surgeons make a lot less than i thought!?

[Pilot Doc]

if these practices joined as a multisurgical group, or multispecialty group, they might be able to lower their overhead costs (a group can get a better rate on malpractice then an individual, less office space, less staff),

While multispecialty groups may offer better bargaining power from a purchasing standpoint, they typicall have overheads much,much higher than single specialty surgical groups. A good surgery practice can have overhead around 20%. MSG's are often twice that and use proceduralists to shore up the rest of the group.

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[Winged Scapula]

being paid $110 doesn't mean it's $110 in his pocket. given that, by current figures, an efficient primary care practice spends 52-56% of its revenue on overheard costs, then the profit may "only" have been around $60. and if his office is not so efficient, the profit may have been less.

I think that's fairly obvious that regardless of what he is reimbursed, its only gross pay, not net.

However, my point was simply to reinforce that my PCP can have me come back for multiple visits, dealing with the SAME ISSUE, and still get paid for each and every one (it doesn't really matter WHAT he gets paid...he still gets paid) whereas the surgeon doesn't get paid for any post op visits in the first 90 days, even for complicated ones.

 

[elwademd]

While multispecialty groups may offer better bargaining power from a purchasing standpoint, they typicall have overheads much,much higher than single specialty surgical groups. A good surgery practice can have overhead around 20%. MSG's are often twice that and use proceduralists to shore up the rest of the group.

but 20% or 40% as a the cost of overhead costs is better than 53-56%! a multispecialty group may also benefit the surgeon from the standpoint of cardiac clearance/preoperative cardiac evaluation & quicker referral processes on both sides.

with that said, we newer physicians are a bit different in our thinking in that we see the potential "beauty" of a group based practice, whether it be single specialty surgical group, or multispecialty surgical group. it's the older folks, in all specialties, that still see solo practice as the way to go.

I think that's fairly obvious that regardless of what he is reimbursed, its only gross pay, not net.

However, my point was simply to reinforce that my PCP can have me come back for multiple visits, dealing with the SAME ISSUE, and still get paid for each and every one (it doesn't really matter WHAT he gets paid...he still gets paid) whereas the surgeon doesn't get paid for any post op visits in the first 90 days, even for complicated ones.

my point was simply to point out reimbursement issues to the other sdn members that might be viewing this topic. didn't mean to get into issues of reimbursement for internists versus surgeons!

 

[misery]

this thread really makes me depressed and pissed I hope you all make some political and policy changes before I get done.

 

[Faebinder]

this thread really makes me depressed and pissed I hope you all make some political and policy changes before I get done.

For a change of policy that means the surgeons have to be politically involved... and that wont happen... most are too busy in the OR and the old school guys who are not too busy are not suffering the problem cause they are close to retirement and have been well compensated.

There are however some serious obvious signs.. i see them in my hospital for example... look out for the political talks on who is going to take different surgical calls. If it doesn't pay enough, many surgeons will shy away from taking call and the hospital starts taking some pressure.

 

[maxflash04]

My suggestion: Move south!

 

[-Goose-]

The more important question is what, if anything, can we do to change this in the future.

 

[Leforte]

Not much aside from opting out of medicare/-caid. I know several practices that do this with medicare and most, locally anyway, do not accept medicaid. Although this limits the referral base, they do very well, as there is plenty of work for everyone. Personally, I feel an obligation to treat everyone - but, who knows, this may change once I get into practice and actually have to deal with all the BS instead of just showing up to the OR for my attendings' patients.

Perhaps once the insurance companies have forced all physicians into hospital employees, then we can legally form a union. Until then however...

 

[pdz]

Yeah, I'm not saying that 145k a year is a little! But again, after 7-8 yeras of training (i.e. losing a few years of opportunity that you could have been making 100+k in other fields), the fact that you work more than most other fields.... well, no wonder why people aren't doing surgery. I won't be an attending until I'm at LEAST 35 (assuming I do a fellowship), and if I'm only making 110-145k in the first 5 years with my expenses (debt, children, support my dad, etc), I'll still be renting and literally driving a crap car 'til I'm 40+!


oh well

But how come this comes as a surprise to you? Didn't you do your research before deciding to go for a field? I know many attendings who just earn around 110K, and yeah, that's not enough money at all if you live in a big city! Medicine is no longer lucrative. The people in Wall St. and in the hedge funds in CT are the ones making the big bucks. But hey, you are suppossed to do what you love, aren't you?

 

[Miami_med]

Everyone does know that there are plenty of jobs that are not as academic surgeons at big name programs in NYC right? The basic economics of a big city with a bazillion surgery residencies ensures a tight market for job applicants to a limited number of prestige positions..

 

[Pilot Doc]

Personally, I feel an obligation to treat everyone -

You can always make a given % of your practice pro bono. You probably do more good taking the working poor uninsured, who have almost no access to care and who are often financially devastated by emergencies, than by offering care to CMS patients who have reasonable access to care.

 

[jubb]

The thing that sucks is not doing your charity work on your own terms. You just don't get the same rewarding feeling. I think most docs are more than willing to do a fair percentage of free care and would do a lot more of it if they weren't already feeling like slave labor and haggard by doing all this forced BS. I guess it's hard to take the kind of beating you can take nowadays and still feel like you owe something back.

It's kinda scary when I realize how little responsibility people feel to pay their hospital bills. I overheard some high functioning people in society and the husband was telling the wife that they didn't need to pay off their hospital bills so fast. He said "it's not like they really expect you to pay all that back." I guess we really are ripening for government health care. People who haven't paid the price of insurance for years, counting on the fact that they won't have a medical catastrophe, suddenly feel like it's someone else responsibility when the need for emergency surgery arrives. That it's somehow not fair that they get stuck with such a huge bill. It's a gamble and when you buy your home theater system instead of having health insurance and the people who are paying their insurance shouldn't be subsidizing your care when you finally do get caught.

 

[doc02]

It's kinda scary when I realize how little responsibility people feel to pay their hospital bills.

Why are you shocked by this when everyone goes around talking about how health care is a right? If you believe that statement (I don't know if you do or not), then what's the problem? You don't have to pay for something that is your right, so of course paying your bill is not a priority. In fact, paying your bill makes you a sucker because people who pay for their health care are the ones subsidizing the ones who do not. Saying that rich people have more of an obligation to pay for health care than poor people is silly. The only people who think that are people who will never be rich because they have no common sense.

 

[jubb]

Why are you shocked by this when everyone goes around talking about how health care is a right? If you believe that statement (I don't know if you do or not), then what's the problem? You don't have to pay for something that is your right, so of course paying your bill is not a priority. In fact, paying your bill makes you a sucker because people who pay for their health care are the ones subsidizing the ones who do not. Saying that rich people have more of an obligation to pay for health care than poor people is silly. The only people who think that are people who will never be rich because they have no common sense.

I guess I was shocked to see it in such high functioning people. People who make good money and are raising kids and trying to instill good values in them and stuff.

 

[Winged Scapula]

I guess I was shocked to see it in such high functioning people. People who make good money and are raising kids and trying to instill good values in them and stuff.

Some of those same "high functioning" people have daughters who are surgeons and yet still see health care as a right, but only if someone else pays for it (because paying for your Mercedes is more important than health insurance).

 

[Enough]

this thread really makes me depressed and pissed I hope you all make some political and policy changes before I get done.

Let take a look at the problems in surgery:

1) Our surgical profession has been raped by our senior surgical colleagues for years,
2) Hospitals want to shutdown outpatient surgical centers and make surgeons employees of the hospital just like PA (Physician Assistants)
3) Malpractice Insurance companies
A) Raise your insurance every time you are named in a law suite (not only when you lose a case)
B) Settle out of court behind your back
C) They can drop you from coverage for no reason or for multiple frivolous law suites.
4) Malpractice lawyers are holding seminars in nice hotels and have Talk Radio shows – where they are encouraging the population to sue.
5) Health care insurance companies are constantly cutting our reimbursement – many private surgeons can not afford malpractice and overhead.


I see where you can be depressed. The solution is part of the problem - Surgeons attitude and lack of unification. We have no leverage against our enemies unless we are united.

 

[Faebinder]

Let take a look at the problems in surgery:

1) Our surgical profession has been raped by our senior surgical colleagues for years,
2) Hospitals want to shutdown outpatient surgical centers and make surgeons employees of the hospital just like PA (Physician Assistants)
3) Malpractice Insurance companies
A) Raise your insurance every time you are named in a law suite (not only when you lose a case)
B) Settle out of court behind your back
C) They can drop you from coverage for no reason or for multiple frivolous law suites.
4) Malpractice lawyers are holding seminars in nice hotels and have Talk Radio shows – where they are encouraging the population to sue.
5) Health care insurance companies are constantly cutting our reimbursement – many private surgeons can not afford malpractice and overhead.


I see where you can be depressed. The solution is part of the problem - Surgeons attitude and lack of unification. We have no leverage against our enemies unless we are united.

Been saying this for a while.. but the root of that problem is the fact that unlike other specialties... surgery is a ranking army style specialty. The attending who did 500 Lap Nissens believes he is more important than the attending who did 100 Lap Nissens. This pushes for segregation of the ranks. I did 500 esophagotomies but he did only 50, so I should get a bigger bite of the pie. It's the belief of most surgeons that if attending A did 500 esophagotomies and attending B did 50 then attending A should get paid more for his 501st esophagotomy than attending B for his 51st. Do you think for example that a radiologist reading his 1000th CT Scan expects to get paid more than the one reading his 500th? So yeah, this problem wont be resolved until there is more of an equalizer in the ranks which wont happen... so then what needs to happen is that the old school attendings need to stop feeding their young to the dogs. Sorry, I also feel that senior attendings are probably doing this to the profession by enabling this to happen instead of genuinely agreeing to collaborate. It's probably due to the lack of protection for the seniors in the current system... a protection that they are capable of installing if they do collaborate together.

 

[misery]

Let take a look at the problems in surgery:

1) Our surgical profession has been raped by our senior surgical colleagues for years,
2) Hospitals want to shutdown outpatient surgical centers and make surgeons employees of the hospital just like PA (Physician Assistants)
3) Malpractice Insurance companies
A) Raise your insurance every time you are named in a law suite (not only when you lose a case)
B) Settle out of court behind your back
C) They can drop you from coverage for no reason or for multiple frivolous law suites.
4) Malpractice lawyers are holding seminars in nice hotels and have Talk Radio shows – where they are encouraging the population to sue.
5) Health care insurance companies are constantly cutting our reimbursement – many private surgeons can not afford malpractice and overhead.


I see where you can be depressed. The solution is part of the problem - Surgeons attitude and lack of unification. We have no leverage against our enemies unless we are united.

Why can't the ACS level this problem. Is it something that is a significant issue at the conferences, if not why?

 

[doc02]

The reason there's a problem is because everyone wants socialized healthcare. Surgeons generally do necessary operations (even the Plastics guys go on and on about "quality of life" when it comes to cosmetic boob jobs, even though that's a complete joke) and therefore the general feeling is that everyone must be able to obtain these operations no matter what their ability to pay. And that's the problem right there.

 

[misery]

The reason there's a problem is because everyone wants socialized healthcare. Surgeons generally do necessary operations (even the Plastics guys go on and on about "quality of life" when it comes to cosmetic boob jobs, even though that's a complete joke) and therefore the general feeling is that everyone must be able to obtain these operations no matter what their ability to pay. And that's the problem right there.

I agree, what we need, and I'll be an dingus and say it, are more surgeons demanding payment before the procedures. A couple people die and then it would be front page news. I'd love to see a Dr on TV saying "yes we could have saved him, but I wouldn't get paid, so this is what you get." God I wish it were that easy.

Better idea kill the lawyers!!!

 

[OHMAN0125]

I agree, what we need, and I'll be an dingus and say it, are more surgeons demanding payment before the procedures. A couple people die and then it would be front page news. I'd love to see a Dr on TV saying "yes we could have saved him, but I wouldn't get paid, so this is what you get." God I wish it were that easy.

Better idea kill the lawyers!!!

Lawyers serve their purposes too. For instance, the fear of litigation prevents a flood of foreign graduated non US boarded docs from just opening shop here or just the takeover of primary care by midlevels.

 

[Winged Scapula]

I agree, what we need, and I'll be an dingus and say it, are more surgeons demanding payment before the procedures. A couple people die and then it would be front page news. I'd love to see a Dr on TV saying "yes we could have saved him, but I wouldn't get paid, so this is what you get." God I wish it were that easy.
!!

While I can see your point, this will only backfire:

"why that rich doctor only cares about making money so he can take a trip to Tahiti every year!"

You'd better believe the public will see it that way and the lawyers will spin it that way. Americans believe health care is a right and they shouldn't have to pay for it.

 

[Blade28]

You'd better believe the public will see it that way and the lawyers will spin it that way. Americans believe health care is a right and they shouldn't have to pay for it.

Which is why statistics that show "X% of Americans are uninsured" and seek social/healthcare reform often miss the point. I've seen patients without insurance (at our county hospital) receive free health care, then drive away in their Escalades and Cayennes WAY too often.

It's not that they all can't afford it...many just choose not to pay for it.

 

[Winged Scapula]

Which is why statistics that show "X% of Americans are uninsured" and seek social/healthcare reform often miss the point. I've seen patients without insurance (at our county hospital) receive free health care, then drive away in their Escalades and Cayennes WAY too often.

It's not that they all can't afford it...many just choose not to pay for it.

I know, I know...you have described members of my own family (who wail about the cost of recommended tests but seemingly think nothing of spending the same amount or more for a dinner out).

 

[Blade28]

I know, I know...you have described members of my own family (who wail about the cost of recommended tests but seemingly think nothing of spending the same amount or more for a dinner out).

Ooops, yeah, forgot about that anecdote (I think you mentioned it a couple weeks ago)...sorry, wasn't trying to poke fun or anything.

 

[misery]

While I can see your point, this will only backfire:

"why that rich doctor only cares about making money so he can take a trip to Tahiti every year!"

You'd better believe the public will see it that way and the lawyers will spin it that way. Americans believe health care is a right and they shouldn't have to pay for it.

I'll be 36 years old and 250,000 in debt when I get out of school. If I want to take a trip to Tahiti I should be able too! Damn it!

I know I'm preaching to the choir, crap like this just pisses me off. Its on my mind because a patient this morning accused me of being a rich doctor, wish I could type in ebonics so you'd get the full effect. I felt like punching the ignorant as$hole in the face, instead I explained that medical students didn't get paid and doctors don't make that much. Fncking idiots!

 

[Winged Scapula]

Ooops, yeah, forgot about that anecdote (I think you mentioned it a couple weeks ago)...sorry, wasn't trying to poke fun or anything.

Eh...no worries. I've long since forgiven (if not forgotten) them for their attitudes about doctors and health care.

 

[Blade28]

Eh...no worries.

When you say things like this it always confuses me...I can never figure out if you have an Australian accent or not. If you keep saying "no worries," "heaps," etc. (or can correctly pronounce "Aussie" [i.e. OZ-EE and not AUS-EE] or "Alice Springs" [i.e. AL-EH-SPRINGS and not AL-ES-SPRINGS]) then I'll know.

(I lived near Sydney for 6 months after high school.)

 

[Winged Scapula]

When you say things like this it always confuses me...I can never figure out if you have an Australian accent or not.

Not anymore, but if I spend heaps of time around my mother I do.

If you keep saying "no worries," "heaps," etc. (or can correctly pronounce "Aussie" [i.e. OZ-EE and not AUS-EE] or "Alice Springs" [i.e. AL-EH-SPRINGS and not AL-ES-SPRINGS]) then I'll know.

(I lived near Sydney for 6 months after high school.)

I can speak 'strine with the best of 'em. Even though I've lost the accent since I've been back, I still find myself saying, "straw-brie", "ras-brie", "respri-tree" or "tra-kia".

We had a bunch of South Africans in my residency and all the Pennsylvanians used to think they were Aussie which was funny to me because they sounded quite different.

Oz-ee, Oz-ee, Oz-ee - Oi, Oi, Oi!

 

[Blade28]

We had a bunch of South Africans in my residency and all the Pennsylvanians used to think they were Aussie which was funny to me because they sounded quite different.

Not to sound like an accent snob, but I HATE it when people confuse a British accent with an Australian one! I mean, seriously? You can't tell the difference between Clive Owen and Hugh Jackman? Between Keira Knightley and Nicole Kidman? Really? Are you kidding me?

(Then again, I'm lucky because I spent several years growing up in Hong Kong, so I had lots of friends from England and Australia.)

BTW, I KNEW it! I knew you used to have an Australian accent...that's awesome! One of my favorite accents.

 

[Winged Scapula]

I think growing up around different accents really gives one an ear for it and the sometimes subtle nuances. Between my mum and dad (he was from Kentucky), I really learned to appreciate them as I'm sure you did in HK as well.

 

[Blade28]

I think growing up around different accents really gives one an ear for it and the sometimes subtle nuances. Between my mum and dad (he was from Kentucky), I really learned to appreciate them as I'm sure you did in HK as well.

Yeah, don't get me started on the differences between an English vs. Scottish vs. Welsh vs. Irish accent.

Sean Connery <> Pierce Brosnan <> Clive Owen <> Colin Farrell, etc.

 

[gasnewby]

australians vs new zealanders (go all blacks!) always gets me

 

[Winged Scapula]

australians vs new zealanders (go all blacks!) always gets me

Its subtle but there is a difference, especially with some words.

 

[Blade28]

australians vs new zealanders (go all blacks!) always gets me

Now THOSE accents I don't claim to be able to distinguish.

 

[domer621]

General surgeons and onc surgeons start off so low? EVEN 145k is like LESS than a hospitalist medicine doc makes who only works like half the year!

My ex-gf's dad was a general surgeon and made $280k per year working at an academic hospital, and we're not even in an expensive area of the country.

 

[Winged Scapula]

My ex-gf's dad was a general surgeon and made $280k per year working at an academic hospital, and we're not even in an expensive area of the country.

Which is probably exactly the reason he is making so much. Medicine works opposite the rest of the world...they pay less to work in expensive or geographically desirable areas or at "name" institutions.

It was one of the reasons why I didn't seriously consider any of the offers to go back home to Cali...not worth it when you're talking about $50-$100K/year less.

 

[doc02]

I've seen patients without insurance (at our county hospital) receive free health care, then drive away in their Escalades and Cayennes WAY too often.

It's not that they all can't afford it...many just choose not to pay for it.

So what? What are we, total socialists and Marxists now? Lenin was the one who said "from each according to ability to each according to need." We castigate the middle- and upper-class for not paying for a service and then demand that they ALSO pay for the service for poor people AND then justify that by saying "health care is a right" BUT even though it's a right the people who can do so still need to pay? You need to have taken a baseball bat to the head to find that statement logical. The more they socialize health care, the more I'm glad when "rich" people stiff the system because they need to take complete advantage of socialism.

 

[Blade28]

I don't believe that health care should be socialized. I find Canada's model to be inefficient and a little ludicrous. I'm fairly liberal in many issues, but for health care I'm a firm believer in everyone having to pay something - trust me, I'm sick and tired of my state/county taxes here going towards [fill in the blank] patients at the county hospital who don't pay.

 

[doc02]

I'm a firm believer in paying for services rendered or GTFO. I saw a guy today who is like everyone else I've seen ever: 51 y/o male PMH HTN, DM, ESRD on HD, CAD s/p MI, stent x 3, s/p CABG x 3v, PVD. Are you kidding me? That's like a few MILLION DOLLARS in care right there. And everyone is like, "aw, he's so young." I was like, "holy crap, he should be dead." He's going to make it to 70 and probably be admitted a few times with angina, get cathed, have complications from his dialysis, and so on. And he'll pay something like, what, a couple grand total? And be pissed about it?

 

[Kubed]

I... Its on my mind because a patient this morning accused me of being a rich doctor, wish I could type in ebonics so you'd get the full effect. I felt like punching the ignorant as$hole in the face, instead I explained that medical students didn't get paid and doctors don't make that much. Fncking idiots!

I admit I get a some satisfaction when I reply to something like that with "actually, I'm paying $35,000 a year for the privilege of being here." The look of shock/confusion/horror they give me warms my heart

 

[Blade28]

I'm a firm believer in paying for services rendered or GTFO. I saw a guy today who is like everyone else I've seen ever: 51 y/o male PMH HTN, DM, ESRD on HD, CAD s/p MI, stent x 3, s/p CABG x 3v, PVD. Are you kidding me? That's like a few MILLION DOLLARS in care right there

That'll be 100% of my patients in the future.

 

[Winged Scapula]

I admit I get a some satisfaction when I reply to something like that with "actually, I'm paying $35,000 a year for the privilege of being here." The look of shock/confusion/horror they give me warms my heart

I had the same satisfaction as a resident when telling the nurses that I made less than they did (as well as my family who thought once I finished medical school I'd be making "big bucks"!).

 

[Blade28]

Yeah, usually the nurses are astonished to find that they may make up to 2-3 times the salary that I do.

When you calculate it on a per-hour basis, it's even worse! More like 4-6 fold.

 

[doc02]

Why do you guys get satisfaction in telling people who are less educated and work fewer hours and work less when they ARE working that you make a fraction of what they do? You sure showed them! Now they'll be nicer to you for two hours! Hooray!

 

[Winged Scapula]

Why do you guys get satisfaction in telling people who are less educated and work fewer hours and work less when they ARE working that you make a fraction of what they do? You sure showed them! Now they'll be nicer to you for two hours! Hooray!

I dunno...its the thrill of seeing their shocked faces and then hoping that's one more person who might not think that doctors are all rich hustlers looking to con another patient into a procedure just so he can buy another Porsche.

 

[H_Caulfield]

I think socialism, and therefore socialized medicine, is an awful idea NOT because I'm greedy, nor because I hate people who expect to do nothing yet leech off the productive population and survive, nor even because I'm so acutely aware of how hard I'm going to have to work to be rewarded so sparingly.

I'm against socialism because it's capable of destroying our entire race with disease and poverty. It's literally an attempt to pull an exponentially increasing and unchecked weight: rather than successfully pulling it up we'll all go down with it. I'm choosing my residency program based on which might allow me to round with a copy of Atlas Shrugged strapped to my belt.

 

[doc02]

I think socialism, and therefore socialized medicine, is an awful idea NOT because I'm greedy, nor because I hate people who expect to do nothing yet leech off the productive population and survive, nor even because I'm so acutely aware of how hard I'm going to have to work to be rewarded so sparingly.

Any time some liberal talks glowingly about socialism or how they approve of the latest tax hike, I will knock them down and take any money on them. That because they apparently find it OK for the government to take money that is not theirs and give it to people who did not earn it; therefore, I presume this to mean that they are equally happy with the redistribution of THEIR wealth. Usually I will leave these liberals naked and crying in the street and I donate their clothing to Goodwill and spend their money on XBox games.

 

[Faebinder]

Our PA today had the pleasure of sitting loudly on the phone and telling one patient that it was not my attending that is charging him $35,000 to do the surgery he wants done.... my attending is barely getting paid $700 for it. The patient was just constantly arguing that shame on my attending charging so much etc etc etc etc..

Truly people have no idea who is taking their money... they just know that they are paying a lot and the want to blame the most obvious captain of the ship.. the physician. In a way they should, we let the damn hospitals control us.

 

[doc02]

As soon as he said "shame on you," the next thing he'd be hearing would be the dial tone. I should try that on everyone. Go to the grocery store and just take stuff and when the police come, I go, "uh ...shame on you for wanting me to starve!! Shaaaammme!" Then I'd go to a car lot and take a car and go, "uh ...shame on you for wanting me to lose my job because I don't have transportation!! Shaaaaammme!!" Socialism is for people who are pathetic.