Given the current legislative efforts to reform health care, it’s not surprising that there are plenty of articles being written on the subject. But I was surprised that in just one day last weekend I managed to read three articles that blamed doctors for a decent chunk of our out of control health care costs. More interesting, not one of these articles was talking about defensive medicine or a focus on high tech care; no, they were all basically saying that too many doctors are greedy for money.
First there was this article in the NY Times, which discussed how the AMA has since 1929 (yes, 80 years ago) fought against systems (such as cooperatives) that would potentially limit doctor incomes by creating a salary structure rather than a fee for service structure. Although some cooperatives were formed, it was over the objections of the AMA. Not coincidentally, the two medical groups that are continually held up as paragons of cost-effective and world-class care, the Mayo Clinic and the Cleveland Clinic, are both cooperatives. At a recent conference on cost-effective care, most doctors and hospital executives agreed that the fee for service system is “archaic and fundamentally at odds” with good practice.
Next was this article by Dr. Atul Gawande in The New Yorker, in which he investigates why health care in McAllen, Texas is so much higher than the national average. In fact, he notes, McAllen’s health expenses are twice as high as El Paso, Texas, which has the exact same demographics. Gawande explores a number of reasons – service quality, technology, legal environment – but ultimately concludes that it comes down to massive overuse of medical care. Doctors in McAllen do far more tests and scans and procedures than average.
But Gawande goes even further. He blames this overuse not on a surfeit of caution, or desire to better treat patients, but on doctor greed. Doctors make more money when they do more procedures, and if they have ownership stake or revenue sharing agreements with imaging centers or labs or hospitals (and many of them do), then they have financial incentive to send patients to those facilities. Interviewing doctors in McAllen, Gawande uncovers a culture of greed, where doctors are in it for the money. Or, as a McAllen cardiac surgeon says, “Medicine has become a pig trough here.”
I sent Gawande’s article to a friend of mine, who is a doctor in a family practice, but who also has a Master’s in Public Health and did a fellowship in preventative medicine. My friend agreed with Gawande’s conclusions, noting that “nobody wants to give up that $500k+ salary, and the AMA is a huge lobby.”
Finally, The New Republic had a piece that sort of summed it all up, noting:
“Given how much of the game of reining in costs hinges on doctors–whether they see themselves as profit-maximizing small businessmen (or, for that matter, large businessmen), or as fundamentally involved in healing patients and receiving fair compensation for that service–I think we have to think about the kinds of people who go into the profession.”
And this is where I get to have my say. Because if someone is going into medicine because they want to make a million dollars, I say they should go to Wall Street instead. As this chart shows, it isn’t exactly like doctors are hurting for money. Practicing medicine isn’t a license to print money, and when a doctor orders an extra $1,000 procedure, while he gets to keep that $1,000, we all have to pay for it through higher insurance premiums. At which point he is no better than the greedy mortgage-backed security trader whose huge bonus ended up being subsidized by taxpayers.
This just in: right before posting, I read this article in the Wall Street Journal about how the AMA and the American College of Surgeons both came out against the idea of a commission setting Medicare payments to doctors. These groups continually lobby against reductions in Medicare payments.
Added bonus links:
- Slate article describing how a Supreme Court anti-trust decision gave rise to doctor-owned hospitals and other greedy doctor abominations.
- Denver Post article about a woman who died when a doctor-owned specialty hospital that didn’t have the resources necessary to handle her post-surgery complications.
- Book review by Harvard Medical School professor Arnold Relman, who attacks the “medical-industrial complex” and the whole concept of profit-driven medicine: “in no other country is medical care marketed and advertised so aggressively, as if it were just another commodity in trade.”
- New York Times article describing how the greediest hospital in Gawande’s article is one of the largest contributors to Democrats this year as it lobbies “to soften measures that could choke its rapid growth.” This lobbying has been successful, as language limiting physician ownership of hospitals has been stripped out of bills. According to Democrat Pete Stark, the physicians “just thought they could buy their way out of it, and it’s a sad commentary on the Congress.”
If doctors were not so greedy, health care would be more affordable.
People keep blaming the insurance companies for the high cost of health care. The blame lies squarely with the doctors.
Whats even worse is when doctors force you to come back to get prescriptions you normally get just to get you to pay for an office visit. THATS JUST PURE GREED. They can call it in to the pharmacy, but routinely ask for an office visit to boost income and do nothing more than push a pen for the money.
There’s more to it than that, considering how the medical profession has control of how many doctors enter the profession and practice medicine in the U.S. Their biggest snafu actually occurred almost two decades ago and we’re all still paying for it. What happened was that they over estimated how much HMOs would restrict patient activity and thus restricted further than they had previously the numbers of new practitioners entering the field. They have tried to remedy this somewhat, but considering how long it takes to train a full-fledged doctor, much less open a new school, we are still behind. But guess what . . . this means that the AMA and related associations treat their profession as a Medieval Guild! This is not the free market. I am all for legal reform, but almost no one is able or willing to take on the doctors directly. Moreover, the vast majority of new physicians are specialists and of the 9 percent allocated to be general practitioners coming through the schools, 7 of the nine are foreign! The vast majority of U.S. doctors are in it for the money.
I read that 62% of all bankruptcies in the US are medical related. What was even more shocking was that 74% of those people had medical insurance.
I still don’t know why the same medicine in the US costs twice as much as it does if you buy it in Canada.
Just about every business related to medicine is a money making machine. It is a woefully inefficient system at the expense of consumers. Here are some specific problems:
1. Doctors – When you think of doctors, rich comes to mind. They charge too much for the work performed. These days when a patient sees a doctor, we spend more time filling out forms and answering questions from assistants while the doctor barely spends a few minutes to listen to us and answering questions before finding an excuse to dash out of the room. They are quick to refer us to specialists and write prescriptions that we don’t really need.
2. Insurance – The system is set up so that there’s no incentive for patients to check and question the charges. The providers bill the insurance companies directly. They bill whatever they want and if the insurance companies don’t pay, they go after the patient. Most patients really don’t care how much is billed as long as it’s paid for by the insurance company. Most people’s insurance is subsidized by employers so they don’t directly feel the full brunt of the costs.
3. Pharmaceuticals – Why do you think there’s a Walgreens on every corner and there’s a pharmacy in every grocery store? Why do you think they are giving out money if we transfer prescriptions to them? Why do you think pharmaceuticals employ legions of reps to visit doctors and hospitals to pedal their drugs? It’s a huge money maker.
Too many doctors in this country think nothing but profits. I went to the ER and discovered I had congestive heart failure. I was admitted and stayed for 5 days. My hospital bill was over $20,000 and I have no insurance. I have lots of bills and paying them as best I can. The ER MDs does not want anything less than $25/month. They told me that it will go to collections if I don’t pay that minimum. I told those greedy morons that all they’re getting from me is $10/month because I’m overwhelmed with medical bills. I was told they will accept $10 but will still go to collections. I lost total respect for doctors in general because they’re so money hungry and couldn’t care less about the little people.
I am a doctor and… yes, I love the money! Its amazing, you gomers keep coming back to us and we just sprinkle a little Rx here or a little there and bam, we charge it. I get about 175/hr if I moonlight. Can’t help it if you losers were too busy thinking you could become awesome investment bankers or physicists when you could look around you and see that physicists are selling pizza in their spare time to make ends meet. Me, i looked around saw the benz’s and the $$$ and no doctors selling Pizzas and knew that I was gonna hit this field up.
I finished my phd recently and worked closely with recent graduate MDs. These people are disgusting, greedy and self-entitled. I say, lets shove money down their throats and see if they become happy. I have lost my hopes of good doctor-patient relationship, and just pray I will never need their services. I know they are smart, competent, etc, but they are so obsessed with money, they constantly talk about money, it’s unbearable. And it’s not only an american thing, medicine attracts the smartest kids who feel the world owes them something, and who are not particularly passionate about any science. So they hide behind the guise of altruistic nonsense to cash is, it’s a scam. They are terrible to one another, and their work environment is hell. I say, lets give them all the money in the country, see if they will be happy. Give them all your money and hope they don’t screw up.
Julia is clearly a troll but her attitude is common amongst physicians when they are speaking behind closed doors. Calling patients “gomers” is common and the amount of arrogance is astounding. American doctors are not healers they are businessmen/women. They bill hundreds of dollars an hour for 5min with a patient and another 5 dictating into a phone. They schedule patients in overlapping times so they can bill for more “patient contacts”. They moan about malpractice insurance yet they are rarely actually punished then they DO commit malpractice.
There is some myth that American medicine is the best in the world. I guess that is because we have shinier facilities. But when it comes to the physician some of the best care I have ever received is in third world countries. These doctors actually care about healing and are getting paid little to do it. American doctors see themselves as an
upper class and patients as ‘clients’ not humans.
First I want to say that there are several very good doctors out there however trying to find a good doctor is like winning the lottery. I went to see a doctor and I times it on my watch she gave me 2 minutes and 23 seconds, when I complained about being extremely pail she said “get vitamin b-12” when I told her I had severe pain in my stomach she said it was gas, and to take tums then she said okay times up… if you want to see me again make an appointment in 3 months. I blocked the door and said what the hell was that? she said “this is what I learned in medical school” This is your typical doctor.. Just because someone have the cognitive ability to become a doctor doesnt mean that they have the desire to actually be a doctor. I have a rare disease and I have never had a doctor who had my best interest, One hispinac dr did things that were not neccasary because he knew the insurance wouldnt cover it. So he found a loop hole to get money off a patient. I went to a chiropractor and my insurance paid him and he went after me for thousands of dollars, he saw that I bought a new car so he new I can afford it so he charged me for sessions I never had. I wish there was a show like Dexter but this time it was going after doctor… LOL…
I earned an undergraduate degree in Economics and in 7 months I will graduate from medical school and start my emergency medicine residency – I feel qualified to comment. I feel sad about all the bitterness I read in these comments, and I genuinely wish that each of you had even a speck of insight into the medical profession (or a basic understanding of economics for that matter). Most physicians in this generation graduate with approximately 200k in debt, more if you already have a family – that said, I don’t “deserve” to make big bucks just because I have already spent 8 yrs in post-high-school training without being paid a dime. I don’t “deserve” to make big bucks just because I’ve spent 70+ hours per week studying and working for the past 4 years (again, no pay!) and will spend 80+ hours per week studying and working for the next 4 years. I will “deserve” big bucks because I can do something that you can’t do for yourself. You NEED me because I provide a service that you NEED and can’t (or aren’t willing to) perform for yourself. And I do it as effectively and efficiently as the current legal climate will allow me to. To answer some comments in turn:
– You have to come back to the office for prescriptions, because I have to physically see you to be able to assess the effect of the medications. Otherwise you can sue me when I don’t catch something that goes wrong.
– American medicine doesn’t cost twice as much as Canadian medicine… per unit cost adjusted for consumption and liability is equivalent. You THINK you pay more, but that’s because you pay for all the freeloaders and lawsuits as part of your insurance premium.
– “Rich” doctors are a thing of the past. I don’t get any money from writing you a prescription – I only write prescriptions for people that want prescriptions.
– A 5-day stay only cost $20,000? You got off cheap! Just stepping into our Emergency Department costs $400. Now you are only willing to pay $10/month for your care? Are you kidding me? Your heart isn’t worth even the $25/month? Whose obligation is it to pay for YOUR health? You could have signed out “against medical advice” and walked out of the hospital at any moment.
– I’m sure you had some great primary care in a 3rd world country… in America the healthcare costs so much because everybody demands the latest and greatest. Nevermind that a $50,000 operation and a $100,000 ICU stay for an 80yr old only buys an extra 10 days of life…. this is America and I’m entitled to it!
People – you need to take responsibility for your own situation and realize that the Constitution does not gauruntee your inalienable right to my labor. I provide a valuable service that has taken me years of effort to develop. If you can find that service somewhere else for less money, I encourage you to do so!
Do you have any idea what taxpayers spent for your medical education? Average taxpayer output per med school grad is close to $1 million, so yes, I think you should be required to see me or pay back the big bucks. U.S. docs make twice what doctors make in any other developed country and live like movie stars or celebrity athletes.
One thing us doctors need to stop doing is this “only we work hard” nonsense. Society is suffering, it’s much easier to work hard and provide to our families than to work hard and question the future all the time. Spend some time in not-so-well-to-do communities, you will see extremely hard-working people who never had the opportunities we had and struggle to make ends-meet. Also, may I remind you: miners work hard, peasants work hard, a lot of people work hard and do not have the same rewards.
-The hard-work justifies high returns rhetoric does not apply. Most people do work hard in this planet. You’re not alone in the great blue-sphere.
-If you claim “our work is intellectual, hence we deserve more”, this is also not true. There are plenty of other intellectually dense jobs that don’t come close to the payment. And as an economist, where do you think the money comes from? Do we produce wealth for our nations? Is it so smart to undervalue the productive sectors?
The excessive returns to physicians is hurting society. I hope you can appreciate that with your economics background better than me. Bankruptcies only lead to lower consumption, retraction and recession. I see nothing positive in that.
To the most difficult point: the way doctors are educated and the excessive costs of this process was also challenged in the original post. I come from a country where the government pays for the entire training, and you can leave school debt-free and make a fortune in private medicine: the issue is not the cost of education, but the mentality of the people who hold this particularly easy-to-exploit field. Face it: society values medicine (of course) but doctors have crossed the line.
Medicine needs reform from within. Trying to justify excessive returns won’t take us anywhere. I’d like to see more doctors demanding the equivalent of labor laws: we should sleep more and spend more time with our families.
The post is a bit confusing, but my bottom-line is: medicine does not reward well because doctors work harder than anyone else, not because the training is expensive, not because of liabilities. Medicine rewards well because society values it: it’s well placed in the supply-demand space, and by controlling quantity, prices are well-adjusted. I guess I learned something in economics.
Good luck in the field, you have your heart in the right place, but don’t go around thinking you are the only hard working person in the world. Patients are more than “cases”, they are people, and you will be a patient too.
Thanks Paul…that is a very helpful and thoughtful comment. I think that most people would agree that doctors should be well-compensated professionals. They spend a lot of time (and money in the US!) on their training, and provide an incredibly valuable service. Where things seem to break down is when doctors decide that their fees aren’t high enough, so they do thinks like buy imaging machines and then order lots of imaging tests. Well compensated professional: yes. Entrepreneur who games the system to create demand: no.
The training in the US is wildly expensive, and I never quite understood the need to do a 4-year college to then pursue a 4-year MD, which is then followed by residency (where you will learn your daily chores). As far as I know, only the US and Canada share this system. Most European nations and here in South America have a 6-year MD followed by the residency (which again, is where you are actually trained).
I have often heard that the US-Canadia style produces more medical researchers, which I partially agree.
The cost of training will never change over there. The opposite of that happens in my country (Brazil) where MDs get their training for free and, if well-positioned in the market from start, dedicate their careers to the private sector without ever contributing back to the system that educated them: that’s unsymmetrical. A lot do work for the public sector, but those who inherit private practices basically get a free-ride form the government to then live like american doctors in the upper crust of the local elite.
When I observe how the private medicine here works, it’s identical to everything I read about american health care. I personally dislike the idea of a family going bankrupt, still having to bury their loved one (and then paying the bills). One quick anecdote: patient with larynx cancer was given an estimate of 250K for treatment and low chance of survival: he chose to not treat and leave the family with the money that would help the children’s education.
I personally oppose the idea of giving people the option of treatment versus bankruptcy. But we want to live in democracies, and if we chose so, so be it.
Don’t get me wrong, doctors need to be well-compensated, but we don’t need to become macroeconomic burdens on society.
I will anxiously watch how this all unfolds.
Ironically enough, Ryan embodies just the attitude that the post discusses. He doesn’t DESERVE anything. Yes, doctors provide a valuable service. So does my plumber, and he gets a nice hourly rate as a consequence. But my plumber doesn’t own an MRI center that he sends my pipes to, even when they don’t need it, so that he can make a few thousand dollars with every scan. It’s the doctors who think they deserve to make a lot of money who pull scams like that.
It’s incredible the uniformity of doctor’s views of themselves. Ryan is textbook. According to Ryan his services merit his income. Does the mafia strongman who demands protection deserve his income because he has special skills?
Does the free market apply to determine Ryan’s income? No. Their strongmen have bought congress for decades to prevent the free market from deciding what Ryan is worth. If it did there would be a lot more greedy Ryans out there offering their services for patient dollars, so many that each Ryan and Julia Head would have to chase pretty hard to satisfy their greed.
Hey Julia Head, the vast majority of Doctors don’t have the brains to shine the shoes of a Phd physicist or mathematician. I’m glad the greedy mathematician and physicist would laugh at your yearly income, it wouldn’t cover half his bonus.
Ryan and Julia Head, I wish you luck with your future earnings. The free market is coming and it won’t look kindly to 3 trillion dollars spent for your services.
We need price controls on health care.
Three years ago when I had surgery I had to pay one anesthesiologist. Now I have to pay two even though only one is needed. This is now standard policy with anesthesia companies in order to maximize profits and stop the riff of who makes the most money. Greed has replaced morality.
The problem with greedy docs starts with admission criteria for med school. I’ve been a specialist for a few decades, primarily in academic medicine. In college, tho, I did not want to be premed because of the cutthroat attitude of many of the students. Getting an “A” in every course was critical to getting accepted to medical school, and that kind of attitude was helpful. Med schools need to find a way to identify truly compassionate people- unfortunately, many of these people often put the needs of others before their own, and their grades may suffer as a consequence. Most nurses are compassionate individuals, and if they had the same training as the docs, the cost of healthcare would plummet.
Another huge problem is the “arms war” in growing profits in hospitals. Rewards go the docs who do the most procedures, without much concern over appropriateness. In other countries such as Australia, each hospital is given a yearly sum of money, and priorities regarding how it is used for the local population is left up to hospital physicians. The hospitals here, in contrast, have a blank check with no limits.
I am losing my eyesight because I have been deliberately misdiagnosed by doctors. I took a medication that caused diabetes the Nurse Practitioner I’d been seeing for years did not tell me that I had diabetes for six years because I believe she didn’t want me to be able to take part in a class action suit against the pharmaceutical company. I have been diagnosed with glaucoma when I believe that I have diabetic retinopathy. Diabetic retinopathy is a reimbursable ailment. I’ve seen several doctors and am constantly told the pressure in my eyes is 15 or 16 which in within normal limits but I am rapidly losing my vision.
In 1993 I was injured in an automobile accident that was not my fault. The doctors I saw told me that they couldn’t find anything wrong with my shoulder. I was forced to stop working and going to school. I was treated as a drug addict and 15 years later I walked into yet another doctors office and he said, “You know you have a broken bone in your shoulder”. Further test revealed a torn rotator cuff and some arthritis. I later found out that this doctor was from the UK and wasn’t familiar with the way doctors practice medicine here in the US. Surgery was performed and I was fine for 1 yr before I re-injured the shoulder. When I returned to the doctor he said that he didn’t know what to tell me. Said no to physical therapy. I ended up going to Venezuela after seeing other doctors in the US. In Venezuela tests revealed two torn ligaments and a separated bone. The doctor wanted to perform surgery right away but my insurance wouldn’t pay for surgery outside of the country. I have been suffering terrible pain. I have liver damage from taking some much acetaminophen, however, doctors in the states deny that I have any liver damage.
IF YOU CAN IN ANYWAY HELP ME PLEASE CONTACT BY E-MAIL @
I am a physician (of 15 years), and up until two years ago I would have insisted that the vast majority of physicians had their patients best interests at heart. Yes, there were always those few in a community who were overly self interested and ordered tests and did procedures that weren’t necessary, but most were genuinely concerned for humanity. What happened to change my perspective? I moved into an upscale suburb near a large metropolitan area. I have been shocked and disgusted by what I see. Medicine is truly a business here and even though I am a physician, I have to work very hard to find good quality, honest care for my family. I hate admitting this, but I now understand the need for regulation. This is something I never would have agreed with before. I think the bottom line is that there are good doctors out there and there are places where medicine is still an honorable profession, but a lot depends on your particular environment. I feel badly for patients – they aren’t capable of knowing whether tests and procedures are truly in their best interest.
Experienced the same here in South America. I am an intensive care physician, worked for 10 years in a public university hospital, moved to a high-scale private ICU. It’s difficult.
There are doctors challenging dogmas, but they are rare. I see no change in the near future, the private sector here operates in the same way as medicine in the USA.
It is nice to know it isn’t only the U.S., although I’ve always suspected much of the bias against our healthcare system was more “the grass is greener” phenomenon.
I’m happy to report that a change in employment to a large, publicly funded research institution has made a big difference in attitude for me. There are good things happening there and it is exciting.
Hi Kay: let me try to explain how it works here in Brazil, to an approximation. Here we have two systems (that subdivide within themselves. It is in the brazilian constitution to provide universal healthcare to everyone (including non-citizens, I think)). Being a poor country (technically one small rich country and a large poor one “sharing” territory and resources) the public option is indispensable. The best universities are public, but you can create a private medical school (there are many).
– The public system goes from top-quality hospitals connected to the universities, to gradually worse hospitals in more distant areas. The quality of the public option is not uniform, and access varies depending on the area. I have seen people who waited 8 months to see an ophthalmologist. The government has implemented the family medicine program, which works great. Local small “posts” take care of communities and address their everyday needs: it works, and addresses what all medical students learn only on: preventive medicine is the most effective tool.
My message is: the family medicine program works well, the top-notch public hospitals work well (but are crowded), everything in between struggles and the patients (and doctors) suffer. It is hard to work with bad equipment, bad staff and low pay. The caveat is: why would the best doctors work for the university hospitals if the pay isn’t good? Because of connections, curriculum and access to a well-established highly selected community of physicians. One gains reputation here in the top public hospitals, to then sell this expertise and reputation in the private sector for a high price. So, next, the private option.
– The private option. The market is essentially free to open hospitals, clinics, offices and there is an insurance market for them. As far as I understand, it’s identical to the way things are done in the USA. There are subdivision in the private sector as well. The local big names in medicine treat their wealthy patients in luxury hospitals. Beneath that you’ll find a middle class that pays for private insurance and fluctuates on the differing scales of quality found in the continuum of private care, going from the inaccessible crème to questionable cheap private hospitals. From a physician’s perspective (especially if you work in ICUs or emergencies), these hospitals are where you make your savings. They pay for shifts and hire aggressively, our economy is growing, there is no shortage of jobs.
Medicine is the best paid profession here, if you perform the statistics based on what degree the person obtained. The public sector pays by a service table (say, an appendectomy will pay you X bucks), and this table exists to varying degrees from the private insurers (a bad insurance will also pay X a good one 2X a loved one 5X). Us mortals that work in ICU’s get hired by the hospitals and receive a salary.
I hope our country develops, becomes more equitable, and everything that happens in the US needs to serve as example. Health care and pensions are complex issues that cannot be looked at simply from the efficiency point of view, we need to develop a community-sense to take care of the sick and support the elderly. A society that is willing to allow families to go bankrupt in time of sickness needs to revise its values. But democracy is more important, and if we choose so, so be it.
What is certain is the economic disaster that is upon us. As we have at least 40 trillion dollars of liabilities in medicare until the last baby boomer draws his/her last breath, medicine is going to change. If the medical cartel is not forcibly broken from within, due to the corruption of our politicians, then it will be broken from outside as hundreds of hospitals and thousands of clinics emerge along the US/Mexican border to treat this massive population at 1/10th the price delivered by the cartel. Change is coming as the greatest debt de-leveraging the world has ever witnessed strips apart the institutions that are totally unsustainable and totally corrupt.
Doctors are nothing more than glorified mechanics. Only, the machines they repair are biological. They seriously do need to take a drastic pay cut, all of them. True doctors can be found- those who believe in and commit to the Hippocratic Oath, who genuinely care for other human beings, and who wish to use their skills and gifts to better society, rather than to just make a buck. Just look at Medecins sans Frontieres (Doctors Without Borders) for a definition of a true doctor. Many do it for free. Pretty much every doctor in the world does their job for reasons other than money. The only place you will consistently find greedy doctors is America. Just like the only place that charges outrages fees for college, is America.
What we need are price controls- strict price controls, with violations punishable by execution.
just read that George H.W.Bush & Dan Quayle with ties to Eli Lilly encouraged the fast track of the rDNA synthetic insulin through the FDA & then the Bush administration tried to limit the public’s ability to sue drug companies. The profits from rDNA synthetic insulin affords the powerful to purchase new cars for their children, while we parents of diabetic children are left to purchase coffins or worse for our children, because of the defective insulin that we are forced to buy in America.
Cloned insulin is a defective product. In Eli Lilly’s cloned insulin’s phase 2 clinical trials in England in 1982, there was a 30% adverse reaction rate. But Eli Lilly covered that percentage up and had their own doctors report a 2 to 3% adverse reaction rate. Again, Eli Lilly wanted to raise the price of insulin and couldn’t do so unless they “improved” it. But cloned insulin IS NOT an improvement, just another defective product from Eli Lilly.
Doctor’s are paid by drug companies. I don’t believe a thing that comes out of their mouths.
You’re an idiot and a dilettante. Here’s why: It’s illegal for doctors to have stake in labs to which they refer patients. AMA represents just 17% of doctors in the country. It’s illegal for doctors to prescribe without seeing a patient. Beyond that, there’s tons and tons of further laws; not even mentioning that a doctor never wins a lawsuit against him/her. Surgeons can make $500k+ but often end up paying several $100k in malpractice insurance. If you think doctors are greedy and that you should be suspicious of their every move, either go to medical school yourself or move to a socialized country. Not one other profession spends 10+ years on education and a whole life treating patients to be afterwards labelled greedy and go absolutely unappreciated.
Of the few things that docs ARE allowed to do, it’s to chose not to treat morons like yourself (unless your wariness of health care ends up bringing you to the ER).
I understand your frustration, but attacking the public who do not understand why exactly the feel health-care is a threat to the financial health of their family is not productive.
Also, I find most lawsuits against surgeons I’ve seen complete nonsense: people being heavily punished for honest mistakes.
But please don’t call people names like that.
I’m not sure why Hello displays such vitriol here. Could be a University of Miami thing, which is where he/she is logged in. Could be a doctor thing. Whichever, I appreciate his/her input.
I STARTED FEELING SICK ABOUT 3 MONTHS AGO. HAVING SHARP CHEST PAINS AND MAJOR TROUBLE BREATHING. THEN MY JAW STARTED HURTING. THEN MY LOWER BACK STARTED HURTING. IGOT A PROSTATE EXAM AND ITS ENLARGED. MY PSA BLOOD TEST WAS 11.6 – WAY TOO HIGH. CANT AFFORD THE$700 NEEDLE BIOPSY. IVE BEEN TO THE LOCAL ER MANY TIMES AND THEY DON’T DO SQUAT. AS SOON AS THEY FIND OUT I HAVE NO MEDICAL INS. CARD THAT THEY CAN RAPE… THEY LIE ABOUT MY X-RAYS AND BLOOD TESTS AND SIMPLY TELL ME THERE’S NOTHING WRONG AND DISCHARGE ME. THE NEXT DAY I LOOKED ON MY ER DISCHARGE PAPERS AND IT SAID SUFFERING FROM DYPSNEA AND ENLARGED LEFT SIDE HEART. THE DOCTOR NEVER SAID A WORD ABOUT THIS WHEN I WAS IN THERE. ITS ALL ABOUT THE MONEY. THEY DONT GIVE A SH&^%*)_T. I CANT BREATHE AND CHEST PAINS ALL THE TIME AND IM DIZZY AND CONFUSED. I NEED HELP. THANKS, email@example.com
Doctors are not greedy. If most of you folks had any clue of the strain of going through undergrad, medical school, and residency you wouldn’t so callously make such statements. Most doctors running practices are hardly surviving given the climate of insurance companies. If you look at the cost for a procedure in a hospital, notice how little the doctor actually makes and the massive expense of the hospital visit as well as other fees. The doctor makes pennies compared to corporate America in this transaction. Back in the old days doctors did not have to put up with this crap, and shouldn’t have to when they put in 80 hours a week to keep a practice alive. Doctors that have nice things deserve every penny of it for spending every waking hour in books, hanging on by a thread, studying their asses off to get into residency which is no guarantee, and putting up with crap all through medical school, internship, and residency. 99% of you folks just don’t have what it takes and don’t understand that doctors really are not business people and wish they didn’t have to put up with this financial stuff. Its the insurance companies and high hospital fees that ruin it for everyone. Don’t blame someone that you have no possibility of relating to or understanding.
1- If you do not like study, or did study hard not for passion of studying but for posterior reward, that is a pity and I am certain it created great unhappiness and distress. If you do not like books, studying, for the sake of science and knowledge, medicine is simply not your turf. Neither would linguistics, philosophy, physics, chemistry or any scientific field be. Medicine is not unique in its intellectual demands, so please spare us from this idea that time of study generates immediate necessity for financial reward. The status and good salaries provided by the field suffice.
2- The long-hours need to be changed. Doctors cannot work such long hours, it cannot possibly provide the better outcome for society. But keep in mind: doctors are not the only hardworking people in the world. There are people, millions of people, who work for the bare minimum, have zero status in society and live is deplorable conditions: and they work and they work and they work. You think miners, farmers, and others are lazy? Only people who studied deserve rewards?
3- Doctors deserve every penny, just like everybody else who does honest work deserves every penny. But some doctors might not deserve 900K a year from milking families dry of their savings on end-of-life patients. The point here is the lunacy and excesses of rewards on the high-end costly tertiary medicine, not on primary and secondary care.
Thank you, Paul, for a reply that is better (and more generous) than my own.
I don’t usually respond to comments, but the ridiculousness of Chris above demands some reaction. First of all, I never said all doctors were greedy. I said some doctors were greedy, specifically those who order extra tests purely to make money. Perhaps Chris had to spend “every waking hour in books” because his reading comprehension is so terrible. Second, I have many friends who are doctors, and I fully understand what they did to become doctors. I’ll quote my friend David, the investment banker turned ER doc: “Medicine is so much easier than wall street. Doctors have no idea what it means to really work hard.” Finally, doctors knew when they declared pre-med what they were getting into. Chris, if you can’t stand the heat, stay out of the OR.
As a former banker in Florida I have reviewed many financial statements of physicians and they earn about 90% of their income from medicare. That income easily ranges to 500,000 per year and more. I know one specialist that makes 50,000 per day. My friend has a relative that just graduated from med school and started his first job as an md making over 650,000 per year. The federal government has the market power to force down health care prices but won’t. The scheduled reductions in physician reimbursement rates gets repeatedly delayed because of the terrific pressure the medical lobby puts on legislators. Write to your legislator and tell them they need to stand up to the greedy physicians and stop putting off reductions in physician reimbursement rates for starters. As a friend of mine one said, lawmakers listen only when we take it to the streets!
50,000K/day is 18.25 million a year. Since when do doctors make that much?
Furthermore, an MD does not make 650K/year after graduating from medical school. We have to go through residency which is at least 3 years and then fellowships. To be honest, starting salaries for MDs straight out of residency almost never reaches 650k, let alone that salary graduating from medical school. Perhaps that relative works on Wall Street, but definitely not as a physician specialist.
You’re probably just a disgruntled kid who couldn’t make it through medical school, and you’d probably never succeed in residency.
Because you live in Florida, a state with many elderly retirees, it could be possible that you have seen physicians that earn 90% of their income from Medicare. That is certainly not true everywhere, nor in most specialties. Yes, it is your personal experience, therefore it must exist, but it isn’t a reality that can be generalized to physician practices throughout the county.
Your friend’s relative (making 650 K as a start) is also very unusual. Often, enticements like this are attached to many strings. For instance, the physician may provide a desperately needed service in a rural area and the hospital is willing to pay anything to provide such service to their region. In these circumstances, the physician receives the generous enticement, but later the compensation becomes “productivity based” and the salary is decreased substantially.
As for your aquaintance making 50K per day, I find that excessive and disturbing. This is the person that should be investigated – I can’t see how this could happen legally no matter how into the business side of medicine that person is. I agree that it is disgusting and shameful, especially as many families are probably struggling and struggling to pay his fees. However, as a society we don’t seem to have a problem with greedy businessmen, sports stars, celebrities who all attain this level of productivity. We just keep buying those products and tickets, don’t we?
Two interesting observations: 1) This is by far (by a factor of 20) my most commented-upon post, with comments continuing to come in 3 years after the original post; and 2) the doctors who have commented have been generally defensive and unpleasant. Look at Dr. MD above, and Chris above that. Both attacked their critics in a personal way. Really, Dr. MD? Do you really think that your critics “couldn’t make it through medical school?” That seems unnecessary.
Here here. Let’s watch how their pathetic ugly pleas of superiority, entitlement and merit come spewing forth like excrement from a broken sewer as the medicare they tap into dries up like a spent oil field.
Of course physicians will be defensive and unpleasant when our profession is under attack by people thinking that we’re billionaires living in mansions with 30 yachts and cars waiting when we leave the hospital. Just ask a pediatrician making $150k in LA/SF/NYC/Miami/Boston etc with children and $200K debt at the age of 35 if he is satisfied. Or a primary care physician similar to him (I am not a pediatrician nor a PCP). I’ve heard these stories and I myself have friends with similar situations. Admittedly, I was a bit angry at James the banker from Florida since he is claiming absurdities (50K a day…Really??) about my profession. 50K a day is reserved to the hardcore, career driven, 23 hour work day since mid twenty bankers who are now CEOs managing millions of dollars in trades, not physicians. No physician makes that much, unless he/she is involved in the business practice of medicine (again, very unlikely that he/she will be making 50k a day) or a Wall Street pharma CEO who coincidentally is a physician (doubt there are any of the latter though). I am now questioning James’s credentials to be speaking about physician salaries. A doctor making 50k a day will no doubt be in the news because that never happens and thus it’ll be a surprise which people will want to read about. I’d definitely like to read your response. Thanks.
Well, a “fight between doctors and non-doctors” is the last thing we need and completely empty. I’ve posted here a few times and never been defensive. Be warned that anyone who claims toughness for having passed through the demands of medical school is probably not a doctor and if so, has not passed important milestones of maturity in life. There are endless “tests of toughness” all sorts of people have to go through, and bragging about them won’t do anything productive.
Dr. MD is right: those numbers do not reflect the reality of medicine anywhere in the world. This discussion should be about how SOME overcompensated specialties affect the total cost of medical care and how that affects society. Some specialties are too expensive and this needs to be reviewed.
I think we can all agree that a doctor making $50k per day is about as rare as a black swan, and a first-year doc making $650k per year is nearly as unlikely. However, that doesn’t warrant ad hominem attacks on James or any other commenter here. As for pediatricians making $150k per year at age 35, I would make three points: 1) I think most observers of the medical market, including me, agree that primary care physicians are underpaid relative to specialists; 2) that being said, making $150k per year at age 35 isn’t bad…most people in business aren’t making that much at that age, despite starting their careers right out of college (vs. spending 8 years as a student and apprentice); and 3) since our pediatrician is 35 and not 65, that means that he knew exactly what the market was like when he started medical school, and he still chose to incur all that student debt. Despite all 3 points above, I think that a full-time PCP in the heart of his career should be getting paid more like $250k than $150k. Of course, the original post really had nothing to do with PCPs and the fact that most of them should probably get 80% raises. It was much more focused on the minority of specialists who see medicine less as a healing profession as a path to significant income, gaming the system to achieve that income.
Who is to say that a doctor ‘should be getting paid more like 250K than 150K$’? Shouldn’t this be something that the FREE market decides? What about the physicists and engineers and biomedical scientists who build the tools and drugs that the doctors merely use and prescribe? Where is their 250K in the heart of their careers? (this begs the question: Why do you think many of these highly skilled engineers and scientists are moving to wall street?) Does a doctor in Germany or France expect to be paid 250K in the heart of their careers?
How much of the outrageous cost in the US for health care is due to doctor shortages in the US and their associated 300-500K salaries? Why do we have doctor shortages? The answers to these questions and many more are coming very soon as the debt crisis keeps unwinding. Let’s see how long it takes to stop the leak of 1.5 trillion dollar deficits.
—–>Thetoughbasket, the medical market is very volatile so the pediatrician in question is taking a severe risk applying and training in that specialty. For example, a lucrative medical specialty today might not be an attractive one after graduating residency due to the volatile medical market since people still believe doctors are billionaires with yachts and mansions. It is really outrageous how PCPs and pediatricians are paid if they want to live in a metropolitan city with children and a wife/husband. This is especially outrageous after spending over a decade in studying after high school.
Oh, and people don’t make a lot of money in business? Is that so? What about people who graduated from a top ten business school at the young age of 25/26/27/28 who go into banking and make much more than a PCP/Pediatrician/Family Practice doctor who has spent studying still 29+? Furthermore, top business schools (the majority of business schools actually, ignoring ranking), are party schools and I know because I’ve discussed this with MBAs from Harvard, Stanford, and Wharton. These so called top business schools have students coming in to take a two year vacation since they are confirmed to having a job after graduation. Hell, most of them act like stupid college kids during that time. An average medical school is more rigorous than any business school. What really annoys me is that these Wall Street MBA bankers and hedge fund guys make much more money with much less studying and less rigor during the time of study. Wall Street deserve regulation and salary caps, not doctors. Oh, and keep in mind that the 150K pediatrician has a wife/husband, children, pays significant taxes, lives in a metropolitan city with a high cost of living, AND pays HUGE malpractice premiums. How much does this doctor have in his bank to enjoy himself after paying all of this? 10K? 20k? Physician salaries are deceptive and your ignorance and the ignorance of millions of Americans is destroying health care in our country.
—>Herr Professor Doktor, you too have shown your ignorance of health costs. Physician salaries only account to ~10% of the healthcare cost in the USA. The insurance companies are destroying healthcare, not us buddy. Also, the doctor in Germany or France makes less than the one in the USA because they don’t have $200K debt after graduating from medical school and the length/path to becoming a doctor is years less than in the USA. Adding to that, I believe the doctor in Germany and France don’t pay malpractice premiums which can range up to $100K or more for a surgeon.
Lastly, you want to know why the USA has a physician shortage? Just ask the pediatrician we are talking about. Or other physicians who can’t make a living with their salaries, debt, insurance premium, age etc etc. Students are finding medicine as a less lucrative occupation (especially in primary care which is where the shortage is mostly at) because primary care doctors have similar situations to the pediatrician we’re discussing. Students don’t want to live a miserable life of that pediatrician.
Dr. MD, you are right, but this “tough guy” attitude and comparing who works more and who works less to try to define who deserves what is running in circles. We can go over a long list of incredibly difficult brutal lives that never see monetary compensation. I suspect some bankers and businesspeople are also overcompensated and this has had a cost on society recently in the 2008 crisis.
At the other end of the story there are people going bankrupt when they need to follow a complicated pregnancy, when there is need for complex procedures in the family, etc. Why? Can we solve this problem? Somewhere the two end should be met and doctors need to get their fair share, and also decent livable working hours and less frivolous risks to their careers. But the point of the discussion is that certain specialties, radiology, some fields in surgery and oncology end up having a high cost to society because of the excessively high compensation to the practitioners. I don’t think anybody here wants doctors to make less money, in fact I’d like to have less pressure in the work place and more free time.
And I didn’t get my degree in the US, I went there to do research and fellowships: you are right, with the debt american physicians need to incur, I’d do something else, but I’m really debt-averse. I make less, but I feel I live much better than american physicians.
Thanks Paul, for yet another thoughtful (and polite) entry to this conversation.
I was busy for the past week so I couldn’t reply. Nonetheless, let me reiterate one more time that I do not in any shape or form trying to act tough. If you perceive that through my comments and replies, then I apologize because that was absolutely not my intent.
Now, let me correct myself in the defense of all physicians, regardless of specialty. Physicians don’t contribute to 10% of the healthcare cost in the USA, but actually 8.5 %. Furthermore, Paul, please keep in mind that the highest paid specialties are usually the ones that are required to pay HIGH and ABSURD amounts of malpractice insurance. Hence the high pay. For example, neurosurgeons make $400K+ due to the incomprehensible payments for insurance. Like I said before, these payments can range up to $100K and even more after being sued, regardless of the result of the court decision. You know what is also funny? Ob/Gyn doctors are poorly paid and have high malpractice costs which means medical doctors applying for residency avoid it like the devil. This Ob/Gyn doctor will probably end up like the pediatrician we talked about earlier. No savings. High cost of insurance. Tons of debt. Children to support. Wife to support. Interest on loans etc etc. The salaries of physicians is deceptive and with all due respect, you and every other person (toughbasket included) need to learn more about the struggles of physicians and horrible lifestyles due to some specialties.
Medicine is a broken field. Medicine is broken in the perspective of doctors and patients alike and this needs to be fixed. Obama and his left wing goons tried fixing the problem, but failed more than miserably. For the record on Obamacare, free health insurance DOES NOT equal free healthcare. Unfortunately, Americans will realize this the hard way.
I’m sorry if I was too rough on the “tough guy” argument. But it not uncommon to find physicians and surgeons who use that argument to defend higher payments and to shun any argument. I probably misread you. My response to this argument is always the same: there are plenty of hardworking miserable lives out there that do not see any of the status and monetary compensations physicians enjoy. But I apologize for claiming you acted this way, it’s just my explanation.
Any thoughts? To be honest I am completely lost. I think the richest nation in the planet should be able to devise a health care system that provides care to people who cannot afford it. How to create such system? It’s really hard to discuss this without stirring people up.
I don’t think the system is broken, maybe it needs adjustments. I work in a much worse health care system (Brazil), and we have much bigger challenges to overcome to provide quality accessible health care. If up there is broken, there is no hope here.
As for malpractice insurance, I have a practical question: does anyone know if they are overestimating the real cost of malpractice? And what is their contribution to the final cost of health care. The original discussion was that the high honoraries received by physicians make health care too costly for the general public. This is true in the private health care sector here: the biggest cost is doctor compensation.
Nothing is free: health care will either be paid by the consumers or a government will support it using taxes. We’ll see where it goes.
I know four doctors who work at Kaiser here in California and they all love it. They are happy with their work, happy with the care their patients get, and happy with their pay. So there is at least one health care system that seems to work. But overall, the US health care system is complicated and full of conflicting policies and goals, and changing it will be equally complicated. There is no easy solution.
This took me a while to understand: health care and education should be, in my view, fundamental rights and not consumer goods (services). I used to see medicine and even education as merely services, but I have shifted this view to believing these two facets of life should be inherent rights for all citizens of the world.
Maybe a shift in how we understand health care, not as a service but as a right, guaranteed by governments and communities, will produce a healthier society.
And about doctor compensation. Like any other profession, there are people who are quite happy with their compensation and others who will always think they don’t earn enough.
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