Would we have more doctors if we (taxpayers) comp'ed medical school?

[Slew Foot]

if any of you were actually on a med school ad com
you'd realize that most of the so called qualified applicants make terrible doctors. I'd venture to guess that of the people who finish med school, 25% are woefully bad. Even after residency, a good 15% shouldn't be in practice

 

[Slew Foot]

if any of you were actually on a med school ad com
you'd realize that most of the so called qualified applicants make terrible doctors. I'd venture to guess that of the people who finish med school, 25% are woefully bad. Even after residency, a good 15% shouldn't be in practice

 

[soccerballtux]

If you want to ensure we don't get more doctors trained, taxing income over $250k would be a great start.
One of the major reasons more people don't become doctors is that no matter the amount of money you end up making, you're not going to be able to live a normal life until you're 35 (assuming you get out at ~32...I mean that's half your life right there that you spent in school).

I think the only way to fix this would be to directly pay people studying to be a doctor a stipend for doing it so they can do things like have a family and life, and simply make their studying a 9-6 job.
What do you all think?

 

[Hacp]

Originally posted by: soccerballtux
If you want to ensure we don't get more doctors trained, taxing income over $250k would be a great start.
One of the major reasons more people don't become doctors is that no matter the amount of money you end up making, you're not going to be able to live a normal life until you're 35 (assuming you get out at ~32...I mean that's half your life right there that you spent in school).

I think the only way to fix this would be to directly pay people studying to be a doctor a stipend for doing it so they can do things like have a family and life, and simply make their studying a 9-6 job.
What do you all think?

4 years of med school +3 years of residency for an internist means you get out 29. Plus, plenty of people want to be doctors. Thats why they have all those schools in the Caribbean. There aren't enough slots.

 

[RoloMather]

Doctors should be paid more. Especially the generalists.

 

[soccerballtux]

Originally posted by: Hacp

Originally posted by: soccerballtux
If you want to ensure we don't get more doctors trained, taxing income over $250k would be a great start.
One of the major reasons more people don't become doctors is that no matter the amount of money you end up making, you're not going to be able to live a normal life until you're 35 (assuming you get out at ~32...I mean that's half your life right there that you spent in school).

I think the only way to fix this would be to directly pay people studying to be a doctor a stipend for doing it so they can do things like have a family and life, and simply make their studying a 9-6 job.
What do you all think?

4 years of med school +3 years of residency for an internist means you get out 29. Plus, plenty of people want to be doctors. Thats why they have all those schools in the Caribbean. There aren't enough slots.

It depends on what sort of doctor you're talking about. Even so, 8-29 is 11 years in post secondary school. NO THANKS, I like my life thanks.

I don't know much about this "slots" you're talking about, I'd have to look into that more.

 

[Hayabusa Rider]

The cost of physician salaries are a minuscule portion of health care costs. They do make inviting targets though.

 

[DrPizza]

Originally posted by: Slew Foot
if any of you were actually on a med school ad com
you'd realize that most of the so called qualified applicants make terrible doctors. I'd venture to guess that of the people who finish med school, 25% are woefully bad. Even after residency, a good 15% shouldn't be in practice

Are you implying that these are the 25% worst in the class when they are originally admitted?

 

[AreaCode707]

Originally posted by: soccerballtux
If you want to ensure we don't get more doctors trained, taxing income over $250k would be a great start.
One of the major reasons more people don't become doctors is that no matter the amount of money you end up making, you're not going to be able to live a normal life until you're 35 (assuming you get out at ~32...I mean that's half your life right there that you spent in school).

I think the only way to fix this would be to directly pay people studying to be a doctor a stipend for doing it so they can do things like have a family and life, and simply make their studying a 9-6 job.
What do you all think?

I think someone earlier made a valid point that you'd wind up paying a lot of people who perform poorly and/or never graduate and contribute to the medical world.

 

[3chordcharlie]

Originally posted by: Wreckem
1. There is a shortage of doctors, especially in some fields.
2. This shortage is caused by hard caps on admitted students the AMA puts on Med Schools.

The AMA isnt protecting peoples health from bad Dr's as Med Schools deny thousands of qualified applicants every year. They dont need to lower standards at all. They just need to up the hard caps and open more medical schools. They are simply protecting the salaries of current and future Dr's. This is part of the reason medical costs stay high.

Bingo.

 

[Slew Foot]

Originally posted by: 3chordcharlie

Originally posted by: Wreckem
1. There is a shortage of doctors, especially in some fields.
2. This shortage is caused by hard caps on admitted students the AMA puts on Med Schools.

The AMA isnt protecting peoples health from bad Dr's as Med Schools deny thousands of qualified applicants every year. They dont need to lower standards at all. They just need to up the hard caps and open more medical schools. They are simply protecting the salaries of current and future Dr's. This is part of the reason medical costs stay high.

Bingo.

Its been told a billion times that physician salaries are a small part of the total health care outlay but you idiots dont seem to listen. It like the people who got bent out of shape over AIG 150 million in bonuses but didnt think twice about handing out trillion dollars in bailouts.


You guys cant argue with one simple fact, that even after a 75% decrase in salary since 1980, health care hasnt gotten more affordbable, guess where all your extra money is going, right into the hands of drug companies, insurance companies, and equiptment manufactures.

Edit: rough calculations
Estimated US spending on health care 2008= 2.4 trillion
700,000 US physicians * $150K avg salary=110 billion
Physician salaries are equivalent to about 5% of the total health care cost is the country.

If you really wanted to save money, youd go after the drug companies and the insurance industry.

 

[3chordcharlie]

Originally posted by: Slew Foot

Originally posted by: 3chordcharlie

Originally posted by: Wreckem
1. There is a shortage of doctors, especially in some fields.
2. This shortage is caused by hard caps on admitted students the AMA puts on Med Schools.

The AMA isnt protecting peoples health from bad Dr's as Med Schools deny thousands of qualified applicants every year. They dont need to lower standards at all. They just need to up the hard caps and open more medical schools. They are simply protecting the salaries of current and future Dr's. This is part of the reason medical costs stay high.

Bingo.

Its been told a billion times that physician salaries are a small part of the total health care outlay but you idiots dont seem to listen. It like the people who got bent out of shape over AIG 150 million in bonuses but didnt think twice about handing out trillion dollars in bailouts.


You guys cant argue with one simple fact, that even after a 75% decrase in salary since 1980, health care hasnt gotten more affordbable, guess where all your extra money is going, right into the hands of drug companies, insurance companies, and equiptment manufactures.

No need for name calling (idiot!), I haven't any love for the drug companies either, but we weren't talking about them.

The next time a simple 10-minute office visit costs you $100-$200, let me know which over-priced drug was to blame.

 

[Slew Foot]

Originally posted by: 3chordcharlie

Originally posted by: Slew Foot

Originally posted by: 3chordcharlie

Originally posted by: Wreckem
1. There is a shortage of doctors, especially in some fields.
2. This shortage is caused by hard caps on admitted students the AMA puts on Med Schools.

The AMA isnt protecting peoples health from bad Dr's as Med Schools deny thousands of qualified applicants every year. They dont need to lower standards at all. They just need to up the hard caps and open more medical schools. They are simply protecting the salaries of current and future Dr's. This is part of the reason medical costs stay high.

Bingo.

Its been told a billion times that physician salaries are a small part of the total health care outlay but you idiots dont seem to listen. It like the people who got bent out of shape over AIG 150 million in bonuses but didnt think twice about handing out trillion dollars in bailouts.


You guys cant argue with one simple fact, that even after a 75% decrase in salary since 1980, health care hasnt gotten more affordbable, guess where all your extra money is going, right into the hands of drug companies, insurance companies, and equiptment manufactures.

No need for name calling (idiot!), I haven't any love for the drug companies either, but we weren't talking about them.

The next time a simple 10-minute office visit costs you $100-$200, let me know which over-priced drug was to blame.

The 15 minute office visit is reimbursed 56 bucks by medicare, about 100 for insurance, and 150 by cash. To set up that appointment, you need a receptionist (10/hr), MA or RN ($40/hr), and a billing agent or office manager to actually collect the bill (usually 10% off of all collections). Factor in about 20% loss for no shows and insurance that never pays, then factor in office rent and supplies and you dont come out with much.

My wife runs her own private practice and she runs up 30K a month in incidentals(staff fees, lab fees, equipment rental, office rental, accountant, etc..) before she gets paid a cent. I work for the university so I get a flat salary paid by the state, my life is much easier

 

[3chordcharlie]

Originally posted by: Slew Foot
The 15 minute office visit is reimbursed 56 bucks by medicare, about 100 for insurance, and 150 by cash. To set up that appointment, you need a receptionist (10/hr), MA or RN ($40/hr), and a billing agent or office manager to actually collect the bill (usually 10% off of all collections). Factor in about 20% loss for no shows and insurance that never pays, then factor in office rent and supplies and you dont come out with much.

My wife runs her own private practice and she runs up 30K a month in incidentals(staff fees, lab fees, equipment rental, office rental, accountant, etc..) before she gets paid a cent. I work for the university so I get a flat salary paid by the state, my life is much easier

Most office visits (at least the ones I've had) don't take 15 minutes of the doctor's time, but I'd still say 4-6 per hour is a reasonable number.

Everything you say makes sense, but we're stilling talking about gross receipts of $300-600 per hour for a single physician, or about 600-1200 thousand a year for a full time 9-5. Factor in all of your costs, and you certainly come out with less than half, but a good deal more than 'not much'. Share receptionists and nurses in a multi-physician practice, and you come out with even more. Doctors in that sort of setting could easily take home six figures seeing nothing but medicare patients.

You are presenting the problems of every business owner ever as though they applied only to doctors. It is not 'unfair' that so much money passes through without becoming profit. It is also not 'unfair' if take-home profit from a clinic is only 20% of billings.

 

[Slew Foot]

Originally posted by: 3chordcharlie

Originally posted by: Slew Foot
The 15 minute office visit is reimbursed 56 bucks by medicare, about 100 for insurance, and 150 by cash. To set up that appointment, you need a receptionist (10/hr), MA or RN ($40/hr), and a billing agent or office manager to actually collect the bill (usually 10% off of all collections). Factor in about 20% loss for no shows and insurance that never pays, then factor in office rent and supplies and you dont come out with much.

My wife runs her own private practice and she runs up 30K a month in incidentals(staff fees, lab fees, equipment rental, office rental, accountant, etc..) before she gets paid a cent. I work for the university so I get a flat salary paid by the state, my life is much easier

Most office visits (at least the ones I've had) don't take 15 minutes of the doctor's time, but I'd still say 4-6 per hour is a reasonable number.

Everything you say makes sense, but we're stilling talking about gross receipts of $300-600 per hour for a single physician, or about 600-1200 thousand a year for a full time 9-5. Factor in all of your costs, and you certainly come out with less than half, but a good deal more than 'not much'. Share receptionists and nurses in a multi-physician practice, and you come out with even more. Doctors in that sort of setting could easily take home six figures seeing nothing but medicare patients.

You are presenting the problems of every business owner ever as though they applied only to doctors. It is not 'unfair' that so much money passes through without becoming profit. It is also not 'unfair' if take-home profit from a clinic is only 20% of billings.

300-600 if youre only seeing cash patients in a boutique setting or if you're a dermatologist doing botox or something. Most clinics will generate about 2-300 an hour in revenue. Figure 100/hr for staff, $20/hr for rent/utilities, then 50-100/hr for equiptment and disposables. Assuming everyone shows and everyone pays you're left with -$20-80/hr, which is peanuts for someone with that much training. The plumber or mechanic charges more than that.

 

[3chordcharlie]

dp

 

[3chordcharlie]

Originally posted by: Slew Foot

Originally posted by: 3chordcharlie

Originally posted by: Slew Foot
The 15 minute office visit is reimbursed 56 bucks by medicare, about 100 for insurance, and 150 by cash. To set up that appointment, you need a receptionist (10/hr), MA or RN ($40/hr), and a billing agent or office manager to actually collect the bill (usually 10% off of all collections). Factor in about 20% loss for no shows and insurance that never pays, then factor in office rent and supplies and you dont come out with much.

My wife runs her own private practice and she runs up 30K a month in incidentals(staff fees, lab fees, equipment rental, office rental, accountant, etc..) before she gets paid a cent. I work for the university so I get a flat salary paid by the state, my life is much easier

Most office visits (at least the ones I've had) don't take 15 minutes of the doctor's time, but I'd still say 4-6 per hour is a reasonable number.

Everything you say makes sense, but we're stilling talking about gross receipts of $300-600 per hour for a single physician, or about 600-1200 thousand a year for a full time 9-5. Factor in all of your costs, and you certainly come out with less than half, but a good deal more than 'not much'. Share receptionists and nurses in a multi-physician practice, and you come out with even more. Doctors in that sort of setting could easily take home six figures seeing nothing but medicare patients.

You are presenting the problems of every business owner ever as though they applied only to doctors. It is not 'unfair' that so much money passes through without becoming profit. It is also not 'unfair' if take-home profit from a clinic is only 20% of billings.

300-600 if youre only seeing cash patients in a boutique setting or if you're a dermatologist doing botox or something. Most clinics will generate about 2-300 an hour in revenue. Figure 100/hr for staff, $20/hr for rent/utilities, then 50-100/hr for equiptment and disposables. Assuming everyone shows and everyone pays you're left with -$20-80/hr, which is peanuts for someone with that much training. The plumber or mechanic charges more than that.

But they don't make that much.

You have a very confused jumble of ideas here, most of which have at least some merit.

I have trouble with your gross revenue number because I've never seen a doctor other than a specilist who went through less than five patients an hour, and specialists are charging even more money. But leaving that alone, based on your numbers, a doctor failing to make $160K per year is probably doing something wrong. Certainly they should be free to work longer, or harder, or improve office efficiency, or even raise prices. What they should not do is complain that they make 'peanuts' and expect any kind of sympathy, because based on things as they are, doctors are not in need of sympathy.

The amount of education someone has does not have a direct bearing on what they make, nor does it infer anything about what they 'deserve' to make. I'm not sure if you are a full-on 'you are worth exactly what you are paid' type or not, but certainly you are versed enough to know that a business owner is a special case of this at all times. It's a rare business that would not be pretty lucrative if gross receipts were profits.

Doctors who choose to work alone are making a choice to do so; this should seem obvious. They are spending money for the luxury of doing so, either because they have never considered doing otherwise, or because it is worth it to them to take home less money, but have full control of their practice.

Now in terms of cutting costs to the patient, I would become concerned if the numbers for a two-physician clinic suggested that $100-150K per physician was out of reach for a well-run operation. Even at close to medicare rates, this is simply not the case. There is absolutely room to have more doctors and allow competition to lower the cost to the patient.

Personally, I don't think there should be caps on med school at all; one thing aout anyone who goes to med school is they are pretty bright, and f the market is saturated, they will move on - look at the lawyers and engineers making good for themselves elsewhere in the business world by combining talents, and doctors are way smarter than them, right?

 

[ebaycj]

Originally posted by: Hayabusa Rider
The cost of physician salaries are a minuscule portion of health care costs. They do make inviting targets though.

Yep, it's the cost / wastefulness of one-time-use materials, cost of drugs, and cost of routine procedures (MRI, for example).

I say pay the doctors more, bring down the costs on these other things to reasonable levels. There is no reason a Tylenol needs to cost $10.

 

[waggy]

Originally posted by: 3chordcharlie

Originally posted by: Slew Foot

Originally posted by: 3chordcharlie

Originally posted by: Wreckem
1. There is a shortage of doctors, especially in some fields.
2. This shortage is caused by hard caps on admitted students the AMA puts on Med Schools.

The AMA isnt protecting peoples health from bad Dr's as Med Schools deny thousands of qualified applicants every year. They dont need to lower standards at all. They just need to up the hard caps and open more medical schools. They are simply protecting the salaries of current and future Dr's. This is part of the reason medical costs stay high.

Bingo.

Its been told a billion times that physician salaries are a small part of the total health care outlay but you idiots dont seem to listen. It like the people who got bent out of shape over AIG 150 million in bonuses but didnt think twice about handing out trillion dollars in bailouts.


You guys cant argue with one simple fact, that even after a 75% decrase in salary since 1980, health care hasnt gotten more affordbable, guess where all your extra money is going, right into the hands of drug companies, insurance companies, and equiptment manufactures.

No need for name calling (idiot!), I haven't any love for the drug companies either, but we weren't talking about them.

The next time a simple 10-minute office visit costs you $100-$200, let me know which over-priced drug was to blame.

considering all that goes into that 10 minute viset i think #$100-200 is a good deal to see a highly trained doctor to keep me healthy.

 

[SammyJr]

Originally posted by: soccerballtux
If you want to ensure we don't get more doctors trained, taxing income over $250k would be a great start.
One of the major reasons more people don't become doctors is that no matter the amount of money you end up making, you're not going to be able to live a normal life until you're 35 (assuming you get out at ~32...I mean that's half your life right there that you spent in school).

I think the only way to fix this would be to directly pay people studying to be a doctor a stipend for doing it so they can do things like have a family and life, and simply make their studying a 9-6 job.
What do you all think?

We could directly pay people to be doctors, but the money would have to be a loan. The loan would then be completely forgiven after 10 years or so in practice. If the doctor quit practicing without a good reason (death, disability, etc.), they would be responsible for the prorated balance. But yeah, I think your idea is good in principle.

But seriously, how many potential Med students look at the tax brackets before deciding to become a doctor? Many doctors don't come close to $250k and the ones that do aren't going to quibble about a few percentage points increase on their income over $250k - they're living high on the hog either way, assuming they're not stupid with their money like one Doc I know.

 

[SammyJr]

Originally posted by: RoloMather
Doctors should be paid more. Especially the generalists.

I agree. We have a shortage of GPs as many students weigh paying $300k for med school against potential salaries. Do you become a specialist and make $300k+ or do you become a GP and make $100-150k?

At the minimum, we should forgive student loans for GPs.

 

[3chordcharlie]

Originally posted by: SammyJr

Originally posted by: RoloMather
Doctors should be paid more. Especially the generalists.

I agree. We have a shortage of GPs as many students weigh paying $300k for med school against potential salaries. Do you become a specialist and make $300k+ or do you become a GP and make $100-150k?

At the minimum, we should forgive student loans for GPs.

There is a shortage of doctors because there is a shortage of places in medical school.

Raising the price of a GP visit might shift the balance from specialists towards GPs, but I'm not aware of anyone complaining that there are too many specialists.

 

[abj13]

Originally posted by: 3chordcharlie

I have trouble with your gross revenue number because I've never seen a doctor other than a specilist who went through less than five patients an hour, and specialists are charging even more money.

If that is your impression of a primary care physician, then you simply don't have any experience of really occurs in a primary care office (with no PA/NPs). At least 5 patients an hour? That's absurd. The PCPs don't see 0-50 year old people as their primary population. If every patient was as simple and healthy as people between 0-50 years, then sure they could fit in 5 patients an hour. But that's not how it works. The vast majority of patients, not including a pediatrician's office, are people over 50. These are the people with increasingly more complex medical situations, culminating with the medicare population (who not only pay less than non-medicare patients, but have 2-3 times more medical conditions to deal with).

Have you ever seen what happens to a newly diagnosed type II diabetic? You honestly think it can take only 10 minutes? Please. You simply don't have the experience to make that claim. Ever work with a patient who has been recently discharged home after admission for pneumonia, who also hypertension and asthma? That isn't going to take 10 minutes. How about a 50 yo patient with a newly onset dry cough? If you knew the differential of that condition was (Most common: asthma, allergies, GERD; Worrisome: Malignancy of lung or larynx/vocal cords), you would actually realize that it takes more time that just 10 minutes.

But what is really troublesome, do you really think a PCP working 9-5 will see 35 patients a day (1 hr lunch, 7hours*5 pts/hour)? Again, you don't seem to have sufficient understanding of the dynamics of a PCP's office. All physicians have to chart. Nowadays its either dictate or type, either way, even the fastest PCP could only get through a dictation in 5-10 minutes per patient, depending on complexity. Even if a PCP could see 35 patients a day, that would mean 35 dictations a day, and even if they could all be done in 5 minutes, that is still another 2.5+ hrs of dictation per day. Now you're talking about someone working from 9-8, each day. Then you have to add in the time spent dealing with patients calling in, writing orders, reviewing labs/imaging, sending/calling out results, taking care of administrative activities, your time calculations are not even close to reality. What happens if the PCP still wants hospital privileges over their admitted patients? When are they going to round?

If you ever sit down and talk with PCP's, they tell will tell you outright, a practice of only medicare patients is a sinking ship, it is unsustainable without outside help. They are too complex, and the reimbursement is too low. Even the most experienced PCP's I've worked with, 20 patients is their max for the day. Even then, they are lucky if they stay on time and are home before 6:30p.

 

[3chordcharlie]

@abj13:
Didn't mean to post and run I've been busy all weekend though.

For every patient that takes more than 10-15 minutes, there's one (like me) who is only there because you can't self-prescribe medication for most simple problems. I average about one trip to the doctor a year, usually for something I can diagnose myself, but need a prescription to fix (last year's was bad athlete's foot, for example). Less than three minutes of the doctor's time for that one.

Even if we just use your numbers for patients, I don't honestly see a problem with doctor compensation; as a previous poster mentioned, everyone in the world thinks they are underpaid, but that doesn't make it true, and manipulating the market by creating a cartel isn't a good way to get public opinion on your side, whether you are right or wrong.