But this is almost always where people believe cuts should be made (not just in the medical field, but in any field). Labor is always seen as the most fungible part of the equation for overall cost in any business. This is why organized labor in any field matters, because they will always come for salaries. What makes this more complicated is that many doctors are in private practice, which I’m going to assume is more like being an entrepeneur (correct me if I’m wrong on that count, of course). But doctors go to school (often expensive schools) for years, and more often than not, becoming a surgeon or some other high profile type of doctor pays better. I know that they keep talking about a shortage of physicians here in my state, especially in rural areas, and how doctors who came from overseas are seen as a solution to that problem. I’m gonna guess that they aren’t getting paid even what you make down in Appling or Bacon or Lowndes county, despite providing a critical service to those communities. There is probably even a major difference between different parts of the metro area - North vs south dekalb or north vs. south fulton.
Much like we pay our teachers, firemen, and police crap, not paying our doctors a decent salary would be a disaster. We can and SHOULD cut costs in other ways.
You are exactly correct. I cannot say what my salary actually is, because essentially it is what is left over after everything else is paid for. For perspective, my actual, adjusted pay peaked in 2001. I have taken pay cuts every year since then as expenses go up and reimbursement is static at best. I am close enough to retirement that I think I can work out the string, but we have been unable to recruit any new docs for years (for kinda obvious reasons) and once I (and my same-aged partners) retire, there will be another community with no primary care available. As I said upthread, I have no answers, just observations. And they are pretty grim.
Well, honestly, as much as you’re part of all this, I don’t think it’s entirely on YOU and other doctors to have all the answers here. We should listen to what you and other doctors, especially those providing critical services have to say about what drives up your costs, and other critical things, but this needs to be a community wide fix. I fear that the continued retirement of boomers and their increasing needs as they age are really going to make costs spiral out of control even further. We’ve got to get a handle on this now, or there won’t be a workable health care system for me and my generation as we age and for our kids and grandkids either.
The kind of bullshit this couple has endured just for having a baby is down right criminal.
“We see a wide variety of behaviors from [health insurers]. Some are definitely creating extra challenges to try to wear people down,” said Carol Sakala, PhD, director of Childbirth Connection programs for the National Partnership for Women and Families. “The public thinks we have a healthcare system, but at its base, it’s a business, and different businesses have different degrees of how responsibly they operate.”
You are probably well aware (but others here may not be) of the RVS update committee, which Medicare uses to determine what it will pay physicians, and which all the insurers have adopted as well. The committee is heavily stacked with procedural specialists, and to absolutely no one’s surprise, has been for decades reaching the conclusion that neurosurgeons, orthopods, and cardiologists should be making 2-4x what general practice physicians make.
Beg to differ. If you took the typical hospital, and removed the cost of everyone who actually diagnoses or treats patients, everyone who supports patient care (dietary, housekeeping), all the medications, and all the implanted devices, what’s left would be no more than 20% of the total.
Oh trust me, I am painfully aware of the RVU system. This is what allows ophthalmologists to make $5k or more for a 10 minute cataract removal, whereas a well child visit lasting 30 min or more will get me around $100 give or take. As we say, you get paid to do, but not to think and never to talk.
I admit it, it’s easy to go after you guys…but then look at median income for an ER doctor vs median US household income. I live in a poor area and there are extremely expensive cars parked in the doctors’ spots. If you can travel to another country, you’re doing better than the majority of Americans and need to check your privilege tbh.
Having said that, I’ll readily admit the real major problem is unchecked prices. A mammogram costs about $80 in Canada; here in the States, our local hospital billed our insurance company nearly $18,000, and we owe “only” just shy of $700. If we’d caught it in time we would have complained that the average cost was far lower than that.
It takes a lot of years for the average teacher to make that kind of money. My wife has a master’s degree but doesn’t make nearly that much, puts in a lot of hours, and has done so for a lot of years. But yeah, that’s also true of people who put in a lot of hard physical labor but might not make as much as her, or close to it for hard physical labor.
I mean, you seem defensive. What’s your solution? I drive by local clinics in an area where average income is well below average, and can tell who the physician is because that’s the person driving either a 7-series BMW, or a higher-end Jag. All I ask is that you check your privilege a bit…
And I’ll fully acknowledge that the companies some of you work for are highway robbers, as are their suppliers, and that you’re just a component in why healthcare is expensive.
To repeat, I am not asking or expecting sympathy. We are not struggling, and we recognize that we are pretty damned privileged. Merely pointing out that if you want to control healthcare costs, you are not gonna make much headway if you are going after my salary. For the years of schooling involved, I think you would find that there are many more lucrative professions than mine.
This kinda makes my point. The salaries of the providers are only a small portion of the out-of-control health care cost spiral. For a job that requires as much schooling as ours, involves as much responsibility as ours does, and in which mistakes involve significant consequences, are you really looking for “who will work for the least money?” We are already seeing this in pediatrics, the relatively poor reimbursement has sent the majority seeking higher paying subspecialty or hospitalist positions. I sympathize with your ER experience, but most of those costs (I think, not speaking with authority here) will not be direct patient care.
I have actually gotten “The job you do is so important, and impacts so many people, I can’t believe you have the nerve to charge for it!” Not entirely certain how to respond, other than “I like living indoors and eating regularly?” No clue. As I said upthread, I am old enough that I think I can work out the string, but the next generation is in trouble. Theoretically, primary care is supposed to be “the key to controlling healthcare costs” but is also expected to work for less year after year. In my twon, there are no primary care internists anymore, the family practice docs are aging and not bringing in new docs, and at 54 I am the youngest peds in town. Grim times coming.
The boomers will be the real test. Not in my field, of course, but the explosion of more-or-less elderly (technically, I think I am the tail end of the boomers, so, yeah not entirely elderly) folks needing increasing levels of medical care in their “golden years” will cause significant disruption in the current barely-to-non functional system.
Exactly. This is the flip side of avoiding the doctor who’s in it mainly for the money. It’s valuable work that requires a lot training and can involve life-and-death decisions, so complaining about physicians’ and nurses’ salaries is churlish and focusing on them as the problem with health care costs to the patient misses the point.
Another factor in all of this is student debt. From what the doctors I know tell me, this can be significantly larger than that of your average holder of a postgrad degree.
Well, I came out with $37k in debt, but was a scholarship kid and went to a state school way back in the dark ages. Usual debt now runs north of $300k for most, and much as it hurts to say, if that was me, I could not have gone into peds. Not and lived indoors.
The current system might get it from both ends: a large elderly cohort who are under-insured or uninsured in the face of expensive late-life care, and a large young cohort of members of the precariat who can’t afford insurance at all. Combine that with the generally unhealthy lifestyle choices of Americans and I expect that the healthcare system will start coming apart in a way no-one can ignore about a decade from now if nothing is done.
It already is, but most of the “upper caste” hasn’t seen the effects yet. They are rapidly spreading upwards, though. Medicaid patients have been seeing the effects for several years already, and the underinsured are starting to see it now.
