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I agree.
7 was the only appropriate one.
An earache with or without fever is 99% not appropriate for ER.
Well - I am not a doctor. Can't get all of them right . As a person close to 70 - if I had a sudden terrible ache near my ear - well I figure it might be a stroke (everything that was unusual sudden painful disorienting "up there" might be a stroke). Reckon if I were dealing with a 5 year old - especially one with a history of ear infections - it might be different.
FWIW - my worst ever experience when it came to medical care was I once developed a big deal earache in my 40's (the inside of my ear really hurt). Went to a bunch of doctors (never an ER) - and the worst of them (a well known specialist) - after looking in my ear - said it was "all in my head". Phooey . About 3 months into the thing - one morning - I woke up with an ear full of puss looking stuff. Turns out I had a big sebaceous cyst in my ear (admittedly unusual) And - when it popped and drained - voila - instant relief . I honestly hate it when doctors tell their patients - especially us women (seems to be more common with women than men) - that it's all "in our heads".
Don't let the patients who abuse ERs ruin it for the rest of us. And - for anyone who works in an ER in any capacity (or for all doctors for that matter) - if you haven't already - read this book:
Classic text read by every physician in training. "Gomers go to ground." "There is no body cavity that cannot be reached with a strong arm and a 14-guage needle."
1. Whether physicians actually pocket 10% or 20% of the amount paid in physician fees is irrelevant in terms of this analysis. The question was: What percentage of total health expenditures are physician fees? Answer: 20%, or one fifth of all health care expenditures. Do physicians have overhead? Of course, they do. Is running an office expensive? Yes, it is. Could we save money in the health care system by enacting certain reforms that reduce or limit physician fees? Absolutely. That's the point. We have to look everywhere and not treat any area of healthcare as though it was sacrosanct. No one here is saying we ought to stop paying physicians.
2. Law school graduates graduate with less debt than medical students do. However, college debt everywhere is increasing. The average physician graduates with a median debt of about $170,000.
If you review the information I presented on average physician salaries, virtually every salary is in the $200,000 to $400,000 range for every medical specialty. My point would be that $170,000 in debt is a lot of money, but it is a completely manageable debt for someone earning $200,000 to $400,000 per year--even when their living expenses are taken into account. I currently am paying off a mortgage that has a balance of about $130,000. Its a relatively easy thing for me to do in a low interest rate environment on far less of an income, or salary than the average physician earns.
Actually, the salary and debt data got the curious side of me thinking. I wonder if it would be an economic bargain for our country to agree to pay off all medical school debt if the average physician would agree to reduce his salary by $50,000 per year? I think we would save far more in the long run with that kind of a model. My guess is that physicians wouldn't hear of it. They'd do the math and conclude that it made more sense over the long run to simply pay off their student debt. This demonstrates that the issue is a sort of "straw man" that is often erected to justify salaries that exceed what the normal forces of the market would generate.
3. You talk about "what is going out of physician's pockets". The salaries described in the article I have quoted are net salaries. They are not gross salaries. They wouldn't include student loan repayments, but they would include what a physician receives after all office, overhead, and insurance expenses.
4. The stress and rigor of a physician's education is certainly worthy of comment. I calculate this would include four years undergraduate education, four years of medical school, and a residency lasting somewhere between three and five years. Family physicians and most primary care doctors do a three year residency. I believe neurosurgeons and perhaps cardiac surgeons might do a five year residency. However, the problem is that many other professions are similarly demanding and not nearly as lucrative. My sister, the college professor, would be happy to tell you all about that. I know scientific researchers, people who have pursued intensive graduate programs in education, and a few super engineers that can compare their training with medical doctors in terms of years and complexity. None of them earn between $200,000 and $400,000 a year.
5. Finally, I'm not big on anecdotes, but I have physicians in my family and I've seen too much waste, too much extravagance, to be mislead into the idea that they aren't overpaid on some level. I know physicians who own their own islands or 5,000 acre ranches. The biggest complaint I hear from most is not about income its about difficulties "avoiding taxes". I have a family doctor who lives next door to me and I cannot say he seems at all extravagant. However, it may be because he chose to have six children.
In short, my comparison between physicians and a sitting district court judge is a highly relevant one. Loan repayments on a $150,000 loan should not exceed $10,000 a year. After a physician earning $200,000 pays this, he will have $190,000 left. This is still a third more than a district court judge will be earning. in my state.
What I've noticed in discussion of health care costs is that many people are reluctant to go after what I will call "sacred cows". Physician income is a sacred cow of sorts. I'm not silly enough to think physicians will work for free or for vastly reduced salaries. I do think there is room for containing these salaries and particularly increases. Tackling the whole issue of health care costs is going to be unpleasant and it is going to require more aggressiveness and stamina than most people seem willing to muster. Further, I don't accept the condescension in your post which seems to suggest that ordinary people--like me---have no clue what we are talking about when we talk about high physician salaries as being a problem in containing medical costs. We simply have to find ways to economize in health care. The alternative is unaffordable insurance (or physician fees) no matter what scheme is put in place.
Mark - as a fellow lawyer - I think your analysis is off target. First - if you cut physician salaries a lot - the best are just going to get law degrees and work in medical malpractice law firms. There are a lot of doctor/lawyers in Florida. One of the most profitable states in the US to do this kind of work. Or they will work elsewhere. My brother the nephrologist now works at a big biotech company - where he earns more than he earned as a doctor - and he has more benefits too (including stock options). Or doctors will just move to other countries. We're getting a fair number now here at Mayo JAX from Canada and other countries. IOW - doctors aren't stuck simply being doctors in any particular place. They have other opportunities - and they will pursue them if they can't make a living they consider to be decent treating patients in the US.
I think you are off on the training periods. Look into them when it comes to various specialties.
As for comparing doctors and college professors - especially in these politically correct days - GMAFB. I probably wouldn't hire your sister or any other college professor to clean my house or do my yard. Comparing her and her colleagues to any of my doctors is just nonsense.
I know nothing about lawyers in Utah. Here in Florida - I know many who make 6 or 7 figures. I think one thing lawyers - except for personal injury lawyers (who advertise all over the place) - are very bad doing is marketing themselves. For example - Florida is a title insurance state. Someone will make a commission selling you that title insurance. But 99% of the people I run across on my local CD board don't know that real estate lawyers sell title insurance - and will often work for the title commission to do your closing. So that commission goes to their broker's captive title insurance firm instead of to lawyers.
Most lawyers here who go after judicial positions are pretty much losers (in terms of money) who see the last years of their life "on the bench" as a way to get really good retirement benefits. Perhaps Utah is different.
I don't begrudge my doctors one penny of what they earn. Especially since the one I use who probably earns the most - my plastic/cosmetic surgeon - will take Medicare patients when it comes to things that are covered by Medicare. That don't pay a lot. Like skin cancer surgery - or breast cancer reconstructive surgery. Which they don't have to do.
Finally - that $1000 your client's doctor was asking you to pay to "write a note". What kind of case - what kind of note? Malpractice case - worker's comp? Whatever. I don't have an opinion without specifics. Robyn
Classic text read by every physician in training. "Gomers go to ground." "There is no body cavity that cannot be reached with a strong arm and a 14-guage needle."
Or "buff 'em and turf 'em". Do you think students in training still read this stuff these days? Perhaps I should send my niece a copy of the book as a holiday present (might ask her if she has a Kindle or similar)?
Note that my husband is also a big fan of The Citadel (entirely different kind of medical novel with an entirely different tone). Robyn
Over the past couple of weeks I have been telling my Medicare patients that I will no longer be a Medicare provider beginning January 1, 2016. I have only had one patient give a long thoughtful pause to consider if she would continue with me. I told her she can decide later and there is no reason she cannot continue to see me. I went on to explain that once I am out-of-network, I will have the freedom to give steep discounts and I plan on working with these patients for Medicare rates, but the difference is that I get paid up front and I don't have to hire extra employees to sit on the phone and argue with Medicare. It's not the money as much as it's the headaches I am running away from.
Finally - that $1000 your client's doctor was asking you to pay to "write a note". What kind of case - what kind of note? Malpractice case - worker's comp? Whatever. I don't have an opinion without specifics. Robyn
If it's something that is guaranteed to be read in detail by attorneys....you can bet the price goes up because of the extra care that goes into wording every phrase very carefully. A diagnosis "caused by..." will be changed to "may be related to...".
Over the past couple of weeks I have been telling my Medicare patients that I will no longer be a Medicare provider beginning January 1, 2016. I have only had one patient give a long thoughtful pause to consider if she would continue with me. I told her she can decide later and there is no reason she cannot continue to see me. I went on to explain that once I am out-of-network, I will have the freedom to give steep discounts and I plan on working with these patients for Medicare rates, but the difference is that I get paid up front and I don't have to hire extra employees to sit on the phone and argue with Medicare. It's not the money as much as it's the headaches I am running away from.
Interesting. Do you take Medicare Advantage plans? I'm sure some of those are from the health insurance companies that you deal with. Assuming the you do still take health insurance at all.
Interesting. Do you take Medicare Advantage plans? I'm sure some of those are from the health insurance companies that you deal with. Assuming the you do still take health insurance at all.
I am still trying to figure out how this works when I am NOT a Medicare provider but I am in-network with BCBS and Aetna who administer Medicare Advantage plans. I dropped Cigna and United Healthcare last year. I never signed up with Humana but they somehow insist that I did.
I am still trying to figure out how this works when I am NOT a Medicare provider but I am in-network with BCBS and Aetna who administer Medicare Advantage plans. I dropped Cigna and United Healthcare last year. I never signed up with Humana but they somehow insist that I did.
The way it works from my POV as a customer is that providers are free to accept or decline patients from various insurance company plans. For example - Mayo Clinic here - where I get most of my health care - accepts many insurance plans from various insurance companies - but not Medicare Advantage HMO plans from the same companies:
I suppose an insurance company could require a provider to accept all of its plans/patients - but the insurance companies apparently don't do that.
When it comes to regular Medicare - not Medicare Advantage - there are 3 options. I am familiar with the first 2. "Accepting" Medicare. And not "accepting Medicare" but accepting Medicare patients. The first means that a doctor will take what Medicare/Medigap policies pay in full payment. I have 2 doctors outside the Mayo system who do that.
The second - which is what Mayo does when it comes to Part B Medicare expenses (not Part A) - means that the doctor will accept Medicare patients but patients are responsible for their own bills. What this means operationally is that you go to Mayo. Mayo sends you a bill for its services. Which you are responsible for paying. Mayo does notify Medicare and your Medigap insurance company of the visit(s)/charges(s). And you get the money to pay the bill from Medicare/your Medigap carrier (parenthetically - this is nice way to rack up miles/points on your credit card ). By operating in this fashion - a provider is allowed to charge you 15% more than normal Medicare rates (don't ask me why - nothing logical about it IMO). Which Mayo does. This extra 15% may or may not be covered by your Medigap policy (it is covered under the Medigap policies my husband and I have).
The third is just opting out of the Medicare program altogether - having nothing to do with it. In that case - you can see Medicare patients - charge them whatever you want - and they are responsible for paying you (and they won't get any help from Medicare for the most part either).
Note that this is just a general outline. Although I am a lawyer - I am not a health care lawyer. And I would recommend consulting with a lawyer - or perhaps going to some CME courses/getting CME materials - to make sure that I was doing everything properly (regardless of what I decided to do). Robyn
Last edited by Robyn55; 11-23-2015 at 03:07 PM..
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. As a person close to 70 - if I had a sudden terrible ache near my ear - well I figure it might be a stroke (everything that was unusual sudden painful disorienting "up there" might be a stroke). Reckon if I were dealing with a 5 year old - especially one with a history of ear infections - it might be different.
. About 3 months into the thing - one morning - I woke up with an ear full of puss looking stuff. Turns out I had a big sebaceous cyst in my ear (admittedly unusual) And - when it popped and drained - voila - instant relief 
. I honestly hate it when doctors tell their patients - especially us women (seems to be more common with women than men) - that it's all "in our heads".
