Organized Medicine?

[LADoc00]

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Anyone ever thought would MDs could accomplish if for example all the docs in one city decided that their Medicare reimbursement were too low and they would go on strike, call in sick or all take vacation at the same time? Imagine the political pressure of people running to an empty/closed ER, seeing a closed lab, local doctor's office etc. People would freak the hell out and something might actually change!

Imagine it.

 

[timtye78]

One of the problems would be coordinating an event like that, and there is bound to be some conscientous (sp?) doc(s) out there who wouldn't participate and the idea would crash, the rest of the docs would look like jerks.

That being said I did hear of something like that happening in Las Vegas a couple of years ago. I heard they shut down their own trauma unit/ED or something when their malpractice premiums went up. I never heard a followup to the story.

Another thing is maybe today's physicians are too caught up in financial commitments to undertake something as dramatic as that that could risk their ability to make incomes. Many people still seriously hesitate to refuse consults just in fear that they might bever be asked again if they did refuse. In fact, it seems to be the 'mark' of the more than established physician who can afford to refuse consults.

I am suprised by the lack of lobbying power of the highest earning people in America. How come so many mid to lower levels can become so powerful a force with lobbying groups, and some of the 'smartest', highest income earning groups in America continually lose ground?

 

[doc05]

I am suprised by the lack of lobbying power of the highest earning people in America. How come so many mid to lower levels can become so powerful a force with lobbying groups, and some of the 'smartest', highest income earning groups in America continually lose ground?

It's a matter of numbers. "mid" and "lower" earning people make up a much larger segment of voters. Hence, they have more power.

 

[blocks]

Still, there is power in the most highly trained/most responsible saying 'you have pushed us too far, and we will not stand for this anymore'. The reason why it hasn't been done is not because of numbers, it's because physicians are ingrained with the idea that they need to sacrifice their wellbeing to care for others. Midlevels and nurses don't have that same set of ideals, to them it's a job, and if they're geting shafted, they will rise up or walk out. I think that what the OP alludes to should be seriously considered, in the face of 'socialized medicine', when most docs realize what a disaster that is, for ourselves, and for healthcare quality in general.

It is time for those of us who are the ones ultimately responsible for healthcare to stand up and take a leading role in its future, and not let people who have no clue about the realities of the situation, and don't give a damn about docs, to make the dictate how we practice.

I urge all graduating MS4s and residents to get involved, and at least write their representatives. I really don't want to have to choose between sending my kids to college and paying off my own 1/4 million in debt.

 

[DarksideAllstar]

That being said I did hear of something like that happening in Las Vegas a couple of years ago. I heard they shut down their own trauma unit/ED or something when their malpractice premiums went up. I never heard a followup to the story.

The trauma center here was shut down for a few weeks, all traumas were diverted to Arizona/Utah. The state ended up footing part of the malpractice until a new carrier was found I believe.

 

[docB]

As for the Vegas angle a few points are relevant. The docs at the trauma center didn't strike, they quit. There's an important difference. These were orthos who decided that they couldn't afford the cost of med mal to be on call for the traumas so they just gave up all their trauma call effectively closing the trauma center. They didn't strike in as much as they weren't holding back and trying to bargain. After they quit the hospital and the county came up with a plan to mitigate their liability and then many of them started taking call again. The plan revolved around additional subsidies to cover the med mal and the county essentially hired the on call docs as employees that put them under a $50K liability cap that the county has.

In general striking will not work for doctors. The public relations backlash would be too great. The public think that doctors make enough that we should put up with whatever society throws at us, med mal crisis, EMTALA, decreasing reimbursements, whatever. The public thinks that we're like cops and firefighters and can't strike and the justice dept's stance on using the RICO laws to stop collective bargaining by physicians seems to support that belief.

I think that what we need to do is be much more aggressive about educating the public about the downside of all of these factors. I want everyone to know that EMTALA is behind the long waits in the ER, that med mal is behind defensive medicine and the scarcity of specialists, and that their 6 minute office visit is due to the reimbursement for that visit. The public is totally ignorant of these factor and their effects.

 

[LADoc00]

As for the Vegas angle a few points are relevant. The docs at the trauma center didn't strike, they quit. There's an important difference. These were orthos who decided that they couldn't afford the cost of med mal to be on call for the traumas so they just gave up all their trauma call effectively closing the trauma center. They didn't strike in as much as they weren't holding back and trying to bargain. After they quit the hospital and the county came up with a plan to mitigate their liability and then many of them started taking call again. The plan revolved around additional subsidies to cover the med mal and the county essentially hired the on call docs as employees that put them under a $50K liability cap that the county has.

In general striking will not work for doctors. The public relations backlash would be too great. The public think that doctors make enough that we should put up with whatever society throws at us, med mal crisis, EMTALA, decreasing reimbursements, whatever. The public thinks that we're like cops and firefighters and can't strike and the justice dept's stance on using the RICO laws to stop collective bargaining by physicians seems to support that belief.

I think that what we need to do is be much more aggressive about educating the public about the downside of all of these factors. I want everyone to know that EMTALA is behind the long waits in the ER, that med mal is behind defensive medicine and the scarcity of specialists, and that their 6 minute office visit is due to the reimbursement for that visit. The public is totally ignorant of these factor and their effects.

Certainly anything percieved as a strike would be dealt with harshly by the government, it would have to take the form of mass resignations. The first step in all this is sharply limiting the supply of doctors and specialists so there arent tons of vultures in the wings eager to take anything. To me this is real issue. Many med centers know that they can get new trainees or other doc to replace the malcontents very very quickly, change that and you change the power dynamic. Close 1/3 of all med school as the Pew Commission declared 10 years ago and put massive massive restraints on the entry of IMGs into the system. Both those are out of government hands and would go a very long way to solving these issues.

 

[deleted4401]

Doctors do not strike. We're better than that.

We are a part of a true profession, alone with the clergy and the law (certainly questionable, now), that have certain privileges as well as responsibilities. One is to self regulate, another is to take care of anyone that needs our services, another is to teach those junior to us, and finally, another is to show up to work, no matter what the circumstances.

I guess I'd be one of those that "screws up the strike" by showing up. There's too much at stake for us to damage our crediblity and turn our profession into nothing more than a group of technicians. We're not air traffic controllers or truck drivers, people. Yeah, sometimes a lot of this sucks - I know, I'm about to be an intern. But, you show up to work, you take care of people, and you hope society understands how much you care and why you spend so much time at the hospital.

The first time a sizeable group of physicians strike is the last time the public have any faith left in us.

My simple and sincere opinion,
Simul

 

[docB]

Doctors do not strike. We're better than that.

We are a part of a true profession, alone with the clergy and the law (certainly questionable, now), that have certain privileges as well as responsibilities. One is to self regulate, another is to take care of anyone that needs our services, another is to teach those junior to us, and finally, another is to show up to work, no matter what the circumstances.

We've definitely lost the right to self regulate. CMS (the Center for Medicare and Medicaid Services) sets our prices, we are in the midst of a med mal crisis where we get sued all the time so are we self regulated? I'd say no.

The first time a sizeable group of physicians strike is the last time the public have any faith left in us.

My simple and sincere opinion,
Simul

Does the public have any faith in us now? I'd say no.

 

[deleted4401]

Maybe I'm not cynical yet, maybe I haven't experienced as much as many people, but ...

As far as self-regulation goes, compared to other industries that have the percentage of funding from the government that we do (~60%), we're relatively free. Just not free from an absolute standpoint. As far as educating, doing research, and for the most part, the practice of medicine is guided by the physician. Maybe funding isn't, maybe reimbursement isn't, maybe if you are a salaried employee of a tightly regulated HMO, then the powers from above might trip up your game.

I think the public definitely has faith in us. Even with all the med-mal, the short visits, the advertising from enterprising docs, the endless paperwork patients endure, the increasing copays and premiums ... I still have mostly positive patient interactions. I'm not saying every one is great, but most of the patients, especially the ones most in need (the elderly, the critically ill, parents of sick children) are generally very satisfied and comforted when I spend my time with them.

Also, when I meet people on the outside, at least to my face, almost every single one of them is impressed and happy to see that I'm pursuing what I pursue. My friends and family feel the same way, as well. The admin and techs where I'm at right now are the same way.

Maybe I've just had unique experiences. At the Tulane hospitals, Charity, VA and the elective places I've rotated: Mayo, Beaumont, U of Chicago, UT-SW, doctors are still regarded highly, by patients, staff, and the public. And this being the case, by organizing and having the possiblity of a strike, I think it cheapens the field considerably.

I can understand people's frustrations with the way things are and appear, but we don't want to lower ourselves by organization. If you run with dogs, you'll catch fleas.

Simul

 

[LADoc00]

Doctors do not strike. We're better than that.

We are a part of a true profession, alone with the clergy and the law (certainly questionable, now), that have certain privileges as well as responsibilities. One is to self regulate, another is to take care of anyone that needs our services, another is to teach those junior to us, and finally, another is to show up to work, no matter what the circumstances.

I guess I'd be one of those that "screws up the strike" by showing up. There's too much at stake for us to damage our crediblity and turn our profession into nothing more than a group of technicians. We're not air traffic controllers or truck drivers, people. Yeah, sometimes a lot of this sucks - I know, I'm about to be an intern. But, you show up to work, you take care of people, and you hope society understands how much you care and why you spend so much time at the hospital.

The first time a sizeable group of physicians strike is the last time the public have any faith left in us.

My simple and sincere opinion,
Simul

A.) Im definitely not above striking.
B.) The public already has lost all faith in us.

The whole situation came about as the results of the attitude above. Meaning "Turn the other cheek" works great as a foundation for a monotheistic religion but has NO place whatsoever in the business world where real life occurs. Society doesnt give one rat's ass about physicians, look the absurd number of bogus malpractice cases that get settled, the American people almost elected John Edwards! If there ever was a bigger slap of the face of physicians everywhere, I would like to know what it is. No other job NONE has the ridiculous expectations of physicians, people are honestly going into it thinking they are gonna live forever!! And they want this spectacular care for next to nothing!

We collectively need a serious attitude adjust and realize medicine is a business not a calling from God. When someone goes to McDonalds and they are light on $, do they get big macs for free??! HELL NO.

 

[cloudnine]

A.) Im definitely not above striking.
B.) The public already has lost all faith in us.

The whole situation came about as the results of the attitude above. Meaning "Turn the other cheek" works great as a foundation for a monotheistic religion but has NO place whatsoever in the business world where real life occurs. Society doesnt give one rat's ass about physicians, look the absurd number of bogus malpractice cases that get settled, the American people almost elected John Edwards! If there ever was a bigger slap of the face of physicians everywhere, I would like to know what it is. No other job NONE has the ridiculous expectations of physicians, people are honestly going into it thinking they are gonna live forever!! And they want this spectacular care for next to nothing!

We collectively need a serious attitude adjust and realize medicine is a business not a calling from God. When someone goes to McDonalds and they are light on $, do they get big macs for free??! HELL NO.

LADoc if you really only care about the almighty dollar, why did you ever go into medicine? You should have been a hedge fund manager like my NY buddies who are 30 and Millionares!

People should go into medicine because they have a passion for it. I do agree there are fields within medicine that are not compensated as well (ie primary care, where doctors should be paid for the time spent on counseling a patient about their health conditions, like lawyers get paid for the time).

But you are in pathology right? that is what it says in your profile. You should have been smarter and gone into Biz if you really want a bigger piece of the pie.
And how can you compare to McDonalds to Medicine? Come on...now!

 

[docB]

Maybe I'm not cynical yet, maybe I haven't experienced as much as many people, but ...

As far as self-regulation goes, compared to other industries that have the percentage of funding from the government that we do (~60%), we're relatively free. Just not free from an absolute standpoint. As far as educating, doing research, and for the most part, the practice of medicine is guided by the physician. Maybe funding isn't, maybe reimbursement isn't, maybe if you are a salaried employee of a tightly regulated HMO, then the powers from above might trip up your game.

Well I'd say that a business in which the government regulates what you can charge, pays most of your bills and sets the fees paid to you by the private payers, then has authority over you by such entities as the CMS and the OIG is pretty tightly regulated. I mean if they set your prices and pay your bills you're in their pocket. No doubt about it.

 

[docB]

LADoc if you really only care about the almighty dollar, why did you ever go into medicine? You should have been a hedge fund manager like my NY buddies who are 30 and Millionares!

People should go into medicine because they have a passion for it. I do agree there are fields within medicine that are not compensated as well (ie primary care, where doctors should be paid for the time spent on counseling a patient about their health conditions, like lawyers get paid for the time).

But you are in pathology right? that is what it says in your profile. You should have been smarter and gone into Biz if you really want a bigger piece of the pie.
And how can you compare to McDonalds to Medicine? Come on...now!

This argument really annoys me. The assertion that everyone in medicine should not worry about the business aspects of it because "we're above all that" is how we got into this mess in the first place. Yes, you're suppose to have a "passion" for medicine but what do you do when you get to the end of the road and the regualtions and med mal make your day to day practice worse than a trip to the DMV? You keep slugging away and fight like Hell to change it.

 

[cloudnine]

This argument really annoys me. The assertion that everyone in medicine should not worry about the business aspects of it because "we're above all that" is how we got into this mess in the first place. Yes, you're suppose to have a "passion" for medicine but what do you do when you get to the end of the road and the regualtions and med mal make your day to day practice worse than a trip to the DMV? You keep slugging away and fight like Hell to change it.

Of course you try to change it, but if you are only changing it to be come a millonaire...than you went into the wrong buisness. It is hell of it easier to do so in any other profession. And in this profession, I would hope you do have passion and you are above it. I propose we get paid for our time as well as procedures, just like all other profesionals do. Time is money, and we are probably among the very few professionals who do not get reimbursed for our time. we should have an hourly rate, as well as fee for service. But it is the insurance companies, and lawyers who control us b/c most people do not think of the econimics. But comparing medicine to buying a burger at Mc Donalds, when you are responsible for someone's life. Come on! Go and get an MBA and stop complaining. Or go work for Micky D's!

 

[blotto geltaco]

One issue that has not been mentioned is possibly the most important of all, rather than some of the knee jerk responses seen so far. Federal antitrust law prohibits boycotts, or joint or collective refusals to deal with another party. As an example, in 1983 the court found that physicians in the Michigan State Medical Society unlawfully agreed amongst themselves that none of them would participate in the state Medicaid program until the state increseased their rate of payment for physician services. An interesting article can be found here

 

[retroviridae]

Doctors in Europe and many other countries strike all the time. Is it surprising that they get paid overtime for their hours on call, work 9-5 5 days a week (weekends are again overtime)? Doctors-in-training are much better off overseas than here. Heck, I know a Pedi ID doc who went back to Ireland and is being paid 185K Euros a year in academia. Can you even imagine that here in the US???

I agree, we should not be above striking. Do what all other docs the world over do, see only emergency cases, and stop seeing everyone else. Would there be a public backlash, yes. So you need to educate the public as to why we are striking. Proper PR could accomplish this.

There is a reason why most components of the medical system see continued increases in costs/renumeration, while MD salaries go down down down. We don't put up a fight, and are a helluva lot easier to manipulate.

In reality, I don't think we would even need to strike, a credible threat would be enough. Of course, since this would be unprecedented (I think) in the US, one or two might be necessary to get the ball rolling.

Of course, the US can't afford it's current healthcare system. So short of nationalizing healthcare, perhaps the best we can hope for is stabilizing our salaries while lowering renumeration for drugs, etc.

 

[dry dre]

I agree, we should not be above striking....Would there be a public backlash, yes. So you need to educate the public as to why we are striking. Proper PR could accomplish this.

No PR in the world would convince a population whose average household income is less than $50k that docs need to be ~paid more. I'm not saying that docs are overpaid, but goooooooood luck. As it is, states are having a hard time convincing their populations that ob/gyns are a good thing to have around...get serious now.

 

[docB]

Of course you try to change it, but if you are only changing it to be come a millonaire...than you went into the wrong buisness. It is hell of it easier to do so in any other profession. And in this profession, I would hope you do have passion and you are above it. I propose we get paid for our time as well as procedures, just like all other profesionals do. Time is money, and we are probably among the very few professionals who do not get reimbursed for our time. we should have an hourly rate, as well as fee for service. But it is the insurance companies, and lawyers who control us b/c most people do not think of the econimics. But comparing medicine to buying a burger at Mc Donalds, when you are responsible for someone's life. Come on! Go and get an MBA and stop complaining. Or go work for Micky D's!

Who said anything about becoming a millionaire? And as for the proposal that we get paid based on time rather than procedures, propose whatever you want but how are you going to make it happen? Primary care has been lobbying for that for a long time without success. Should they strike? Probably not, but they're not getting anywhere as it is.

As for the burger analogy it is applicable. Even though some of us hold health care as an etheral calling it is a commodity. It is bought and sold and is based on supply and demand with an unhealthy amount of regulation thrown in. The burger analogy is powerful because it illustrates the absurdity of the health care system. How long would McDonald's be in business if they had to give the burgers away for free then try to get "reimbursed" down the road. The fact that in medicine we even talk about "reimbursement" shows how our business model is in the toilet.

Telling people who take the business of medicine seriously that they should have gotten MBAs instead of MDs and should go work for Mickey Ds is just being part of the problem.

 

[beyond all hope]

I'm sorry, but MDs in Europe make much less money than doctors in general do in the U.S.. Also remember that they pay much higher taxes, up to 90%.

Doctors go on strike regularly in Israel as well. The difference is that they only strike for elective stuff: not for emergencies. They still take call and still staff the ER. The death rate goes down during a doctor strike...(probably due to less elective surgeries). It's not really very effective, and would be less effective here where many just go the ER rather than waiting for a doctor's appointment.

This is a difficult situation, and unfortunately doctors are not an effective lobbying force simply because we will always knuckle under rather than 'stand tough' and let our patients suffer. If you cut my salary I'm not going to stop going to work. I'll hate it and bitch and whine and moan but I'll keep seeing patients. Overall we're a pretty softhearted bunch. Also most doctors are very conservative and unwilling to take risks such as losing profits from referrals, bad recommendations, etc.

We need to organize. I think that a strike such as the ones done in Israel may become necessary (as an ER doc it wouldn't affect me much, because I would NEVER refuse true emergencies. I would send away people with toe pain and vagitch).

The currrent reimbursement system is not helpful for anyone except entire armies of billing personel that are employed to keep it running. It needs to be simplified. Cut the bureaucracy!

There are a few decent lobbying groups such as AAEM, but we are really small right now. We need more. Support your local lobbying group, like the lawyers do. Make your voice heard.

 

[retroviridae]

I'm sorry, but MDs in Europe make much less money than doctors in general do in the U.S.. Also remember that they pay much higher taxes, up to 90%.

Doctors-in-training get paid much better in Europe (with overtime). Yes taxes are higher. But then you get free healthcare/pension with that. I have to pay for my parking here. Anyway, the US is the promised land for MD salaries, I agree.

A strike would not sit well with the public, but it would get their attention. I think there are laws against residents striking. Isn't that in our contract somewhere (since our salaries come from medicare or the VA)?

 

[yaah]

It's all well and good for aspiring doctors and doctors to say "it's not about the money" or "Why did you go into this area if you are so worried about money." But the thing is - there are lots of non doctors out there who ARE worried about the money. And if physicians just let it all slide, they are going to get the short end of the stick time and again. Administrators and politicians and advocacy groups would be all too happy to reduce physician salaries further.

 

[MSHell]

I'm sorry, but MDs in Europe make much less money than doctors in general do in the U.S.. Also remember that they pay much higher taxes, up to 90%. ...

90% in income tax? are you on crack or just out of touch? The most heavily taxed european countries I wouldn't put above 55%. But the taxes pay for free health & dental care, prescriptions and other social niceties, like free education, including university. Oh, and low to no med mal to boot.

Back on track, I think that we are all partially in it for the money (or security, whatever you choose to call it), but also for some humanitarian aspect as well. If all you wanted to to was help people, there are a ton of other (and easier) ways of doing so that do not include med school + beyond. Same holds true if you only want to make the big bucks.