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Doctors Unionize to Resist the Medical Machine

nytimes.com

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Re: Doctors Unionize to Resist the Medical Machine

#41

Post by bradleyjg »

pragone wrote: post #11
c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

> Doctors are already paid absurd salaries in the US To put it in context, when I finish all my training, I will owe over $600,000. It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administratio…

>> Doctors are already paid absurd salaries in the US

>To put it in context, when I finish all my training, I will owe over $600,000.

> It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administration, whose positions keep multiplying.

It's a red herring. If you compare physician compensation in the UK to the US, the costs of medical education are made up within the first ten years. Yes, even after malpractice insurance. Hospital administrators are also wildly overpaid, but there just aren't as many of them. Physician compensation as compared to foreign doctors, which get the same or better results, is just too large a piece of the pie to brush under the rug by pointing at other problems.

Re: Doctors Unionize to Resist the Medical Machine

#42

Post by ZanyProgrammer »

hardcandy wrote: post #16
c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

What do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to…

How is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.

Re: Doctors Unionize to Resist the Medical Machine

#43

Post by samfisher83 »

ZanyProgrammer wrote: post #42
hardcandy wrote: post #16

Earlier quoted context omitted.

What do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to…

How is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.

I think the Doctor has a little more job security as well. Medical industry has a higher barrier to entry.

Re: Doctors Unionize to Resist the Medical Machine

#44

Post by hardcandy »

c3534l wrote: post #35
hardcandy wrote: post #26

Earlier quoted context omitted.

You're incorrect, the cost of medical care is measurably lower as a result of tort reform in Texas. And maybe more importantly, accessibility of care has increased. You see price reflected in at least two places: 1) the variable in the formula for medicare reimbursements that reflects practice environment costs, and 2) more visibly, in Obamacare rates for the State of Texas, which would be significantly higher in the…

That second link is interesting since it claims that the perception of malpractice risk is overestimated among physicians since doctors are sued a fair amount (leading to a high perception of risk), rarely do they ever actually lose a case (leading to low actual costs). I don't see where it says that malpractice caps have any substantial reduction in the prices of medical care. Further, your first link actually dispu…

Read the whole post (it's worth it). The part you quoted refers to states which have damage caps >$1m (versus Texas at $250k). The author writes about his own experience going from Illinois to Indiana and then Texas. My uncle was a surgeon in Texas pre and post tort reform and I saw first hand how much of a difference it made. It's anecdotal of course, but his malpractice dropped from $150k to $50k solely as a result of that law. He reaped the gains for a couple years and then reimbursements were lowered to compensate. Those lower reimbursements are used to calculate premium costs which then also benefited from the reduced med mal costs. The emergency physician correctly points out that med mal functions largely as a transfer of wealth from people with health insurance (which is now, in theory, everyone) to trial attorneys. Lastly I'd point out, again from my uncle's experience, that being sued is an extremely stressful experience even if the eventual financial outcome isn't very impactful. I couldn't relate to it until I went through the same experience myself.

Re: Doctors Unionize to Resist the Medical Machine

#45

Post by falsestprophet »

douche wrote: post #33
induscreep wrote: post #28

I don't understand this about healthcare in the USA. Why not import a few thousand doctors from Asia through H1Bs, and drive down the cost of medical care? Remove artificial caps on licenses imposed by the AMA while at it.

Culturally, I suspect this would not go over well. There are a shocking number of people that would be less than impressed to be served by a doctor with a non-Anglo-Saxon last name, even if they spoke perfect English. Especially older people, who are the largest consumers of healthcare.

People are accustomed to having foreign physicians, other-than-white physicians and certainly other-than-Anglo-Saxon physicians.

Nearly 30% of US primary care physicians trained abroad.

Source: http://www.nytimes.com/2010/08/12/health/12chen.html

Only 8.7% of the US are descended from the English (Anglo-Saxons)

Source: http://www.census.gov/prod/2004pubs/c2kbr-35.pdf

That said, the US could easily recruit physicians from Europe including the UK so you may very well get more Anglo-Saxon physicians!

Re: Doctors Unionize to Resist the Medical Machine

#47

Post by potatote »

objclxt wrote: post #32
induscreep wrote: post #28

I don't understand this about healthcare in the USA. Why not import a few thousand doctors from Asia through H1Bs, and drive down the cost of medical care? Remove artificial caps on licenses imposed by the AMA while at it.

Because you have to spend years re-training and certifying to US standards, all the time without a job and earning money to pay for said training: http://www.npr.org/sections/money/2013/02/15/172108835/shoul... And that's putting aside the fact H1-Bs are not exactly easy to come by right now.

Not trying to undermine your point, but I believe it won't take much long to re-train those "imported" doctors. Only those who are ambitious and bright would come to the US and I have at least a handful of friends from the medical school in Myanmar, who were in the same class year as I was, already doing their residencies. Most of them took ~2-3 years of taking the USMLE and applying for hospitals in the US which sponsors H1B (mostly the rural ones). They seem to be liking what opportunity they've been given to as far as I can tell. I actually regret quitting med school there and leaving for college in the US after my 2nd year just because I want to be an aerospace engineer (turns out, I cannot because there's almost no company that would hire an H1B aerospace engineer, so I had to change my studies back to comp sci).

Re: Doctors Unionize to Resist the Medical Machine

#48

Post by lvs »

c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

If you think MD salary increases are even a tiny speck of the driving force for cost increases in US healthcare, you know less than nothing about the topic.

Re: Doctors Unionize to Resist the Medical Machine

#49

Post by hardcandy »

ZanyProgrammer wrote: post #42
hardcandy wrote: post #16

Earlier quoted context omitted.

What do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to…

How is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.

Out of curiosity then, what would you consider appropriate salaries for GPs, general surgeons, and specialized surgeons like neurosurgeons, orthopods, or ENT?

Keeping in mind that medical school costs an extra $250k (whether in debt to sallie mae or paid for by mom and dad), and the post-bac education timelines are 7 years for GPs (4+3), 9 years for surgeons (4+5), and 11 years for neurosurgeons (4+7).

Re: Doctors Unionize to Resist the Medical Machine

#50

Post by dang »

Dr_tldr wrote: post #13
pragone wrote: post #11

Earlier quoted context omitted.

> Doctors are already paid absurd salaries in the US To put it in context, when I finish all my training, I will owe over $600,000. It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administratio…

And yet, when Texas put a cap on medical malpractice awards, the cost of medical care didn't go down at all. Surely you have a good explanation for that and you're not just repeating discredited talking points for personal gain.

Personal attacks are not allowed on HN. Your comment would be a fine one without the second sentence, which (apart from a personal attack) carries no information.
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