Primary Health Care Providers

[BLAZER PROPHET]

If I am not mistaken, the Obama Plan will pay PCP doctors less money than they make now. Here is an interesting article written by one such doctor. First the link and then a quote from the doctor for those who are as lazy as I am and rarely follow the link or do so but only read part of the article:



http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html



I am in my 22nd year in practice, now caring for 3,600 patients. Having me in the system has resulted in savings in the hundreds of thousands of dollars each and every year. My financial incentive to hang in there and work harder is that I now make less than half what I did 20 years ago. This year I will make even less.

 

[Mediocre Man]

Hey, it's worked well in every other country.

 

[mook]

There is no Obama health plan.

 

[BLAZER PROPHET]

Hey, it's worked well in every other country.

Ohhhhhhhhhhhhhhhhhhhhhh it has indeed.

"Wasted away again in Obamaville;"

"Searchin' for my lost shaker of salt:"

"......."

 

[Mediocre Man]

Ohhhhhhhhhhhhhhhhhhhhhh it has indeed.

"Wasted away again in Obamaville;"

"Searchin' for my lost shaker of salt:"

"......."

Some people say that there's an Obama to blame, but I know

It's the people who voted for him's own damn fault

 

[barfo]

Let's do a little math here. The guy has 3600 patients. He gets paid a paltry $75 for telling them they aren't having a heart attack. That's $270K per year, if he sees each patient once and only once per year, and if every visit results in the same fee (obviously not all are fake heart attacks, and given that he's complaining about how much he makes for fake heart attacks, most likely he makes more for other things). The man lives in Redding, and makes $270K/year (probably more). He's not starving.

And, note that he's complaining about the current health care system, not proposed reforms. His pay didn't drop by a factor of 2 over the last 20 years due to Obama.

barfo

 

[BLAZER PROPHET]

Let's do a little math here. The guy has 3600 patients. He gets paid a paltry $75 for telling them they aren't having a heart attack. That's $270K per year, if he sees each patient once and only once per year, and if every visit results in the same fee (obviously not all are fake heart attacks, and given that he's complaining about how much he makes for fake heart attacks, most likely he makes more for other things). The man lives in Redding, and makes $270K/year (probably more). He's not starving.

And, note that he's complaining about the current health care system, not proposed reforms. His pay didn't drop by a factor of 2 over the last 20 years due to Obama.

barfo

Let's do some more math here..........

He has a staff (if he's a solo paractioner) that will include at least a receptionist, billing and a nurse. He has substantial office expenses and malpractice insurance that costs alone a minimum of $30,000 per year...

Wanna guess what he really makes?

And even if he works in a staff setting with other doctors, the costs are huge and shared. He's lucky to see 35% of his gross income. That means, at best, he's making $95K per year before personal taxes.

So for spending hundrends of thousands for medical school, hundreds of thousands (maybe closer to 1.2 million) to set up an office, he's making less than $100K per year.

Yeah, I do feel bad for him. And now the Obama Plan wants to screw him further.

Yep, what a great country, commrade.

 

[PapaG]

Let's do a little math here. The guy has 3600 patients. He gets paid a paltry $75 for telling them they aren't having a heart attack. That's $270K per year, if he sees each patient once and only once per year, and if every visit results in the same fee (obviously not all are fake heart attacks, and given that he's complaining about how much he makes for fake heart attacks, most likely he makes more for other things). The man lives in Redding, and makes $270K/year (probably more). He's not starving.

And, note that he's complaining about the current health care system, not proposed reforms. His pay didn't drop by a factor of 2 over the last 20 years due to Obama.

barfo

Be sure not to include taxes, staff, rent/lease, and malpractice insurance in your analysis.

 

[PapaG]

Let's do some more math here..........

He has a staff (if he's a solo paractioner) that will include at least a receptionist, billing and a nurse. He has substantial office expenses and malpractice insurance that costs alone a minimum of $30,000 per year...

Wanna guess what he really makes?

And even if he works in a staff setting with other doctors, the costs are huge and shared. He's lucky to see 35% of his gross income. That means, at best, he's making $95K per year before personal taxes.

So for spending hundrends of thousands for medical school, hundreds of thousands (maybe closer to 1.2 million) to set up an office, he's making less than $100K per year.

Yeah, I do feel bad for him. And now the Obama Plan wants to screw him further.

Yep, what a great country, commrade.

I was an evil pharma rep in a former life. I made more money than many of the PCPs that I visited. Specialists, however, were a completely different story in terms of income.

 

[barfo]

Be sure not to include taxes, staff, rent/lease, and malpractice insurance in your analysis.

I left that out because I assumed he was leaving it out. That is, I assume the $75 is net, not gross. Of course I could be wrong about that, but since he didn't specify I assume he quoted the figure that made his argument look better.

barfo

 

[barfo]

Let's do some more math here..........

He has a staff (if he's a solo paractioner) that will include at least a receptionist, billing and a nurse. He has substantial office expenses and malpractice insurance that costs alone a minimum of $30,000 per year...

Wanna guess what he really makes?

Already did. Note he writes "my reward" is $75, not "My gross is $75, but out of that I have to pay all my expenses".

barfo

 

[mook]

The lesson I take away from this is that it's just too expensive to go to medical school. Seems like a no-brainer that we should introduce massive scholarships and grants so that it's no more expensive to go to medical school than it is community college (provided you have the grades). With a massive influx of new doctors and nurses, doctors like this guy would see workloads drastically reduced.

Salaries for doctors would also continue to fall, of course, but that's fine by me. Doctors who spent $200k to get an MD in years past would be pretty pissed off, I suppose. Again, I think it's worth it to have a massive surge in highly qualified health care providers.

This country is only getting older. You can slice and dice the mechanism for how it's paid for (Medicare, free market, HMO, public plan, whatever), but if there aren't enough doctors around to actually provide care we all lose.

 

[BLAZER PROPHET]

The lesson I take away from this is that it's just too expensive to go to medical school. Seems like a no-brainer that we should introduce massive scholarships and grants so that it's no more expensive to go to medical school than it is community college (provided you have the grades). With a massive influx of new doctors and nurses, doctors like this guy would see workloads drastically reduced.

Salaries for doctors would also continue to fall, of course, but that's fine by me. Doctors who spent $200k to get an MD in years past would be pretty pissed off, I suppose. Again, I think it's worth it to have a massive surge in highly qualified health care providers.

This country is only getting older. You can slice and dice the mechanism for how it's paid for (Medicare, free market, HMO, public plan, whatever), but if there aren't enough doctors around to actually provide care we all lose.

When one considers that a doctor who either wants their own practice or with a few other doctors will spen well over $1,000,000 to get there and then makes about $100,000 per year or less will mean fewer and fewer PCP's. Or, we'll see the bottom of the basement doctors who can't make it any other way as our PCP's. Scary. But, it works well for socialism.

 

[mook]

When one considers that a doctor who either wants their own practice or with a few other doctors will spen well over $1,000,000 to get there and then makes about $100,000 per year or less will mean fewer and fewer PCP's. Or, we'll see the bottom of the basement doctors who can't make it any other way as our PCP's. Scary. But, it works well for socialism.

I don't understand your point. Sorry--I'm probably just being thick.

Anyway, I suppose my solution is "socialist" in the same way our postal system or the satelite GPS system is socialized. Some things there just aren't good free market solutions for.

We've had a shortage of doctors for decades, and the problem only seems to be getting worse. It's obvious why: It's a huge gamble people have to make in terms of time and money to become an MD, and consequently there just aren't enough people willing to roll the dice.

If we can stack the deck a little for them by offering better scholarships, the gamble becomes much, much less. Take money out of the equation, and it's just a risk of time.

The beauty of this kind of investment is that it's hard to imagine it backfiring. If we produce too many qualified doctors (is that even possible?), they'll have no problem finding jobs overseas, or they can always go into research.

 

[barfo]

I don't understand your point. Sorry--I'm probably just being thick.

Anyway, I suppose my solution is "socialist" in the same way our postal system or the satelite GPS system is socialized. Some things there just aren't good free market solutions for.

We've had a shortage of doctors for decades, and the problem only seems to be getting worse. It's obvious why: It's a huge gamble people have to make in terms of time and money to become an MD, and consequently there just aren't enough people willing to roll the dice.

If we can stack the deck a little for them by offering better scholarships, the gamble becomes much, much less. Take money out of the equation, and it's just a risk of time.

The beauty of this kind of investment is that it's hard to imagine it backfiring. If we produce too many qualified doctors (is that even possible?), they'll have no problem finding jobs overseas, or they can always go into research.

Of course, this doctor who is complaining here? That's the last thing he wants. More doctors means more competition means fewer patients and lower rates for him.

barfo

 

[mook]

Of course, this doctor who is complaining here? That's the last thing he wants. More doctors means more competition means fewer patients and lower rates for him.

barfo

True enough. But I won't really lose sleep over it.

You look at the long hours they have to work during their residency, the exorbitant salaries for specialists, the long waiting time for patients, the lack of house calls (they still do house calls in England and France, if you can believe that), the frustration and burnout---all these problems stem from the fact that there are too few doctors trying to care for too many patients.

Unfortunately, even if we did do exactly what I prescribe, we wouldn't see any significant benefit for 7 or 8 years.

 

[yakbladder]

True enough. But I won't really lose sleep over it.

You look at the long hours they have to work during their residency, the exorbitant salaries for specialists, the long waiting time for patients, the lack of house calls (they still do house calls in England and France, if you can believe that), the frustration and burnout---all these problems stem from the fact that there are too few doctors trying to care for too many patients.

Unfortunately, even if we did do exactly what I prescribe, we wouldn't see any significant benefit for 7 or 8 years.

That's okay, we'd still see the benefit in 7 or 8 years

I really think that is a good plan but I imagine there would be some harping from the medical lobby about "when they went to school..."

And again I think it's important to clarify this as PCP/General Physician than specialist. I have a friend who is a specialist and people think he's only making $90K net, that's absurd.

I'd also point out that the numbers change even for PCPs if they are part of a large unit rather than rushing out to start their own practice.

 

[mook]

Yeah, I think if you did have a massive influx of new doctors, they'd probably lean more heavily toward specialists, driving down their wages first. Just a hunch on my part, I admit. I figure people who weren't willing to go to med school because of the cost are probably more concerned with money and are probably more likely to go into a specialty. But I imagine it'd impact general practitioners too.

It's hard to imagine the AMA getting behind this idea, though. After all, the reason NBA rookies get horrible contracts is because nobody represents their interest during CBA player/management negotiations. Existing NBA players know they'll make more money if the rookie contract is less, so they don't give a fuck about people who aren't in the league yet.

Similarly, there's no incentive for current doctors to encourage a massive influx of new doctors. Except, of course, it could save a bunch of people's lives.

 

[barfo]

Heath care in Japan

Thought this was interesting (and, from what I've seen, accurate).

barfo

 

[PapaG]

I left that out because I assumed he was leaving it out. That is, I assume the $75 is net, not gross. Of course I could be wrong about that, but since he didn't specify I assume he quoted the figure that made his argument look better.

barfo

Why would you assume he's leaving out the cost or running his practice?

 

[PapaG]

There is a dearth of PCPs on the horizon. Out of the last medical school class at OHSU, there was only one doctor who is going into primary care.

 

[barfo]

Why would you assume he's leaving out the cost to run his practice?

Two reasons, both of which I already stated. One, he phrased it as "my reward", not "my gross income". Secondly, "I assume he quoted the figure that made his argument look better."

barfo

 

[PapaG]

Two reasons, both of which I already stated. One, he phrased it as "my reward", not "my gross income". Secondly, "I assume he quoted the figure that made his argument look better."

barfo

In other words, your critical analysis is based on assumption. Gotcha.

 

[barfo]

In other words, your critical analysis is based on assumption. Gotcha.

If he'd provided a complete set of data on his earnings, I'd be able to use the facts. However, he chose to provide only a small amount of data, and so one must make assumptions in order to analyze it. Not sure why you'd object to that.

barfo

 

[PapaG]

If he'd provided a complete set of data on his earnings, I'd be able to use the facts. However, he chose to provide only a small amount of data, and so one must make assumptions in order to analyze it. Not sure why you'd object to that.

barfo

You claim the guy is complaining about making $270k in Redding. I'd like to know how you calculated your criticism of him. I doubt he's making $270k/year off of his practice. Do you know any PCPs?

 

[BLAZER PROPHET]

You claim the guy is complaining about making $270k in Redding. I'd like to know how you calculated your criticism of him. I doubt he's making $270k/year off of his practice. Do you know any PCPs?

I spoke with a couple today who work for our parent company. Both left their practices as due to rising costs of malpractice insurance, employees... and sinking costs of reimbursements they had to for financial reasons.

 

[PapaG]

I spoke with a couple today who work for our parent company. Both left their practices as due to rising costs of malpractice insurance, employees... and sinking costs of reimbursements they had to for financial reasons.

I don't think PCPs are beyond criticism by any means, but the criticism put forth by barfo was so lacking in both substance and reality that I couldn't let it pass unchallenged.

 

[PapaG]

I spoke with a couple today who work for our parent company. Both left their practices as due to rising costs of malpractice insurance, employees... and sinking costs of reimbursements they had to for financial reasons.

I know a few PCPs who actually quit to become medical supply and pharma reps because they could make more money.

 

[maxiep]

If I am not mistaken, the Obama Plan will pay PCP doctors less money than they make now. Here is an interesting article written by one such doctor. First the link and then a quote from the doctor for those who are as lazy as I am and rarely follow the link or do so but only read part of the article:



http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html



I am in my 22nd year in practice, now caring for 3,600 patients. Having me in the system has resulted in savings in the hundreds of thousands of dollars each and every year. My financial incentive to hang in there and work harder is that I now make less than half what I did 20 years ago. This year I will make even less.

It used to be our best and brightest chose medicine as a vocation. Now, those docs are lucky if they make $150K. Why not go into a field where you need less schooling and can make considerably more? People lament that the number of physicians isn't increasing with the population growth. The answer is simple: pay more, and you'll get more doctors.

 

[maxiep]

Heath care in Japan

Thought this was interesting (and, from what I've seen, accurate).

barfo

Put Americans on a diet of fish, soy and rice and we'd be healthy too. Also, we'd have to have the Japanese mindset of "the nail that sticks up is the first to get hammered". Unfortunately for the author (and for you), we're a land of fatty foods and where the individual is celebrated. Japan is a terrible example of what we should do.