Your doctor's big, fat paycheck

[JABWS]

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I woke this morning to a very disturbing newspaper article. Here are a few snippets to give you an idea of the author's basic premise:

1) "High wages in the medical sector are the underlying cause of ballooning health costs," says Eli Lehrer

2) "There's no way around it. Wages drive high medical costs much more than any other factor."

3) "A physician practicing in a primary care setting, according to the Bureau of Labor Statistics, earned an average of just over $200,000 in 2010, while specialists averaged over $355,000, the highest of any professional category tracked. By comparison, lawyers average just over $110,000, airline pilots about $92,000, and chartered actuaries-who calculate risk for insurance companies and must pass complex exams longer and arguably more difficult than the medical boards-about $150,000."


From my knowledge of the healthcare system, this assertion is simply not true. Please discuss.

Disclaimer: I am not attempting to plagiarize. The article, "Your doctor's big, fat paycheck," was written by Eli Lehrer and can be found in its entirety in Section P of The Dallas Morning News dating July 29, 2012.

 

[AdrianVeidt]

Lawyers only make 110k? I thought all those guys were filthy rich.

 

[Haislip]

This guy is making a shallow insight into medicine. Becoming an actuary harder than becoming a doctor?

 

[samsunimomo]

3) "A physician practicing in a primary care setting, according to the Bureau of Labor Statistics, earned an average of just over $200,000 in 2010, while specialists averaged over $355,000, the highest of any professional category tracked. By comparison, lawyers average just over $110,000, airline pilots about $92,000, and chartered actuaries-who calculate risk for insurance companies and must pass complex exams longer and arguably more difficult than the medical boards-about $150,000."

Actuary exams <<<< pre-med classes + MCAT + medical school apps + 4 years of medical school + residencies + board exams + debt + malpractice insurance

 

[Praefectus]

Actuary exams <<<< pre-med classes + MCAT + medical school apps + 4 years of medical school + residencies + board exams + debt + malpractice insurance

This.

Also, one of the chief drivers in healthcare costs is the fact that we have a 3rd party payer system for routine stuff like checkups. The co-pay price removes the customer from the real price and artificially raises demand. This also stems from the fact that states have a ridiculously long list of procedures, mandating insurance companies to provide unnecessary coverage. If you want to see what healthcare would look like without bumbling bureaucracy, research LASIK eye surgery.

 

[Bangersandmash]

Admin costs are nowhere near 40% of health care expenditures. Hospital care and physician care together are something like 50-60% of it. Administration is more like 10%.

Wages may play a big role in cost, but it is advancing technology that accounts for about 50% of growth per year in health care expenditures.The biggest and the best and the newest doesn't necessarily mean it's the most cost effective. Could most doctors take a paycut and still live comfortably? I'm sure. Would it make a HUGE dent in health care expenditures? Doubtful.

Not to mention, insurance for OB/GYN's is something on the cusp of 100 grand in my state (Florida). That's hefty even if you are making 355K a year.

 

[zerog]

From my knowledge of the healthcare system, this assertion is simply not true. Administrative costs account for something like 40% of annual healthcare expenditures. Please discuss.

I can't imagine that you are very knowledgeable on the subject.

 

[JABWS]

Admin costs are nowhere near 40% of health care expenditures. Hospital care and physician care together are something like 50-60% of it. Administration is more like 10%.

Wages may play a big role in cost, but it is advancing technology that accounts for about 50% of growth per year in health care expenditures.The biggest and the best and the newest doesn't necessarily mean it's the most cost effective. Could most doctors take a paycut and still live comfortably? I'm sure. Would it make a HUGE dent in health care expenditures? Doubtful.

Not to mention, insurance for OB/GYN's is something on the cusp of 100 grand in my state (Florida). That's hefty even if you are making 355K a year.

You're right, I'll amend my initial statement. I remember reading that somewhere, but it must have included additional costs as well. The number I just found was 14%.

 

[JABWS]

I can't imagine that you are very knowledgeable on the subject.

Since you can't seem to leave me alone, I went back and flagged all of your previous posts. From now on, though, I'm not going to give you the satisfaction of a response.

 

[zerog]

Since you can't seem to leave me alone, I went back and flagged all of your previous posts. From now on, though, I'm not going to give you the satisfaction of a response.

 

[SpecterGT260]

The figures (pie charts) for health costs inappropriately lump physician salary in with other overhead costs and then try to act like it's all the salary. The actual amount of money going into the pockets of physicians is about 6% of the total pie.


Id like to put that into perspective for everyone.... if every doctor in the US decided to work completely for free, the average American would only see about a nickel back on the dollar spent. So.... decimating a work force for an effect nobody will actually notice.

Sent from my DROID RAZR using SDN Mobile

 

[sliceofbread136]

People want doctors who are quick, never make mistakes, are personable, and who do it for free. Nothing new to see here.

 

[kpcrew]

People want doctors who are quick, never make mistakes, are personable, and who do it for free. Nothing new to see here.

Uh you're supposed to be compassionate and caring. How dare you try to take my money?

 

[alerk323]

one hospital bed costs an average of about a million dollars to build and then a quarter of a million dollars to staff/maintain... In other words, inpatient beds incur more costs than the doctors

 

[neuro nephrons]

this is what angers me about our society....we knit pick about people who are making lives for themselves when pro athletes players don't even need to go to college to make $20 million a year.

 

[Geebeejay]

As someone who considered both, I'd say it's up for debate. There are more than 10 actuarial exams, and they are incredibly difficult. Seems like it takes most people 15-20 years to complete all of the exams and modules, and many candidates are expected to initially fail a lot of the exams.

This guy is making a shallow insight into medicine. Becoming an actuary harder than becoming a doctor?

 

[TheMightySmiter]

The high cost of health care is due to a population who doesn't take care of themselves until it is too late and then sues the medical establishment for all they've got instead of actually complying with their own treatment.

/cynic

 

[LizzyM]

Many physicians still work in private practice and are paid based on productivity. That means the more the do, the more they are paid. And the more they do, the more the cost of health care rises whether what they do goes in their pocket (more visits, more surgery) or to a hospital, imaging center or other institution.

Physicians who are salaried and paid regardless of the amount they "do" would be a way to cut costs but would the care be better?? Discuss.

What about physicians who are salaried and paid a bonus if their patients overall stay healthy? Define "healthy".

 

[SpecterGT260]

I can't imagine that you are very knowledgeable on the subject.

You could at least offer some insight. As I am not aware of too many insurance companies covering psychoanalysis or divorce counseling, I can't imagine you are any better

 

[SpecterGT260]

Many physicians still work in private practice and are paid based on productivity. That means the more the do, the more they are paid. And the more they do, the more the cost of health care rises whether what they do goes in their pocket (more visits, more surgery) or to a hospital, imaging center or other institution.

Physicians who are salaried and paid regardless of the amount they "do" would be a way to cut costs but would the care be better?? Discuss.

What about physicians who are salaried and paid a bonus if their patients overall stay healthy? Define "healthy".

I think it is important to understand that the "Healthcare cost" in normal discussion is the total dollar value spent by all americans on health. This doesn't necessarily mean that healthcare is expensive. Understand- I am very well aware that it is quite expensive, but the idea that we are spending a lot of money doesn't necessitate any situation where the items purchased are actually high in price. This is coincidental in this case.

 

[NickNaylor]

The figures (pie charts) for health costs inappropriately lump physician salary in with other overhead costs and then try to act like it's all the salary. The actual amount of money going into the pockets of physicians is about 6% of the total pie.


Id like to put that into perspective for everyone.... if every doctor in the US decided to work completely for free, the average American would only see about a nickel back on the dollar spent. So.... decimating a work force for an effect nobody will actually notice.

Sent from my DROID RAZR using SDN Mobile

Came here to point this out. Physician salaries are such a small part of the pie yet receive such a huge part of the ire around the medical care system. I guess they're easy targets.

(sent from my phone)

 

[SpecterGT260]

Came here to point this out. Physician salaries are such a small part of the pie yet receive such a huge part of the ire around the medical care system. I guess they're easy targets.

(sent from my phone)

it is because it is a very easy thing for joe schmoe to wrap his head around.

 

[alerk323]

Many physicians still work in private practice and are paid based on productivity. That means the more the do, the more they are paid. And the more they do, the more the cost of health care rises whether what they do goes in their pocket (more visits, more surgery) or to a hospital, imaging center or other institution.

Physicians who are salaried and paid regardless of the amount they "do" would be a way to cut costs but would the care be better?? Discuss.

What about physicians who are salaried and paid a bonus if their patients overall stay healthy? Define "healthy".

this is a situation that does happen. In canada, a lot of the hospital docs are employees of the hospital and while a lot of them have productivity incentives, reimbursement is controlled by the government and so there are limits to how much you can treat.

The result? you have to wait 6 months to up to a year to get elective surgery done and emergency departments are often forced to play games with the system to adhere to emergency service compliance rates.

edit: also, hospitals in canada are in this situation where they are paid a lump sum based on the population they serve, not how much they treat them. They essentially lose money for every patient they treat. As a result, hospitals keep their census artificially high and accumulate huge wait times for treatment and a busy hospital environment, both objectively bad for patients.

 

[Birdnals]

this is a situation that does happen. In canada, a lot of the hospital docs are employees of the hospital and while a lot of them have productivity incentives, reimbursement is controlled by the government and so there are limits to how much you can treat.

The result? you have to wait 6 months to up to a year to get elective surgery done and emergency departments are often forced to play games with the system to adhere to emergency service compliance rates.

This is the result of a single payor system, however, not of physicians being employed by the hospital. In regards to Lizzy's question, it would not shock me if salaried physicians performed (physicians, not the hospitals) much like docs in a single payor system whom research indicates provide equal care to those in third party payor systems. From my extremely limited experience, physicians seem to be wired in a way which prevents them from providing substandard care based on who I paying for their services.

I think an easy way to find your answer would be to look at research pertaining to the performance of hospitalists which seems to be essentially what you are you talking about (employees of the hospital).

 

[LizzyM]

I think it is important to understand that the "Healthcare cost" in normal discussion is the total dollar value spent by all americans on health. This doesn't necessarily mean that healthcare is expensive. Understand- I am very well aware that it is quite expensive, but the idea that we are spending a lot of money doesn't necessitate any situation where the items purchased are actually high in price. This is coincidental in this case.

Each CBC is cheap. Doing a CBC every time on every patient, whether there is a reason to do it or not, adds up. The fact that a CBC is cheap does not justify the argument that health care costs are not high. And yes, I am talking about the high proportion of GNP we spend on health care or the US population.

We know that certain preventive services do nothing to improve health outcomes but the peope who are making money at it will scream bloody murder and argue that wanting "the best" for patients and "better safe than sorry" is an argument for continuing with tests such as PSA (a test for prostate cancer) that leads to surgery that has a negative impact on quality of life with a questionable effect on life span.

Don't get me started on implantable defibrillators which are not cheap and which may be over prescribed.

 

[SpecterGT260]

Each CBC is cheap. Doing a CBC every time on every patient, whether there is a reason to do it or not, adds up. The fact that a CBC is cheap does not justify the argument that health care costs are not high. And yes, I am talking about the high proportion of GNP we spend on health care or the US population.

We know that certain preventive services do nothing to improve health outcomes but the peope who are making money at it will scream bloody murder and argue that wanting "the best" for patients and "better safe than sorry" is an argument for continuing with tests such as PSA (a test for prostate cancer) that leads to surgery that has a negative impact on quality of life with a questionable effect on life span.

Don't get me started on implantable defibrillators which are not cheap and which may be over prescribed.

I wasnt making an argument in either direction, just pointing out a nuance that gets overlooked. The debate uses total dollars spent and attempt to relate it to the out-of-pocket expense by a single patient. The "impact" a patient feels is actually completely independent of the total dollar value. We could make it so every procedure costs $1, for everything. And we could still reach our outrageous total expenditures due to over use. The dual uses of "cost of healthcare" sets up an inappropriate metric for discussion. That's all.

 

[Bangersandmash]

The high cost of health care is due to a population who doesn't take care of themselves until it is too late and then sues the medical establishment for all they've got instead of actually complying with their own treatment.

/cynic

Actually, the costs associated with medical malpractice and litigation are one half of one percent of total health care expenditures. Aging accounts for less than 5% of annual growth in health care spending and obesity accounts for less than 5% of annual growth in health care spending.

So before you go blaming a population that doesn't take care of themselves, maybe you should go blame a population that takes too much care of themselves in an exorbitant manner.

 

[SpecterGT260]

Actually, the costs associated with medical malpractice and litigation are one half of one percent of total health care expenditures. Aging accounts for less than 5% of annual growth in health care spending and obesity accounts for less than 5% of annual growth in health care spending.

So before you go blaming a population that doesn't take care of themselves, maybe you should go blame a population that takes too much care of themselves in an exorbitant manner.

I don't think you are including the price hikes that are designed to offset expected losses to settlements and the unnecessary procedures or tests that are done in the off chance that a patient with the sniffles has something life threatening (even unrelated) and you, as the doctor, miss it and are found liable.

 

[LizzyM]

Actually, the costs associated with medical malpractice and litigation are one half of one percent of total health care expenditures. Aging accounts for less than 5% of annual growth in health care spending and obesity accounts for less than 5% of annual growth in health care spending.

So before you go blaming a population that doesn't take care of themselves, maybe you should go blame a population that takes too much care of themselves in an exorbitant manner.

The words you are using are B.S. words.... "the costs associated with medical malpractice and litigation" might refer only to the cost of malpractice insurance which pays for the awards and the defense of mapractice suits. What that does not include, and which is a major driver of costs, is the over-use of tests and procedures to protect against a charge of malpractice.

"growth in health care spending" is more B.S. because something that is huge won't need to grow much relative to other costs becuase it is HUGE. Those who are not good at reading and math will believe that aging and obesity each add 5% to the cost of health care but that's not what that passage said at all.

 

[TheMightySmiter]

Actually, the costs associated with medical malpractice and litigation are one half of one percent of total health care expenditures. Aging accounts for less than 5% of annual growth in health care spending and obesity accounts for less than 5% of annual growth in health care spending.

So before you go blaming a population that doesn't take care of themselves, maybe you should go blame a population that takes too much care of themselves in an exorbitant manner.

The real cost is not in the litigation itself, but in the attitude that develops among healthcare providers to use defensive medicine instead of proper medicine. It's the attitude of, "Well, this drunk college kid who hit his head passed all his neuro exams, but we don't want his parents suing us when he wakes up in the morning with a headache, so let's run a CT." The scenario is an exaggerated one, but the attitude is real. Doctors should be able to use their best judgment without the fear of being sued.

 

[High Roller]

Actually, the costs associated with medical malpractice and litigation are one half of one percent of total health care expenditures. Aging accounts for less than 5% of annual growth in health care spending and obesity accounts for less than 5% of annual growth in health care spending.

So before you go blaming a population that doesn't take care of themselves, maybe you should go blame a population that takes too much care of themselves in an exorbitant manner.

I'm assuming you're pre-med, so all I can say is that 5-10 years down the road you will realize how naive this statement sounds.

Defensive medicine is very real, and almost everyone practices it to the detriment of health care costs.

 

[Pedge]

I thought it was common knowledge that the rapid rate of expensive technological advancements was the primary culprit responisble for the ever-rising health care costs.

 

[High Roller]

I woke this morning to a very disturbing newspaper article. Here are a few snippets to give you an idea of the author's basic premise:

1) "High wages in the medical sector are the underlying cause of ballooning health costs," says Eli Lehrer

2) "There's no way around it. Wages drive high medical costs much more than any other factor."

3) "A physician practicing in a primary care setting, according to the Bureau of Labor Statistics, earned an average of just over $200,000 in 2010, while specialists averaged over $355,000, the highest of any professional category tracked. By comparison, lawyers average just over $110,000, airline pilots about $92,000, and chartered actuaries-who calculate risk for insurance companies and must pass complex exams longer and arguably more difficult than the medical boards-about $150,000."


From my knowledge of the healthcare system, this assertion is simply not true. Please discuss.

Disclaimer: I am not attempting to plagiarize. The article, "Your doctor's big, fat paycheck," was written by Eli Lehrer and can be found in its entirety in Section P of The Dallas Morning News dating July 29, 2012.

Thanks for sharing this. My thoughts:

1) Not True at all.

2) Definitely wrong.

3) Probably true...but weird comparisons from the author. An actuary? I don't even know what those guys do, but it its more stressful than taking care of sick people, kudos to them.

And If any of those guys really feel that slighted, they could take on the debt and sacrifice a big chunk of their life while they go to medical school and residency. Its a free country. But I imagine people would rather bitch about perceived unfairness cause its way easier.

 

[Socrates25]

Eli Lehrer is a director of a struggling "free enterprise" think tank. If you look at his twitter feed, he keeps asking his friends to hashtag him so he can increase views to his website. He used to work at a place called Heartland, but his stuff wasnt up to snuff so he got kicked out and now he is on his own.

He's obviously a desperate little man who's crappy little business is failing. He probably knows a doctor who makes 10 times more money than he does, so of course he's jealous and lashing out.

Take a look at his crappy website: http://rstreet.org/about/staff/eli-lehrer/

Here is his twitter feed: https://twitter.com/elilehrerdc

 

[Socrates25]

Here is the actual article he wrote:

http://www.dallasnews.com/opinion/s...akes-too-much-money.ece#slcgm_comments_anchor

He says that actuary exams are more difficult than medical boards. This guy has the biggest penis envy I've ever seen!

I looked at his website and as far as I can tell, this is the FIRST healthcare-related article he's ever done. Most of his tripe consists of insurance regulation. But when you have a failing business, I guess it behooves you to strike out with ridiculous tripe and try to make a name for yourself.

Here is his contact info (all publicly available on his lame website):

Phone: 202.615.0586

Email: [email protected]

Twitter: @elilehrerdc

 

[typicalindian]

Uh you're supposed to be compassionate and caring. How dare you try to take my money?

You should follow in my footsteps. When I become a physician I am going to give a $100 bill to each patient that steps into my office. That's how caring and compassionate I will be.

 

[deleted103644]

Actuary exams <<<< pre-med classes + MCAT + medical school apps + 4 years of medical school + residencies + board exams + debt + malpractice insurance

Not really.

The actuarial exams are much harder than the MCAT or the USMLE.

Just think of how many physicians barely struggled through calculus (and most never took differential equations).

Not saying the article is right, but people seriously over estimate the intellectual firepower necessary to become a physician. The main obstacles are money and time, not intellectual difficulty.

 

[typicalindian]

Not really.

The actuarial exams are much harder than the MCAT or the USMLE.

Just think of how many physicians barely struggled through calculus (and most never took differential equations).

Not saying the article is right, but people seriously over estimate the intellectual firepower necessary to become a physician. The main obstacles are money and time, not intellectual difficulty.

There's certainly tons of actuaries who struggled through general bio, physics, orgo, and chem too. I'm not really seeing your point. Although, I do agree with this statement "people seriously over estimate the intellectual firepower necessary to become a physician."

 

[deleted103644]

There's certainly tons of actuaries who struggled through general bio, physics, orgo, and chem too. I'm not really seeing your point. Although, I do agree with this statement "people seriously over estimate the intellectual firepower necessary to become a physician."

All you need for medicine is the ability to memorize and interact with people.

Actuaries often are lacking the latter, but the level of intelligence required is higher for that field on average.

And I'm saying this as a physician.

 

[typicalindian]

All you need for medicine is the ability to memorize and interact with people.

Actuaries often are lacking the latter, but the level of intelligence required is higher for that field on average.

And I'm saying this as a physician.

 

[Renaissance Man]

The actuarial exams are much harder than the MCAT or the USMLE.

You have taken all of them?

 

[Narmerguy]

Just because something is harder doesn't make it more valuable. Memorizing how to solve a Rubik's cube is hard. Memorizing how to solve a 7x7x7 cube in under 5 minutes is harder. Probably harder than most of what's on the MCAT, though that certainly doesn't make it more valuable.

 

[deleted103644]

You have taken all of them?

MCAT and USMLE.

Thought about taking the first actuarial exam, but decided it was pointless since I didn't want to be an actuary.

 

[TheMightySmiter]

If you're talking about intellectual ability, there are lots of professions that are probably more "difficult" than medicine. Astrophysics, or nanotechnology, or software engineering. Actuarial sciences might be one, I have no idea. The things that make medicine difficult are the combination of an enormous volume of material to master, a long training period, difficult hours, responsibility over the lives of others, etc. I'd say there is much less risk involved in becoming an actuary, which is of course ironically appropriate.

 

[Socrates25]

Not really.

The actuarial exams are much harder than the MCAT or the USMLE.

Just think of how many physicians barely struggled through calculus (and most never took differential equations).

Not saying the article is right, but people seriously over estimate the intellectual firepower necessary to become a physician. The main obstacles are money and time, not intellectual difficulty.

Astrophysics PhD qualifying exams >>>> actuarial exams

We can play this game all day long

 

[deleted103644]

Astrophysics PhD qualifying exams >>>> actuarial exams

We can play this game all day long

Probably, lots of respect for the astrophysicists.

There are many math heavy professions that require much more intellectual firepower than medicine.

Pretty much anyone with money/without aversion to massive debt and a decent work ethic can be a doctor. (Probably need at least average intelligence too - usually, but brilliance is definitely not required.)

Not everyone can be an astrophysicist.

 

[Dbate]

this is what angers me about our society....we knit pick about people who are making lives for themselves when pro athletes players don't even need to go to college to make $20 million a year.

I really HATE this argument. People always try to make it seem as if professional atheletes contribute nothing to society.

Let's be honest. For the VAST majority of people, life sucks. They have jobs they don't enjoy, too little money to really live the way they want, and are constantly worried about their financial situation. Sports, movies, music, etc allow MILLIONS of people to forget about their worries for a little bit and enjoy their lives.

It is difficult to quantify the positive impact this has on our society, but per capita each professional athlete contributes more to the happiness and fulfillment of more people's lives than doctors ever will.

And on top of that, they generate much more than their salary. They are the life force of a multibillion dollar industry that provides jobs for tons of people (from stadium workers, to merchandise manufacturers, and even sports news broadcasters).

Professional athletes deserve every dollar they get. And it is ALOT harder to become a professional athlete than it is to become a doctor.

Doctors (or rather doctors to be) should step off their high horse and stop acting like they are the only people who contribute to society.

 

[Drrrrrr. Celty]

It's always easier to blame doctors than to blame insurance companies, big pharma, and big law.

 

[Perrotfish]

Probably, lots of respect for the astrophysicists.

There are many math heavy professions that require much more intellectual firepower than medicine.

Pretty much anyone with money/without aversion to massive debt and a decent work ethic can be a doctor. (Probably need at least average intelligence too - usually, but brilliance is definitely not required.)

Not everyone can be an astrophysicist.

You're underselling yourself. I would say maybe 15% of the nation could make it if they had sufficient dedication, but only the top 5% or maybe 10% could do it without sacrificing every waking hour to study, just to be the bare minimum of competent. I won't get into the quantum physicisist vs. engineers vs. physicians argument (who wants to?) but the ability to pass the exams we pass and function competently as a physician requires way above average intelligence. Not Nobel level genius but definitely the kind of smart that you only see a handful of in an average high school's graduating class.

I've always thought there was a bit of ego stroking present when physicians talk about how anyone can do this job. It implies that they got the job that most people want because they were a harder worker. That it was a reward for virtue. If it was native intelligence then they'd just be lucky, and they'd need to be grateful rather than proud. It sounds exactly the same as when beautiful people say the key to success in relationships is 'confidence'. It obviosuly works because, hey,they're confident and people will cross the street just to try to buy them dinner.

 

[deleted103644]

It's always easier to blame doctors than to blame insurance companies, big pharma, and big law.

Haha, can't really blame the lawyers.

They're in much worse shape than we are.

Republicans defend pharma and insurance, Democrats defend nurses and people who don't pay for healthcare, no political party really defends the doctors.