Should MDs take a pay cut to make healthcare more affordable?

[guest794]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

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[Winged Scapula]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

What percentage of US expenditures on health care do you think physician reimbursement is responsible for?

 

[Spinach Dip]

You noted that insurance and drug prices are out of control, then ask if doctors should be paid less?

 

[TheUPSIDEdown]

 

[StudyLater]

MDs aren't the only ones with high salaries in healthcare (CRNAs, AAs, PAs), and DO's receive the same compensation.

826k active docs as of 2009 (ref: http://www.statista.com/topics/1244/physicians/). Assume 250k apiece average (being generous). So like ~206b. Total expenditures 17.1% of GDP (http://www.statista.com/topics/1244/physicians/).

0.171*USGDP($16.77t ref: http://data.worldbank.org/indicator/NY.GDP.MKTP.CD) = $2.87t

$206b/$2.87t ~ 7.2%

 

[guest794]

You noted that insurance and drug prices are out of control, then ask if doctors should be paid less?

Capitalism and healthcare don't work. We need to focus on preventative medicine, helping the patient, insurance (responsible for doctor reimbursement) and drug companies are no longer allowing doctors to provide a reasonable quality of care, they reject necessary procedures and encourage doctors to bankrupt patients (because there is no other way). The system simply has to change.

 

[StudyLater]

Capitalism and healthcare don't work. We need to focus on preventative medicine, helping the patient, insurance companies (responsible for doctor reimbursement) are no longer allowing doctors to provide a reasonable quality of care, they reject necessary procedures and encourage doctors to bankrupt patients (because there is no other way). The system simply has to change.

Well yeah...if you actually care about the patients.

 

[Spinach Dip]

Capitalism and healthcare don't work. We need to focus on preventative medicine, helping the patient, insurance companies (responsible for doctor reimbursement) are no longer allowing doctors to provide a reasonable quality of care, they reject necessary procedures and encourage doctors to bankrupt patients (because there is no other way). The system simply has to change.

Agreed.

But "the system has to change" and "should doctors be paid less" is a non-sequitur if I've ever seen one.

 

[Cytarabine]

MDs aren't the only ones with high salaries in healthcare (CRNAs, AAs, PAs), and DO's receive the same compensation.

826k active docs as of 2009 (ref: http://www.statista.com/topics/1244/physicians/). Assume 250k apiece average (being generous). So like ~206m. That...really isn't much compared to total expenditures ($17.1b ref: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS)

$206m/$17.1b ~ 1.2%

826k*250k = 200 billion

 

[SpartanWolverine]

MDs aren't the only ones with high salaries in healthcare (CRNAs, AAs, PAs), and DO's receive the same compensation.

826k active docs as of 2009 (ref: http://www.statista.com/topics/1244/physicians/). Assume 250k apiece average (being generous). So like ~206m. That...really isn't much compared to total expenditures ($17.1b ref: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS)

You mean $206.5 Bn. (826k x $250k) and $2.98 Tn. (17.1% of $17.42 Tn. GDP), respectively.

 

[guest794]

Agreed.

But "the system has to change" and "should doctors be paid less" is a non-sequitur if I've ever seen one.

My point is, as potential doctors we shouldn't mind taking a pay-cut if we can help patients in a more reasonable manner without bankrupting them. My real problem is with insurance/drug companies, but everyone will have to make a small sacrifice

 

[StudyLater]

826k*250k = 200 billion

This is what you get whipping something up in 3min late at night.

Fixed. Sorry.

Even still, it's a relatively small percentage. 7.2% from my calcs.

 

[Azete]

I agree that basically everybody in the healthcare industry should be paid less.

Given the cost of training, though, it's unrealistic to ask doctors to take less money and still incur the same debt. Unless you're fortunate enough to leave medical school with zero debt, the take-home pay of physicians is actually quite modest early in their careers.

Personally I would have no issue at all earning 100k as an attending, but somebody better be covering my education costs.

 

[guest794]

I agree that basically everybody in the healthcare industry should be paid less.

Given the cost of training, though, it's unrealistic to ask doctors to take less money and still incur the same debt. Unless you're fortunate enough to leave medical school with zero debt, the take-home pay of physicians is actually quite modest early in their careers.

Personally I would have no issue at all earning 100k as an attending, but somebody better be covering my education costs.

Great point! Do you know the the average cost of medical school is in Quebec? $2,200. Outside of Quebec in Canada? $13,000. The cost of education in this country leads to an unsustainable toxic chain of events. It's time to cut out the insurance companies, the bloated cost of tuition pushing students in endless debt, cut healthcare professional's salary to a level our future patients can afford and that is equitable with the service we provide, put the patient first, do our job, cut out capitalist middle-men parasitically feeding off the value healthcare professionals provide and live in a functioning society again.

 

[StudyLater]

Great point! Do you know the the average cost of medical school is in Quebec? $2,200. Outside of Quebec in Canada? $13,000.

.....................and I'm assuming that's CAD???

The cost of education in this country leads to an unsustainable toxic chain of events. It's time to cut out the insurance companies, the bloated cost of tuition pushing students in endless debt, cut healthcare professional's salary, put the patient first, do our job, cut out capitalist middle-men parasitically feeding off the value healthcare professionals provide and live in a functioning society again.

Wondering how you plan to turn a juicy profit with the bolded.

 

[guest794]

.....................and I'm assuming that's CAD???

Wondering how you plan to turn a profit with the bolded.

Yes, that is in Canadian dollars, it's still much more affordable. And if you don't want to put patients first work for an insurance company denying a doctor claims for his patient's necessary MRI scans when they have a possible brain tumor or deny them insurance and bankrupt them (because the choice is go bankrupt or die)

 

[Lawpy]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

Healthcare economics is actually a lot more complicated than first thought. And yeah i know i'm supposed to prepare an analysis (and i got lazy...).

But i can say that cutting physicians' reimbursements is a very bad idea. Yes, cost-cutting measures should be taken, but if anything, the drug development process should be repaired and pharmaceutical industries should avoid wasting resources in drug discovery.

I can elaborate my thoughts elsewhere (or create my own thread with my own analysis), since i can see this topic becoming messy

 

[LabMonster]

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

 

[guest794]

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

I'm disappointed with your answer. Blaming the patients. Why did you become a doctor? (sorry if I misinterpreted) Like I said before, Canada and European countries provide the same quality of care American doctors do, but healthcare and capitalism aren't mixed and they aren't bankrupting their population with medical bills, pushing ludicrously expensive drugs on their patients or denying them medically necessary scans because the insurance company doesn't exist to say no.

 

[Lawpy]

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

I'm disappointed with your answer. Blaming the patients. Why did you become a doctor? (sorry if I misinterpreted) Like I said before, Canada and Europe provides the same quality of care American doctors do, but healthcare and capitalism aren't mixed.

Sigh... again with the premed moral superiority over an attending realism. If anything, LabMonster is spot on, and his experiences can be expanded very adequately in any profession. The issue lies in the waste of resources and irrational consumer behavior (like laziness and bad behavior when your insurance is covered).

Regardless, a cut in physician pay is necessarily a terrible idea. The opportunity costs of training and licensure are too high, and such a pay cut aggravates the problem. Instead, repair the insurance market and implement waste/cost-cutting measures.

 

[guest794]

Repairing the insurance market won't work and hasn't worked. Obamacare was the best Congress could do and it should be called "Unaffordable care". Every time I bring this up, we seem to ignore the fact good Canadian and European doctors exist who went to much cheaper schools, are paid a bit less, but who have patients who can actually afford to visit and be treated by them. No more repairing an impossibly flawed bureaucratic mess of a system . Healthcare and education are a right, ask any Swede or Norwegian, and the final goal is to make a government financed system with a stronger focus on preventative medicine. Insurance companies are bloating healthcare to the point of absurdity, ask anyone outside the American bubble who will tell you "Healthcare in America is mad" and they aren't wrong.

 

[StudyLater]

Yes, that is in Canadian dollars, it's still much more affordable.

Right. Your dollar is 3/4 ours, making that ridiculously cheap. That was what I meant to say with the "I just came" comment. That medical education cost is literally orgasmic. Too bad the schools are all region-biased, (I'm pretty sure?) more competitive than our schools are for us, and there's not too many of them in the first place.

And if you don't want to put patients first work for an insurance company denying a doctor claims for his patient's necessary MRI scans when they have a possible brain tumor or deny them insurance and bankrupt them (because the choice is go bankrupt or die)

Many people do this. It's a viable life option to profit off of the misery of others.

We're all adults here.

Healthcare economics is actually a lot more complicated than first thought. And yeah i know i'm supposed to prepare an analysis (and i got lazy...).

Hey. At least you're honest and not just bullsh*tting figures with no source.

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

The "help meth-heads make babies" is such an ER doc thing to say.

But no I mean it's a good point. The burden is on both sides, for sure. If healthcare professionals are going to tighten the purse, why shouldn't patients? Oh yeah, the whole "human nature" thing. This might help you see why leaders in big business frankly don't give a f*ck about people dying. I'm sure they know it goes both ways.

So anyway.

 

[Lawpy]

@StudyLater i was able to find some really good information regarding the healthcare cost-cutting methods from reliable resources. All the cool figures and stuff, but the economics/finance got technical and involved stuff like game theory that is difficult to explain to a layperson (much less a stubborn, furious premed )

I think i will compile everything into a separate thread in the future. But again, i am being entirely open-minded here since i am relying on reports, so it would help to get an added perspective from residents/attendings.

@efle someone said something about Scandinavian healthcare, so get over here.

 

[kenjixshadow]

Canadian and European doctors exist who went to much cheaper schools

Exactly why US physicians shouldn't take a pay cut but get a raise.

who have patients who can actually afford to visit

Not happening in US. There will always be patients with no health insurance because they can't afford it and aren't eligible for ACA.

No more repairing an impossibly flawed bureaucratic mess of a system.

There is no such thing of a perfect system as you can always find fault within one. Healthcare may or may not be heading to the right direction. Perhaps you shouldn't pursue it, premed.

Insurance companies are bloating healthcare to the point of absurdity

Thank you captain obvious. Why don't you do anything about it? They are the problem, not physician compensation.

 

[bashwell]

As I said in OP's other cross-posted thread:

Doctors' salaries are a miniscule and quite arguably insignificant part of the reason why US healthcare is so expensive.

The biggest pieces of the healthcare cost pie are Medicare, Medicaid, the VHA, and CHIP. These make up something like 67% of US healthcare costs.

 

[StudyLater]

Pissed off attending. Pissed off med student. Come on let's go for the trifecta with a resident. @Crayola227 give us some anger.

 

[guest794]

Exactly why US physicians shouldn't take a pay cut but get a raise.

Exactly why US tuition should match Canadian and European medical schools.

Not happening in US. There will always be patients with no health insurance because they can't afford it and isn't eligible for ACA.

In Europe and Canada healthcare is a right. In America it's a luxury. That's bad medicine.

There is no such thing of a perfect system as you can always find fault within one. Healthcare may or may not be heading to the right direction. Perhaps you shouldn't pursue it, premed.

Ask the millions of Americans bankrupted from medical bills who can't afford basic scans, drugs or procedures how imperfect our system is. Ask a Scandinavian how imperfect American healthcare is. American healthcare plays the imperfection game VERY well.

Thank you captain obvious. Why don't you do anything about it? They are the problem, not physician compensation.

They're related.

 

[Psai]

I'm disappointed with your answer. Blaming the patients. Why did you become a doctor? (sorry if I misinterpreted) Like I said before, Canada and European countries provide the same quality of care American doctors do, but healthcare and capitalism aren't mixed and they aren't bankrupting their population with medical bills, pushing ludicrously expensive drugs on their patients or denying them medically necessary scans because the insurance company doesn't exist to say no.

You ever met a patient?

 

[Crayola227]

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

I was with you until that last piece. Do me a favor and read the ACE Adverse Childhood Events paper and other studies based off it.

I basically lived that life, and growing up in the ghetto, I can tell you what it takes to get out of it. Doctors are in the top 1% in more than one way.

Until you're telling me all about your sexual abuse history, poverty, being raised by meth heads and getting tricked out, being 13 the first time your mom smokes meth with you, I'm not going to clap you on the back for not shooting up or even not just stuffing your face with Wendy's burgers if that's what helps you cope with that psychic pain. Doctors get zero respect from me because they are doctors that can look down their nose at patients.

Double amputees in the special olympics? Good for them. I don't sneer at the ones on SSI or make them watch tapes of the special olympics to demonstrate how they should be achieving more. Just because some people are given **** and spin it into gold, doesn't mean I raise my expectations for the other 99% of people just trying to get by.

Doctors have higher rates of substance abuse, particularly alcohol abuse than the average population, and suicide. Maybe you think it's at least a greater sign of deference to society offing ourselves than the meth heads who "don't care enough to" do so to stop being a burden in your ED, but my point is the profession can get off its holier-than-thou impoverished drug user type with all our great self-care and education. Doctors only rate better than the population on self-care and health outcome measures in a few categories, most of which have more to do with health literacy.

Until we have a better educational system, a system that is actually tolerant of parents, kids, hell even ****ing residents going to the dentist to get a rotten tooth drilled without risking losing your job or being short on the electric bill, I don't have much tolerance for the intolerance of whatever **** way people are taking care of themselves.

We all know the mental health system is a ****ing joke in this country, so while we might point to all the people who can just learn to cope better with horrific scenario **** above, even Obamacare doesn't mean the schizophrenics are put in housing off the streets on meds, the alcoholics and other drug users tucked in to rehab when they want it, kids any time in the healthcare system, even the ones who are covered because you know what, it *can* be that hard to get a day off.

I could rant more about all the blue collar people I know who needed a sick day and got cut the week after.

You're pissed because being in the ED you are forced to take the people thrown under the wheels of society, ground into paste, and now the solution is you putting a band aid on it. It pisses me off too.

Sure there's a contingent of people who are just idiots and don't give a damn and living a hedonistic lifestyle, but most of the people I know taking **** care of themselves doing drugs were started on that path by their parents and neighborhood, and the support for them to get off that path? Minimal at best.

Most people are paycheck to paycheck even cutting vice out, people who finished high school, college, don't do drugs, whatever, and still finding themselves in the ****ter.

Capitalism and healthcare don't work. We need to focus on preventative medicine, helping the patient, insurance (responsible for doctor reimbursement) and drug companies are no longer allowing doctors to provide a reasonable quality of care, they reject necessary procedures and encourage doctors to bankrupt patients (because there is no other way). The system simply has to change.

Encourage doctors to bankrupt patients? I've never in my time in healthcare seen any doctor encourage a patient to bankrupt themselves. As a doc, my primary concern has been to encourage patients towards life, better health, preventative care.

I'm disappointed with your answer. Blaming the patients. Why did you become a doctor? (sorry if I misinterpreted) Like I said before, Canada and European countries provide the same quality of care American doctors do, but healthcare and capitalism aren't mixed and they aren't bankrupting their population with medical bills, pushing ludicrously expensive drugs on their patients or denying them medically necessary scans because the insurance company doesn't exist to say no.

I addressed blaming the patients.

Sorry, but these other healthcare systems also have problems, and none of those problems exist or were solved because of physician reimbursement.

People in Canada with approval for knee replacement waiting for 3 years to get their surgery? Might be better than the people here who can't afford one not getting one ever, and the people with money getting theirs in the next 6-12 weeks.

I wish I could remember the very good documentary I watched (was it Sicko? No, maybe, I don't know if it was any good) where doctors in England were threatening to strike, hospitals were going bankrupt and closing all over Japan.

Gues what? There's plenty of MDs just lining up to work for $50,000 a year and not getting to. It's everyone who doesn't match for whatever reason. Plenty of docs who would work for FREE, offer free care, and can't because of malpractice issues. And plenty of docs walking away from $500,000 per year salaries if debt isn't what's going to ruin them and their family's entire financial future, so they could other work, any other work. People doing so not because they hate patients, but they're tired of a system that forces them to shortchange patients so they put them through the meatgrinder.

I'm guessing there's a poll you could start.

If you took away my debt, got my hours down to 60 per week, and I spent the amount of time I really needed with each patient to maximize their care, and let my documentation reflect what made sense purely for providing care to patients, I'd do it for under six figures. It would be my pleasure.

In a system where you can't PAY doctors to stay in the system, and a system where doctors CAN'T work for free, literally cannot, please tell me how physician reimbursement is anywhere away from the bottom of the list of issues that need addressing?

But you have no idea. None. You won't understand it until you've not only studied the system reading about it, but went to work at least 80 hours a week with $300K in loans, while the system made short work of your idealism, while you were forced to spend more time with your keyboard than your suffering patient, or while you were 12 hours a day wrist deep in someone's innards all day while you struggled to get a meal in, all the while having endless amounts of verbal abuse dumped on you, by people above you in the hierarchy suffering not much less, or by patients you don't have time to make understand. None of which would phase you as much as how helpless you were to make things better for yourself or the patients. You think the system is unjust now? Just you wait.

Please read like all of my post history if you're interested in learning more.

There's not a doc I know that wouldn't give up some income to make some of those things better. But guess what? Docs today make less than they did before and under worse conditions. Docs making less hasn't made things better.

If all you want to do is take money out of someone's pocket while they, or the people they serve, do no better, well, why in the world would anyone want that?

 

[Crayola227]

Your whole argument is predicated on some notion that US docs could have their education susbsidized, take a big paycut, and oila!

Fantasy European-style socialism where the people are riding exercise bicycles that look uncannily like unicorns into a sunset where no one sticks a needle in their arm getting hep C, no need for spendy reasearch or spendy drugs, procedures, MRIs, the malpractice lawyers will go spend time on the farm teaching little Timmy Yoga and sustainable horticulture rather than suing docs, docs will be getting more sleep, making less errors, they too will hop on those unicorn-exercise bikes, or do laps in the pool before sitting down to a healthy family dinner before starting up their nightly hobby time at the research bench installed in their basement. Donald Trump, the stockholders, and the guys working in the coal mines, the kids slinging meth or flipping hamburgers to buy a $2 hamburger as their one meal of the day, they will all hand over a dollar a day to see this dream to a reality. And it all starts with physicians in this country, who are averaging 60-80 hr work weeks post residency, to just cut their salaries to get the ball rolling.

 

[mehc012]

The cost of healthcare today is absolutely outrageous, and this is coming from a pre-med student. Insurance costs are completely out of control, common prescription drugs, like Xarelto (latest blood-thinner) are far too expensive for the average American.

In my opinion universal healthcare is the end-goal. Obamacare hasn't helped much, a vast percentage of Americans can't afford healthcare. Something has to change, for the sake of the system we need to cut insurance companies out and cut doctor pay, there is no other ethical solution.

European countries and Canadians pay their doctors less and America doesn't offer a statistically superior outcome for the majority of illness.

Doctors' salaries are completely unrelated to the cost of Xarelto.
Yes, our healthcare spending is phenomenally high, and we get little in return, but instead of starting with the other population that's being screwed over by the current system, let's perhaps actually try poking the problem where it hurts.


(My go-to quickie healthcare spending vid, sources at the bottom...certainly not comprehensive, but a solid 7mins nonetheless!)

 

[MrLogan13]

You're welcome to take the first pay cut.

 

[efle]

The best first steps to take would be switching to single payer to cut massive administrative waste, pouring a lot more money into preventative/educational efforts (like the recent anti smoking campaign from the CDC, incredible QALY $ ratio), setting up a "gatekeeper system" in which all non-emergency cases first see their free GP and only then are sent to specialists for the more fancy stuff (in Denmark this gets 95% of health issues resolved at GP). Putting doctor pay onto salary or capitation instead of fee-for-service has been shown in a few studies to reduce the amount of unnecessary testing and overly expensive treatment choices. (Note that this doesn't mean compensation has to go down at all, just that it's a bad idea to have physician pay be based on number and price of things they order).

Reducing physician pay is way low down on this kind of list of improvement priorities, and would really only make sense if we could 1) make medical education much cheaper or free 2) protect GPs from dropping much below where they are already at. Its only the crazy 1/3 - 1/2 million per year specialists that would have any room for compensation drops at the moment

 

[NickNaylor]

When you have completed your training, and your debt from that training comes to ask you "Hey, thought you were good for it." Then, and only then can you talk about it. \

We are in the "1%" but we actually pay taxes, and you will love that when you are board certified. I was told at my last tax meeting that I support at least 3 families in my state. Great. Super happy to help the meth-heads make babies, and also glad to finance managing their abscesses.

What I see is people abusing the system, also, not USING the system set up for them...

Anyway, we have too much usage of ER resources, too much reliance on "state" healthcare - people don't care for themselves and then demand the ER take care of them. We are the urgent clinic and convenience center.

The cost basis will not change, unless people take their health to task. People want to smoke, drink and eat **** food and be guaranteed they won't have an MI.

So, yeah, noble thoughts and bad returns. Find a better use of your brain than medicine.]

Completely agree. I'm actually not completely soulless, but the problem I see with people that get free (i.e., tax-subsidized) healthcare is that they don't seem to actually use it wisely and have minimal interest in their health. At the county hospital we rotate at, the hospital actually has a policy now where patients must call the hospital to activate a referral rather than give them an appointment automatically because the no-show rate for appointments was so high. I'd be interested to know how many of those folks actually end up activating those referrals. People regularly leave the hospital at discharge without picking up their medications. Guess what happens then? Depending upon the their medical problems, readmission will be anywhere from a couple days to several months. But they WILL be back.

There was a guy on my service admitted for chest pain and SOB a couple of weeks ago 2/2 cocaine use. We counseled him on the importance of not using cocaine extensively, gave him solid follow-up appointments, adjusted his medications and refilled everything, etc.. He was good to go. Two days later, he's back in the ED with chest pain and SOB, now worse than before. His urine drug screen was positive for cocaine. Awesome. Glad all that work did some good. All that time and the hospital bed could've gone to someone for whom that time and work may have actually made a difference. This story may not be typical of everyone, but it is typical of a large number of the people that I see.

I have no problem with taxes going to support people that are seemingly incapable of supporting themselves, but I start to get frustrated when those people are incapable of taking the initiative to be invested in their own health.

I see additional money going into that system as a complete waste. Why give people more expensive services when a good chunk of them already don't use them effectively despite having their hand held through the process? It's throwing good money after bad.

Especially as hospitals, drug companies, and device manufacturers rape the system for all of they can, I'm not particularly inclined to support a decrease in my pay while having a mortgage in the form of student loans hanging over my head.

 

[jqueb29]

Doctors do NOT need to take a pay cut. If anything, they deserve more money.

 

[Psai]

Completely agree. I'm actually not completely soulless, but the problem I see with people that get free (i.e., tax-subsidized) healthcare is that they don't seem to actually use it wisely and have minimal interest in their health. At the county hospital we rotate at, the hospital actually has a policy now where patients must call the hospital to activate a referral rather than give them an appointment automatically because the no-show rate for appointments was so high. I'd be interested to know how many of those folks actually end up activating those referrals. People regularly leave the hospital at discharge without picking up their medications. Guess what happens then? Depending upon the their medical problems, readmission will be anywhere from a couple days to several months. But they WILL be back.

There was a guy on my service admitted for chest pain and SOB a couple of weeks ago 2/2 cocaine use. We counseled him on the importance of not using cocaine extensively, gave him solid follow-up appointments, adjusted his medications and refilled everything, etc.. He was good to go. Two days later, he's back in the ED with chest pain and SOB, now worse than before. His urine drug screen was positive for cocaine. Awesome. Glad all that work did some good. All that time and the hospital bed could've gone to someone for whom that time and work may have actually made a difference. This story may not be typical of everyone, but it is typical of a large number of the people that I see.

I have no problem with taxes going to support people that are seemingly incapable of supporting themselves, but I start to get frustrated when those people are incapable of taking the initiative to be invested in their own health.

I see additional money going into that system as a complete waste. Why give people more expensive services when a good chunk of them already don't use them effectively despite having their hand held through the process? It's throwing good money after bad.

Especially as hospitals, drug companies, and device manufacturers rape the system for all of they can, I'm not particularly inclined to support a decrease in my pay while having a mortgage in the form of student loans hanging over my head.

Hey no worries, obamacare will dock your pay for readmissions because if a patient ends up in the hospital again after 30 days, it's definitely not the patient's fault. It's not like doctors are being heavily pressured into kicking patients out of hospitals early or that patients are taking terrible care of themselves which brought them to the hospital in the first place

 

[efle]

Very surprised to hear a psychiatrist talk about cocaine-addicted behavior as being weakness/stupidity/fault in the patient

 

[DokterMom]

Looking at the costs of healthcare -- a VERY interesting read. In short, it ain't the doctors --


http://www.washingtonpost.com/news/...-14000-to-treat-a-snakebite-with-14-medicine/

 

[NickNaylor]

Very surprised to hear a psychiatrist talk about cocaine-addicted behavior as being weakness/stupidity/fault in the patient

When you have been counseled and given plenty of resources to attempt to address the behavior and have failed to follow up any of them while showing up at the ED q3-4d for several months, my patience wanes.

 

[Goro]

When the drug companies start spending more money on research Than advertising, then I'll take your suggestions a little more seriously.

My point is, as potential doctors we shouldn't mind taking a pay-cut if we can help patients in a more reasonable manner without bankrupting them. My real problem is with insurance/drug companies, but everyone will have to make a small sacrifice

 

[allantois]

On the other hand, there's no reason for certain surgical specialists to be making millions off Medicare.

And those physicians are the ones complaining about people sucking money from the government

 

[Gandyy]

The best first steps to take would be switching to single payer to cut massive administrative waste, pouring a lot more money into preventative/educational efforts (like the recent anti smoking campaign from the CDC, incredible QALY $ ratio), setting up a "gatekeeper system" in which all non-emergency cases first see their free GP and only then are sent to specialists for the more fancy stuff (in Denmark this gets 95% of health issues resolved at GP). Putting doctor pay onto salary or capitation instead of fee-for-service has been shown in a few studies to reduce the amount of unnecessary testing and overly expensive treatment choices. (Note that this doesn't mean compensation has to go down at all, just that it's a bad idea to have physician pay be based on number and price of things they order).

Reducing physician pay is way low down on this kind of list of improvement priorities, and would really only make sense if we could 1) make medical education much cheaper or free 2) protect GPs from dropping much below where they are already at. Its only the crazy 1/3 - 1/2 million per year specialists that would have any room for compensation drops at the moment

I agree. GPs especially are already paid what you could call "below the opportunity cost" when factoring in years of training, cost of tuition, loan payback and so forth.

I wouldn't feel so bad about hyper specialists getting reduction in pay cuts as long as the hospital revenue was also somehow funneled towards making our healthcare system more efficient for the patient.

 

[Psai]

On the other hand, there's no reason for certain surgical specialists to be making millions off Medicare.

And those physicians are the ones complaining about people sucking money from the government

Why not?

 

[bearintraining]

Just to comment on the Canadian system, as a Canadian, and having family members in healthcare in Canada:

It is cheaper in Canada for a few reasons:

1. The provincial/federal governments negotiate with drug companies and they essentially prevent companies from selling their drugs at exorbitant prices (i.e. either you sell the drug at $X or we just make it completely unavailable in Canada)
2. Hospitals & their administration aren't out to make millions of dollars in profits
3. Medical testing and procedures that aren't urgent can take months vs days-weeks in the US. (e.g. it took me 8 months to get sinus surgery even though it was causing me significant discomfort and reduction in QoL).
4. Most provinces require income-earning individuals to contribute in some way or another.. so it is not entirely "free". Similarly, most drugs in Canada have to be paid for.
5. As some have said, tuition at Canadian schools is easily half that of the US. Unfortunately it is also much more difficult to get accepted (~10-25% acceptance rate vs 65% in the US; most Canadians apply 2.7 cycles to get in). This is because they are all public universities and heavily subsidized.

Also you are incorrect - Doctors in Canada get paid well - perhaps not as much as in the US, but I'd say easily at least 75% that of US docs.

 

[bashwell]

[Source]

 

[deleted716403]

Currently health care is not affordable for many because of private insurance and administration that drive costs through the roof. Doctors are paid a small percentage while most of the costs go to private companies. With universal health insurance, I imagine that the cost would decrease substantially while still maintaining the same quality of care - actually the quality would even improve because there wouldn't be people with Bach degrees telling doctors what to do any more. Doctor salaries might decrease, but only a little. Take France and Switzerland for examples: doctors there are extremely well paid while everybody has access to care.

 

[SSSMDt]

When the drug companies start spending more money on research Than advertising, then I'll take your suggestions a little more seriously.

Exactly!!! How many times have you seen a patient walk into a clinic and say "hey i saw this on TV, i want it" and the doc says "oh, hmm... Ive never thought of that, ok"... It goes more something like "no you idiot you cant take this for XYZ" in my experience.

I also wonder how much these frivolous lawsuits on drug companies have an impact on the cost of drugs in America. When great drugs like Vioxx get sued out of existance or Avandia gets frivously slander completely off the market for some time and still dealing with the fall-out.. Now a drug company has to spend millions on research and millions on drug liability, probably ending up costing twice as much to produce this drug. I wonder how much of an impact this ends up making on cost of the drug in America.

 

[Gandyy]

Exactly!!! How many times have you seen a patient walk into a clinic and say "hey i saw this on TV, i want it" and the doc says "oh, hmm... Ive never thought of that, ok"... It goes more something like "no you idiot you cant take this for XYZ" in my experience.

I also wonder how much these frivolous lawsuits on drug companies have an impact on the cost of drugs in America. When great drugs like Vioxx get sued out of existance or Avandia gets frivously slander completely off the market for some time and still dealing with the fall-out.. Now a drug company has to spend millions on research and millions on drug liability, probably ending up costing twice as much to produce this drug. I wonder how much of an impact this ends up making on cost of the drug in America.

really now ... doctors say "no you idiot you cant take this" in your experience? really?

Most doctors dont even take that tone with patients let alone call them idiots.

 

[SSSMDt]

really now ... doctors say "no you idiot you cant take this" in your experience? really?

Most doctors dont even take that tone with patients let alone call them idiots.

No of course they dont call them idiots...

 

[allantois]

Exactly!!! How many times have you seen a patient walk into a clinic and say "hey i saw this on TV, i want it" and the doc says "oh, hmm... Ive never thought of that, ok"... It goes more something like "no you idiot you cant take this for XYZ" in my experience.

I also wonder how much these frivolous lawsuits on drug companies have an impact on the cost of drugs in America. When great drugs like Vioxx get sued out of existance or Avandia gets frivously slander completely off the market for some time and still dealing with the fall-out.. Now a drug company has to spend millions on research and millions on drug liability, probably ending up costing twice as much to produce this drug. I wonder how much of an impact this ends up making on cost of the drug in America.

Almost every patient at the Neurologist's office I shadowed at came in inquiring about a certain drug that they saw on TV/ read about. The physician did not give in one time; nor did he have to after explaining patients what the deal with drug companies is and the he always has their best interest in mind.

Now, I can only begin to imagine how much billing dermatologists generate daily by biopsying everything and anything even when they know that it is nothing. Someone needs to put a stop on all of the unnecessary procedures that physicians are financially encouraged to perform.