A worrying trend ... Doctor's are going broke.

[dmcowen674]

A worrying trend ... Doctor's are going broke.

What did they expect by charging such insane prices?

There is only so many rich that they can pillage.

Come on Rich Republican, start paying these guys double and triple.

 

[SirStev0]

Doctors (in general) already make enough damn money. Drive around a staff parking lot in a hospital and tell me how many brand new BMWs/Mercedes-Benz/Porsche/Inifinties you don't see.

Fact is we are just better people than you and therefore not only deserve to drive expensive European luxury cars but also a huge salary on top of that. Because, you see, while you are at home jerking off to Battlefield 3 Montages, I am out playing god and saving lives.

There you go, now that I insulted you, you have an actual reason to dislike doctors instead the "they drive cars that are cool and I don't and my mom told me I was the smartestest boy alive so I should" mentality. I am sure that will help your rage boner later this evening.

 

[PottedMeat]

I am sure that will help your rage boner later this evening.

do you need viagra for that?

 

[zanejohnson]

Maybe they should have saved some money instead of buying that pretty little 911 Turbo and the Victorian mansion on Lindsay street....you know what a real crisis is the most inspirational person in my life was a an older computer class teacher who encouraged my love for technology...he mowed lawns after school to support his family..I bet he pulled 40k at the most.

 

[SirStev0]

$150,000 medical school debt on average, 4 years pre-med, 4 years of med school, 3 to 7 years of internship.... how many people would do that to be able to drive around in a 1998 honda civic?

And if a welder welds the wrong pipe... do you think they are subject to million dollar lawsuits? If a welder sees a broken pipe out in public is he obligated to fix it? Aside from the time and expense of becoming a doctor, there is quite a bit of responsibility that comes with the title.

The number is closer to $200k these days. And when they adjust it for people who are actually taking out loans (pretty much removing the people who are coming out debt free due to family) it is around $250k. Average Medical School tuition per year is $35k + another 15k to live on x 4 years. Then whatever you paid for undergrad. Probably another 50k to 100k.

Then Residency, which pays 20-50k for 3-7 years and is still even with time restrictions basically slavery. All of that salary goes to paying loans.

Also, the American mentality towards doctors now blows. A whole lot of fun to look forward to...

 

[SirStev0]

I suspect you're going to see doctors in more large practices run by professional managers or as hospital employees. That and more physicians who refuse to take Medicare patients.

This is actually already the case. Even small cities outsource to the big Universities. And all the younger docs coming out of residency are chomping at the bit to become "employees". Frankly it is just much much better to avoid the business/legal end of medicine.

In our mindset, the 10-15% income loss is well worth the 500% decrease in headaches, payrolls, and interactions with lawyers.

You can actually see the generational splits with a lot of the docs in the 40's and 50's kicking and screaming against becoming a hospital employee instead of running their own practice.
They used to be able to make a very decent living and had a lot of control on how they practiced, but modern medicine and current attitudes by the public on what a "doctor" roles should be has changed that.

 

[Mr. Pedantic]

Not really a surprise, malpractice insurance is through the roof since everyone is sue happy, and insurance companies are force feeding us information to live healthier, thus removing the demand for seeing doctors as often.

Since I've been eating healthier, quit smoking and started exercising a few years ago, I haven't been sick or needed to see a doctor at all.

In terms of malpractice suits, the only doctors that really get sued are the ones with crappy bedside manner. Nobody likes suing someone they like, even if they're totally incompetent - blame cognitive dissonance. Most suits happen when someone screws up and they're really bad at communicating about it. The easiest thing that most doctors can do, therefore, to avoid malpractice action is to just be nicer and more empathetic towards their patients - listen, take the effort to explain things properly, and try and imagine how vulnerable and difficult being a patient must be.

As for your personal health, you are exceptionally lucky, especially since you used to be a smoker. But it's kind of irrelevant in any case; most medical expenditure is on chronic conditions - high blood pressure, diabetes, COPD, etc. Exercise, healthy diet, and quitting smoking/drinking do help, and they help a lot, but even if everyone ate a perfect diet, met the exercise guidelines that the government sets, and never smoked, we would still have people with these diseases. They just happen sometimes.

 

[SirStev0]

Malpractice is but a small part of the problem. People who think we just need to fix that and we'll be good are delusional.

Malpractice plays a much bigger role that most people think. When docs bitch about malpractice they aren't just whining because we have to pay a large percentage of our supposed fortunes to covering our asses... it is because the constant worry of getting our asses handed to us in lawsuits FORCES us to practice terrible medicine.

There is a horrible new trend in the philosophy of care called Defensive Medicine. Every doctor knows exactly what it means and I very much doubt the public has any fucking idea. It is Defensive in the sense of it is what you hope you did when you are defending yourself in court.

People have it in their head that we send you off for exotic expensive test because we somehow make a profit or we are buddy-buddy with the radiologist and want to throw them a bone. Not even close. Fact is we do it because on the 1 in a million chance that you actually have necrotic bowel and we miss it, you are going to pound our ass in court until ever nickle I ate as a child comes spewing out my eyeballs.
Walk into an ER or Urgent Care and watch how decisions are made. Everything decision is made on a risk management scale. And it is completely taking over medicine.
We are preached this "evidence based medicine" model throughout medical school but as soon as we step into the real world we see every experimentally proven method thrown out the window and every lawyer-written risk management protocol enacted.

It is why when you walk in with a cough and cold for 1 week you get a chest xray and at the very least are given grossly overpowered antibiotics. Sure you probably have the viral sniffles but heaven help the doc's butthole if you have pneumonia and he sends you home to sip chicken soup.

Horrible Horrible medicines.
But that is what the lawyers and insurance companies want. And the public has no problem with it either.

 

[ichy]

You can actually see the generational splits with a lot of the docs in the 40's and 50's kicking and screaming against becoming a hospital employee instead of running their own practice.
They used to be able to make a very decent living and had a lot of control on how they practiced, but modern medicine and current attitudes by the public on what a "doctor" roles should be has changed that.

I've heard that part of the reason that Emergency Medicine has become so popular is that it's a specialty where being an employee rather than a practice owner has always been the norm. If you work in EM you take a job, get paid for every hour you work, and then go home and leave work behind. If you want to make extra money you work an extra shift.

 

[IAteYourMother]

In terms of malpractice suits, the only doctors that really get sued are the ones with crappy bedside manner. Nobody likes suing someone they like, even if they're totally incompetent - blame cognitive dissonance. Most suits happen when someone screws up and they're really bad at communicating about it. The easiest thing that most doctors can do, therefore, to avoid malpractice action is to just be nicer and more empathetic towards their patients - listen, take the effort to explain things properly, and try and imagine how vulnerable and difficult being a patient must be.

My boss's wife did her residency as an ob/gyn. Everyone in her residency class, including her, got sued at least one time, if not multiple times. And I'm pretty sure there's no way they were all negligent enough to be sued. She ended up leaving ob/gyn practice because the malpractice and headaches were just so enormous, and her income coming straight out of residency was actually more than her income after 20+ years in practice, which is ridiculous. She works at the FDA now making more money without any of the headaches.

 

[SirStev0]

In terms of malpractice suits, the only doctors that really get sued are the ones with crappy bedside manner. Nobody likes suing someone they like, even if they're totally incompetent - blame cognitive dissonance. Most suits happen when someone screws up and they're really bad at communicating about it. The easiest thing that most doctors can do, therefore, to avoid malpractice action is to just be nicer and more empathetic towards their patients - listen, take the effort to explain things properly, and try and imagine how vulnerable and difficult being a patient must be.

I see you are from New Zealand so I will excuse the fact that you have no idea what you are talking about. Maybe over there docs are lucky enough that being a good care giver is enough to save them from lawsuits. Here in the good old US of A it doesn't matter at all.

 

[TheVrolok]

Edit:

nm, I don't even want to get involved.

 

[SirStev0]

I've heard that part of the reason that Emergency Medicine has become so popular is that it's a specialty where being an employee rather than a practice owner has always been the norm. If you work in EM you take a job, get paid for every hour you work, and then go home and leave work behind. If you want to make extra money you work an extra shift.

Incredibly true. I have 2 friends who are doing it for that very reason.

And more and more specialties are finding a way to do this.

Anyone who has spent a few days in a hospital will notice that there are suddenly a whole bunch of "hospitalists" running around these days.
They are primary care doctors hired by the hospital to manage people while they are there. They work a shift pass the person off when their shift is done and then call it a night.

 

[Mr. Pedantic]

I see you are from New Zealand so I will excuse the fact that you have no idea what you are talking about. Maybe over there docs are lucky enough that being a good care giver is enough to save them from lawsuits. Here in the good old US of A it doesn't matter at all.

I think that you will find that it correlates a great deal:

http://www.ncbi.nlm.nih.gov/pubmed/12110787

Obviously correlation does not prove causation, but it implies it, and even if it doesn't, would it really hurt you to be nicer to your patients?

But yes, we are lucky that we have the Health and Disability Commissioner to resolve medicolegal disputes instead of through courts, and allows the practice of actual medicine rather than shotgun, money-wasting defensive medicine. You guys should try it.

 

[ichy]

Incredibly true. I have 2 friends who are doing it for that very reason.

And more and more specialties are finding a way to do this.

Anyone who has spent a few days in a hospital will notice that there are suddenly a whole bunch of "hospitalists" running around these days.
They are primary care doctors hired by the hospital to manage people while they are there. They work a shift pass the person off when their shift is done and then call it a night.

Supposedly that it's going the same way in surgery. Hospitals are at least thinking of hiring "surgical hospitalists" or acute care surgeons who're salaried & take all the ER surgery calls and emergency surgeries. The private practice guys stick with the more profitable elective procedures.

IMO the hospitalist thing sounds like a far more sensible way to do things. I guess people like the idea that their primary care doc would also be responsible for them in the hospital, but the inefficiency of a doctor going between their office and multiple hospitals where they have admitted patients is ridiculous.

 

[IronWing]

On loans: I haven't met a med student yet that didn't try to start living a doctor's lifestyle while still in school. "I need a quiet place I can study" translates to "I need to rent a house for three times what any other student would consider paying". The loans aren't simply a factor of tuition. They are a result of lifestyle decisions made by med students.

On medical malpractice suits: It is problem of who pays. Medical care is so freaking expensive that injured/sick folks face a choice: face a life of poverty trying to pay outrageous bills or find someone, anyone, to sue to cover the costs. Doctors are an easy target because they have money. A single payer system would solve this problem by removing a major driver - the fear of life time impoverishment.

 

[Miramonti]

Not sure how I feel about this since there are many issues here, but it's hard enough to get a doctor's appointment with the current supply.

 

[TheVrolok]

On loans: I haven't met a med student yet that didn't try to start living a doctor's lifestyle while still in school. "I need a quiet place I can study" translates to "I need to rent a house for three times what any other student would consider paying". The loans aren't simply a factor of tuition. They are a result of lifestyle decisions made by med students.

Apparently you haven't met many medical student; or you've only met a few of the ones that have mommy and daddy paying for everything. The bold statement is one you make out of complete ignorance, and it borders on absurd. I know a fair few med students, I'd wager far more than your sample size, and very, very few are living anywhere near what you'd consider a lavish lifestyle.

On medical malpractice suits: It is problem of who pays. Medical care is so
freaking expensive that injured/sick folks face a choice: face a life of poverty trying to pay outrageous bills or find someone, anyone, to sue to cover the costs. Doctors are an easy target because they have money. A single payer system would solve this problem by removing a major driver - the fear of life time impoverishment.

So doctors should provide care and pay for it as well? This is just silly.

 

[IronWing]

Apparently you haven't met many medical student; or you've only met a few of the ones that have mommy and daddy paying for everything. The bold statement is one you make out of complete ignorance, and it borders on absurd. I know a fair few med students, I'd wager far more than your sample size, and very, very few are living anywhere near what you'd consider a lavish lifestyle.

Well I have.

So doctors should provide care and pay for it as well? This is just silly.

Nope, and that's not what I wrote. Doctor's should provide care and a sinlge payer system, funded through income taxes, should pay for it.

 

[JulesMaximus]

Fact is we are just better people than you and therefore not only deserve to drive expensive European luxury cars but also a huge salary on top of that. Because, you see, while you are at home jerking off to Battlefield 3 Montages, I am out playing god and saving lives.

There you go, now that I insulted you, you have an actual reason to dislike doctors instead the "they drive cars that are cool and I don't and my mom told me I was the smartestest boy alive so I should" mentality. I am sure that will help your rage boner later this evening.

PWND! :thumbsup:

 

[IHateMyJob2004]

The paper work that has to be done is the issue.

 

[vi edit]

in 2012 we have things called computers that do these things. a lot of the doctors i know still use paper and do everything manually because they think every little expense is money out of their pockets

For many independent offices there are not many options available to them for a full blown EMR system. They aren't easy to evaluate, buy, cheap to install or cheap to support. Plus they simply don't want the hassle of training staff on them, supporting them, or working on them.

It's easy to say "throw a computer in there and work on that!" but that's simply not the case. Software is everything. Most big players aim at enterprise systems or healthcare networks. The little independent guys need either massive loads of money thrown at them or a huge amount of help to put them in.

And when you can't actually roll that cost back into what you charge people because the government has dictated what things should cost, then the incentive grows even smaller.

 

[TheVrolok]

Well I have.

Well, then you're sample size is of such an insufficient size that it may as well be ignored if you're honestly arguing that medical school debt is high because students are living luxurious lifestyles.

 

[SirStev0]

On loans: I haven't met a med student yet that didn't try to start living a doctor's lifestyle while still in school. "I need a quiet place I can study" translates to "I need to rent a house for three times what any other student would consider paying". The loans aren't simply a factor of tuition. They are a result of lifestyle decisions made by med students.

On medical malpractice suits: It is problem of who pays. Medical care is so freaking expensive that injured/sick folks face a choice: face a life of poverty trying to pay outrageous bills or find someone, anyone, to sue to cover the costs. Doctors are an easy target because they have money. A single payer system would solve this problem by removing a major driver - the fear of life time impoverishment.

You will have to introduce me to some of these med students because I have met very few that don't live just barely out of squalor.

I know for a fact that the gov has a hard cap on the amount of money over tuition that you can take out as student loans. I believe it is about 18k. 18k to live on for an entire year. 18k that needs to be used for 200 dollar a shot books. 1200 dollar exams (3 of them). 800 dollar Diagnostic kits. And you know, little things like gas, heating and food.

Unless they are taking out private loans, which are a horrible experience, I don't know how 'all these medical students you know' are living the kush life.

Please, please let me know. I really want a Bentley, but since I live in the real world and not in your "they are smarter than me and more successful than me and that makes me mad" world of make believe, I guess I will have to settle for my 94 Suburu Legacy station wagon with 330k miles on it.

 

[ichy]

vi_edit: I think that the little independent guys are an economic anachronism. It makes much more sense to have administrative overhead shared between a number of physicians.