I just received the following letter from my ENT (I went to him once, when I had labyrinthitis):
To all my patients,
After over 46 years of practicing otolaryngology I have decided to retire. I have enjoyed my medical life and leave it with some regrets. Although I am still in good health, the economics of medicine today leaves me with little choice.
All business costs steadily increase, but much of our reimbursement is fixed by our government at a level it considered reasonable 15 years ago and is going down this year.
A recent statement by the St. Mary's Hospital Chief of Staff is very true: "Federal and state laws and imposed regulations have made doctors wage slaves of the federal government and insurers, medicine a public utility, and patients victim of an unjust system of health care delivery."
The cost to practice medicine will continue to increase, even without the gigantic outlays expected for implementing electronic health records, yet the federal government plans to continue to decrease physician reimbursement annually.
Of course, this is a guy who spent about ten minutes talking to me, looked in my ears, and charged about $300 for this.
Hard to have sympathy for doctors who live in million dollar homes, drive 3 BMWs and complain about their payscale
ReplyDeleteIf he was an ENT for 46 years, then unless he was a total idiot with his money, he's going to be just fine from a financial standpoint.
ReplyDeleteA lot of doctors struggle under mountains of debt these days. Despite what seems to be the popular perception, not all doctors live in million dollar homes or drive 3 BMW's. And yes, you can complain about the payscale when you only get reimbursed 23% of what you bill and when you work 80+ hours a week and take call every fourth night. Being a doctor is not a bed of roses...
ReplyDeleteA lot of doctors struggle with this -- today. A doctor who practiced as long as this guy had isn't nearly as affected as younger doctors are by the changing tides.
DeleteAre we supposed to feel badly for him? A specialist? Who can pick and choose who he sees? Who I have to beg to see my medicaid patients? Kids with sleep apnea with ginormous tonsils? Multiple episodes of ear infections due to bad anatomy and antibiotic resistance? Seriously?
ReplyDeleteHow about primary care docs?...now that is truly a labor of love...I'll save my sympathy for them.
If he started at, say, 29 (graduate at 22 with BA/BS, four years med school, 3 years residency), then he's about 75. Maybe it's time to retire?
ReplyDeleteENT residency is 5 years and most ENTs do a fellowship which would add on another 2 years.
DeleteDude has to be around 70, it is time for him to retire, to blame it on something other than that is just smoke and mirrors. Having said that: The practice of medicine is changing, but you know what? It has been changing since the beginning of time. Anyone that goes into medicine with the expectation of getting rich, I don’t want treating me. Anyone that has an issue with me being paid well, does not realize the sacrifices I had to and continue to make and to be blunt, I don’t want as my patient.
ReplyDeleteI agree 100%. I understand him trying to save face by saying that to his country club buddies, but to announce to your random patients is just silly.
DeleteHe's got to be around 75. Yes he has worked long enough, go and retire, but admit that you've worked long enough and would like to enjoy the rest of your time. Don't blame it on something out of your control. Take personal responsibility for why you are retiring.
I'm not in medicine, so I'm a little torn here. The economy has caused a ton of us to suffer economically. I don't do anything that someone can't live without if money is tight so I'm in terrible shape right now. Medicine isn't really in that category. You sometimes have to see a doctor whether you have the money or not.
ReplyDeleteIt's understandable that if you start to practice with enormous debt, you'll be very distressed to find that your income won't be what you need to both pay off that debt and live well after all those years of "sacrifice."
But anyone who has had a medical problem (or a relative with one), will be familiar with the way medical treatment is billed: You get a summary of the costs and you find a bunch of bizarre charges and you say to yourself "Who is Dr. Whosis and what did he do that is worth $500?" "They charged $50 for ONE aspirin!" Does increased specialization play into this? If all you do is get asked to confirm an x-ray reading, do you charge $500--because you're a professional even if it took only 5 seconds to confirm the reading? So when us laymen also notice that insurance reimbursed Dr. Whosis $35 despite what he charged, some of us think "Good. Because given what was wrong with me and that fact that I never even heard his name mentioned, he probably didn't do anything worth that kind of money." Probably that's a terrible attitude...but it's human nature given that nothing I can do will provide me with $500 for 10 minutes of work.
And we've all run across doctors who just decide to call themselves Cardiologists (without additional training) because there is more money in cardiology than internal medicine. Or doctors who are doing nothing to treat you, but stop by your bed to say "How are you?" each morning in order to bill a consulting fee. The attempt to remove abuses is a double-edged sword that also affects the innocent, which is sad, but rarely are there perfect solutions to problems. I suppose Anon 6:10 is correct: Don't go into medicine for the money. But then, lots of us pick fields despite the remuneration because you're happiest when you do work you love, even if it doesn't pay squat.
Hospitals charge more for the aspirin because they can't bill for things like the electric bill, nursing staff, cleaning staff, and all the stuff inside a hospital that we take for granted (like hospital beds that prevent pressure ulcers). You can't skimp on this stuff.
DeleteThe billed fee for a given service is higher than its net worth because the payment has to cover EVERYTHING in a patient's stay. Insurance companies pay far less than the billed amount. For example, Medicare pays $8.83 for a chest x-ray -- has to cover the tech's work, equipment cost, and radiologist's interpretation! Does anyone think this is realistic? People love to blame hospitals and doctors for medical expenditures, but insurance companies are seeing far more of the health care dollars (with increased profits every year, unlike hospitals and doctors) than any other entity.
During my residency the hospital asked for donations from employees (seriously!!) to cover things like new hospital beds. The hospital seemed to have plenty of money, but there was a ton of pressure on employees to contribute. Most patients feel entitled to everything at a discount but they have no concept of how much it costs to run a hospital (one reason why many have closed in the past few years).
Also, maybe part of the reason they bill that $500 is so that they can get the $35. Imagine if they billed $35 they'd get $2.45.
DeleteDoes anyone else out there know of someone who calls themselves a cardiologist without the training? Really? Because I don't. Just asking.
DeleteAlso, just because someone just seems to be stopping by your bed and doing nothing doesn't mean it's necessarily so. They have most likely read the chart, reviewed your medicines checking for interactions and effect on your vitals/labs/etc., considered further testing, discussed your case with ancillary staff, etc. All these things have taken years of medical training and have a very real value.
- Grace
Grace: I agree.... the amount of time I spend on a patient's care is often much longer than the time I spend with a patient.
DeleteBe glad that nurses don't bill and that we're thrown into the room charges such as bedpans and laundry. I can tell you we'd charge much more than what you pay for now.
DeleteThe "sacrifice" was quoted - people have no idea how much doctors sacrifice to get trained and become excellent practitioners. Most people wouldn't do it. Those that do deserve respect and appropriate compensation. That's my opinion.
Most non medical people have no idea just how much time doctors and nurses talk about the patients' care. Doctors may stop by and see the patient for 5 minutes, but behind the scenes, the doctor spends a lot of time reviewing charts, checking labs, consulting specialists and receiving numerous calls from the nurses. The nurses spend more time with you, however, we are the eyes and ears for the doctor. We keep them informed of changes in condition, medications you may need, possible resources required after discharge and the list goes on. From the doctor's perspective, it's not "out of sight, out of mind".
I'll charge $35 for an X-ray interpretation, but with my limited education in that area, would you really want me to do it?
I absolutely agree---as part of a "thinking speciality" much of what I do does not involve touching the patient. Review of the chart, labs (sometimes years worth!) etc... take 95% of my consult time, especially when you've got a patient that can't give you much relevant history (ICU, dementia, or just doesn't really know much about their illness). Its kind of sad to think that a patient would dismiss all that because I didn't spend an hour chatting them up or doing irrelevant physical exams.
DeleteOK, I stand corrected.
DeleteBut what occurs to me is medical people and facilities need some serious help with managing appearances. The doc who drops by to say "How are you?" needs to walk in with an arm full of folders (even if all they have are blank paper in them)--Oh, and a laptop is not as impressive-- and start the conversation with "I've just spent two hours reviewing your charts and blah, blah, blah." It doesn't take much longer than "How are you?" but impresses the hell out of the patient, who will now be thrilled by your dedication and awed by your hard work. Also, hospitals need to find some other way to cover overhead. A $50 aspirin is ludicrous. Surely there are other things (and the more medical jargon the better) that could be used to bury overhead. Hire a disreputable accountant if you need suggestions.
But, sorry, I can't completely agree that those who sacrifice to become doctors "deserve" respect and appropriate compensation. Lots of us spend a lot of time in school and in training, but go into fields where the compensation is not commensurate with time spent or energy expended. Research the field before you commit to it if compensation really matters.
Please tell me another field that requires a minimum of 7yrs post grad and a maximum of up to 15 years training? Sorry but you seem to have no real idea that hours it takes to become a competent physician.
Delete(Anon#1 here) I shouldn't have to emphasize to every patient how much time I spend preparing for my visit with them and then even more time following up (reviewing additional records other consultants, the primary team, labs, documenting the visit and a well-reasoned assessment and plan) after the visit. I'm a physician, not a salesperson or Hollywood actor.
DeleteIt would be disingenuous (a.k.a. a lie!) to carry an armload full of folders with blank papers to justify my job to patients. I do wish you could shadow me for just one day so that you could glimpse what I actually do, but it's not my job to convince you that I do far more behind-the-scenes work for each patient than patients and their families realize. I think most patients would rather I focus my finite energy on doing my job -- making a correct diagnosis and recommending the appropriate treatments -- well.
While you seem to mean well in your recommendations, I get the impression you are not particularly appreciative of efforts others make on your behalf.
"The doc who drops by to say "How are you?" needs to walk in with an arm full of folders (even if all they have are blank paper in them"
DeleteSo essentially we should lie in order to justify the REAL work we do? What if the patient asks to see what's in the folder?
"Research the field before you commit to it if compensation really matters."
ReplyDeleteI guess that could be said for those that go into fields where compensation isn't that great after years of education also.
Doctors make decisions that could easily cause someone to die everyday. They can't have days that they are "off of their game". A simple mistake can cause great harm and with that responsibility comes better compensation.
Perhaps doctors and hospitals should use billing hours like lawyers do. Imagine how expensive healthcare would be if they did that. At least the patient would see exactly how much time was spent on them.
Fizzy,
ReplyDeleteHad he picked up an operable tumor and saved your hearing or your life, would have been worth $300? You ought to know as a physician what a physicians finds and (as noted above) what you see a physician do often do not reflect the training, work, knowledge base, decision-making, or care rendering that actually goes into a visit. And I seriously doubt any physician thinks we should bill based on the actual diagnosis made (as opposed to the complexity of diagnostic possibilities).
Furthermore, if your argument is that he is paid so much a reduction in what he is earning shouldn't matter, that same argument can be applied to pretty much all physicians and even most professionals since we all make considerably more than the average person in our society.
DeleteThat said, it is ridiculous but a fact of life that hospitals have to overcharge to cover their other costs. It would be nice if there were a better system.
It would be interesting to see what costs physicians could charge if we had a true market system. Everyone assumes it would go down but it would be interesting to see what people would agree to pay when they are afraid or in pain. In some ways, the current system does reign it in.
As a doctor myself, I'm pretty sure the only way he could have picked up a tumor during that visit is if he had CT scan vision. I was not impressed.
DeleteTotal crap. This is what we decided at work the other day.
ReplyDeletePGY5-10: Broke as hell
PGY10-15: Kinda broke but finding ways
PGY15-20: Doing well if sensible
PGY20+: Yeah, made it.
(we decided there isn't a category bad enough for the trouble modern residents are in)
If you are PGY 40+ and complaining about money, things being as they were, then there's something seriously wrong. Like someone else said, he was probably pulling ~300g's. That's comfortable in any man's language. STFU and retire with our blessing, but quit the hand-wringing over something that is no longer your concern.