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How Being a Doctor Became the Most Miserable Profession

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Re: How Being a Doctor Became the Most Miserable Profession

#131

Post by commandar »

judk wrote: post #97
commandar wrote: post #49

Earlier quoted context omitted.

>Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Grant…

Those top 5 have nothing to do with doctor salaries. The top 5 at any software company of 1000+ engineers to better than that.

It specifically surprised me because we're not a huge hospital in a particularly large market. We're a good hospital, but we're by no means renowned. If you want that, you drive a couple of hours north to a number of the best (inter)national facilities available.

tl;dr - I suspect that there are more doctors as a percentage of that workforce earning, say, 400-500k+ than there are software engineers doing the same.

Re: How Being a Doctor Became the Most Miserable Profession

#132

Post by commandar »

will_work4tears wrote: post #107
commandar wrote: post #49

Earlier quoted context omitted.

>Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Grant…

I dunno, I saw some statistics that put the median salary of a GP at 130k. That's in the Seattle Metro area too. Certainly some of the top make much more, but there are obviously programmers that make 400k too, but I can't expect that myself, or say that if you are a programmer you'll likely make that much.

To put some context on this, we're also a city with a heavy banking presence and reasonable salary ceiling for a software engineer here is 100-110k. Our facility does not draw nationally, and even regionally would rank good but far from best.

My point is more along the lines that I was surprised that these docs could draw that sort of salary in this particular market (and not that they don't deserve it). It was more or less along the lines that these are good, but perhaps not exceptional, docs in a market where wages are typically lower than the national norm.

EDIT:

And I'll note that I did specify specialists/surgeons for a reason. I'd expect GPs -- and most docs at my facility -- to earn significantly less than that. What I was getting at is that a specialist MD in a small market could expect to earn more than an above average developer in most markets. i.e., the doc absolutely has a harder path to their profession, but if they specialize beyond GP, they have a greater likelihood of return than your average specialist software engineer to compensate for it.

Re: How Being a Doctor Became the Most Miserable Profession

#133

Post by dunmalg »

rflrob wrote: post #88

"Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care." I'm curious how the arithmetic on that works out. The median pay for medical assistants is $14.12/hour [1], which means that assuming the assistant is handling the insurance form, tha…

Cost of employing someone is more than just their hourly rate * hours worked. For example, at one job where I was paid $26/hr, my time was billed at $48/hr--- and this was for a government agency internally billing itself, so there was no profit margin involved, just the cumulative cost of wages, benefits, and associated overhead.

Re: How Being a Doctor Became the Most Miserable Profession

#136

Post by collyw »

jseliger wrote: post #11

Also relevant: I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( http://jseliger.wordpress.com/2012/10/20/why-you-should-beco... ) based on watching the experience of my fiancée and her friends and peers. EDIT: In the essay I describe why it can become so hard to leave medicine after one has invested more than a year or two in med school bec…

Medicine is a very wide profession in itself, with lots of options for specialization in something that interests you somewhat. On top of that I am sure it is not too difficult to go into research that is only slightly related to medicine (I personally know a couple of people doing this).

Re: How Being a Doctor Became the Most Miserable Profession

#137

Post by collyw »

cwal37 wrote: post #28
clarkmoody wrote: post #19

Earlier quoted context omitted.

> give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles I agree completely, but you forgot to add under what we believe: (5) "government has the solution for everything." At least that's what it feels like lately. The cynic in me says that the healthcare industry will continue to get worse for some time before it gets better, if ever. We m…

In countries with socialized healthcare systems, costs are much lower, as is the overall amount spent on healthcare. Americans actually display stunning recalcitrance towards this fact, and as a result we have an incredibly polarized debate which has led to a bastardized and amalgamated system comprised of several other, and often conflicting, constructs.

Not only that, many Americans seem to believe their system of having insurance companies as middlemen improves the system somehow.

My girlfriend is a doctor here in Europe (though she has worked in Mexico). As such she has worked with private and public systems (generally in Europe, you are automatically part of the public system. You can pay private yourself and generally have to wait less).

Anyway, both her and her boss pointed out that if you have anything serious, go to the public system. Why? Because insurance companies always want to pay the least for the cheapest drugs / treatment. The doctors don't enjoy working for the private, because too much of it is trying to justify using the more expensive treatment to the insurance companies.

At the end of the day the public healthcare system exists to help people get better. The private healthcare system exists to make money.

Re: How Being a Doctor Became the Most Miserable Profession

#138

Post by ZachPruckowski »

dfc wrote: post #76
selmnoo wrote: post #44

Earlier quoted context omitted.

> To pay this off in 10 years, the monthly payment would be on the order of $3400. Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k af…

> True, but as it turns out, most doctors are sons and daughters of rich folks > (at least that's what sister tells me, who's doing her residency now). Lets pretend that anecdata is useful and assume that it is generalizable to the entire population of med students. Do you think the prevalence of rich kids is alarming? Possibly an indication that something needs to change in the financing of healthcare or healthcare…

I'd say that a prevalence of rich kids is alarming, and not from an equality perspective or anything. It's alarming because an advanced and specialized economy like ours is at its most efficient when people are doing the jobs they're best suited for. If I'm well-suited to be a DBA and I'm instead doing something I'm much less well-suited for (like sales) then it's a societal net-loss[1]. Unless we assume there's a reason that the people who are best-suited or at least well-suited to be doctors are disproportionately rich, then we're probably winding up with poor/middle-class folks who'd make excellent doctors doing some other job they're less good at.

[1] This is not and should not be read as an argument that DBAs > sales or anything to that effect.

Re: How Being a Doctor Became the Most Miserable Profession

#139

Post by msandford »

SapphireSun wrote: post #75
msandford wrote: post #47

Earlier quoted context omitted.

There's a million fixes for that. Ultimately it needs to be the patients that are in charge of the payment. As it stands there are no published prices (or they're bogus, if your published prices are 3x what insurance companies pay it's not a real price) for anything so nobody can shop around. That means there is no competitive pressure on the non-critical, non-life-threatening things that are expensive-ish but possib…

That's a popular theory, but it doesn't help much because a) we want universal access (poor people just won't use it if they have to pay) b) non-professionals don't review metrics critically and don't have enough knowledge to (and the metrics are hard to interpret for experts) and c) laymen just don't have enough knowledge to make good decisions with their money, they'll just use price as a signal of quality regardle…

I agree that the emergency or otherwise time sensitive stuff is harder to fix up but it's still doable.

I am not suggesting that the rich be able to spend $100 to see a doctor and all the cattle should be left to fend for themselves. What I am suggesting is that it's not outside the realm of possibility for people to fund their own care.

Right now the way insurance is structured they lump together "maintenance" with "serious" and "catastrophic" all in a single insurance policy. That is unfortunate because most regular human beings can self-fund "maintenance" and many can even self-fund "serious" but only very wealthy folks have the capacity to pay for "catastrophic"

The reason we want individuals to pay for "maintenance" and even some "serious" stuff out of pocket is two-fold. First we want competitive pressure on doctors to not jack their prices up. Second, it will help encourage a culture of "do I really need this?" among patients and they will ask their doctors about more than "will it help" but more like "is it worth it" and while some doctors might lie to enrich themselves most that I have met aren't the type.

Why do we want competitive pressure on doctors not to jack their prices up? Because right now the way things work is that the insurance companies have a pretty good idea of what things cost and they negotiate doctors down very aggressively on that. They will of course let the docs make a little money, but nothing crazy. Let's say 10% as an example. If you can only make 10% on your costs then the easiest thing to do is to work on increasing your costs, which then makes a bigger pie for you to earn 10% of. Furthermore there is no incentive for doctors to come up with cost-savings because if they do, it simply reduces the size of their pie to earn 10% of. The unfortunate side effect is that even though medicine has more and more technology and that technology is getting cheaper and cheaper, the cost of medicine is rising.

I realize that I don't have the answers to everything but competitive pressure and rewarding innovation are sorely lacking in medicine today. Other forces are also necessary, like publishing outcome statistics in addition to prices. But I find it very difficult to believe that for the mundane stuff that makes up a lot of a person's exposure to medicine until something serious or catastrophic happens (or late in life) would go a long way towards reshaping people's expectations as well.

Re: How Being a Doctor Became the Most Miserable Profession

#140

Post by jjoonathan »

riahi wrote: post #125
jjoonathan wrote: post #122

Earlier quoted context omitted.

> Well, someone has to pay the salaries of medical trainees. Who would you suggest do it? Our options are: government, students, and hospitals. Government has demonstrated an inability to manage the market. Hospitals don't have a good reason to pay students. Therefore, it has to be the students. > [paraphrasing] But then students will have to borrow even more ! Costs will spin out of control! You're assuming the infl…

1. New schools are being built and they aren't cheaper. Quinnipiac University is the newest medical school to open (accepted its first class in 2013) and it is just as expensive as any other private medical school. See: http://www.quinnipiac.edu/academics/colleges-schools-and-dep... 2. Inflated education costs are the result of easy access to loan money that is not dischargeable. Most university education cost increa…

1. New != cheaper, but that's never what I was arguing. I argued that if the bottleneck (legal or organizational) were removed, enough new capacity would be built to reduce costs (the word "enough" is key).

2. Easy access to loan money increases demand for degrees, yes, but you're forgetting the supply side of this equation. Supply will increase to compensate unless there's a barrier to creating more supply (such as accreditation or actual economic demand for prestige, which only becomes significant when the degree itself doesn't suffice for employment).

Why would government funding of medical school not fall victim to a similar fate to GME? What if someone offered the compromise "government pays for tuition, but then government gets to set the salaries." How appealing would that be?

3. I'm familiar with what IS done, but I would be astounded if the "we can't possibly cut expenses" line continued once competition started to kick in.

4. No supply controls? Xodarap's evidence looks awfully damning: http://skeptics.stackexchange.com/questions/4561/does-the-am...

5. Yes, the point is to have students pay for their education, so that the supply of medical education can scale with the demand for it. It's not reasonable to expect the U.S. government to manage the supply of doctors at this time or in the near future.

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