What Is Your Life Worth?

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U crack me up. What type of physician are you? Is your field over saturated with writers or if EM more interesting to write about?
 
I just wanted to comment on your paragraph about the inverse relationship between a procedure which is life saving and the perceived value (i.e. I shouldn't have to pay if it's life or death).

I totally agree and see responses from patients like that every shift. Unfortunately that sentiment seems to be echoing everywhere in medicine. Soon I predict that the orthopods will be hearing that they need to be charging less for hips because people are in such terrible pain that it should be their duty to relieve pain and suffering... Food for thought.

Also, I think that beyond the monetary compensation, you make a good point about people resenting doctors for charging for life saving procedures. I feel like that may be a big factor contributing to physician burn out.

Sent from my PC36100 using Tapatalk
 
A fascinating corollary to this is the difference in public perception between doctors and firefighters. I begrudge firefighters nothing and have been one myself. They are resoundingly respected and thought of as selfless.

However in many areas, such as my own, they routinely campaign for funding and are politically ruthless if they feel their compensation is in danger. In my are they have recently and many senior officers indicted for crimes involving fraudulent overtime and sick time claims.

Yet they are beloved and we are reviled.

I believe this is because most people can't make the connection between paying taxes and paying for a service. They hate taking out their wallet at the doctor's office or their checkbook when the ER bill comes. Taxes just don't seem to have anything to do with the big red trucks. And almost half of people don't pay anyway.
 
Bane said:
U crack me up. What type of physician are you? Is your field over saturated with writers or if EM more interesting to write about?
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"U" must be new around here.
 
docB said:
I believe this is because most people can't make the connection between paying taxes and paying for a service. They hate taking out their wallet at the doctor's office or their checkbook when the ER bill comes. Taxes just don't seem to have anything to do with the big red trucks. And almost half of people don't pay anyway.
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I was reading through the responses from the LA Times article, and a few people brought up that the fire department wasn't demanding payment at all. They really don't make the connection between them and taxes.

Some other gems from the comments: "if the doctor is giving servicde to a patient in the ER then they are an ER doc. It doesn't matter what specialty they work in." And from another poster: "It doesn't matter. If she's got ER privileges and is treating patients in the ER, she's an ER doctor at the time she is treating patients in the ER."

"To you other comment, which for some reason, I cannot reply to: You are not a mechanic, ER doctor. Health care is a basic human right. Owning a care is privilege" So you no longer deserve to have any say in the value of your services.

"When you go to a emergency room, one does not request a damn plastic surgean, you just want to be fixed up, no is asking for a lipo suction, this doctor should be in jail for fraud, conspiracy and her license should be taken" And yet this patient did, in fact, decline the services of the EM physician in favor of a plastic surgeon.

"Don't contract with hospitals if you don't like it. Open up your private practice, charge what you want, and stay there." And this is why several other plastic surgeons declined to see this patient. Maybe now Dr. Martello, who apparently was not on the call schedule, will have the good sense not to treat them either, and they won't even have the option to pay a bigger bill to get a specialist they feel they need. Sounds like a fantastic idea. They can all be like the plastic surgeon who commented, "This is precisely why I as a plastic surgeon, like Dr. Martello, have not stepped in an Emergency Room since 1999."

While Dr. Martello's tactics may have been overly aggressive, the public just doesn't seem to get that continually cutting reimbursement will eventually lead to specialties that will no longer play ball and treat them on CMS and the insurance companies' terms. Then they either won't be able to access them unless they have the cash, or the government steps in and forces them to.

It's a beautiful time to be a medical student, on the road to a quarter million dollars plus in debt, with the sense that you may be sailing right into a storm.

It's a shame I don't like teeth more...
 
totally agree.

it's also okay to spend up to a few hundred bucks to catch a game too. or spend a cool 100 watching the game and drinking 3-4 beers and having wings and fries and a burger while at a hooters.
 
As DocB said, the public thinks we are "rich" and thus should just work for what they're giving us, instead of "wanting more." Even though the public (including Obama) has no idea what the physician gets for their services. And since the affordable part of the ACA is paying doctors less, but not hospitals, or pharmaceutical companies, or anyone else less, why not?
 
Well written Birdstrike. Definitely sharing with others. Another great one!
 
Birdstrike said:
it follows that a total cost of approximately $40,000 for a hip replacement tends be generally well accepted and frequently paid by insurance companies along with the physician portion of $1,505 (CMS CPT27130.)
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You quoted an emergency intubation as $112 and cardioversion as $131 in your linked article.

$1,505 divided by 2 hours (average hip replacement OR time) = $753/hour

$112 for a 3-minute intubation/RSI = $2,240/hour

$131 for a 1-minute cardioversion = $7,860/hour

I think the value is there. I can RSI someone in less than a minute if the meds are drawn up. A cardioversion takes about 30 seconds if the meds are drawn up.

I agree with you that the public thinks negatively about physicians and the pay we deserve, but the numbers you quote don't really support your argument. When viewed as an hourly rate, they are well paid procedures.
 
Birdstrike said:
Interesting analysis, but I have a few comments.

First of all, you are required to spend at least 30 minutes on a critical care patient (total time, not necessarily at bedside) to bill CMS the CPT 99291 I referred to in the article for $226 (varies slightly by region, and only applies to CMS, not private insurers.)

Second, can you really respond to an apneic patient, walk in the room, do an RSI, and walk out 3 minutes later and be completely done and wash your hands of the patient? You're not ordering labs, imaging, calling consults, sometimes arranging transfer, interpreting results, adjusting the ET tube, ordering medications, documenting, formulating an often complex differential diagnosis, and exposing yourself to hundreds of thousands of dollars of potential liability?

Similarly, can you walk in a room, defibrillate a patient and wash your hands of them 60 seconds later?

You need to change your denominators.

Like I said in the original post, "I am not suggesting that Emergency Physicians (in the United States) aren't paid well, because they are".

I am suggesting that societal priorities are very warped. Do you disagree that a life saved is more valuable, either morally or monetarily, than a pair of luxury shoes, breast implants, or a new hip?


(original post: http://www.epmonthly.com/whitecoat/2012/09/what-is-your-life-worth/ )
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Yes, I can RSI and intubate someone in less than 3 minutes and cardiovert in less than a minute. You are billing for the procedure and not the time spent with the patient. No, I can't get someone admitted, work them up, etc., but that is billed under critical care time. Likewise, an orthopedic surgeon doesn't work up a hip pain during the 2-hour procedure. He/she does it before and is reimbursed for an office visit (probably less than what we get paid, but I haven't looked at the numbers).

I agree with your concept, but not your examples. People place more emphasis on buying their cigarettes, new shoes, iPhone 5, and Escalade than they place on someone saving their life. The examples you quoted on an hourly rate don't support your argument.
 
I believe you're right. I think any post-operative care is included. Pre-operative evaluations are not though.

Birdstrike, I think leaving off the procedural stuff and concentrating on reimbursement for critical care or level 5's is sufficient. Just mentioning how people grumble at paying their ED bill while texting away on their new iPhone is enough IMO.
 
Apollyon said:
Isn't that a global fee, though, for everything for 90 days? That $753/hr really drops precipitously, then. I thought one of the general surgeons on SDN had mentioned the 90 day thing.
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It is a 90 day thing. The "good" news is that, in general, the initial consult doesn't fall under the 90 day global, only the post-op care (both inpatient and outpatient). Which is why you will almost never actually see your surgeon (just his/her PA/NP) during a post-op visit.
 
Birdstrike said:
LOL. That's kind of what I was thinking, too. I do want to hear what he thinks of the article, though.
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Good article and points. Ortho is paid because they have political capital... hell thats why anyone gets $ in medicine. Has little to do with value or worth. Same with FM. Managing HTN pays nada but is invaluable to healthcare costs.

I thought you quit.EM. my bad.

On phone hence typos and short words like U. Laziness
 
I cant plan my emergent intubation or cardioversion. The orthopod can wake up, eat breakfast, go for a jog and if he shows up 5 mins late for the hip replacement no big deal. I have to emergently intubate someone without it being on my schedule.
 
Love Birdstrike posts 🙂
Please continue to post and provide your input -- to be honest you are very rare voice of reason with great insight on these forums
Plus you have a good logic and your view on many things in medicine and on EM world is very similar to mine but I cant write like you do
Keep up a good work and don't listen to trolls
As Churchill once said -- if you have enemies it means you have done something usefull in your life
 
Apollyon said:
To this point, to a VERY large part, I say "yes". Ditto for GI and heme/onc.
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Hmmm. They are still IM. Not the vest argument. IM is broad conceptually.
 
Birdstrike said:
Ha. Card carrying cottonheadedninnymuggin right here. Who called me that. You? Niner? Greenbbs? I can't remember.

What I've done is to go through an excedingly difficult transition period to get to a point where I can earn my entire income without any of it being EMTALA-bound....unless I want it to. The freedom is intoxicating. I can work as many or as few general ED shifts as I want. I have complete freedom to work 18, 10, 1 or zero ED shifts and have ZERO drop in my income. I can choose to work 9-5 Mon-Fri without any nights weekend or holidays, jump into the rotating shift pool, or mix it up. When I'm not in the ED, I draw on my EM experience with every interaction. It is where I earned my wings. My overall stress and burnout level is 10% of what it used to be. (Yet, I am not independently wealthy. I must work.)

Has an ED director that works very few shifts in the ED, and does almost entirely administrative work, abandoned EM?

Has an internist that decides to pursue a cardiology fellowship abandoned internal medicine?

Has the EP that now runs his 50 doctor group and does rare if any clinical work abandoned EM?

Like I've said before, feel free to put "BirdStrike" on ignore.
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I like your points. Share the side career options for EPs. Or share a.link please!
 
Bane said:
Hmmm. They are still IM. Not the vest argument. IM is broad conceptually.
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Show me a heme/onc group, GI, or cards that still sees general IM patients (not specific to their specialty) and I'll show you a dinosaur. Cards doesn't even need to maintain their primary IM boarding. They may come from IM, but they are not dealing with the coughs, colds, nonspecific abdominal pain, marital troubles, rashes, or depression. So, I stand by my point.

In the same vein, show me a plastic surgeon (who did 5 years of general surgery) that does ANYTHING in the abdomen. NO plastic surgeon does ANYTHING GSx after training. Likewise, what about pediatric neurology? They only have to do 1 year of peds, then go into their residency. Would you want a peds neurologist to be your kid's primary pediatrician? I doubt that the neuro would even accept that role.

Honest question: what are your credentials, or, what year are you, if any?
 
Apollyon said:
In the same vein, show me a plastic surgeon (who did 5 years of general surgery) that does ANYTHING in the abdomen.
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Liposuction?
I kid.

Although, the reconstructive guy I worked with did a fair number of components separations. Not a whole lot else near the abdomen though. Your point is pretty valid.
 
Dr.McNinja said:
Liposuction?
I kid.

Although, the reconstructive guy I worked with did a fair number of components separations. Not a whole lot else near the abdomen though. Your point is pretty valid.
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Yeah, but that isn't actually "in" the abdomen - the rectus abdominis is specifically outside the omentum (as is the adipose). Even if the words are there, the spirit I would hope is clear; no plastics guy is doing any GBs, appys, liver whacks, LARs, APRs, or diverting colostomies.
 
Apollyon said:
Show me a heme/onc group, GI, or cards that still sees general IM patients (not specific to their specialty) and I'll show you a dinosaur. Cards doesn't even need to maintain their primary IM boarding. They may come from IM, but they are not dealing with the coughs, colds, nonspecific abdominal pain, marital troubles, rashes, or depression. So, I stand by my point.

In the same vein, show me a plastic surgeon (who did 5 years of general surgery) that does ANYTHING in the abdomen. NO plastic surgeon does ANYTHING GSx after training. Likewise, what about pediatric neurology? They only have to do 1 year of peds, then go into their residency. Would you want a peds neurologist to be your kid's primary pediatrician? I doubt that the neuro would even accept that role.

Honest question: what are your credentials, or, what year are you, if any?
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Medicine is so into credentials. I'm not really. Take what I say at face value. I am not a resident or attending.
 
Birdstrike why did you delete all your knowledge? We love your posts!
 
Bane said:
Medicine is so into credentials. I'm not really. Take what I say at face value. I am not a resident or attending.
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Medicine is "into" credentials because, as it turns out, not just any idiot can do this. Most idiots can (otherwise we wouldn't have NPs)...but not all. So we like to have a basic idea of who/what we're dealing with when confronted with somebody who "just knows" what they're talking about.

You're not a physician and you're not willing to tell us what medical education/training you do have. Therefore, we will take what you say not at face value, but as irrelevant blathering.
 
Apollyon said:
Show me a heme/onc group, GI, or cards that still sees general IM patients (not specific to their specialty) and I'll show you a dinosaur.
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Agreed (for the most part). I don't see patients as their PCP...that's not what I do. But I will say that, at least in my specialty, once a PCP learns that their patient has cancer, the vast majority throw up their hands and turf everything to me.

Uncontrolled HTN? Must be the Avastin (that they never got).
DM out of control? Clearly the steroids I give for 1 day a month as a chemo pre-med.
Hyperlipidemia? Look!!! Squirrel!!! With Cancer!!!
UTI? Can't tamoxifen cause a UTI?

The cards folks run into this a lot as well (outside of the cathing for dollars crowd anyway).
 
gutonc said:
Medicine is "into" credentials because, as it turns out, not just any idiot can do this. Most idiots can (otherwise we wouldn't have NPs)...but not all. So we like to have a basic idea of who/what we're dealing with when confronted with somebody who "just knows" what they're talking about.

You're not a physician and you're not willing to tell us what medical education/training you do have. Therefore, we will take what you say not at face value, but as irrelevant blathering.
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Good for you. My self worth has little to do with your appraisal of what I say. And when I'm an attending and foolish people put value in my words because of my title, I will again hold little value in their opinions even if it's praise.

Calling nurses idiots is just another failure of this egotistical field (I can't generalize that completely, as many humble doctors exist but they are not as loud as the arrogant bunch). You are neither an idiot or a genius because of a title or a level of training that you've completed.

I do find it immusing that, in your worldview, anyone who is not an MD at the moment is blathering irrevalent words. Good to know I can call you a colleague one day! 🙂

Im not upset in anyway, just think your perspective is not only pervasive but socially acceptable/preferable in our field.
 
Bane said:
I do find it immusing that, in your worldview, anyone who is not an MD at the moment is blathering irrevalent words.
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Why don't you just say you're a second year medical student and be done with it? Your words become irrelevant here because you seem to be trying to hide your credentials, so it's reasonable to assume that you're willing to be deceptive about other things as well. Your opinion would be written off when discussing anything clinical for obvious reasons. Add to it a borderline antagonistic first post here, and people are more than willing to write you off.

But this is all off topic and puts more fuel on the "attendings only forum" fire, so how about we drop it so we can continue to enjoy the forum as students?
 
Bane said:
Good for you. My self worth has little to do with your appraisal of what I say. And when I'm an attending and foolish people put value in my words because of my title, I will again hold little value in their opinions even if it's praise.

Calling nurses idiots is just another failure of this egotistical field (I can't generalize that completely, as many humble doctors exist but they are not as loud as the arrogant bunch). You are neither an idiot or a genius because of a title or a level of training that you've completed.

I do find it immusing that, in your worldview, anyone who is not an MD at the moment is blathering irrevalent words. Good to know I can call you a colleague one day! 🙂

Im not upset in anyway, just think your perspective is not only pervasive but socially acceptable/preferable in our field.
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"Irrelevant blathering" means you are talking out of your ass. I asked about credentials not because I am "hung up" on them, but, as gutonc said, to know if you know what you are talking about - which you don't.

YOU made a statement against mine, which I believe was neither nuanced nor based in experience or knowledge. I asked what was your background, in order to weigh your statement, and you bristled.

Now, you perseverate. You are talking about things about which you are not informed, you seem somewhat inflexible, and you would rather insult and be sarcastic. As such, you receive the same in return, along with scorn, instead of collegiality. One party already believes you are trolling.

One is appreciated for what one CAN contribute, not what one CANNOT. Whatever is your aim here is not clear, unless it is to be contrary and petulant. If that is it, then you are succeeding handily.
 
Bane said:
I do find it immusing that, in your worldview, anyone who is not an MD at the moment is blathering irrevalent words.
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Oh man, you were doing so good up to that point! Then you misspelled amusing and irrelevant, making your sentence amusing and irrelevant blathering. Isn't it ironic? Don't you think? It's like that moment when the poised and elegant ballerina does the splits and drops a load in her leotard; That precious moment when you realize your teacher's pants are unzipped mid-lecture; That awkward moment when you see the huge booger working its way out an acquaintance's nostril as you try to make small talk with them.
 
Druggernaut said:
Why don't you just say you're a second year medical student and be done with it? Your words become irrelevant here because you seem to be trying to hide your credentials, so it's reasonable to assume that you're willing to be deceptive about other things as well. Your opinion would be written off when discussing anything clinical for obvious reasons. Add to it a borderline antagonistic first post here, and people are more than willing to write you off.

But this is all off topic and puts more fuel on the "attendings only forum" fire, so how about we drop it so we can continue to enjoy the forum as students?
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My vote is that he's a chiropractor and not even in a scientific field. He's focused on our concern about "credentials", yet appears to be lacking in even the most basic of grammatical skills.
 
Apollyon said:
"Irrelevant blathering" means you are talking out of your ass. I asked about credentials not because I am "hung up" on them, but, as gutonc said, to know if you know what you are talking about - which you don't.

YOU made a statement against mine, which I believe was neither nuanced nor based in experience or knowledge. I asked what was your background, in order to weigh your statement, and you bristled.

Now, you perseverate. You are talking about things about which you are not informed, you seem somewhat inflexible, and you would rather insult and be sarcastic. As such, you receive the same in return, along with scorn, instead of collegiality. One party already believes you are trolling.

One is appreciated for what one CAN contribute, not what one CANNOT. Whatever is your aim here is not clear, unless it is to be contrary and petulant. If that is it, then you are succeeding handily.
Click to expand...

Sounds good. I will leave you guys alone since you think I'm trolling. Not sure if I will do EM or not but interesting reactions from my future colleagues.

Druggernaut said:
Why don't you just say you're a second year medical student and be done with it? Your words become irrelevant here because you seem to be trying to hide your credentials, so it's reasonable to assume that you're willing to be deceptive about other things as well. Your opinion would be written off when discussing anything clinical for obvious reasons. Add to it a borderline antagonistic first post here, and people are more than willing to write you off.

But this is all off topic and puts more fuel on the "attendings only forum" fire, so how about we drop it so we can continue to enjoy the forum as students?
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Not hiding. But agreed. My first post was antagonistic bc I read a post by bird trashing EM once (or parts of EM) and also saying it was so bad that he left it. Seeing these Pro EM articles seemed like a different person.

Jarabacoa said:
Oh man, you were doing so good up to that point! Then you misspelled amusing and irrelevant, making your sentence amusing and irrelevant blathering. Isn't it ironic? Don't you think? It's like that moment when the poised and elegant ballerina does the splits and drops a load in her leotard; That precious moment when you realize your teacher's pants are unzipped mid-lecture; That awkward moment when you see the huge booger working its way out an acquaintance's nostril as you try to make small talk with them.
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It's autocorrect. I type on phone typically. I have a full tuition scholarship at top 30 us news.

Good luck guys.
 
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GeneralVeers said:
My vote is that he's a chiropractor and not even in a scientific field. He's focused on our concern about "credentials", yet appears to be lacking in even the most basic of grammatical skills.
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Lol, nope. I attend a solid allopathic school.
 
Bane said:
Sounds good. I will leave you guys alone since you think I'm trolling. Not sure if I will do EM or not but interesting reactions from my future colleagues.
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Quite lacking in character: instead of taking the high road and saying, "Hey guys, I'm not trolling - I'm actually a preclinical med student. No harm intended", you say, "You think I'm a troll, so I'm leaving!" The most interesting reactions you should note are your own. Your veiled insult in your comment to your "future colleagues" is noted. You seriously don't get it - you don't see that, when it's everyone else, it's actually you.

Bane said:
It's autocorrect. I type on phone typically. I have a full tuition scholarship at top 30 us news.
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First - autocorrect? Bull****. Either BS, or you have misspelled "amusing" before, and saved it. However, "revelant" IS a word, obscurely from the real estate world, but "irrevelant" is NOT, except as a substandard form of "irrelevant", as per Merriam-Webster. Dictionary.com does not even list it. As such, knowing autocorrect as I do, I, again, call "bull****" on your statement.

As for your patting yourself on the back and trying to paint yourself as some sort of intellectual superior, first, you DO know the value of a UNWR list, right? Like, essentially nil? That you would hang your hat on that, and throw in your "full tuition scholarship" - is that academic, or something specific to a legacy or ethnic group, or military, or what? - and you make yourself look like a ******. Hardcore like a ******. I'll give you a hint...there are quite a few people here that had full academic scholarships to med school. I wasn't one of them - I'm just some "filthy FMG" (as a redneck here on SDN called me), but I am also board certified in EM, and, 20 years ago, wanted to join MENSA, as I have the stats for it, but a professor at my college said, "Why would you want to join those booger eatin' nerds?"

So your tooting your own horn has hit a flat note.
 
Apollyon said:
first, you DO know the value of a UNWR list, right? Like, essentially nil?
- I'm just some "filthy FMG" (as here on SDN called me), .
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I'm not going to argue, but I will correct the factual inaccuracy. Top 40 us news is tracked by nrmp and these student DO better in the match. Source - any charting outcomes ever. Also PD surveys track it and, it matters.

I don't think you're filthy bc you're IMG. Good luck.
 
.
 
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