People who don't want to make money should consider a different career.

[GH253]

If you object to high physician incomes and only care about the welfare of poor people, you should consider a career in social work instead of medicine. Become a pro bono attorney or open a soup kitchen. Medicine is not for you, and real doctors are sick of listening to your babble. That is all.

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Members don't see this ad.

 

[Rendar5]

<_<
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>_>
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*confused to whome the post is addressed*

 

[GH253]

It's addressed to anyone who would complain about the fact that some physicians aren't satisfied with $150,000 a year.

 

[tibor75]

Doctors who whine about not making enough money should think about the last time they were concerned about being laid off, their company being bought out, or their job being outsourced.

 

[GH253]

Doctors who whine about not making enough money should think about the last time they were concerned about being laid off, their company being bought out, or their job being outsourced.

Why should they think about that? Because doctors have some kind of moral obligation to suffer as much as people who get laid off?

 

[docB]

Doctors who whine about not making enough money should think about the last time they were concerned about being laid off,

We haven't laid anyone off yet but my group has seen a drop in reimbursements of about 15% since the recession started. If this continues we'll have to cut hours and then we'll lay people off. We've already cut off our part timers. So I'm concerned about layoffs.

their company being bought out,

As hospitals get squeezed tighter the competition for EM, rads, path and hospitalist contracts gets more fierce. I am always concerned I might see my contract underbid by a competitor.

or their job being outsourced.

You mean like to midlevels, naturopaths, chiropractors and so on? Based on the number of threads about those on SDN I'd say people are plenty concerned about it.

But let's not forget that we live with the omnipresent threat of litigation for every patient interaction we undertake. We also face investigations and sanctions from running afoul of any of the Byzantine rules in the most heavily regulated industry in the universe. And I needn't point out the time spent in training or the debt incurred for that training.

So I think it's perfectly reasonable for docs to argue for higher pay. I certainly think it's a bad idea to let politicians and lawyers, who have shorter training, comparable incomes and no risk, try to guilt us into working for less.

 

[MOHS_01]

docB,

I was in the process of pointing out those very things last night when a sudden case of "WTF, why do I even bother anymore" struck.

I have personally witnessed EM, pathology, radiology, and anesthesiology become outsourced at several hospitals within the past 5 years.

I have watched hospital systems buy practices, start their own practice networks, flood the market with providers (both MD and midlevel), at times in a retaliatory or aggressive tone towards existing groups who were not being "good little soldiers", all in an effort to drive down incomes and reimbursement.

Discussing issues with those who suffer from more liberal leanings proves frustrating at times. In their mind, they are arguing from a position of moral superiority; everyone should strive in every effort to avail self to martyrdom for their fellow man. At one time I believed that they ignored basic human nature, logic, common sense, and reasoning... what I have since learned is that the common lib fits that mold fairly well, a lemming for the cause, while their leaders are a more sinister bunch who understand these concepts all too well. This is why they have systematically shaped the education, written media, and entertainment systems and continue with the progressive legislative march, eventually transferring all freedoms, liberties, rights, and responsibilities from the individual to the state.

Significant personal cost and sacrifice is incurred by a doctor along the way. If you do your job right, it is not easy. Compensation should be commiserate with these costs and responsibilities.... and, like all things, compensation is relative to alternative career compensation levels.

 

[MOHS_01]

One other thing -- they do not have to find another field... they can work for free for all that I care.... just as long as they do not hinder, hamper, or otherwise negatively effect the wage for those of us who do not share the desire to work as an indentured servant unto society.

It's funny how I never hear about a practicing physician complain that they are overpaid, saying that they welcome the opportunity to work more for less, etc. If so, they can come work for me and I'll gladly remove their guilt for them....

 

[tibor75]

We haven't laid anyone off yet but my group has seen a drop in reimbursements of about 15% since the recession started. If this continues we'll have to cut hours and then we'll lay people off. We've already cut off our part timers. So I'm concerned about layoffs.

As hospitals get squeezed tighter the competition for EM, rads, path and hospitalist contracts gets more fierce. I am always concerned I might see my contract underbid by a competitor.

You mean like to midlevels, naturopaths, chiropractors and so on? Based on the number of threads about those on SDN I'd say people are plenty concerned about it.

But let's not forget that we live with the omnipresent threat of litigation for every patient interaction we undertake. We also face investigations and sanctions from running afoul of any of the Byzantine rules in the most heavily regulated industry in the universe. And I needn't point out the time spent in training or the debt incurred for that training.

So I think it's perfectly reasonable for docs to argue for higher pay. I certainly think it's a bad idea to let politicians and lawyers, who have shorter training, comparable incomes and no risk, try to guilt us into working for less.

And this must be the reason why medical journals and job sites are absolutely devoid of any jobs for doctors....

Whhaa! I can't find a 300K job in New YOrk City! Whaa!!

I'm still waiting to read the article about the residency class that graduates and can't find any jobs...

 

[Charles_Carmichael]

I don't understand why physicians do not fight against decreasing reimbursements, etc. I have never encountered any other profession where workers were fine with losing pay. Go tell the auto workers that they will be getting paid less this year and they'll tell you to piss off. I don't know. Maybe I just have no idea how the real world works, but this is the feeling I'm getting after reading all these debates on here.

 

[MOHS_01]

It's not the working, practicing physicians who are for these cram down pricing mechanisms -- it is the misguided, inexperienced youth who are.

 

[ChandutheMagici]

It's not the working, practicing physicians who are for these cram down pricing mechanisms -- it is the misguided, inexperienced youth who are.

Physicians really did it to themselves. They chose to accept medicaid/medicare and they chose to accept "insurance". Now that these things are not turning out to be what they thought they would you're seeing a lot of guys switch back to cash only. I just wonder if it's too late?

As best I see it, pricing mechanisms set by anyone other than the physicians breed ****ty assembly line medicine. I worked for an FP and he generally saw 10 to 12 people in his first hour. That isn't to say you can't be a good physician in 5 to 6 minutes, but the odds that you'll miss something (I'm guessing) have got to increase with a decrease in time spent with a patient.

I tried to find a concierge physician, but unfortunately there is only 1 in my state and he is 2 hours away. So now, I'm stuck paying insurance (or prepaid health care, which is required by my med school) so I too can go to the cookie cutter doctors. None of which I have yet to see (I've been there once to get a Rx filled), but they still bill the doctor price for the PA.

I think you get what you pay for. I don't want to pay the lowest cost for a physician. I want to pay them what they're worth. And they are certainly worth more then they're getting paid now, especially PC guys and gals.

 

[docB]

Doctors who whine about not making enough money should think about the last time they were concerned about being laid off, their company being bought out, or their job being outsourced.

We haven't laid anyone off yet but my group has seen a drop in reimbursements of about 15% since the recession started. If this continues we'll have to cut hours and then we'll lay people off. We've already cut off our part timers. So I'm concerned about layoffs.

As hospitals get squeezed tighter the competition for EM, rads, path and hospitalist contracts gets more fierce. I am always concerned I might see my contract underbid by a competitor.

You mean like to midlevels, naturopaths, chiropractors and so on? Based on the number of threads about those on SDN I'd say people are plenty concerned about it.

But let's not forget that we live with the omnipresent threat of litigation for every patient interaction we undertake. We also face investigations and sanctions from running afoul of any of the Byzantine rules in the most heavily regulated industry in the universe. And I needn't point out the time spent in training or the debt incurred for that training.

So I think it's perfectly reasonable for docs to argue for higher pay. I certainly think it's a bad idea to let politicians and lawyers, who have shorter training, comparable incomes and no risk, try to guilt us into working for less.

And this must be the reason why medical journals and job sites are absolutely devoid of any jobs for doctors....

Whhaa! I can't find a 300K job in New YOrk City! Whaa!!

I'm still waiting to read the article about the residency class that graduates and can't find any jobs...

Now wait a minute. You threw out some things that you were arguing doctors don't need to worry about, specifically lay offs, buy outs and outsourcing. I pointed out that these are real concerns for physicians. So now your point changes to accusing docs of whining ("Whhaa! Whaa!!") who can't find a terrific job (>$300K) in NYC? That's apples and oranges. And the fact that there are jobs available in magazines doesn't speak to the quality of those jobs we all know that the really good jobs don't have to advertise.

So I'm really confused about what your point is. Are you really arguing that all docs have to so good that none of us should ever stand up for ourselves when faced with decreasing reimbursements or other policies that would hurt us? If that's your stance then at what level would it be ok for docs to speak up? When the average annual income drops below $125K, $100? When?

 

[coldweatherblue]

I agree that to a lot of people outside medicine, PC physicians complaining about making ~150k/year might seem a bit ungrateful.

I used to be a really strong proponent of "wealth equalization". I still believe that if money is *properly* allocated to developing countries a lot of good could be done with sanitation, clean water, immunizations, basic health-care, etc. However after seeing the effects of wealth redistribution in an already wealthy society (those given wealth without having to work for it do not appreciate it or use it productively, those from whom wealth is taken are less likely to continue the productivity that made them wealthy in the first place) I've become a lot more conservative..

my view: If you are a financially responsible, socially and morally "intact" person, it is perfectly acceptable to build wealth as long as it doesn't become the overriding focus of your life. If someone pays taxes, contributes to charity, raises well-behaved children, makes good use of the land he/she purchases, takes care of his/her possessions, and generally contributes "positive" vibes to those around him/her, it does good for this person to have wealth. Much better for modest income to be spent in this way than going to wasteful government programs. JMO.. obviously not all physicians are so responsible with their money but I think a good deal are when compared with the general public.. physicians should not at all be ashamed of fighting for their due, whatever that may be. There is absolutely nothing wrong with doing what you can to ensure the best possible life for you and your family.

 

[MOHS_01]

I disagree vehemently with Tibor, but the OP, unfortunately, is equally wrong. There is no reason that people who are disinterested in financial matters should avoid medicine as a career. It is a noble profession. The real argument that needs to be made (and I believe was intended) is that medical professionals should not be forced into a life of indentured servitude. It is not an easy job by any measure, and compensation should be commensurate.

 

[michaelrack]

Doctors who whine about not making enough money should think about the last time they were concerned about being laid off, their company being bought out, or their job being outsourced.

things are going well for me now, but 2.5 years ago I was very worried about my sleep disorders center going under. I wasn't worried about losing a job, I was worried about the several hundred thousand dollars of sleep center loans that I had personally guaranteed.

 

[physasst]

I disagree vehemently with Tibor, but the OP, unfortunately, is equally wrong. There is no reason that people who are disinterested in financial matters should avoid medicine as a career. It is a noble profession. The real argument that needs to be made (and I believe was intended) is that medical professionals should not be forced into a life of indentured servitude. It is not an easy job by any measure, and compensation should be commensurate.

post in this thread. Unfortunately, most of the rest is rubbish, and the OP was a deliberate trolling attempt.

If you really want to make money, medicine is perhaps the last field you should choose, there is, and always has been an altruistic component. A component of empathy and caring. To only care about your paycheck is the stuff of company CEO's and bankers. I would gently suggest to the OP that perhaps he should think of those careers.

No one, at least with any sense of economics is suggesting that physicians should be forced into indentured servitude. BUT, a real attempt at cost controls needs to be made. This will likely involve pay for performance initiatives, a move away from reimbursing for volume, and a reduction in payments for services that do not statiscally provide a high yield. (IE; why does a spine surgeon doing a two level fusion get reimbursed at a MUCH higher rate than an orthopedist doing a complicated hip replacement, when the hip patient has a higher likelihood of a complete and good outcome). We cannot sustain the unbelievable growth in health expenditures, not all of which is related to physician salaries, but articles like Gawande's are a good example of many of the problems.

 

[NonTradMed]

Why is it that some people seem to think that caring about money and caring about people are mutually exclusively? Why can't I care about BOTH?

It's the liberal in me that directed me towards medicine, but contrary to what some people's crude stereotypes of me *should* be, I also believe in building wealthy and being financially secure. I consider myself socially liberal and fiscally moderate. I don't believe in large government programs for everything but I also don't believe in ignoring the plight of those less fortunate. I understand that by helping the poor, I sacrifice my own income but I'm willing to find a middle ground in that regard.

I was poor as a child and I think it's great that there are programs to help people like me and also that there are people who are willing to let me work hard and (hopefully) someday achieve a measure of financial security.

The ability to help the poor AND make a decent amount is what attracted me to medicine. I'm happy with $150k because that's still lower than my debt would be after I graduate and that's enough to live very well in my area of the country. But I also don't mind making more if possible. However, I believe that while it's no our legal duty to help those less fortunate, as physicians, it is a moral duty to provide some care to those that are least able to afford it. Does that make me a bad fit for medicine? I hope not!

 

[MOHS_01]

....

If you really want to make money, medicine is perhaps the last field you should choose, there is, and always has been an altruistic component. A component of empathy and caring. To only care about your paycheck is the stuff of company CEO's and bankers. I would gently suggest to the OP that perhaps he should think of those careers.

No one, at least with any sense of economics is suggesting that physicians should be forced into indentured servitude. BUT, a real attempt at cost controls needs to be made. This will likely involve pay for performance initiatives, a move away from reimbursing for volume, and a reduction in payments for services that do not statiscally provide a high yield. (IE; why does a spine surgeon doing a two level fusion get reimbursed at a MUCH higher rate than an orthopedist doing a complicated hip replacement, when the hip patient has a higher likelihood of a complete and good outcome). We cannot sustain the unbelievable growth in health expenditures, not all of which is related to physician salaries, but articles like Gawande's are a good example of many of the problems.

Physasst,

We have danced around this in the past. Medicine has, at least for the last 100 years or more, consistently been one of the higher paying professions (and for good reason, I believe). It is also a "safe" career choice in so far as it represents one of very few career options that affords the likelihood of a six figure income, relative job security, and the option of living in any corner of the country you desire. People work hard both becoming a physician and as one; I contend that the income is justified.

Regarding reform... I can see no viable or responsible way for volume to be removed from the reimbursement structure. We provide services; that is the nature of the job. If someone provides 20 units of good, appropriate service to 20 people in need, they should be rewarded accordingly over the individual who provides 10 for 10... and, because of the cost structure inherent to most service industries, this discrepancy in pay turns out to be more than 2 fold.

Physician income constitutes a minor portion of the total healthcare tab -- we just constitute an easy target and represent the low lying fruit. Until they do something to curtail covered services or make the population healthier, we cannot succeed in containing costs.

 

[docB]

BUT, a real attempt at cost controls needs to be made. This will likely involve pay for performance initiatives, a move away from reimbursing for volume, and a reduction in payments for services that do not statiscally provide a high yield.

I continue to say that "pay for performance" is not a panacea and that it is very likely to cause unintended behaviors and consequences. I again cite the "core measures" debacle as an example. It may simply elevate the burearucrats to a new level of possible malfeasence.

Regarding reform... I can see no viable or responsible way for volume to be removed from the reimbursement structure. We provide services; that is the nature of the job. If someone provides 20 units of good, appropriate service to 20 people in need, they should be rewarded accordingly over the individual who provides 10 for 10... and, because of the cost structure inherent to most service industries, this discrepancy in pay turns out to be more than 2 fold.

I agree that it wouldn't be responsible or viable but one can easily see a situation where the public perception that doctors are too busy to spend "enough" time with them gets contorted into a policy that caps doctors at patient loads so that more time can be spent. For example the system could limit a PMD to 80 patient encounters a week (ie. 30 min per). Remember we're talking about the advent of totalitarian interventions into the healthcare system.

 

[physasst]

I continue to say that "pay for performance" is not a panacea and that it is very likely to cause unintended behaviors and consequences. I again cite the "core measures" debacle as an example. It may simply elevate the burearucrats to a new level of possible malfeasence.

I agree that it wouldn't be responsible or viable but one can easily see a situation where the public perception that doctors are too busy to spend "enough" time with them gets contorted into a policy that caps doctors at patient loads so that more time can be spent. For example the system could limit a PMD to 80 patient encounters a week (ie. 30 min per). Remember we're talking about the advent of totalitarian interventions into the healthcare system.

I agree with you to an extent, and I understand your concerns, as I think that they are quite valid. However, 6.2% annual increases are not sustainable. SO, we have to control costs, what are your suggestions, since you apparently disagree with some of the things that I mentioned. BTW, I am not a complete supporter of all of them, but I realize that some attempts need to be made.

 

[MOHS_01]

I think that most would agree that an annualized 6.2% growth rate is not sustainable over the longer term; the first question that must be answered is "what is an appropriate level of spending for healthcare services for a population?" I don't know how one goes about assigning an answer to that question, honestly -- but I will say that an economy in all likelihood cannot enjoy long term, sustainable growth and prosperity if an ever increasing percentage of its resources go to services.

The next question is "do we get value for our dollars?" Clearly, there are many time where we do not. Marginal utility needs to be defined and determined for various procedures, diagnostic tests, medications, etc. Once that metric has been established, we can then go about the process of stratifying these services based upon their marginal utility and cost, much like the tiered formulary system for pharmaceuticals today. The system does not have to frankly disallow certain procedures, but it should somehow determine how much it is willing to pay for treatment of a certain condition or for a certain service, and the balance can be worked out between provider and patient.

Something has to be done to address the core issue of an unhealthy populace. This cannot be effectively legislated, education and teaching apparently are of little help, so the only option left is to place some form of economic reward system in place for this to regulate itself. This would be virtually impossible under any federally driven system.

 

[physasst]

I think that most would agree that an annualized 6.2% growth rate is not sustainable over the longer term; the first question that must be answered is "what is an appropriate level of spending for healthcare services for a population?" I don't know how one goes about assigning an answer to that question, honestly -- but I will say that an economy in all likelihood cannot enjoy long term, sustainable growth and prosperity if an ever increasing percentage of its resources go to services.

The next question is "do we get value for our dollars?" Clearly, there are many time where we do not. Marginal utility needs to be defined and determined for various procedures, diagnostic tests, medications, etc. Once that metric has been established, we can then go about the process of stratifying these services based upon their marginal utility and cost, much like the tiered formulary system for pharmaceuticals today. The system does not have to frankly disallow certain procedures, but it should somehow determine how much it is willing to pay for treatment of a certain condition or for a certain service, and the balance can be worked out between provider and patient.

Something has to be done to address the core issue of an unhealthy populace. This cannot be effectively legislated, education and teaching apparently are of little help, so the only option left is to place some form of economic reward system in place for this to regulate itself. This would be virtually impossible under any federally driven system.

exactly would that be impossible. I believe it is North Carolina, IIRC, (too tired to look it up right at the moment) that changed their insurance structure for state employees, and are mandating higher co-pays and out of pocket costs for obese employees. I'll look up the article tomorrow if I have time.

 

[MOHS_01]

It would be politically untenable, for a democratic congress, to effect changes like those mentioned for a federal entitlement. The only way that they know how to stratify is through a progressive structure, reverse discrimination according to income level. States can do so because they contract out through third party payors, and it is the third party payor who enacted such reform. I see no reason for hope that Medicare would ever enact similar methodologies.

 

[docB]

I agree with you to an extent, and I understand your concerns, as I think that they are quite valid. However, 6.2% annual increases are not sustainable. SO, we have to control costs, what are your suggestions, since you apparently disagree with some of the things that I mentioned. BTW, I am not a complete supporter of all of them, but I realize that some attempts need to be made.

Eliminate med mal. That will save a huge amount by eliminating the reliance on defensive, costly diagnostic modalities.

Put people back in the role of wary consumer rather than ignorant sponge. Medical savings accounts coupled with reasonable out of pocket expenses for basics could help with that.

There are alternatives to "pay for performance." Among the worst aspects of P4P plans is that they will transfer decision making from the physician to the bureaucrats. "I'm sorry Mr. Johnson but while I think the best way to handle your case would be to proceed along course X that's not the mandate under P4P so I'm going to have to do Y."

P4P will also make it even more difficult to force compliance with the spirit of the program. Any P4P measure you devise I'll be able to suggest a way to game the system. You can try to close those loopholes and I'll find another way. That's the cat and mouse game the OIG plays with dishonest docs now in regard to upcoding and so on. Under P4P it would increase dramatically.

 

[physasst]

Eliminate med mal. That will save a huge amount by eliminating the reliance on defensive, costly diagnostic modalities.

Put people back in the role of wary consumer rather than ignorant sponge. Medical savings accounts coupled with reasonable out of pocket expenses for basics could help with that.

There are alternatives to "pay for performance." Among the worst aspects of P4P plans is that they will transfer decision making from the physician to the bureaucrats. "I'm sorry Mr. Johnson but while I think the best way to handle your case would be to proceed along course X that's not the mandate under P4P so I'm going to have to do Y."

P4P will also make it even more difficult to force compliance with the spirit of the program. Any P4P measure you devise I'll be able to suggest a way to game the system. You can try to close those loopholes and I'll find another way. That's the cat and mouse game the OIG plays with dishonest docs now in regard to upcoding and so on. Under P4P it would increase dramatically.

Nope, best estimates is maybe a 5-8% savings. Medical Malpractice costs only total less than 2% of medical spending, and estimates of defensive medicine vary, but seem to be in the 5-6% range. Not saying it won't help, but not as helpful as you might think.

Considering that malpractice costs, including premiums, torts, and payments only account for less than 2% of all healthcare expenditures

http://www.cbo.gov/doc.cfm?index=4968&type=0http://www.cbo.gov/doc.cfm?index=4968&type=0

and, in 2005, the HHS estimated defensive medicine costs at 60-108 billion. Not small change for sure, and could, and would definitely help.

http://www.managedcaremag.com/archives/0503/0503.regulation.htmlhttp://www.managedcaremag.com/archives/0503/0503.regulation.html

However, in a 2.4 trillion dollar system, even at 108 billion, this only represents less than 5% of all healthcare expenditures. Would it help certainly. But considering the price tag of Obama's reform, which, according to the CBO is 1.5 trillion over the next ten years. 108 billion doesn't go very far.

It certainly would help though. Just won't create the kind of massive cost savings that many physicians think. Hoo and I have discussed this on any number of occasions. His summation is that, eliminating all malpractice costs would stabilize, or neutralize the increases in medical costs for ONE year. Then we would be right back to where we are now. And he's right.

NOW, even if you say, WAIT, how did the CBO account for all of this. Well, the CBO's accounting for the total relative cost of malpractice, including, awards, tort filings, premiums, etc. is quite accurate. The estimates by the HHS as pertains to defensive medicine is more difficult to figure. It is a much more elusive figure, but here is something more to ponder.

The Mass. Medical Society release a report in November of 2008 that suggests defensive medicine costs of 1.4 billion. Criticisms include the fact that figures counted are only from 8 specialties, and only represent 46% of practicing physicians in Mass.

http://massmed.typepad.com/each_pat...-medicine-costs-mass-at-least-14-billion.htmlhttp://massmed.typepad.com/each_pat...-medicine-costs-mass-at-least-14-billion.html

But, even if you DOUBLE that to 2.8 billion in costs, and then multiply by fifty states (crude, I know, but even figuring some states like California and Florida will have higher figures, they will be offset by smaller, lower populated states, like wyoming, montana, and the dakotas), you STILL only get 140 billion. Or approximately 5.8% of total healthcare expenditures.


So there you have malpractice reform, in a nutshell.

 

[hopslam]

Just curious . . . how do you attendings feel about the private insurance system? I know that that is extremely general and vague, but I'm just looking for an overall sentiment.

 

[chessknt]

Nope, best estimates is maybe a 5-8% savings. Medical Malpractice costs only total less than 2% of medical spending, and estimates of defensive medicine vary, but seem to be in the 5-6% range. Not saying it won't help, but not as helpful as you might think.

Considering that malpractice costs, including premiums, torts, and payments only account for less than 2% of all healthcare expenditures

http://www.cbo.gov/doc.cfm?index=4968&type=0

and, in 2005, the HHS estimated defensive medicine costs at 60-108 billion. Not small change for sure, and could, and would definitely help.

http://www.managedcaremag.com/archives/0503/0503.regulation.html

However, in a 2.4 trillion dollar system, even at 108 billion, this only represents less than 5% of all healthcare expenditures. Would it help certainly. But considering the price tag of Obama's reform, which, according to the CBO is 1.5 trillion over the next ten years. 108 billion doesn't go very far.

It certainly would help though. Just won't create the kind of massive cost savings that many physicians think. Hoo and I have discussed this on any number of occasions. His summation is that, eliminating all malpractice costs would stabilize, or neutralize the increases in medical costs for ONE year. Then we would be right back to where we are now. And he's right.

NOW, even if you say, WAIT, how did the CBO account for all of this. Well, the CBO's accounting for the total relative cost of malpractice, including, awards, tort filings, premiums, etc. is quite accurate. The estimates by the HHS as pertains to defensive medicine is more difficult to figure. It is a much more elusive figure, but here is something more to ponder.

The Mass. Medical Society release a report in November of 2008 that suggests defensive medicine costs of 1.4 billion. Criticisms include the fact that figures counted are only from 8 specialties, and only represent 46% of practicing physicians in Mass.

http://massmed.typepad.com/each_pat...-medicine-costs-mass-at-least-14-billion.html

But, even if you DOUBLE that to 2.8 billion in costs, and then multiply by fifty states (crude, I know, but even figuring some states like California and Florida will have higher figures, they will be offset by smaller, lower populated states, like wyoming, montana, and the dakotas), you STILL only get 140 billion. Or approximately 5.8% of total healthcare expenditures.


So there you have malpractice reform, in a nutshell.

So 8% of total healthcare costs being sucked up by another parasitic industry is discountable because it isnt bigger? Dont forget that this also discounts that innumerable desk monkey jobs created to handle all of the paperwork necessary to protect hospitals against liigation.

Fixing this would help offset skyrocketing costs at the very least, as well as establish more trust/faith in the dr-pt relationship.

 

[docB]

Nope, best estimates is maybe a 5-8% savings. Medical Malpractice costs only total less than 2% of medical spending, and estimates of defensive medicine vary, but seem to be in the 5-6% range. Not saying it won't help, but not as helpful as you might think.

Considering that malpractice costs, including premiums, torts, and payments only account for less than 2% of all healthcare expenditures

http://www.cbo.gov/doc.cfm?index=4968&type=0http://www.cbo.gov/doc.cfm?index=4968&type=0

and, in 2005, the HHS estimated defensive medicine costs at 60-108 billion. Not small change for sure, and could, and would definitely help.

http://www.managedcaremag.com/archives/0503/0503.regulation.htmlhttp://www.managedcaremag.com/archives/0503/0503.regulation.html

However, in a 2.4 trillion dollar system, even at 108 billion, this only represents less than 5% of all healthcare expenditures. Would it help certainly. But considering the price tag of Obama's reform, which, according to the CBO is 1.5 trillion over the next ten years. 108 billion doesn't go very far.

It certainly would help though. Just won't create the kind of massive cost savings that many physicians think. Hoo and I have discussed this on any number of occasions. His summation is that, eliminating all malpractice costs would stabilize, or neutralize the increases in medical costs for ONE year. Then we would be right back to where we are now. And he's right.

NOW, even if you say, WAIT, how did the CBO account for all of this. Well, the CBO's accounting for the total relative cost of malpractice, including, awards, tort filings, premiums, etc. is quite accurate. The estimates by the HHS as pertains to defensive medicine is more difficult to figure. It is a much more elusive figure, but here is something more to ponder.

The Mass. Medical Society release a report in November of 2008 that suggests defensive medicine costs of 1.4 billion. Criticisms include the fact that figures counted are only from 8 specialties, and only represent 46% of practicing physicians in Mass.

http://massmed.typepad.com/each_pat...-medicine-costs-mass-at-least-14-billion.htmlhttp://massmed.typepad.com/each_pat...-medicine-costs-mass-at-least-14-billion.html

But, even if you DOUBLE that to 2.8 billion in costs, and then multiply by fifty states (crude, I know, but even figuring some states like California and Florida will have higher figures, they will be offset by smaller, lower populated states, like wyoming, montana, and the dakotas), you STILL only get 140 billion. Or approximately 5.8% of total healthcare expenditures.


So there you have malpractice reform, in a nutshell.

And again I disagree with those figures. There is a big disincentive to realistically look at the costs of defensive medicine. This disincentive covers the CBO and HHS particularly as they are very susceptible to political pressure.

We went over this exact same discussion in this thread. Again my rebuttal to these minimized numbers is as follows:

I agree with dilated. The numbers attributed to actual costs, med mal premiums, awards and fees is the tip of the iceberg. Those who say that defensive medicine only costs a small amount are looking at testing that falls outside the “standard of care.” They are missing the fact that the “standard of care” has evolved under the constant threat of litigation and is extremely conservative. It is much more conservative than is prudent in a system trying to use resources appropriately for a whole population.

Examples include ruling out every chest pain no matter how non-cardiac it seems because missed MI is top dollar loser for EM, CT scans of clearly benign or clearly surgical abdomens, the endless TIA and syncope work ups, “emergent” DVT evaluations and so on. Do any of these practices fall outside the standard of care? No. But they are very expensive, low yield, and are done out of fear rather than genuine concern.

For a good illustration of this go ask a primary doctor or an ER doctor when was the last time they really tried to evaluate whether chest pain was cardiac or not. Most will tell you they haven’t done it in a very long time. That chest pain gets sent to the ED and from the ED it gets admitted.

Now IIRC this rehash started because I was arguing that pay for performance initiatives will be ineffective. You asked me what my alternative was. I answered and now you are arguing against one of my alternatives. So is your only argument for P4P that everything else is worse or can you rebut any of my arguments against P4P?

 

[physasst]

So 8% of total healthcare costs being sucked up by another parasitic industry is discountable because it isnt bigger? Dont forget that this also discounts that innumerable desk monkey jobs created to handle all of the paperwork necessary to protect hospitals against liigation.

Fixing this would help offset skyrocketing costs at the very least, as well as establish more trust/faith in the dr-pt relationship.

No, what I am saying is that fixing med-mal, or even eliminating it completely, would at best, cause stagnation in growth for a little over one year.....that's it, then we would still be back where we are.

I'm not arguing AGAINST it, as I think that malpractice reform is important. However, I'm just saying that it will not be the panacea that some think.

 

[RGMSU]

If you wanna help people but don't feel a need to get paid for it, become a Catholic priest. You can help people all day long and take a vow of poverty to boot. Just don't make me take one with you out of your abundance of kindness. We have the craziest folks around in this country. Nobody bitches about entertainers making millions of dollars a year for doing nothing, but everybody bitches about doctors making a comparatively minute $150,000 spending all day saving peoples' lives and safeguarding peoples' health.

 

[RabbMD]

No, what I am saying is that fixing med-mal, or even eliminating it completely, would at best, cause stagnation in growth for a little over one year.....that's it, then we would still be back where we are.

I'm not arguing AGAINST it, as I think that malpractice reform is important. However, I'm just saying that it will not be the panacea that some think.

That is tantamount to saying reducing all fees paid to doctors by 33% and their salaries by 50-75% after expenses are paid out of those fees would at best cause stagflation in growth for a little over a year... If that is the case then why does it seem that methods to reduce physician reimbursement is all Obama is pursuing?

 

[RGMSU]

Reducing physician reimbursement is about all Obama will accomplish. Why? Because it's the most politically tenable thing to do. Physicians are a relatively small group. Most of them didn't vote for him anyway. Physicians have allowed themselves to become pretty politically impotent, and it shows glaringly in all the Congressional actions at the moment. All we're going to get out of this deal is an insurance pool, so that insurance companies can enroll more folks and make more money. And, of course, we will expand Medicaid so all the poor folk who don't want to work can be treated for free and continue to happily vote for Democrats. At the same time, we're going to cut back money for Medicaid and Medicare reimbursement. So, insurance companies, following suit, will think they can drop their reimbursement rates also. So, we're spending a lot of money - oh, it's ONLY a trillion dollars now - to enroll new people into a new system and then cutting back money to existing systems that are already struggling to survive fiscally. What a great plan? We're doing just like Obama said in the election process - spreading the wealth - taking it from doctors' pockets in the process.

 

[FatKid]

Reducing physician reimbursement is about all Obama will accomplish. Why? Because it's the most politically tenable thing to do. Physicians are a relatively small group. Most of them didn't vote for him anyway. Physicians have allowed themselves to become pretty politically impotent, and it shows glaringly in all the Congressional actions at the moment. All we're going to get out of this deal is an insurance pool, so that insurance companies can enroll more folks and make more money. And, of course, we will expand Medicaid so all the poor folk who don't want to work can be treated for free and continue to happily vote for Democrats. At the same time, we're going to cut back money for Medicaid and Medicare reimbursement. So, insurance companies, following suit, will think they can drop their reimbursement rates also. So, we're spending a lot of money - oh, it's ONLY a trillion dollars now - to enroll new people into a new system and then cutting back money to existing systems that are already struggling to survive fiscally. What a great plan? We're doing just like Obama said in the election process - spreading the wealth - taking it from doctors' pockets in the process.

If you vote for a socialist douche, then socialism is what you are going to get.

The American people brought it on themselves.

What the American people don't realize is the doctors will do what they do in Canada - work part time, not be productive, go through the motions. Why? Because there is no incentive to work hard.

Socialism breeds laziness and the system eventually collapses under itself. Happens every time.

 

[RGMSU]

Yeah, I only hope that if we wind up getting paid half as much we will have the privilege of working half as much and dragging our asses. The double screwing would be if we take a pay cut and still have to work as hard or harder to make it under the new system. Pay me a salary of $200,000 and let me work 40 hours a week - no overtime - in any specialty. I'd take it in a heartbeat. Give me $200,000 to work 80 hours a week and be paged a hundred times I night, I'll tell somebody to shove it.

 

[efex101]

Trust me, you can FAKE working .....but yeah we could get ****ed if we get the socialist medicine pay *and* yet still have to work our assess off. In Europe the doctors work paltry hours for the "government" run mental masturbation and then go to their private cash only and work hard.