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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

#141

Post by nilkn »

selmnoo wrote: post #44
[deleted] wrote: post #32

Earlier quoted context omitted.

[deleted]

> 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…

Odd, you must have replied concurrently with my deleting my post. If I ever delete something here on HN, I always double-check first to make sure that it hasn't received replies first to avoid this situation. It's only by casually re-reading this thread a day later that I amusingly discovered by deleted post had received a reply. =]

> most make way more than $300k after only a handful of years of experience.

I was referring to family physicians. They do not make this sort of money on average, especially not just out of residency. There are numerous serious physician compensation reports that will confirm this.

Re: How Being a Doctor Became the Most Miserable Profession

#142

Post by nilkn »

commandar wrote: post #49
[deleted] wrote: post #32

Earlier quoted context omitted.

[deleted]

>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…

Apologies for deleting my post--I hadn't realized it had received replies when I deleted it.

You're completely correct that the top earning physicians (mostly surgeons) can make seven figures or nearly so. I was referring only to family physicians, where $170k-$200k really is a realistic salary (even with several years of experience).

Re: How Being a Doctor Became the Most Miserable Profession

#143

Post by mudil »

Shinkei wrote: post #123
mudil wrote: post #68

Earlier quoted context omitted.

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.) The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications. Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the go…

I don't believe you. I am a physician too and you are repeating a lot of the falsehoods that are perpetuated among those that don't understand the billing process or aren't actually physicians. AMA is an insurance and loan agency? I... I... don't know what to say to this. How about start by reading this (poorly written, but summary nonetheless): http://en.wikipedia.org/wiki/American_Medical_Association and one of the…

Sure it's true. If I do two cases, and my billing times overlap even by one minute, I am not going to get paid for either one of them by Medicare. If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours.

The question is why medicine is becoming the most miserable profession (with polling data to back it up) while the gov't interference in it is at all time's high and going higher and higher all the time.

Re: How Being a Doctor Became the Most Miserable Profession

#144

Post by [deleted] »

karmajunkie wrote: post #94
araftery wrote: post #51

Earlier quoted context omitted.

I disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't. Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay…

I don't know any cardiologists who would perform that kind of surgery on a 90yo.

[deleted]

Re: How Being a Doctor Became the Most Miserable Profession

#145

Post by riahi »

jjoonathan wrote: post #140
riahi wrote: post #125

Earlier quoted context omitted.

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…

This doesn't have to be a theoretical discussion. Dentistry residencies to specialize require tuition from the residents. Only a few provide salary.

Dentists make more money and work less than doctors. Simply forcing medical students to pay to be residents won't make things cheaper.

Re: How Being a Doctor Became the Most Miserable Profession

#146

Post by throwwit »

nathanvanfleet wrote: post #113
HIbachikabuki wrote: post #87

Earlier quoted context omitted.

It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody. Not everybody can live in a McMansion and not everybody can afford to have an MD/CS for their every single health need, no matter how minor or how routine. Tradeoffs have to be made. US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under th…

I like people from the US who want to cut out people poorer from being helped by an MD because it's "impossible"; when so many other developed countries seem to manage with it just fine.

I'm still amazed some want to go back to a system that charged them more for marketing it to themselves than actual care-- boggles the mind.

Re: How Being a Doctor Became the Most Miserable Profession

#147

Post by FireBeyond »

mudil wrote: post #143
Shinkei wrote: post #123

Earlier quoted context omitted.

I don't believe you. I am a physician too and you are repeating a lot of the falsehoods that are perpetuated among those that don't understand the billing process or aren't actually physicians. AMA is an insurance and loan agency? I... I... don't know what to say to this. How about start by reading this (poorly written, but summary nonetheless): http://en.wikipedia.org/wiki/American_Medical_Association and one of the…

Sure it's true. If I do two cases, and my billing times overlap even by one minute, I am not going to get paid for either one of them by Medicare. If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours. The question is why medicine is becoming the most miserable profession (with polling data to back it up) while the gov't…

"If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours."

Wuh? I'm not a physician. But I do work for an ambulance service. And my day job has involved working with insurance reimbursement algorithms for Hospital and Insurance Administrators.

But "$36 for epidural and not a penny for the next 18 hours?"

You might want to look into that. Medicaid allows a Maximum Fee of $1.16/minute for an anesthesiologist's time.

"Essentially, hospitals will be reimbursed at $669.90 for the epidural procedure performed in the hospital setting; whereas, in office setting, after removing the portion designated for the physician professional fee, office practice expense will be reimbursed at $30.28 to $34.36 a whopping 2,315% to 2,668% with SGR cut and 1931% to 2312% without SGR cut more in the hospital setting."

Yes, epidurals are cut - but under what circumstances are you monitoring a patient bedside for 18 hours in a non-hospital setting?

And for every one of these examples, there's a flip-side:

Wisdom teeth under general anesthesia.

"Hi, I'm Mr X and I'll be your anesthesiologist today. How you doing? Now, to confirm, no allergies, right? And it says you weigh 180lb? Great, see you in theater!"

Bill:

"Pre-operative anesthesiologist consultation: $662"

For about 90 seconds. Now, I know the principles of anesthesia, though I'd never claim my knowledge was within orders of magnitude of that of a specialist, but I routinely perform RSI for ET intubation, and I know all about "the charge isn't for the time, it's the knowledge", but nonetheless.

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