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My son went to an ER about a month ago with sever pain in his abdomen. Most of the time was spent in the waiting room doubled over in pain. When they finally took him, they gave him a scan which revealed he was passing a kidney stone. He then was put in a cubical and told to wait, and that he eventually would pass it.
He never spoke to the doctor except for once when he poked his head in and said "How you doing there. Hang in there, it will pass."
This stint of almost total isolation there for about 3 hours came with a bill of over $14,000. The hospital charge was paid at $4,300, and the doctor who poked his head in the curtain to say "Hang in there" billed over $!,400. Radiology was separate too. I think that was around $2,300. In fact part of the doctor's bill was considered "balance billing" as he charged too much and my son had to pay over $300 of it.
Other than the scan, the hospital did noting for my son other than give him some fluids and pain medication, which the nurses handled. I believe those costs were unreasonable.
HAHAHA...I love that line "Other than the scan, the hospital did noting for my son other than give him some fluids and pain medication, which the nurses handled." So the hospital did a scan (CT machine, CT Tech, Bio-Medical Engineer to make sure the CT machines stays up and is accurate, Radiologist to either read the film or over-read the ED doc's wet read), gave pain meds (supply chain to purchase the meds, pharmacist to dispense the meds, nurse to give the meds), and gave fluids (supply chain to purchase the fluids, nurse to give the fluids). In addition...housekeepers to clean up after your son, laundry service for the linens he used, registrars to make sure he's in the system correctly, triage nurse to assess him on arrival, etc, etc, etc, etc.
Maybe the next time your son needs nothing done he should stay home and do nothing to himself. I bet that would work out just fine!!!
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.
You bring up a good point about a mortgage which is a "language" everyone understands. I wish my loan was as cheap as a mortgage. You might say I have 3 mortgages. The first is my actual home mortgage just like everyone else, for which I pay $2200 per month. The 2nd is my loan program which costs me about $4000 per month (the average debt in my specialty is around $350,000). The last is my practice buy-in for which I have a loan that costs me $6600 per month. So I have the same mortgage as you which is less than 25% of my income (as recommended by many financial gurus), but then I have additional debt related to the practice of medicine. I have over a million dollar of debt ($660,000 to buy a practice and $390,000 in school loans) without even considering my home mortgage. Those good at math will see that I have to pay over $10,000 per month in loan repayment. With practice overhead around 50%, that means I have to produce $20,000 per month in my office just to service my debt. Now remind me....how much debt does your judge have? How much did he have to pay to buy his bench and courthouse? (I have to buy my own office and supplies). How much does he have to pay the clerks and employees in the courthouse? I have to pay all my employees and I get paid last. Which means when I am starting out and can't make payroll, I have to take out a loan to pay my staff and I don't get paid. With taking risk comes reward, but also comes bigger potential downside. Your judge has taken no risk and his salary reflects it. That is why your comparison is apples to oranges.
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Originally Posted by markg91359
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.
One of the difficulties is looking at physician "salaries" when not all physicians are on salary. I am a private business owner. I get what is left over after paying employees, rent, supplies, equipment repairs and everything else all business owners pay. I have no guaranteed income and I get paid LAST. I took a 20% paycut last year compared to the previous year. Where do you propose this $50,000 comes from? When I produce $50,000 less than last year's "salary" should I just stop seeing patients the rest of the year? This suggestion again shows how many don't understand how the business works.
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Originally Posted by markg91359
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.
Neurosurgeons do 6-7 year residencies and cardiac surgeons do 8-9 years. Interest on debt accrues during this time. I doubt your college professor sister worked 80-100 hours per week during her "training" dealing with constant issues that can cause serious morbidity and even death if not done correctly. Not even in the same ballpark.
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Originally Posted by markg91359
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.
I know people from all walks of life that live to the edge of their means and beyond, and wish they paid fewer taxes. Nothing here specific to physicians.
Well, Ariadne, the lawyers you worked for were unusual. The average salary for an attorney in my state is around $85,000 a year. After thirty years in practice, I typically earn about $110K to $140K per year depending on circumstances. A few partners in big Salt Lake City firms might earn that, but they are far from typical. They represent the highest paid part of the legal profession. What we are seeing here is that average salary for all doctors ranges from between 200K to 400K per year.
Police officers and EMTs deal routinely with "instantaneous, life and death matters". Yet, no one would dream of paying them $200K a year to do it.
I have said before that I do think based on what other highly educated professions earn that I believe medical doctors are overpaid (more so with specialist physicians than PCPs). Its a function of supplying an essential service. No competition because of strict licensing requirements. Finally, the role of third party payers, or insurance is a huge factor in driving these costs up.
In reading these posts, I guess I'm in a sort of bitter mood. I was just informed by an orthopedic surgeon that he couldn't write a medical report for a client of mine without advance payment of $1,000.00. This is for something that will likely take a maximum of one hour of his time.
Sorry, but don't tell me they aren't overpaid.
I agree. I know a lot of people in the legal field and they are THRILLED if they start at 50K these days. Sure, SOME lawyers are making over 100K after 10 years or so, but most are not, and they certainly are not making that kind of money in Wisconsin...Attorney Salary in Madison, WI | Indeed.com
As for the orthopedic surgeon charging that much, they are likely charging that because they don't WANT the work.....
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Originally Posted by NSHL10
Mark aren't you forgetting an important distinction between judges and docs? Most docs currently are self employed and receive no benefits; judges are employees and receive health insurance, vacation pay, pension etc. Those bennies are worth a pretty penny and should be factored into your equation.
BTW How much will you bill your client for YOUR time spent trying to contact the surgeon? I am sure you are getting reimbursed for your time, why shouldn't the doctor? What amount do you find to be equitable?
Law costs are also insulated from competition. I am sure many people would rather pay a paralegal directly for services than pay lawyer fees for a job that gets done by a paralegal in the office anyway.
You are forgetting that being self-employed means they can put 53K into a SEP, vs the 18K as a W-2, they get to deduct all kinds of things on their taxes, including insurance premiums, etc. They build in their "vacation pay" into their business model so they are getting paid over the course of the year. Sure, not having to worry about your business is nice, but setting your own hours, working for yourself, etc. has a lot of benefits too.
You are forgetting that being self-employed means they can put 53K into a SEP, vs the 18K as a W-2, they get to deduct all kinds of things on their taxes, including insurance premiums, etc. They build in their "vacation pay" into their business model so they are getting paid over the course of the year. Sure, not having to worry about your business is nice, but setting your own hours, working for yourself, etc. has a lot of benefits too.
As someone who's done it both ways, trust me, the bennies are better than the tax breaks (which get phased out).
Ah - some "doctors make too much" messages - some written by lawyers . In full and fair disclosure - I'm a retired lawyer. My husband is a retired plaintiff's personal injury/medical malpractice lawyer. And - although I know that there are many lawyers coming out of school today who would be thrilled to find $50k/year jobs (the job market is awful) - our lawyer friends (many of whom are older personal injury lawyers) are in more rarified circles. After all - how much money do you have to make to give the University of Florida $10 million and have the law school named in your honor?
Now I think one area where people are missing the mark is talking about the respective professions as if they had remained static since I graduated (1971). Which they haven't. When I graduated - it was very easy for a lawyer to graduate without debt. And to go into practice 3 years after college graduation - get a good job - make a decent living and live a good lifestyle (the COL was a *lot* lower back then). It was harder for a doctor to graduate without debt. Although it was possible. But the big difference was the length of training. My brother is a nephrologist - and IIRC - he had his 4 years of medical school and then about 4 years of post-medical school training before he could get a "real job". Settle down with his wife - and have children. Note that doctors in my brother's specialty and similar ones don't make "big bucks" like those in some other specialties do. For people my age - I am sure most lawyers wound up better off - in many respects - than many doctors.
Flash forward to today. Law is a totally different profession. It's hard to graduate without substantial debt (I paid < $2k/year in tuition - it's over $40k/year now in many places). And - since it is so cheap to turn out lawyers (schools make money turning them out) - we have been turning out too many of them. Also - the profession has changed - often dramatically. For a variety of reasons - including technology. Resulting in a declining number of good jobs. So - we have a glut of debt-ridden new lawyers - many of whom are struggling to make a living.
But what has happened to doctors? They too are victims of hideous tuition inflation. They just have to pay tuition for more years. And their training is still a lot longer than lawyer training. I have a niece who's a radiology resident now. She finished 4 years of medical school - one year of post-medical training (guess that used to be called an internship) - and she has just started - IIRC - a 5 year residency program. Now the good news is that her "resident's stipend" (which used to be puny way back when) is now a living wage. So she can support herself - kind of - and perhaps start to make a small dent in her student debt. But she will be well into her 30's before she is making a "good living".
FWIW - one reason my niece chose this specialty is because - at least today - interventional radiologists still make relatively good money. Doctors in other specialties don't. Which is why we're seeing shortages in other areas - like primary care - rheumatology - neurology - etc. One way to get a good sense of the areas where there are shortages (apart from trying to find a doctor like a rheumatologist!) - is to look at whether US residency programs are filling all their slots with US trained doctors or whether many slots go to doctors trained outside the US. Dermatology residencies are way oversubscribed - while others are way undersubscribed. Another sign of the times is that a lot of students who might have previously wanted to become doctors are becoming dentists. Because dentists on the whole make better money than doctors. I have lived in a fast growing area for a couple of decades. And about 95% of the new medical professionals who have opened offices in my town are plastic/cosmetic surgeons - dermatologists and dentists (high paying specialty areas).
Overall - I don't think that either profession is especially attractive as a whole these days compared to years past. Although a certain number of people will be able to do well in both. And - as a consumer - when it comes to health care - I want a board certified internist who speaks English as a first language as my PCP. Not a PA in Walgreen's. The former will increasingly be part of a large "medical home" - like the Mayo Clinic - or one of our large hospital/physician groups - like Baptist Hospital. The "stand alone" PCP office is rapidly going the way of the dodo bird due to medical economics/the regulatory environment/etc. (the situation varies when it comes to other specialties). I reckon a doctor like that - in our relatively low priced spread part of the world - will want a minimum of about $125-150k a year - plus benefits - and a reasonable 9-5 work schedule 5 days a week. And - doctors in other specialties will want higher salaries - and should be able to command them. Here in Florida - our highest paid state employees are our college football/basketball coaches (they earn millions). Next highest are a couple of cardiac surgeons who earn about $400k.
Finally - a normal job for a law school graduate where I went to school was a job in a large city working for a high end law firm. Still is. And starting salaries for those students are now $160,000 year:
Which is probably one reason I don't have any problems with excellent doctors who trained forever to get where they are earning mid-6 figures or more in the prime of their lives. Robyn
I can't imagine waiting around for a cardiothoracic surgeon to come in and put in chest tubes. You'd be laughed out of my ED for that.
But excellent point about what ERs are really there for.
Let's see...yesterday I did a shift at a stand-alone, very low volume ER.
Patients that came in:
1. Cough/cold
2. Got drunk, feel dehydrated
3. Earache, oh and while we're here, can you check...4
4. Cold
5. Cough/cold
6. Sore throat
7. Chest pain
Now, how many of those do you think utilized the ER appropriately?
I gave the wrong impression. The surgeon was like 60 seconds away when the ER doc called him (having a cup of coffee waiting for an organ to arrive by helicopter). I wasn't talking about sitting around and waiting for even 5 minutes.
I often see articles about the main complaints people have when they show up in ERs. Seems like upper respiratory infections (colds) are always right up there in the top 3. I don't know why anyone would want to go to an ER for a cold. Especially a busy ER. Since you're likely to wait for hours before you're seen. On the few occasions I have been to ERs for myself (once) - my husband (twice) - my late FIL (several times) - and my father (once) - we have never had to wait. We were always triaged right in. So I guess we are using the place appropriately.
Of the 7 visits on your list - #7 is an appropriate one IMO. Perhaps #3 too (would have to know more about the patient and the "earache" and other symptoms - any fever?). Robyn
As someone who's done it both ways, trust me, the bennies are better than the tax breaks (which get phased out).
I agree with you. My husband and I were both self-employed. And things like the "anti-discrimination rules" when it comes to pension and profit sharing plans pretty much diminished/eliminated the benefits of having these plans in the 80's and 90's.
FWIW - I found the line about deducting insurance premiums kind of humorous. Doesn't mean anyone likes paying insurance premiums. Especially large ones (most doctors pay lots more in malpractice insurance premiums than most lawyers do). Robyn
I'm glad I wasn't the only one who thought it was hilarious that a LAWYER would think that doctors get paid too much.
Quote:
Originally Posted by markg91359
Well, Ariadne, the lawyers you worked for were unusual. The average salary for an attorney in my state is around $85,000 a year. After thirty years in practice, I typically earn about $110K to $140K per year depending on circumstances. A few partners in big Salt Lake City firms might earn that, but they are far from typical. They represent the highest paid part of the legal profession. What we are seeing here is that average salary for all doctors ranges from between 200K to 400K per year.
Police officers and EMTs deal routinely with "instantaneous, life and death matters". Yet, no one would dream of paying them $200K a year to do it.
I have said before that I do think based on what other highly educated professions earn that I believe medical doctors are overpaid (more so with specialist physicians than PCPs). Its a function of supplying an essential service. No competition because of strict licensing requirements. Finally, the role of third party payers, or insurance is a huge factor in driving these costs up.
In reading these posts, I guess I'm in a sort of bitter mood. I was just informed by an orthopedic surgeon that he couldn't write a medical report for a client of mine without advance payment of $1,000.00. This is for something that will likely take a maximum of one hour of his time.
Sorry, but don't tell me they aren't overpaid.
I get those letters from attorneys to type up a medical summary and I just charge the same that attorneys charge. $350 an hour with a minimum of 2 hours. It takes at least an hour to go through any records and at least another hour to put together a summary *for an attorney*. Remember, I have to choose every word very carefully because there will ultimately be some shark scrutinizing it and looking for a gotcha to drag me in to the mess. I do these after hours to keep costs down. It costs me about almost $3000 per day to keep my office open and pay the bills. This is over $350 per hour I must pay. So I stay late after my staff leaves to do these attorney notes where it only costs me my time.
The funny part is that I only charge attorneys. When my patients ask me to do this I usually do it for free.
Of the 7 visits on your list - #7 is an appropriate one IMO. Perhaps #3 too (would have to know more about the patient and the "earache" and other symptoms - any fever?). Robyn
I agree.
7 was the only appropriate one.
An earache with or without fever is 99% not appropriate for ER.
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. In full and fair disclosure - I'm a retired lawyer. My husband is a retired plaintiff's personal injury/medical malpractice lawyer. And - although I know that there are many lawyers coming out of school today who would be thrilled to find $50k/year jobs (the job market is awful) - our lawyer friends (many of whom are older personal injury lawyers) are in more rarified circles. After all - how much money do you have to make to give the University of Florida $10 million and have the law school named in your honor?
