• Welcome to OGBoards 10.0, keep in mind that we will be making LOTS of changes to smooth out the experience here and make it as close as possible functionally to the old software, but feel free to drop suggestions or requests in the Tech Support subforum!

Doctors are paid way too much in America

I am a surgeon. I went to Wake for undergrad and med school ($400,000). After next year, I will have completed 7 medical board standardized exams (4 of them extremely stressful), each one costing approx 1,000 dollars. I started residency at the age of 26 for my first real pay check (approx $50,000 a year). I also live in a city which has a high cost of living. I worked 80 hrs a week for 5 years, not including research, studying, administrative work and practicing surgery outside the hospital. Now I am going through another 2 years of fellowship. After 9 years of training after college, I am married with a son and living in an apartment. I can get called at any time at night and often do. I take calls that are 30 hrs long and get little to no sleep during those calls. I get 4 days off of work a month. I haven't had Christmas off in 5 years. My experience is not unusual for a surgeon. There is a lot of delayed gratification.

Also, just having a specialized skill brings in more money to the hospital than you could ever bill. Hospitals offer services to insurance companies and their customers. If the pediatric cardiac surgeon retires, then the hospital cannot offer that particular service and the insurance company will pay the hospital less for all of the other services. That is why Wake Forest has more negotiating power than a community hospital. It is very easy to replace a primary care doctor. It is very difficult to replace a pediatric cardiac surgeon. I have over simplified the situation, but you get the idea.

One way to decrease the overall cost of medicine is too decrease physician salaries, but it will be indirect. There will be less physicians doing less work, which will limit access to medical care. If you want to limit access to medical care to cut costs, why not just limit the number of physicians going into certain specialties and keep salaries high?
 
The last two posters do realize that we're not questioning how much money your services command. The bigger issue is why you are in so much debt and have to charge so much.

HMO providers have long been on my guillotine list with high end bankers and lawyers. They're scum. Like I wish a Moses death on their first borns.
 
When my oldest son was born, almost 24 years ago, Durham County Hospital billed my wife $4.00 for a tylenol tablet. By any standard for health care costs that is absurd, and that was September 1989. If you want to reduce costs, you can start with stuff like this.
 
bobknightfan said:
I don't believe for a minute that the U.S. has the best healthcare in the world....but it definitely has the most expensive healthcare in the world. A fair way to define the "best healthcare" in my opinion is to determine what kind of system delivers the best overall healthcare to the most people at the best possible reasonable price....not the system that has attained the highest level of specialization for unusual cases. By that definition, i'm not even sure that the U.S. has a better healthcare system than Cuba. I'm sure that my car would run better if a had a complete diagnostic test and changed the oil every two weeks....but what would be the added utility value compared to al that extra cost? In healthcare, as in everything else, there have to be tradeoffs, if we are to provide that aforementioned system that delivers the best overall healthcare to the most people at the most reasonable price. As doctors have moved away from general practice toward specialization over the years, we have developed a healthcare system where we have too few GPs and too many specialists. And there is no mystery as to why these new doctors are drawn toward specialist careers rather than general practice. That's where the money is. And I understand their argument that they need more money due to all the excessive cost in years....too many years....of education to prepare for that specialist field. The entire healthcare system is this country is broken. Due to the direction that healthcare has gone in this country over the years, the cost of healthcare has outstripped overall inflation by how much? 3 times? 4 times? More than that? Much of the financial problem with fanilies in this country today is due to this runaway cost of healthcare.
Click to expand...

There really are a few things that come to mind reading your post.

1. Patients will have to be the drivers of your more cost effective system. As consumers of health care, if they push for more and more, then more and more will be done. Whether anyone admits it or not being a physician, at least in my practice, is a people pleasing industry. You tell people what they don't want to hear they'll go somewhere else. I won't give in to just anything, but people can be very demanding. They want what they want when they want it. I honestly don't know if the American culture of now now will be able to function in a managed care/universal healthcare system like what Canada and the UK have. I have a sinus surgeon friend in Vancouver and the average wait for elective sinus surgery with him is about 6 months. He would be out of a job here in the states, no one would be willing to wait that long for something they have got to have.

2. There has to be some motivation to NOT seek healthcare. Clearly it could effect me, but patients with Medicare and Medicaid have limitless access to me. But more importantly they have limitless access to the Emergency department. Overutilization of emergency services plays back into #1, but is a crippling expense for the healthcare system. Not to knock my ED colleagues, but they overtest and overtreat, partly to placate the patients and partly to cover their assess from litigation. Example, in medical school I was pretty darn sick one weekend and didn't think I could wait until the normal week to be seen. So I went to the urgent care (not emergency dept) and got an antibiotic. My insurance plan was set up such that I was charged $500 for that visit because I was not admitted to the hospital. If I had been admitted then it would have been essentially free to me. Makes you think whether you need to go or not. Gov't insured patients, especially medicaid, seek care for the most routine and benign things because they don't have to pay a thing. What do they care what it costs? They want to be seen today and by God they will be seen. It costs them nothing.

3. We can thank the lawyers for making things all the more complicated. All across healthcare overtreatment is almost always related to fear of litigation, not increasing profits. It comes up in the ED all the time and I can tell you it comes up in my office almost weekly. Multiply that by every emergency department and physicians office across the country and think about the cost. Tests and more importantly scans (which are very expensive) are ordered which have little chance of finding anything. But they are done so some ambulance chaser has no case if that super rare bird actually does come up. The culture of litigation has changed the doctor patient interaction. Instead of being accepting of complications, now everyone is ready to finger point and cash in. The older patients I take care of accept the risk of procedures I offer them and seem to realize that while rare, bad things happen to people on occasion.
 
You are correct on many counts.

The cost of litigation is WAY more than settlement costs. Defensive medicine is a real entity and I'm not sure how you accurately put a price tag on that.

The only point I'll argue with you is about there being too many specialists. I know, at least in theory, that it increases the cost of care. But, I see people every day who saw their PCP two or three times for a problem I can accurately identify and treat in one visit. Office visit to me costs the same as office visit to the PCP. Sometimes it makes sense to cut to the chase.

Great thoughts on your part otherwise.
 
Last edited:
You are nuts if you don't think we have the best medical care in the world. You can certainly argue that the availability of top level care is woefully insufficient.
 
It is the best healthcare in the world if you're 65 years or older.
 
bojanglefunk said:
It's def not the best for neonatal.
Click to expand...

When the royal baby was born, I thought it was interesting to hear how many British mother leave the hospital in the first 24 hours some leave as early as the first six hours. What I found even more interesting is that the mothers actually get home visits from nurses in the month after the birth.
 
BKF - Kindred is a long term care hospital - sort of a bridge between an acute care hospital and a skilled nursing facility (SNF) The facility has an ICU, a step down unit, med surg. units and some OR capabilities.

Your mention of ventilator patients suggests she was on the 23 bed long term care unit (3 West). While I'm not familiar with the facility (their web site describes the various units) , I have no doubt it was capable of providing the care your aunt required.

You are at least partially correct about finances having something to do with your aunt's transfer. Medicare pays acute care hospitals on a DRG basis (diagnostic related groups). A very simplified example follows. Let's say a hypothetical diagnosis requires a stay for 3-7 days. Medicare sets the reimbursement at maybe 5 days. If a hospital can discharge the patient in three days, it makes money. If the patient requires more than five days, the hospital loses money. The hospital is obligated to do what is in the best interests of the patient, although in my experience it doesn't always work that way.

A dozen years or so ago nursing homes were encouraged to expand their services in order to save Medicare dollars. Medicare offered rates much higher than regular skilled care rates, but much lower than hospital rates. I assume Kindred hospital is reimbursed at levels higher than any SNF, but still considerably less than an acute care hospital.

The reimbursement rate disparity doesn't mean the care was inferior at Kindred. Kindred certainly doesn't have the overhead of an acute care hospital. They are set up for the types of patients they get, so the care provided is probably equal to what the acute care hospital can provide. In today's world, if you break a hip you will likely rehab in a SNF because the same care can be rendered in a less costly setting.

I'm sorry your aunt wasn't able to overcome whatever health problems she had.

Edit- Kindred (the company) is a rehab company that also operates SNF's. They have been pretty good at both endeavors. They made a decision in the last year or so to ease out of the nursing home business due to the slim profits vs the risks. I have no idea how that impacts Kindred-Greensboro.
 
Last edited:
WakeGal said:
When the royal baby was born, I thought it was interesting to hear how many British mother leave the hospital in the first 24 hours some leave as early as the first six hours. What I found even more interesting is that the mothers actually get home visits from nurses in the month after the birth.
Click to expand...

Apparently, it's becoming increasingly more common in the states. Or at least it is in Naples.
 
bojanglefunk said:
It's def not the best for neonatal.
Click to expand...

This is just not true. We have a heterogeneous patient population in this country with obesity problems, increase incidence of prematurity and low infant birthweight and at the same time macrosomia. We are more aggressive at keeping neonates alive than any other country (which is not necessarily a good thing). These things don't show up in the statistics. For your own sake, have your kids born in the US.
 
The US, as a whole, has the best health care in the world in terms of quality. Anyone who would argue differently simply doesn't know what they are talking about.

Just because there is a shortage of primary care physicians doesn't necessarily mean they should be paid more.

It's quite easy in the world of modern medicine to practice primary care medicine with extremely limited knowledge and skills. Not to say that there are not excellent primary care physicians out there, but over the course of the last 20 years, two trends in medicine have occurred which make it possible for almost anyone to be a general physician: 1) the near complete reliance on imaging/tests over history/physical exams for diagnosis and 2) the trend to consult whatever subspecialty there is to micromanage nearly every patient problem.

For example, if a patient comes to the hospital with chest pain and shortness of breath with a history of heart disease, diabetes and renal failure. That patient would get a chest CT where the Radiologist would detail every cardiopulmonary finding with a differential of what is wrong, and Cardiology/Endocrinology/Renal would all be consulted to manage their individual aspects. This example is much more the norm than the execption. The only thing left for the primary care physician to do is essentially organize information from other doctors, follow their recommendations and write a summary note in the chart every day. It's mindless work. It's why PAs and NPs have made a huge push in the last 10-15 years in medicine. They can do the same thing with 2 years post graduate education.

IMO, the increased reliance on imaging and the excessive consulting of other services are the two main reasons the current health care system in this country is financially broken. Tort reform is only a part of what drives those two things, because imaging and consulting take much of the legal pressure and burden off the primary care physician. The other factors include increased income for the primary care physician (more consulting and imaging means less time they have to spend with each patient figuring out what's wrong and consequently can see more patients throughout the day), less general knowlegde required (the current generation of physicians physical exam skills are pathetic compared to the previous ones) which means more free time out of work spend doing something fun rather than advancing their education.

There is currently no incentive whatsoever for physicians to not image or consult.

IMO the best way to fix health care is to offer primary care physicans financial based rewards for practicing low cost medicine on top of tort reform. Take the legal handcuffs off primary care doctors and allow them to practice medicine to do what they think is best to take care of people. And by offering financial rewards for low cost medicine, you take a huge economic burden off heathcare by drastically cutting back on unneccessary imaging and consulting. This will in turn raise primary care pay while at the same time lower specialty pay.
 
My question with regards to the litigation is are there more lawsuits because people want to file them and thus more lawyers, or are there more lawyers than there are cases so attorneys push for lawsuits?

I think it's probably the former but I could be persuaded it's the latter if there's an argument to be made.
 
Semi related, but my lady friend works in a pediatrician's office and was discussin how there are wealthy patients that fly over from middle eastern countries so that the wives can give birth and get US citizenship for the child. However, these wealthy families have no insurance so Medicaid kicks in and covers the costs of the child's care.
 
DeaconCav06 said:
Semi related, but my lady friend works in a pediatrician's office and was discussin how there are wealthy patients that fly over from middle eastern countries so that the wives can give birth and get US citizenship for the child. However, these wealthy families have no insurance so Medicaid kicks in and covers the costs of the child's care.
Click to expand...

I don't understand. Medicaid isn't granted to people who don't have insurance, but to people that can't afford insurance, no? Are these people hiding assets from the government?
 
You must log in or register to reply here.
Back
Top