capitalism as something equating no government interference. That is not true. (I state the "ones that get ratings" because conservatives that are intellectually honest such as George Will do not resort to this bull.) Capitalism does, however, mean no interference so long as people work harder to make a better product for a cheaper price.

It might well mean that but the free market also means that free agents are able to enter into contracts that do social and environmental damage to innocent third parties. Eg you buy a car and every one lives with the pollution. It is only governments that can deal with these externalities using tax and regulation as instruments. Secondly some of these externalities can only be dealt with by nations cooperating with other nations. Eg Kyoto

The third point is that the market is not perfect, otherwise speculators would have no reason to operate. When the market fails, as it often does, it has a huge social cost and government can not just sit on the sidelines. Its all very well for the market to set the price of carbonated drinks and potato based snack foods but it is not a rational way to deliver health care. IMO that is the job of government.

The fourth point I would make is that governments are required to deal with both the threats and opportunities caused by multinational corporations as well as shady international tax havens that in fact are anti-competitive.

The other thing these talking heads don't do (I think I know who you mean) is follow through. How many of them would legalise drugs and prostitution? IMO The free market and a bit of regulation are just what is needed here. (no worse than alcohol and cigaret's IMO)

What's going on now is that IMHO is our country is on it's first steps of being tthat empire you read about (Rome, Spain, etc) that who's best days are now behind it. It's a problem that's of our own making. Our dependence on foreign oil, our skyrocketing deficits, people wanting entitlements that are perfectly capable of working, these are all things that if the country collectively as a whole wanted to solve we could.*

Rome fell because it did not as an Empire capitalise on what it had. It had no vision for itself beyond the enrichment of an elite.

Collective being the key word here. The idea that we can all continue to leave our childrens future to market chance is misguided. We have the ability as humans to shape our world and we should do so.

On that note if you are not familiar with him and you may well be, this chap as well as others like him who believed in actively shaping the world may interest you as you often rail against incompetence and you have mentioned "transparency" as an ideal at least once. ( A lancet also being a sort of window as well as a blade). Transparency being a founding principle of The Lancet I wondered if you came to that idea independently or some other influence was at play. Perhaps great minds do just think alike. Sadly the wiki entry only alludes to some of the legal battles he fought which brought the Lancet to prominence.

http://en.wikipedia.org/wiki/Thomas_Wakley

Michealrack

I standby what I wrote but I am happy to rephrase for clarity.

The global depression of the 1930s was the major contributory factor in the rise of totalitarian regimes around the world. The second world war and the Sino Japanese war, that merged with it in the pacific and became part of it, are both examples of what we have to fear from global market failure.
 

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I love psychiatry! Borderline transexuals in the morning, depression & anxiety all afternoon, and 20th century European history and economic theory at night... :D
 

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Transparency being a founding principle of The Lancet I wondered if you came to that idea independently or some other influence was at play. Perhaps great minds do just think alike. Sadly the wiki entry only alludes to some of the legal battles he fought which brought the Lancet to prominence.

http://en.wikipedia.org/wiki/Thomas_Wakley


What an interesting person. You couldn't ask for a better biography to make a movie out of!

Hang on, we're approaching Godwin's Law! :D
:laugh: :laugh:
 

whopper

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Agree with you Ibid on several points.

In the field of Industrial Psychology (and this is not taught in psychiatry), there is the concept of the reinforcer affecting business decisions.

E.g. company dumps toxic waste, it gets fined $10,000 a week. If it actually cleaned up the toxic waste appropriately, it has to pay $100,000/week. Under those circumstances a company could legally dump the toxic waste so long as it payed the fine. Now assume the damage to the local community was $1,000,000/week from the toxic waste.

That's a lot of what is going on now IMHO on several several levels. A lot of the interventions we use are not cost-effective (E.g. a triple bypass vs. educating the patient on diet and exercise, the former gets reimbursed much more).

The market regulations as they are IMHO do not promote quality of care. As I mentioned several times, if I see 5 patients an hour, I get to bill 5x. I see one patient an hour I can only bill once. From my anecdotal experience, the majority, not the minority of private psychiatrists fly through patients with bull$hit a diagnoses and a cascade of medications without really knowing what's going on and it's actually being promoted by the current system.

The flip-side, the psychiatrist that works for a system, they don't make more money. They make the same amount of money but then there's the other problem. Several of them intentionally do less work. I see that now in the state hospital.

As for the talking-heads, it's a shame because many of them are driving a significant level of opinion and much of their comments are bull. An intellectually honest pundit such as George Will gets no attention...because he's ahem, boring.
 

Ibid

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Regarding George Will I was not familiar but a brief perusal confirms he has indeed elevated tedium into an art form. Some of his openers like the one I found below aren't exactly attention grabbing. I guess his p prize is consolation enough for him.

"When liberals advocate a value-added tax, conservatives should respond: Taxing consumption has merits, so we will consider it -- after the 16th Amendment…….zzzzzzzzzzzzzzzz"

Fortunately there are informed commentators on both sides of the political divide so there is some solace in that. Its the empty vessel that makes the most noise.

The flip-side, the psychiatrist that works for a system, they don't make more money. They make the same amount of money but then there's the other problem. Several of them intentionally do less work. I see that now in the state hospital.

I don't have a fully worked up solution to the conundrum posed but I do think that along with utilization review (you have mentioned you find this rather ineffective) there are other sticks that could be used to root out bad practice and change behaviour in both the private and public sector.

The riddle above rotates around money but another thing that doctors in particular value is reputation, so if a common set of easily discernable practices that indicated that a particular Doctor was performing sub-optimally was widely available to patients and the general public it would go some way to eliminating those practices in public and private settings.

The profession itself would have to validate these indicators but I imagine you could come up with quite a few off the top of your head that would not be terribly controversial, indeed you have already mentioned a few.I can see an APA information leaflet now. "Five sure fire ways to tell if your Psychiatrist is a Gibbon." 1. All the fish in the lobby tank are head bumping the glass....2......Perhaps not.