The Evil-Mongering of the AMA

[Ericokle]

http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html

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[womp]

Holy ****... from the article:

According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually,on average, because U.S. doctors make twice as much as their OECD peers. And even the poorest in specializations like radiology and surgery routinely rake in around $400,000 annually.... excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does.

Translation: Because the entire country's doctors are compensated $60 billion per year, defensive medicine due to concerns of malpractice litigation is trivial since it only accounts for $20 billion a year.

Poorest surgeons make $400,000 a year! And she uses radiology and surgery as examples!

the author (senior analyst at Reason Foundation) of this hit piece definitely makes too much money.


Here are some of the rebuttal comments posted on Forbes:

Posted by nervich | 08/26/09 01:53 PM EDT
As one of the thousands of general surgeons in this country who receive 'princely remuneration' in exchange for the 9 years of my life spent in training, I had no idea that I was the center of our nation's health care problem. I guess I missed that memo while I was working 120 hours a week during my 5 year residency (at the princely wage of $32,000 anually), or when I ate $100,000 in uncollected surgical fees on uninsured patients (all of whom received the EXACT SAME CARE that my insured patients did) in 2007.

But, I do have a solution that coincides nicely with your argument: you, and all the others who feel that the evil, overpaid doctors are the problem, can recieve your colonoscopies, surgeries and other invasive procedures from the new batch of doctors and other 'alternative practicioners' who receive their training under the new, relaxed standards necessary to produced increased numbers of higher quality practioners. At, of course, a discounted price. Good luck.

Posted by IanDorward | 08/26/09 03:53 PM EDT
I would urge Ms. Dalmia to investigate a concept known as net present value (NPV). Because of the up-front investment of time made by physicians--who undertake a minimum of 7 years and often well over 10 years of post-graduate training before earning salaries significantly above minimum wage--their starting salaries need to be comparatively much higher than in other fields, such as engineering or law, in order to achieve competitive earning power over the course of a career. Further, the rigors of training, the medico-legal risks, and the exposure of oneself and one's family to myriad diseases all act to further dissuade a prospective physician from embarking upon this career. A handsome salary serves as a reasonable incentive to keep the best and brightest among us going into medicine. It's also a reasonable way to keep our physicians working roughly twice as many hours as those in other OECD nations.

Now, perhaps Ms. Dalmia disagrees with the premise that the best and brightest should go into medicine. It seems evident from this article that she believes the person who is entrusted to extirpate a brain tumor need not possess any exceptional degree of skill or intelligence, and should also not be subject to any great degree of professional scrutiny (save that of the tort system, which Ms. Dalmia no doubt thinks is a great boon to health care in this country).

Well, Ms. Dalmia, for what it's worth, I think YOU make way too much money. And whatever you were paid for this article was a grotesquerie of overcompensation, surely several orders of magnitude above the going rate for drivel in other OECD nations.

 

[turkeyjerky]

Holy ****... from the article:

Translation: Because the entire country's doctors are compensated $60 billion per year, defensive medicine due to concerns of malpractice litigation is trivial since it only accounts for $20 billion a year.

Poorest surgeons make $400,000 a year! And she uses radiology and surgery as examples!

the author (senior analyst at Reason Foundation) of this hit piece definitely makes too much money.


Here are some of the rebuttal comments posted on Forbes:

This article is just ridiculous. I can't believe that Forbes publishes this **** (actually I can believe it and expect it from them, but it still pisses me off). I hope all you right-wingers read this and realize that, rather than trying to protect physicians, the right is actually extremely hostile to physicians and would love to gut their salaries.

According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually,on average, because U.S. doctors make twice as much as their OECD peers

Yes, but that study found that the extra income of physicians in this country was a result of them seeing additional patients over those that doctors in other countries saw (at a ratio of, roughly, 5:3). So, in America, physicians are just more productive than those of other countries. In addition, the McKinsey study found that extra nursing care in this country cost us about 50 billiong dollars too!

But how has the AMA managed to get away with such princely remuneration that ordinary mortals in other professions--even ones such as law and engineering that also require arduous training--can only dream of?

Yeah, right. My brother, an attorney, received a salary of about 160K, plus a production-based bonus, as a first year associate. That's after a grand total of 3 years of law school. A primary care physicians is likely to start at 140k after a total of 7 years of med school and residency. Not to mention that, compared to med school or residency, the workload of law school is a joke (his workload as an associate, however, is fairly strenuous--but not nearly so much as a resident).

But the entities that will be most injurious to the nation's health are not so much in the evil-mongers' group but the first group, including the American Medical Association--a doctors' cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century

What a ridiculous statement. The AMA has no such power. The AAMC, a completely separate body, controls the number of spot in med school. Residency spots are funded, and thus the number controlled by, Medicare, which has refused to expand the number of spots since the mid-90's. Hell, only about 20% of doctors belong to the AMA (many of whom are just nominally involved in the origination).

 

[Thomasss]

What a ridiculous statement. The AMA has no such power. The AAMC, a completely separate body, controls the number of spot in med school. Residency spots are funded, and thus the number controlled by, Medicare, which has refused to expand the number of spots since the mid-90's. Hell, only about 20% of doctors belong to the AMA (many of whom are just nominally involved in the origination).

Calling them completely different bodies is an exaggeration. It's like calling the Senate and the house different bodies. Technically, yes, but they both work together on some of the same things. They are both involved in the US medical education system vie the LCME.
http://www.lcme.org/classsizeguidelines.htm

Purposes of LCME and CACMS accreditation. The accreditation of medical education programs leading to the MD degree serves to assure that they meet national standards of educational quality. The cyclical process of institutional self-study and assessment, coupled with external validation by a team of professional peers, provides a powerful mechanism for ongoing quality improvement. LCME and CACMS accreditation are essential elements in the system of physician credentialing in the U.S. and Canada.

Balance between student enrollment and total resources. Accreditation is awarded to a program of medical education based on a judgment of appropriate balance between student enrollment and the total resources of the institution, including faculty, physical facilities, appropriate numbers and mix of patients, and the operating budget. Significant modifications to the educational program, or substantial changes in student enrollment or in the resources of the institution may distort the balance. While medical education programs are not accredited by the LCME or CACMS for a specific class size, a substantial imbalance in student enrollment relative to resources may have a negative impact on educational program quality, and thus lead to re-evaluation of a program's accreditation status by the accrediting bodies.

 

[Thomasss]

Yes, but that study found that the extra income of physicians in this country was a result of them seeing additional patients over those that doctors in other countries saw (at a ratio of, roughly, 5:3). So, in America, physicians are just more productive than those of other countries. In addition, the McKinsey study found that extra nursing care in this country cost us about 50 billiong dollars too!

Patient ratio doesn't prove productivity, because it doesn't involve quality and effort put into each patient. It's not like they are creating the exact same widgets. There are a million other factors in doctor productivity.
Personally, I'd prefer a lower doctor to patient ratio.

 

[Thomasss]

All of the complaints around doctor compensation are essentially because they have to pay off immense loans and wasted years in school. Why aren't more medical schools allowed to open, thus allowing for more competition and possibly cheaper schools? And why do we need this long pathway for doctors? Why can't there be a straight-out-of-high school career path? A 5 year medical degree without the need for an undergraduate.

 

[Thomasss]

One of the comments stated this:

The AMA has in fact routinely asked for increased funding for residency positions from Medicare.

Is this true? To me, this would be a strong rebuttal to the article's arguments.
it's just that in the same quote there is this

The AMA is simply a professional organization which works for the betterment of the practice of medicine for patients and for its members.

which is so naive to make me doubt anything else said in it. While they may not be medical education's overlords, to state that they have only a single amazingly beneficial goal is an exaggeration to say the least.

however, i will pick good-sounding rebuttals:

residency positions have increased 18% over the past 5 years.
http://www.nytimes.c​om/2009/04/29/education/​29iht-riedmedus.html

in additon, this is a good one:

Regarding the McKinsey report that was referenced, for inpatient care, physician fees have increased <9% in 2003-2006 (the years which the report is evaluating), whereas facility fees increased >20%. The report also cites increasing costs of medical education and opportunity cost for undertaking education in medicine as contributing factors. Increasing costs are also attributed to the increasing usage of diagnostic interventions (of which USA uses the most), which is clearly related to physicians covering every base possible for fear of litigation in our incredibly litigious society, combined with a faulty reimbursement system that pays per procedure rather than for promoting wellness and positive outcomes for patients.

and

McKinsey study that suggests physician compensation represents $60 billion in excess yearly costs compared with other OECD countries, yet when this same McKinsey study estimates the total yearly cost of medical torts and defensive medicine as being in the range of $150-190 billion, she elides that point; pretending to be quoting this same article, she pulls from apparently nowhere a lowball estimate of $20 billion

 

[MOHS_01]

The author is an ignorant troll on the matter. Article was pure rubbish. Forbes should delete it and issue an apology for falling to the level of the NYT's.

 

[badasshairday]

I've got to be honest. I love the collective bitch-slap the comments section gave to the author.

 

[Jeff Mike Hoss Johonson]

MOHS_1 and badasshairday, if you are going to post on this forum, give a reason for the comments, some of the arguments are reasonable, doctors SHOULD be well compensated for their skills and education but there are many duties that CAN be done by those that need less training than the doctors that can keep our health care cost down that would not have to lower the doctors salaries and increase their workload but the doctors fear incursions into their profession from nurse practitioners, midwives etc. as the author stated.

I posted this thread on the forum thread are doctors overpaid, got an email back said it would be printed but it wasn´t (I noticed afterward that they said thread was ended so will reprint it here, does not look as THIS thread ended.)

I have to be frank and I hope that this does not get deleted but I am not a medical student and my personal info in my profile is not true but I happened across the article referred to in Forbes and wrote a rather long response but despite doing all the tomfoolery of registering and logging in I still could not post on THEIR site, so googling I found this site and will post what I wrote HERE as I think what makes a lot of common sense and those that do not agree with me, please post here.

Initially after reading the article and seeing that since doctors in the U.S. are the second highest paid next to the Netherlands (and sometimes there´s a disparity of almost 100K even with other developed westernized countries) I thought yes, they were, but then I read another article in Forbes about the overtime pay in New York City, where some of the employees that were not highly technically trained (like adjusting the thermostat) were getting salaries over a hundred thousand, sometimes more than the head of their dept. you can google ¨Start Spreading The News! NYC Mayor de Blasio Paid City Employees $2B For 33 Million Overtime Hours
and then thought not, doctors here are NOT overpaid.

My proposal is let us have a two type healthcare system in this country, one like the ACA or what they have in other countries, first a one payer system funded by the government and the citizens have to pay for it other than payroll deductions or just paying a monthly fee and. This will be staffed by doctors who had their medical training subsidized by the government at public colleges and in return they would have to spend at least a decade serving in government owned hospitals, clinics, and doctor offices staffed by physicians that are like civil service employees with comfortable salaries, (no need to earn very high salaries as no debt to pay off) working offices where they do not have to worry about paying office rent, office staff, malpractice insurance (government may have arbitration agreements) get all benefits that public employees get (public service supposedly pays less than private industry but supposedly gives you better retirement) no insurance hassles to deal with at ALL, no need to worry about admitting privileges. After they serve their obligatory terms they can go into private practice as they wish, maybe better compensation but more headaches, so some who primary desire to be a doctor is compassion and dealing with the interesting problems they face is more important than the money will most likely stay in the system but in another positive twist, is that doctors with a little experience under their belt, through this, may be more likely to set up a successful private practice.

For those who do NOT want to government physicians they have the option of shopping around and buying a private plan and choosing doctors who want to be entrepreneurial and more independent of government overight bu not entirely as for quality standards. These doctors can go to the most prestigious private colleges and set up fancy offices in affluent areas and deal with the insurance companies, as can some doctors who may go into practices that are in poorer areas because they may have come from that background or be socially conscious. The insurance companies should have two types of plans that doctors could join, both offering the same services but the doctors where the patients pay a higher premium are ones who have nicer offices, went to more prestigious schools, are board certified and more published and thus more highly compensated than the second tier of doctor who serve patients whose premiums are lower and are located in poorer neighborhoods and their patients may have to wait a little longer to be seen or wait longer in the offices that are more crowded as their doctors may have to do more volume to offset the lower compensation. They can also bypass the insurance game entirely and be like some dental offices who are a member of some discount plan, where the patients pay to be a member of an organization and pay for services up front without filing claims and the fees would be cheaper than regular fees or just have their own private plan with other doctors in a medical group, be cash only, be a boutique doctor with their own HMO plan, whatever . Unlike the government medical practices, where only legal residents, citizens or travelers who pay for their services upfront to us and get reimbursed by their own government or travel insurance, the private doctors can take whoever they like including undocumented aliens who HAVE to be allowed to be able to buy any health insurance they can afford without prejudice.

These private insurance plans can offer the high deductible, catastrophic insurance that some young people want (but the charges have to be in line with the insurance companies payments for those whose bills are covered by them.) Employees can buy their insurance from private insurance companies that need to offer the same things that are national insurance offers, patients that buy their own insurance can choose whatever they want. Instead of the fines we now impose for people who do not have health insurance, we would not impose them, BUT we would have the edict that everyone would have to register to get any type of health care including ER and if you did not, you did not get ANY help. We would need to have to have a program that reaches out to everyone including the homeless and indigent and unless you were really, truly poor and not be able to afford anything, everyone would have to pay something.

Of course there should be some oversight that the salaried doctors are not slacking off and seeing their fair share of patients. I once went to a student health center to see a psychiatrist and after a few minutes of talking he whipped out his prescription pad and started writing one out, when I protested and said I wanted to work out my problems, he ACTUALLY said to me ¨Your problems bore me¨ (sorry that I was not bi-polar, schizophrenic or had multiple personalities) and was too young and naiive at that time I should have reported him, another time saw a psychiatrist who kept checking his watch every five minutes making me feel, our my problems too boring for him also? I mention these incidents only in that I felt both these doctors wanted to just draw a salary and not work, but there will be a certain number of patients that doctors would be required to see and not be able to just turn patients away

I am under Medi-Cal and the HMO plan I an under now is horrendous, where the only orthopedic surgeon I can use is two hours away, (Torrance attracts may elderly because it has FOUR hospitals nearby and many, MANY doctor offices, clinics and urgent care offices but none near me are available in specialties under the state health plan as most residents do not have to have Medi-Cal) and works only two days a MONTH. I would like to change to Covered CA the state plan. but at 62, my premiums would equal what I get from soc. sec. which is $600, since I have savings I can draw upon it for at least a thousand a month so I can afford to live, so I CAN afford to pay the subsidized price which is $39 a month with copays for visit, but since I am eligible for the Medi-Cal, if I don´t take it they will most likely not approve the subsidized cost private cost. Because most private doctors have office expenses and thus do not want to take Medi-Cal the only choice for the working poor (like I was) or truly indigent is under government health care whose offices are far away with doctors who were foreign trained or on the cusp of retirement with one star reviews on Yelp. If we had a government plans as I initially suggested in the first paragraph with doctors who are salaried employee with benefits, there will be more and better doctors available for the low income and in more areas.

As for the doctor who in the Forbes article said that many people would not become a physician because what they feel is the low reimbursement rate for the cost of training, this might be a good thing. Many of the procedures that people come in for, do not demand a great deal of education or expertise, and can be handled by nurse practitioners who are now handling many of the general physician and internal medicine jobs that people who want to become doctors are not wanting to do because of the lower salaries. They could also be used more in the national doctors office and clinics vs. the private ones as doctors afraid of the threat to the profession have been fighting them tooth and nail but if it is for government funded medical practices they may be less likely to fight. Ahhh..if I could only run health care in this country, I DO hope that maybe someone in the government has read this and gives my suggestion SOME food for thought.

 

[VA Hopeful Dr]

You realize that you're responding to posts that are 8 years old, right?