Societal Interpretation of a Physician's Monetary Worth

[libertyyne]

No the previous post of yours that I quoted highlights the way you think very well. You get a gut feeling about how things should be then you seek data and experiences to support that opinion. Have you even given any serious consideration to any of the arguments the other posters here have made?

I appologize if I came off as crass, it is difficult assessing tone on boards. I have given consideration to their litigation arguments, however it really doesnt pan out with what the literature says. The cost comparison and confounding variable arguments are usually the first to be raised,however the problem with them is they do not explain overuse of services. Read absolutely anything by atul gawande especially his pieces on the texas hospitals. That guy hits the nail on the head and in poetic prose.

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[Sardinia]

@Cubsfan10 Beautiful post.

 

[libertyyne]

Thank you for some legitimate criticisms and explanation.

Just some thoughts:

- No one can fully understand what you go through unless they do it themselves. An average person believes the first thing they see/read and that's usually the 50 year old cardiologist living on the lake and driving a mercedes.
- Here's the deal for medical school: 1. 350k+ debt. 2. Losing out on your 20's (and early 30s in some cases) 3. working/studying 80+ hours a week x 10ish years (that's like 20 years of working for our cubicle friends) 4. Extreme stress and mental health problems 5. Delayed gratification of EVERYTHING
-- So, just how many people would take that deal if you offered it to them that way. The AMA/AOA have done a terrible job at delineating the training/time/effort a physician goes through and it also hampers our ability to show that we are superior to NPs by a long margin (However, I personally believe we shouldn't compare ourselves to them at all because that gives them a legitimacy they don't deserve).

The problem with this is, select the people who want to do it for the sake of doing it. If all medical students are such altruists, then this should not bother them. The corrollary for this argument is usually well the best the brightest could make money else where- well look at the unemployment rate, even 4.0 college grads arent safe, and the best and the brightest still get stuck in jobs paying median wages.

Second point against this is change the training- PA's and NP's actually provide a valuable lesson in this regard, need more primary care docs- Maybe 7 years is not really needed for that.

Third point is make medical school free. takes away the loan burden issue.

Fourth point is- Most college grads have upwards of 30K in debt with little to no job prospects, dont see how it is different if you owe 30 k and the only job you can get for the next 10 years pays 30K. The higher education system costs need to be looked at as a society.

Fifth point is : if care provided by Midlevels is offensive AAMC should have opened more seats to fill those needs. - they wont because it drives down salaries.

sixth point : Lawyers and PHD's go through excessive years of training only to come out with **** to show for in terms of reimbursement.

Eighth point: its realistically 10 years of earning when comparing to cubical workers 5X salary makes that up pretty quickly even with a 5% return on investment.

Ninth point: If you think MD's are the only people who are workaholics try meeting someone who has two minimum wage jobs to make ends meet. -SES disparities in health and outcomes.

- Healthcare in other countries is difficult to compare and most places who do compare metrics will pick and choose whatever they deem noteworthy for headlines.
I could type pages and pages but it's not worth it.

Yeah, we are consistently terrible on most metrics.
http://www.commonwealthfund.org/pub.../oct/us-health-care-from-a-global-perspective

- Healthcare in the US is no. 1 in almost all metrics if you have insurance. It's only after throwing in the uninsured that we drop in certain metrics.

Please provide some sources for this. The source i provided above actually disputes what you just said. People are still going bankrupt even with insurance. We still have poor outcomes overall. We still overuse with less to show for.

- All healthcare systems in the world have pros and cons and all of them have rising costs.

Look at source above. Slower growth of increasing costs. Also what do we have to show for if our outcomes are still terrible. Doing more is not always better. Especially in healthcare. See Mayo.

- Other countries don't exist in a vacuum either. The majority of technological advancement and research development comes from the US and is exported out. If the US did not exist then those countries would not have the same success. This is similar to the social democrats view of "let's be like denmark or let's be like sweden." Those countries are small and can only succeed in a global network.

Yeah still dont have anything to show for our technological superiority. We still use more, get less, live shorter. If all this money and resources spent is not supposed to improve the lives of the citizenery then what the **** is it for?

- The US is a vastly diverse country with 315 million people across a landmass the size of Europe. Comparing anything (not just healthcare) against countries of 10-40 million that are the size of Indiana is disingenuous. How does the US do against India, China, Russia, Nigeria, and Indonesia?

I could type pages and pages but it's not worth it.

This may be the most coherent argument. A simple argument would be too look at the healthcare spending for these countries and the mortality and morbidity and life expectancy. I will tell you this even on this scale we lag as a nation.

Really the criticism is aimed at OP. You can ask for more money and respect. But I have seen very little ownership of the problems in our system from physicians.

I literally was in a meeting where a physician said " we dont practice EBM here we practice the best medicine based on our guts."

 

[Psai]

Why do we let premeds post here? It's always the same idealistic bullcrap, nonsense statistics of dubious veracity, overwhelming naivety and complete misunderstanding of how physicians are paid. Anyone who talks about salaries has no idea what they are talking about.

 

[deleted480308]

Thank you for some legitimate criticisms and explanation.



The problem with this is, select the people who want to do it for the sake of doing it. If all medical students are such altruists, then this should not bother them. The corrollary for this argument is usually well the best the brightest could make money else where- well look at the unemployment rate, even 4.0 college grads arent safe, and the best and the brightest still get stuck in jobs paying median wages.

Second point against this is change the training- PA's and NP's actually provide a valuable lesson in this regard, need more primary care docs- Maybe 7 years is not really needed for that.

Third point is make medical school free. takes away the loan burden issue.

Fourth point is- Most college grads have upwards of 30K in debt with little to no job prospects, dont see how it is different if you owe 30 k and the only job you can get for the next 10 years pays 30K. The higher education system costs need to be looked at as a society.

Fifth point is : if care provided by Midlevels is offensive AAMC should have opened more seats to fill those needs. - they wont because it drives down salaries.

sixth point : Lawyers and PHD's go through excessive years of training only to come out with **** to show for in terms of reimbursement.

Eighth point: its realistically 10 years of earning when comparing to cubical workers 5X salary makes that up pretty quickly even with a 5% return on investment.

Ninth point: If you think MD's are the only people who are workaholics try meeting someone who has two minimum wage jobs to make ends meet. -SES disparities in health and outcomes.



Yeah, we are consistently terrible on most metrics.
http://www.commonwealthfund.org/pub.../oct/us-health-care-from-a-global-perspective


Please provide some sources for this. The source i provided above actually disputes what you just said. People are still going bankrupt even with insurance. We still have poor outcomes overall. We still overuse with less to show for.

Look at source above. Slower growth of increasing costs. Also what do we have to show for if our outcomes are still terrible. Doing more is not always better. Especially in healthcare. See Mayo.


Yeah still dont have anything to show for our technological superiority. We still use more, get less, live shorter. If all this money and resources spent is not supposed to improve the lives of the citizenery then what the **** is it for?

This may be the most coherent argument. A simple argument would be too look at the healthcare spending for these countries and the mortality and morbidity and life expectancy. I will tell you this even on this scale we lag as a nation.

Really the criticism is aimed at OP. You can ask for more money and respect. But I have seen very little ownership of the problems in our system from physicians.

I literally was in a meeting where a physician said " we dont practice EBM here we practice the best medicine based on our guts."

The "best and brightest" do a ROI analysis and get training that ends up with gainful employment. To connect the hordes of undergrad doofuses (what's the plural of doofus?...doofi?) with 14th century postmodern poetry degrees working at starbucks and "the best and brightest" is improper

And screw the notion that the career field need be altruistic. There is nothing wrong with being in a field to make honest money...honest money is good money

 

[ProfMD]

As a physician, of course I am inclined to say that physicians do not get paid too much. I fully recognize that this is a self serving argument. As my dad told me years ago, when he goes to his cardiologist, he was his doctor to be thinking about his heart, it how he is going to pay for his kids' college tuition.

Having been in practice for a while, I truly believe that the estimates of the effects of defensive medicine are low:
1) Tort reform will only go so far and will not have immediate effect. Suing is a cultural thing in the US. People will still sue even if there is tort reform. Besides making it less profitable to sue, you also need to make it more profitable for malpractice insurers to actually defend doctors and not just settle.

2) Win or lose, being sued is a terrible experience. Of course, there is the money paid out if you lose (or if your malpractice company decides to settle). However, there is also the time taken away from your practice. The part that that is often overlooked by non-physicians, however, is that the lawsuit follows you for your entire career. Every time you apply for a medical license or hospital privileges, you have to report that lawsuit. In addition, it shows up on the web on sites such as RateMDs and HealthGrades.

3) Even the papers that purport to estimate the cost of defensive medicine, such as the one posted above, admit that their estimate is probably low.

There are too many tests and procedures ordered, defensive medicine being only one reason. There are others:
1) Patient expectations. Patients expect tests and treatment. If Doctor A doesn't provide them, then patients do to Doctor B. Patients will doctor shop until they get what they want. The doctors who do not order the tests, lose the patients.

2) Increasing reliance on patient satisfaction surveys. Physicians employed by hospitals are being rated by patient satisfaction metrics. Guess which patients are more satisfied?

3) Physicians order tests that they do not understand. Medicine is complex. Physicians order tests that they think are necessary, but may not be. This is a complicated issue that has to do with rapid advances in healthcare, breadth of medical knowledge, in addition to patient expectations and fears of being sued.

There are also issues of end of life care. Everyone knows that most of the healthcare dollars are spent at the end of life. A lot of money is spent on treatment that has minimal benefit to quality of life, or even quantity of life. This is why it is imperitive to have discussions regarding advanced directives before reaching that stage.

 

[libertyyne]

The "best and brightest" do a ROI analysis and get training that ends up with gainful employment. To connect the hordes of undergrad doofuses (what's the plural of doofus?...doofi?) with 14th century postmodern poetry degrees working at starbucks and "the best and brightest" is improper

And screw the notion that the career field need be altruistic. There is nothing wrong with being in a field to make honest money...honest money is good money

YES, But people like op should stop complaining about the sacrifices he/she makes. Or making it seem like he is doing everyone a favor by practicing medicine.
Your perspective is atleast an honest take on what medicine is, and I respect that, even if I disagree with the need for altruism in medicine.

 

[libertyyne]

As a physician, of course I am inclined to say that physicians do not get paid too much. I fully recognize that this is a self serving argument. As my dad told me years ago, when he goes to his cardiologist, he was his doctor to be thinking about his heart, it how he is going to pay for his kids' college tuition.

Having been in practice for a while, I truly believe that the estimates of the effects of defensive medicine are low:
1) Tort reform will only go so far and will not have immediate effect. Suing is a cultural thing in the US. People will still sue even if there is tort reform. Besides making it less profitable to sue, you also need to make it more profitable for malpractice insurers to actually defend doctors and not just settle.

2) Win or lose, being sued is a terrible experience. Of course, there is the money paid out if you lose (or if your malpractice company decides to settle). However, there is also the time taken away from your practice. The part that that is often overlooked by non-physicians, however, is that the lawsuit follows you for your entire career. Every time you apply for a medical license or hospital privileges, you have to report that lawsuit. In addition, it shows up on the web on sites such as RateMDs and HealthGrades.

3) Even the papers that purport to estimate the cost of defensive medicine, such as the one posted above, admit that their estimate is probably low.

There are too many tests and procedures ordered, defensive medicine being only one reason. There are others:
1) Patient expectations. Patients expect tests and treatment. If Doctor A doesn't provide them, then patients do to Doctor B. Patients will doctor shop until they get what they want. The doctors who do not order the tests, lose the patients.

2) Increasing reliance on patient satisfaction surveys. Physicians employed by hospitals are being rated by patient satisfaction metrics. Guess which patients are more satisfied?

3) Physicians order tests that they do not understand. Medicine is complex. Physicians order tests that they think are necessary, but may not be. This is a complicated issue that has to do with rapid advances in healthcare, breadth of medical knowledge, in addition to patient expectations and fears of being sued.

There are also issues of end of life care. Everyone knows that most of the healthcare dollars are spent at the end of life. A lot of money is spent on treatment that has minimal benefit to quality of life, or even quantity of life. This is why it is imperitive to have discussions regarding advanced directives before reaching that stage.

Thank you for this thoughtful post. Do you think financial incentive should be added to the list of underlying causes of overuse? I am on mobile or I would quote the studies that talk about when reimbursement per procedure is reduced physicians make it up by working more and doing more procedures . Somehow more patients show up, or or the prevalence of diagnosis and need for Treatment goes up for the same population without any underlying changes in legal liability or patient populations!

 

[libertyyne]

Why do we let premeds post here? It's always the same idealistic bullcrap, nonsense statistics of dubious veracity, overwhelming naivety and complete misunderstanding of how physicians are paid. Anyone who talks about salaries has no idea what they are talking about.

Thanks for accepting diverse voices and those of dissent . Especially those that do not align with your world view. I am sure insulating yourself from those will pay dividends to the continued circlejerk. Let me know how that strategy will work when the payors start squeezing you.

Also thanks for making me chortle by calling the national academies of medicine a dubious source.

 

[ProfMD]

Thank you for this thoughtful post. Do you think financial incentive should be added to the list of underlying causes of overuse? I am on mobile or I would quote the studies that talk about when reimbursement per procedure is reduced physicians make it up by working more and doing more procedures . Somehow more patients show up, or or the prevalence of diagnosis and need for Treatment goes up for the same population without any underlying changes in legal liability or patient populations!

Financial incentive is absolutely a contributing factor - both from the physician fee and facility fee size. I just figured that this had been covered. This is usually what high costs of healthcare are blamed on - I was simply offering other factors that are at play.

I would also add that going into medicine to make money is a huge mistake. As much as physicians make, it is not nearly enough to make up for the sacrifices physicians make with regards to time with family, long hours at work, stress, liability, etc. There must be other motivations besides money or people won't make it in this career.

 

[deleted480308]

Financial incentive is absolutely a contributing factor - both from the physician fee and facility fee size. I just figured that this had been covered. This is usually what high costs of healthcare are blamed on - I was simply offering other factors that are at play.

I would also add that going into medicine to make money is a huge mistake. As much as physicians make, it is not nearly enough to make up for the sacrifices physicians make with regards to time with family, long hours at work, stress, liability, etc. There must be other motivations besides money or people won't make it in this career.

as someone who has had 2 other careers before embarking on this one, it's not as simple to make $200k in other ways as people like to imply

 

[Mad Jack]

Actually no, I am arguing as someone who has both gotten a graduate degree focusing on healthcare systems, and a person who has closely worked with legal liability of physicals for almost a decade. Also, I am the one who has posted a wide range of legitimate sources. So sure man, believe what you want to believe.

https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion

Why target the 8% that goes to physician salaries and not the 40% that goes to waste and inefficiencies? We aren't the system, we're just a part of it, and not even close to the largest one. Much of what we do is at the mercy of hospitals, employers, and insurers.

 

[libertyyne]

Financial incentive is absolutely a contributing factor - both from the physician fee and facility fee size. I just figured that this had been covered. This is usually what high costs of healthcare are blamed on - I was simply offering other factors that are at play.

I would also add that going into medicine to make money is a huge mistake. As much as physicians make, it is not nearly enough to make up for the sacrifices physicians make with regards to time with family, long hours at work, stress, liability, etc. There must be other motivations besides money or people won't make it in this career.

Thank you once again.
Do you think a physician driven solution is possible? Or changes in reimbursement and policy initiatives will solve this problem. " it is difficult to convince someone that something is not the case, especially when their livelihood depends on it"

 

[libertyyne]

https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion

Why target the 8% that goes to physician salaries and not the 40% that goes to waste and inefficiencies? We aren't the system, we're just a part of it, and not even close to the largest one. Much of what we do is at the mercy of hospitals, employers, and insurers.

Please read the article you posted. Who do you think is ordering the 14%clinical waste portion? Also refer to the national academies of science and medicine report I linked. Overutilization is responsible for 30% of costs.

 

[samac]

Why did I read this whole thread?

Physicians start much later in life with their careers than the typical college graduate.
I'll have an actual career at about 30. I'm a traditional student.
I'm giving up the prime years of my life to prepare to help my community.

We have every right to a salary that doesn't suck, because we start our careers so much later with a profound amount of debt. I don't have the least bit of guilt for the salary I wil receive.

I didn't go into medicine for the money, but if it was a $60k a year job I definitely would have looked at other options for no other reason that the ability to retire later in life and the ability to enjoy my 20's.

 

[Mad Jack]

Please read the article you posted. Who do you think is ordering the 14%clinical waste portion? Also refer to the national academies of science and medicine report I linked. Overutilization is responsible for 30% of costs.

Physicians alone are not repsonsible for clinical waste or overutilization. Patients don't just get dragged out of their beds by greedy doctors to be treated- they come to us looking for something and some doctors oblige. Hospitals too are a large generator of overuse and waste- physicians don't do literally everything, this isn't television.

 

[ProfMD]

as someone who has had 2 other careers before embarking on this one, it's not as simple to make $200k in other ways as people like to imply

I never said it was simple in other careers. But, medicine is not a simple way to wealth either. There are a lot of sacrifices in medicine. There are other ways to make good money without working weekends and without he constant cloud of litigation floating over your head.

Thank you once again.
Do you think a physician driven solution is possible? Or changes in reimbursement and policy initiatives will solve this problem. " it is difficult to convince someone that something is not the case, especially when their livelihood depends on it"

I think physicians need to be part of the solution. Certainly we can educate ourselves and try and order tests and procedures only when medically indicated.

However, there are many other areas that need to be looked at as well:
1) Liability reform - This is going to take more than limiting damage awards. There needs to be disencentive to filing frivolous lawsuits, not just limiting the incentive to do so.

2) One of the reasons that physicians are incentivized to do more is that there are declining reimbursements. This is not an easy thing to fix but certainly the profit motive of insurance companies contributes. Of course, the worst reimbursement comes from Medicaid and Medicare.

3) End of life care. I am not talking death panels. I am talking about honest discussions with patients about their wishes while they are still capable of making decisions. Also need honest discussions with families about expected outcomes of the multitude of interventions performed at end of life.

4) Drug and equipment companies need to be reigned in. This stuff is crazy expensive and I suspect does not need to be.

5) End direct marketing to patients. Drug reps have less access to physicians now, so they target consumers who then go to their doctors asking for stuff.

I am sure there are other things as well - this is just what I came up with now.

 

[tennischamp822]

.

 

[ProfMD]

Won't doctors be making less in the future due to this fact? Medicare is about to explode in terms of number of users and many people who are on private insurance now will switch over to Medicare in the near future. If Medicare pays less than private insurance, doctors will make less as the payer mix changes. Or am I mistaken?

Depends where you work. Medicare / Medicaid reimbursement is still better than none. So, critical access hospitals / academic centers / etc are better off if people have public insurance rather than nothing. Nothing is what they had in the pre-ACA world.

 

[LuluLovesMe]

Why do we let premeds post here? It's always the same idealistic bullcrap, nonsense statistics of dubious veracity, overwhelming naivety and complete misunderstanding of how physicians are paid. Anyone who talks about salaries has no idea what they are talking about.

Haha love you Psai. That's what I wanted to say but I didn't want to be rude.

 

[673441]

Why do we let premeds post here? It's always the same idealistic bullcrap, nonsense statistics of dubious veracity, overwhelming naivety and complete misunderstanding of how physicians are paid. Anyone who talks about salaries has no idea what they are talking about.

Well that was my bad lol... I meant to post this in Allo, and asked @Winged Scapula to move it as soon as I did. Oh well, made for a good read.

 

[Mad Jack]

Thank you for some legitimate criticisms and explanation.



The problem with this is, select the people who want to do it for the sake of doing it. If all medical students are such altruists, then this should not bother them. The corrollary for this argument is usually well the best the brightest could make money else where- well look at the unemployment rate, even 4.0 college grads arent safe, and the best and the brightest still get stuck in jobs paying median wages.

Second point against this is change the training- PA's and NP's actually provide a valuable lesson in this regard, need more primary care docs- Maybe 7 years is not really needed for that.

Third point is make medical school free. takes away the loan burden issue.

Fourth point is- Most college grads have upwards of 30K in debt with little to no job prospects, dont see how it is different if you owe 30 k and the only job you can get for the next 10 years pays 30K. The higher education system costs need to be looked at as a society.

Fifth point is : if care provided by Midlevels is offensive AAMC should have opened more seats to fill those needs. - they wont because it drives down salaries.

sixth point : Lawyers and PHD's go through excessive years of training only to come out with **** to show for in terms of reimbursement.

Eighth point: its realistically 10 years of earning when comparing to cubical workers 5X salary makes that up pretty quickly even with a 5% return on investment.

Ninth point: If you think MD's are the only people who are workaholics try meeting someone who has two minimum wage jobs to make ends meet. -SES disparities in health and outcomes.



Yeah, we are consistently terrible on most metrics.
http://www.commonwealthfund.org/pub.../oct/us-health-care-from-a-global-perspective


Please provide some sources for this. The source i provided above actually disputes what you just said. People are still going bankrupt even with insurance. We still have poor outcomes overall. We still overuse with less to show for.

Look at source above. Slower growth of increasing costs. Also what do we have to show for if our outcomes are still terrible. Doing more is not always better. Especially in healthcare. See Mayo.


Yeah still dont have anything to show for our technological superiority. We still use more, get less, live shorter. If all this money and resources spent is not supposed to improve the lives of the citizenery then what the **** is it for?

This may be the most coherent argument. A simple argument would be too look at the healthcare spending for these countries and the mortality and morbidity and life expectancy. I will tell you this even on this scale we lag as a nation.

Really the criticism is aimed at OP. You can ask for more money and respect. But I have seen very little ownership of the problems in our system from physicians.

I literally was in a meeting where a physician said " we dont practice EBM here we practice the best medicine based on our guts."

Selecting the most interested people instead of drawing in the most talented is the stupidest way to possibly build a competent physician workforce. When I'm looking for a surgeon, I look at his outcomes, not his ****ing personal statement. Motives don't matter when lives are at stake, performance does.

 

[Mad Jack]

Won't doctors be making less in the future due to this fact? Medicare is about to explode in terms of number of users and many people who are on private insurance now will switch over to Medicare in the near future. If Medicare pays less than private insurance, doctors will make less as the payer mix changes. Or am I mistaken?

If things get bad enough, doctors can just forego insurance. We'll see what the future holds.

 

[673441]

If things get bad enough, doctors can just forego insurance. We'll see what the future holds.

Unless the govt says you MUST take insurance. I don't really see the govt advocating for a physician's salary/compensation in any way shape or form.

Selecting the most interested people instead of drawing in the most talented is the stupidest way to possibly build a competent physician workforce. When I'm looking for a surgeon, I look at his outcomes, not his ****ing personal statement. Motives don't matter when lives are at stake, performance does.

You hit the needle on the head with this one. It's because we have what I believe to be, a "justified compensation," that our healthcare gets better and better. We always throw money at things to make them better. That's just the way things work in Capitalist societies.

 

[W19]

Selecting the most interested people instead of drawing in the most talented is the stupidest way to possibly build a competent physician workforce. When I'm looking for a surgeon, I look at his outcomes, not his ****ing personal statement. Motives don't matter when lives are at stake, performance does.

Nurse practitioners are doing fine!

 

[deleted480308]

Unless the govt says you MUST take insurance. I don't really see the govt advocating for a physician's salary/compensation in any way shape or form.



You hit the needle on the head with this one. It's because we have what I believe to be, a "justified compensation," that our healthcare gets better and better. We always throw money at things to make them better. That's just the way things work in Capitalist societies.

Nope....in capitalism there isn't a"we" throwing taxes at a service. There is millions of individual transactions based on individual value/budget

 

[cbrons]

Well that was a newbie mistake... Can you put this in Allo please @Winged Scapula

No.. I think this thread probably did belong in pre-allo.

 

[Winged Scapula]

No.. I think this thread probably did belong in pre-allo.

It is sort of the annoying topic that premeds like to discuss isn't it?

But since the OP is a current medical student it's just as reasonable to put it here.


Sent from my iPhone using SDN mobile

 

[W19]

It is sort of the annoying topic that premeds like to discuss isn't it?

But since the OP is a current medical student it's just as reasonable to put it here.


Sent from my iPhone using SDN mobile

OP is not a medical student... This stupid thread should be in pre-allo.

 

[Taddy Mason]

OP is not a medical student... This stupid thread should be in pre-allo.

Than what IS op?

 

[673441]

It is sort of the annoying topic that premeds like to discuss isn't it?

But since the OP is a current medical student it's just as reasonable to put it here.


Sent from my iPhone using SDN mobile

Well, I suppose it doesn't really matter. Premeds do usually have a considerable amount of things to say on topics such as this. Considering this thread saw its fair share of doc's commenting, I'll say finding it wasn't very difficult. Carry on then.

 

[cbrons]

Than what IS op?

Bellona, Sol, Auo Kuang, Erlang Shen, Fafnir

Sent from my SM-N910P using SDN mobile

 

[W19]

Than what IS op?

My mistake! I thought @libertyyne started the thread...

 

[Stagg737]

Compared to physicians in most OECD countries MDs in the US on average get paid more.

Just an honest question, who do you think is ordering those services? Nurses? Administrators? Physicians have been terrible stewarts of the system. Fix your overuse problem and then ask for a raise.

And in most OECD countries med school is either free for very cheap and students finish their school and residency well before they're 30 with little to no debt. Look at the net worth of U.S. physicians vs. other OECD docs (especially in the first world countries) and their net worth won't be that different in the end, even with higher U.S. salaries.

As for the bolded, the reason physicians order so many tests (other than covering their asses legally from ridiculous suits) is because insurance companies and the gov often won't pay for the treatment patients obviously need without first having some other test done. Go to the EM boards and ask how many unnecessary CTs or MRIs they have to run in order to get insurance to pay for the treatment that's actually needed. It's not just physicians covering their own asses, it's us making sure our patients don't get stuck with a huge bill the insurance company or medicaid should be paying but will do whatever they can to deny.

Are you even reading the bolded part? Overutilization and unnecessary testing costs 30% of healthcare.

And you can thank insurance companies, medicaid/care, and administrative costs from unnecessary bureaucratic bs for the majority of that.

Third point is make medical school free. takes away the loan burden issue.

Fourth point is- Most college grads have upwards of 30K in debt with little to no job prospects, dont see how it is different if you owe 30 k and the only job you can get for the next 10 years pays 30K. The higher education system costs need to be looked at as a society.

Fifth point is : if care provided by Midlevels is offensive AAMC should have opened more seats to fill those needs. - they wont because it drives down salaries.

sixth point : Lawyers and PHD's go through excessive years of training only to come out with **** to show for in terms of reimbursement.

Ninth point: If you think MD's are the only people who are workaholics try meeting someone who has two minimum wage jobs to make ends meet. -SES disparities in health and outcomes.



Yeah, we are consistently terrible on most metrics.
http://www.commonwealthfund.org/pub.../oct/us-health-care-from-a-global-perspective


I literally was in a meeting where a physician said " we dont practice EBM here we practice the best medicine based on our guts."

Addressing some of the points from your post that weren't already talked about:

I don't think anyone here would have a problem with having free med school and cheaper higher education, but how much are taxes and expenses to our society as a whole going to cost to make that reality? Most would argue the pros and cons for this don't realistically line up.

AAMC doesn't open up more seats for midlevels because there wouldn't be proper funding for them (as the gov hasn't expanded payments for them) and they don't want to open up programs which produce inadequate physicians, which we already have plenty of. The fact that you think salaries dropping due to market saturation in primary fields and not competitive fields like ortho or plastics shows poor understanding up our primary care system.

Lawyers and PhDs do go through a lot of training. However, PhDs receive a stipend and are paid to get that degree while med students are paying tens of thousands of dollars to get their degree. Idk about you, but I've never met or heard of a PhD graduating with anywhere close to six figures of debt which is a fraction of what the average med student debt is. As for lawyers, it's a truly saturated field which finally hit its tipping point relatively recently. Plus a lot of lawyers don't perform duties which people "need" in order to live, unlike medicine.

No, physicians aren't the only workaholics, but we do work more than the vast majority of other careers, including those people working 2 minimum wage jobs that you mentioned. Add to that the fact that we have to pay for an extra 8 years of education, then get paid what is essentially minimum wage for 3-6 years of residency while accruing interest on our debt and you're d*** right I expect to make more than the guy flipping burgers straight out of high school or the person who chose to screw around for 4 years in college then complain that they can only get a job that pays $10/hour.

As for the metrics, there are so many confounding factors that looking at overall numbers is completely useless. We live in an entitled, instant-gratification, blame-everyone-else society. A country where someone survives a massive coronary, gets a triple bypass, and celebrates by getting a super-size Big Mac meal and considers eating 2 bowls of their favorite ice cream every night with their 2-liter bottle of soda more of a priority than keeping their A1C in check so they don't have to have their foot amputated. Too many people here don't care about their health until it's an emergency, and there are too many of those who still don't care afterwards. I've been to a lot of different countries, and as a whole no one has as much of a Idgaf attitude towards their own health as people in the U.S.

To that final comment, Idk where that physician got their training from, but if I were an attending in that meeting I'd get up and walk out of the room after letting him/her know how much of an idiot I thought they were.

 

[dadaddadaBATMAN]

Compared to physicians in most OECD countries MDs in the US on average get paid more. I provided the chart above.
"
Framing synopsis. Healthcare cost increases continue to outpace the price and spending growth rates for the rest of the economy by a considerable margin (Bureau of Labor Statistics, 2009). At $2.5 trillion and 17 percent of the nation’s gross domestic product in 2009 (CMS, 2009), health spending in the United States commanded twice the per capita expenditures of the average for other developed nations, and concerns have never been higher on the economic implications for individuals, families, businesses, and even the overall capacity and fiscal integrity of critical functions for government at the federal, state, and local levels (Kaiser Family Foundation, 2009a; National Association of State Budget Officers, 2009; Orszag, 2007; Peterson and Burton, 2008).

Moreover, there are compelling signals that much of health spending does little to improve health, and, in certain circumstances, may be associated with poorer health outcomes. Between 2000 and 2006, for example, Medicare spending on imaging services more than doubled, with an over 25 percent increase in use of advanced imaging modalities such as nuclear medicine and CT scans compared to an 18 percent increase in readily available standard imaging modalities such as X-rays and ultrasounds, despite the increased risks associated with advanced imaging services (GAO, 2008). Several recent assessments of institutional and regional variation in costs and volume of treatment services indicate that, in many cases, care profiles that are 60 percent more expensive have no quality advantage (Fisher et al., 2003). Medicare spending per capita by hospital referral region, for example, varied more than threefold—from $5,000 to over $16,000—yet there appeared to be an inverse relationship between healthcare spending and quality scores.

In the face of these urgent challenges, the Institute of Medicine (IOM)—with the support and encouragement of the Peter G. Peterson Foundation—convened four meetings throughout 2009, under the umbrella theme The Healthcare Imperative: Lowering Costs and Improving Outcomes. These meetings explored in detail the nature of excess health costs, current evidence on the effectiveness of.......

extrapolation from observed geographic variation within the United States, contrasting overall U.S. expenditure levels with those of member countries in the Organisation of Economic Co-operation and Development (OECD), and summing the lower bounds of the various estimates for the six domains considered in the IOM workshops—amounted to approximately $750 billion, $760 billion, and $765 billion, respectively, for excess U.S. healthcare costs in 2009."

Just an honest question, who do you think is ordering those services? Nurses? Administrators? Physicians have been terrible stewarts of the system. Fix your overuse problem and then ask for a raise.

comparisons to other countries are almost entirely meaningless. They reflect entirely different circumstances in terms of cost of living, social safety net, number of hours worked, vacation time, pay during training, debt and actual services provided.

Even if that weren't the case, I don't give a **** about what a lawyer makes in Uganda when I live in New York. I'm still going to expect to pay New York rates, and I won't whine about how people pay much less in France.

i really don't have time or inclination to explain why we order more tests here. Hopefully you'll learn it by experience

 

[tennischamp822]

.

 

[Mad Jack]

And in most OECD countries med school is either free for very cheap and students finish their school and residency well before they're 30 with little to no debt. Look at the net worth of U.S. physicians vs. other OECD docs (especially in the first world countries) and their net worth won't be that different in the end, even with higher U.S. salaries.

As for the bolded, the reason physicians order so many tests (other than covering their asses legally from ridiculous suits) is because insurance companies and the gov often won't pay for the treatment patients obviously need without first having some other test done. Go to the EM boards and ask how many unnecessary CTs or MRIs they have to run in order to get insurance to pay for the treatment that's actually needed. It's not just physicians covering their own asses, it's us making sure our patients don't get stuck with a huge bill the insurance company or medicaid should be paying but will do whatever they can to deny.



And you can thank insurance companies, medicaid/care, and administrative costs from unnecessary bureaucratic bs for the majority of that.



Addressing some of the points from your post that weren't already talked about:

I don't think anyone here would have a problem with having free med school and cheaper higher education, but how much are taxes and expenses to our society as a whole going to cost to make that reality? Most would argue the pros and cons for this don't realistically line up.

AAMC doesn't open up more seats for midlevels because there wouldn't be proper funding for them (as the gov hasn't expanded payments for them) and they don't want to open up programs which produce inadequate physicians, which we already have plenty of. The fact that you think salaries dropping due to market saturation in primary fields and not competitive fields like ortho or plastics shows poor understanding up our primary care system.

Lawyers and PhDs do go through a lot of training. However, PhDs receive a stipend and are paid to get that degree while med students are paying tens of thousands of dollars to get their degree. Idk about you, but I've never met or heard of a PhD graduating with anywhere close to six figures of debt which is a fraction of what the average med student debt is. As for lawyers, it's a truly saturated field which finally hit its tipping point relatively recently. Plus a lot of lawyers don't perform duties which people "need" in order to live, unlike medicine.

No, physicians aren't the only workaholics, but we do work more than the vast majority of other careers, including those people working 2 minimum wage jobs that you mentioned. Add to that the fact that we have to pay for an extra 8 years of education, then get paid what is essentially minimum wage for 3-6 years of residency while accruing interest on our debt and you're d*** right I expect to make more than the guy flipping burgers straight out of high school or the person who chose to screw around for 4 years in college then complain that they can only get a job that pays $10/hour.

As for the metrics, there are so many confounding factors that looking at overall numbers is completely useless. We live in an entitled, instant-gratification, blame-everyone-else society. A country where someone survives a massive coronary, gets a triple bypass, and celebrates by getting a super-size Big Mac meal and considers eating 2 bowls of their favorite ice cream every night with their 2-liter bottle of soda more of a priority than keeping their A1C in check so they don't have to have their foot amputated. Too many people here don't care about their health until it's an emergency, and there are too many of those who still don't care afterwards. I've been to a lot of different countries, and as a whole no one has as much of a Idgaf attitude towards their own health as people in the U.S.

To that final comment, Idk where that physician got their training from, but if I were an attending in that meeting I'd get up and walk out of the room after letting him/her know how much of an idiot I thought they were.

They also work far less hours- US physicians put in 50% or more work than many of their European counterparts, in both hours and RVUs.

 

[Mad Jack]

How would this be remotely possible? I think that maybe 20% of the population at best can afford medical care without using insurance or Medicare. Even if they could afford it, a lot of people already go overseas for different medical procedures and that would increase when insurance isn't being accepted in the US.

Plenty of physicians already opt out of the system in psych, cosmetic medicine/surgery, and concierge primary care. And many DPC physicians actually cost less than the copay of many insurance plans for comprehensive yearly care. Mathematically, many DPC practices are actually far cheaper than traditional insurance when coupled with catastrophic insurance plans.

 

[monkeypen]

1. Why you thinking you deserve their gratefulness? You get paid for your services. Are you grateful to your cook at a restaurant? You are not doing them a favor, you get reimbursed handsomely for your time.


2. Do you think you are the only person or profession in the world that works hard, or only professional that spends a large amount of time at work after training?

3. If magically tomorrow physican salaries were halved would you still want to work as a physican? What about quartered?

4. Do we overutilize services as a society? Yes.
A. Do physicans contribute to that ? Yes.
B. Do proceduralists have a conflict of interest in doing procedures? Yes.
I. Do all of said procedures improve outcomes? No.
II . Do said procedures continue to be performed? Yes.

5. Are physicans in America overpaid? Probably.

View attachment 209234

6. Should physican education change to reduce loans/cost?
Yes.
7. Is quality of care related to reimbursement? No.
8. Is the current healthcare spending trend unsustainable? Yes.

These graphs are meaningless. Unless they control for the cost and time for education then they're nothing but fluff for people to whine about. Many of the countries that the US is being compared to have subsidized education for both undergraduate and graduate years. This means that they can make much less because they don't have the 200k+ in student loans to pay back (when you add in the interest that gets added to that it's ridiculously high.) That alone makes US physicians need to be paid more, or nobody would save your life because they'd go broke trying to do so. Also, many countries have different educational systems - they don't go through 11+ years after high school of education to become physicians. They have tiered high school systems that are considered "university" that they view as equivalent to the US undergraduate education system, and then after their high school level can apply for medical school. This means that in the US when physicians spend 11+ years to become physicians those in some of the countries listed spend 7+ years. There is plenty of information available with a quick google search about how that lost time to schooling equates to lost wages, lost savings, lost retirement potential, less time for paying back loans, more time for loan interest to accrue, how it shortens the amount of time to make an income, etc.

I think perhaps either you need to pick better sources (assuming they didn't control for it because it doesn't say it in the graph descriptions, and it's too late for me to read the whole report) before going on a rant.


I also think that, while there are many service industries that work long hours and feel they should be paid more, there are very few that deal with literal life and death matters on a regular basis, require such a high level of critical thinking/problem solving, have training that is as physically and mentally demanding as medical school/residency/fellowship, require such a high level of performance at all levels of education, have the ability to get sued for every decision they've ever made because our society likes to blame everything on everyone else even if it's unfounded, and many of distinctions that are relatively limited to the healthcare field and very few other jobs. Trying to compare it to a cook isn't a legitimate comparison. While cooks serve a great purpose, it's just different. If you truly believe that all of the things I just listed don't increase the compensation for said service, then you'd better be okay with getting your medical care from someone that has the same amount of responsibility, legal culpability, and education as a cook.

 

[monkeypen]

 

[libertyyne]

These graphs are meaningless. Unless they control for the cost and time for education then they're nothing but fluff for people to whine about. Many of the countries that the US is being compared to have subsidized education for both undergraduate and graduate years. This means that they can make much less because they don't have the 200k+ in student loans to pay back (when you add in the interest that gets added to that it's ridiculously high.) That alone makes US physicians need to be paid more, or nobody would save your life because they'd go broke trying to do so. Also, many countries have different educational systems - they don't go through 11+ years after high school of education to become physicians. They have tiered high school systems that are considered "university" that they view as equivalent to the US undergraduate education system, and then after their high school level can apply for medical school. This means that in the US when physicians spend 11+ years to become physicians those in some of the countries listed spend 7+ years. There is plenty of information available with a quick google search about how that lost time to schooling equates to lost wages, lost savings, lost retirement potential, less time for paying back loans, more time for loan interest to accrue, how it shortens the amount of time to make an income, etc.

I think perhaps either you need to pick better sources (assuming they didn't control for it because it doesn't say it in the graph descriptions, and it's too late for me to read the whole report) before going on a rant.


I also think that, while there are many service industries that work long hours and feel they should be paid more, there are very few that deal with literal life and death matters on a regular basis, require such a high level of critical thinking/problem solving, have training that is as physically and mentally demanding as medical school/residency/fellowship, require such a high level of performance at all levels of education, have the ability to get sued for every decision they've ever made because our society likes to blame everything on everyone else even if it's unfounded, and many of distinctions that are relatively limited to the healthcare field and very few other jobs. Trying to compare it to a cook isn't a legitimate comparison. While cooks serve a great purpose, it's just different. If you truly believe that all of the things I just listed don't increase the compensation for said service, then you'd better be okay with getting your medical care from someone that has the same amount of responsibility, legal culpability, and education as a cook.

Thank you for taking the time to write a response and criticizing the charts without actually reading the article.
Thanks for belittling the work that Firemen, Pilots, Police officers, Nuclear power plant operators, civil engineers, military service members do.
Your criticism is also meaningless because you fail to account for higher tax burdens in other countries.
Thank you for making the logical mistake that longer duration of training should equate to higher compensation: See PHDs.
Thank you for making the logical mistake that taking out loans = higher salaries. See anyone who has taken loans out for education from private for profit schools, or Lawyers, or pilots.
Perhaps you should read the report before going on a rant.
Lastly, thanks for bumping a thread that is almost two month old without reading any of the nuance in it. I am sure everyone remembers every detail going through their logical train of thought.

 

[samac]

. . . Just stop with this ignorant premed.
We don't need to keep feeding this kid because all though I don't think he's a troll, he's just not going to stop.

Thanks monkey for discussing the actual reality for physicians and the difference in the education we have vs other physicians.

 

[libertyyne]

. . . Just stop with this ignorant premed.
We don't need to keep feeding this kid because all though I don't think he's a troll, he's just not going to stop.

Thanks monkey for discussing the actual reality for physicians and the difference in the education we have vs other physicians.

Thanks for ad Homs those are definitely the best response to differing world views . Also nice view on physicians in other developed countries.

 

[SansaStarkMD]

Thank you for taking the time to write a response and criticizing the charts without actually reading the article.
Thanks for belittling the work that Firemen, Pilots, Police officers, Nuclear power plant operators, civil engineers, military service members do.
Your criticism is also meaningless because you fail to account for higher tax burdens in other countries.
Thank you for making the logical mistake that longer duration of training should equate to higher compensation: See PHDs.
Thank you for making the logical mistake that taking out loans = higher salaries. See anyone who has taken loans out for education from private for profit schools, or Lawyers, or pilots.
Perhaps you should read the report before going on a rant.
Lastly, thanks for bumping a thread that is almost two month old without reading any of the nuance in it. I am sure everyone remembers every detail going through their logical train of thought.

Last word! Nana nana boo booooooo.

 

[samac]

I used the ignore button for the first time and it feels soooooooo good.

 

[FourniersGreenGang]

Hey Libertyyne, focus on getting into medical school first. Once you're here let's see if you sing the same tune. Your job as a premed is to have your mouth shut and your ears open, and to absorb the wisdom that those of us who are in the position in which you desire to be have to give you. Too many premeds are so entitled these days.

 

[libertyyne]

Hey Libertyyne, focus on getting into medical school first. Once you're here let's see if you sing the same tune. Your job as a premed is to have your mouth shut and your ears open, and to absorb the wisdom that those of us who are in the position in which you desire to be have to give you. Too many premeds are so entitled these days.

Thanks for the advice. Was already accepted to an MD school. Still waiting for my "you are entitled to an opinion" card. School said they sent it out already.

 

[DetectiveAlonzo]

LOL 100K? Yeah... he's on that good good.

lmao.

Might as well go be a nurse or midlevel. Working doctor hours... you can clear that easy.

No headache. Not too much liability. No serious debt.

Tell homeboy to go stick it where the sun don't shine.

 

[SansaStarkMD]

Thanks for the advice. Was already accepted to an MD school. Still waiting for my "you are entitled to an opinion" card. School said they sent it out already.

Last word! Nana nana boo booooo!

 

[efle]

Thanks for the advice. Was already accepted to an MD school. Still waiting for my "you are entitled to an opinion" card. School said they sent it out already.

It's actually not until you step foot on campus that you become infallible anytime you disagree with a premed

And you have to wait for the secret M1 classes not shown on any curriculum summaries before your MD also includes the unofficial doctorate in economics and culture studies. That's when you can really start telling the stupid college kids what's what about the other healthcare education and delivery systems all over the world.