Appendix - the final bill.

[JamesV]

I'm just saying that the compensation system in the US is ass backwards, as the service providers get paid FAR less than the hospital they work in, but bear the majority of the risk.

Case in point - My daughter had open heart surgery at 3 months old. Total costs incurred were ~95,000. Greater than 90% of those charges were hospital charges. The remaining 10% was to be divided amongst the cardiothoracic surgeon, two anesthesiologists and seven OR nurses that attended to my daughter during a 6 hour surgery.

FWIW, my next door neighbor is an anesthesiologist and spends most of his time working cardiac cases. He's given me a pretty good breakdown of how doctors are paid. Ever wonder why there are almost no docs in private practice anymore?

Surgeons deserve to be well paid. To say otherwise is crazy. The hospital didn't save the patient's life, the surgeon did. My point is that in the grand scheme of things, the compensation scheme is backwards because the party who is doing the saving/treatment and who is bearing all the risk is not the party that recoups the bulk of the fees.

I'd like to know where you got that information. I highly doubt OR nurses get a 'cut' of every operation.

I'd have more sympathy for doctors if they acted like they should. Out of the eight doctors my great aunt has seen lately, all but one barely spent five minutes with her and was patient with her, because she is legally blind and doesn't hear well.

We even got a bill for $700 for a doctor that stopped in, in the middle of the night while she was sleeping... wonder what he did that was worth $700 when he couldn't even speak to my aunt or myself. Got no sympathy for doctors (except one, the Gastro doctor was really nice to her).

 

[Sho'Nuff]

Some one gets it!
Thanks man. You restored my faith in humanity.
1 down. 313,914,039 more ignorant Americans to go.

Happy to make your day.

 

[Sho'Nuff]

I'd like to know where you got that information. I highly doubt OR nurses get a 'cut' of every operation.

I'd have more sympathy for doctors if they acted like they should. Out of the eight doctors my great aunt has seen lately, all but one barely spent five minutes with her and was patient with her, because she is legally blind and doesn't hear well.

We even got a bill for $700 for a doctor that stopped in, in the middle of the night while she was sleeping... wonder what he did that was worth $700 when he couldn't even speak to my aunt or myself. Got no sympathy for doctors (except one, the Gastro doctor was really nice to her).

Sorry to hear that your great aunt has had such a bad experience with doctors.

As for where I got my information, I discussed my daughter's bills with my neighbor, who I mentioned is an anesthesiologist and has a very good understanding of the medical billing system. In my daughter's case, we were informed that the cardiothoracic surgeon had his own "team," comprised of the anesthesiologists and OR nurses I previously mentioned. They operated as a separate unit within Children's Hospital Boston, and were given a separate line item on the bills we received. Pretty easy to deduce the rest.

 

[SirStev0]

I'd like to know where you got that information. I highly doubt OR nurses get a 'cut' of every operation.

I'd have more sympathy for doctors if they acted like they should. Out of the eight doctors my great aunt has seen lately, all but one barely spent five minutes with her and was patient with her, because she is legally blind and doesn't hear well.

We even got a bill for $700 for a doctor that stopped in, in the middle of the night while she was sleeping... wonder what he did that was worth $700 when he couldn't even speak to my aunt or myself. Got no sympathy for doctors (except one, the Gastro doctor was really nice to her).

You got billed $700 dollars by the Hospital.
In patient consultations for Surgeons are $50 a day if there are 1-3 problems and at least 3 physical exam findings that are documented.

For Medicine Docs I believe it is $75 but it has to be 3-5 problems addressed. And their documentation has to be much more in depth.

If you are lucky, you can bill for critical care time and get $150, but that is only for one physician per patient and you have to have 3 or more "critical" problems and spend greater than 31 minutes.


The reason we don't care to listen to you people whine about your problems is frankly we don't get paid to. The pay out for in patient and out patient exams and H&P is pathetically bad.
Also about 95% of the bullshit and lies you tell us mean nothing to us. The 2 minute physical exam is much more important.


I am sorry your aunt is sick and ill and I am sure she remembers the good old days when doctors were pillars of the community and paid exorbitantly well and we had no problem just sitting down and chatting about all your problems ...
But modern medicine doesn't give us the time to just sit there and chat. If we want to survive and maintain the illusion of being rich and powerful we have to pound through patients.
Many of us come out .33 to .5 of a million dollars in debt (that is real figures) and in our early to mid thirties. That means children and lazy spouses. The first thing we worry about is just trying to stay afloat. And you can't do that seeing 1 patient every half hour. That is 20 patients in a ten hour day.

You would have to run an entire and incredibly expensive business on less than $2000/day. It is just not possible. So instead you get shitty service. Wanna fix the system? Feel free. We'd love that.

 

[SirStev0]

Also, OR Nurses are employees of the hospital and get paid hourly wages which come from the "OR Expenses" part of the bill.
First Assist Nurses and Surgical PA's usually are a part of a surgical team and their wages are part of Operator's Fee.
CRNA's are Anesthesia's Nurses and their salary is usually part of the Anesthesia Fee as they are usually employed by the Anes Group.

 

[SunnyD]

Also about 95% of the bullshit and lies you tell us mean nothing to us. The 2 minute physical exam is much more important.

The is the only thing I took away from your blurb. Thanks for pointing out the problem with healthcare. Good to see the only thing you're interested in more often than not is treating the symptom and not patient. That's the typical MO for most doctors these days. It's what keeps patients coming back after all, generating a revenue stream for doctors.

But then again, your last post did distill down to "It's all about money", and, well, this is America. So I understand exactly why you said that.

 

[techs]

The argument can certainly be made that hospitals have far greater leverage than doctors in keeping the biggest share of patient bills.
The argument can also be made that doctors have a huge fiscal hole when they start their careers.
The argument can also be made that doctors don't make as much, proportionately, than their predecessors.
The argument can also be made that medical devices and diagnostic test have greatly increased in price and prevalence and have cut into doctors earnings.

However, competent doctors in most specialties do earn lifetime amounts that are far greater than almost any other profession. While they make less nowadays, so does the bulk of the population. The argument that doctors don't really start to make money until their 40's and 50's, imo, is flawed since they then make a lot of money.

From what I have read the system is now geared to getting doctors to work on salary in an environment where the hospital or clinic provides insurance and money towards repayment on loans. This enables doctors to do better when they are younger, but precludes them from the big payday of a private or group practice later on.

 

[Slew Foot]

From what I have read the system is now geared to getting doctors to work on salary in an environment where the hospital or clinic provides insurance and money towards repayment on loans. This enables doctors to do better when they are younger, but precludes them from the big payday of a private or group practice later on.

This is quite possibly the first thing youve written about health care that is correct. I think recently it correlates to the increasing amount of women doctors who want a more 9 to 5 medical job with vacation time and benefits without the worry of running a business. Additionally, as the amount of regulations pile up, small private practicioners cant keep up so they get eaten up by larger groups and then eventually large hospital systems which turn them from partners to employees.

This is then complicated by the fact that insurance companies ave lobbied (in CA at least) to forbid most hospitals from putting doctors on their payroll, so some "accounting issues" have to be done.