OT: Are Doctors Overpaid

[stan krajewski]

Most folks think they are underpaid and everyone else is overpaid.

When I come to work in the AM and make my stop in the men's room, I thank God for the poor souls who cleaned it so I'm not standing knee deep in !@?# and swatting flies away from my face.

We are all necessary. Its called society.

The pay for each job? Well, I think supply and demand should determine that until the commies take over. And then, in their infinite wisdom, they will determine what each of us is worth.

[Audible Nectar]

Doctors - I'm OK with their salary. IMO, doctors SHOULD be well paid for what they do....it's difficult, takes much training, and is obviously important. It's also risky (lawsuits).

Nurses: underpaid.......VERY underpaid. Wanna know why there is a nursing shortage in a time of few good paying jobs? It's the pay obtained for the training necessary, and the long hours.

Insurance companies: WAYYYYY overpaid. 20% of all health care costs is pushing paperwork/communication between insurance and healthcare systems. Ask any doctor who is calling the shots and making the healthcare decisions......it's not the doctor, it's the insurance company. Geez, I thought DOCTORS got paid for diagnosing and treating patients! What a concept!

Ad companies who pimp hospitals on billboards (and the Hospital execs who OK them).....WAYYYY OVERPAID. I've got two major hospital systems in my area, and between them occupy one out of six area billboards. Geez, do ya think some of that money might actually go into CARE, instead of ad dollars? Do you think that people might be able to afford hospital services if they didn't have to pay the ad bill?

DRUG COMPANIES: WAYYY OVERPAID. Proof of this exists in the prescription drug bill passed a couple of years ago. Do you think our government would have demanded a volume discount for supplying our nation's seniors???? NOOOOOOOOOOO, the federal gov let the drug companies charge the taxpayers FULL RETAIL PRICE for these medications. When is the last time anyone here bought a large quantity of anything direct from the manufacturer without expecting a discount?

The healthcare system is MESSED up, but it's not the doctors....

[Allan Songer]

My friend Carl is an opthamologist. You know, the guy who does Lasik eye surgery all day long. He bemoans the fact that he'll "never make the kind of money" his father made--from the late 1970's through the early 1990's his pop made well over a million dollars a year on average with the family "Eye Doctor" practice. Carl is only able to pull in about $600,000 per year and FEELS TERRIBLE about it--always pissing and moning about Medicare payments, malpriactice insurance costs, HMOs who take forever to pay, etc.

[kev313]

I don't think doctors are overpaid. Christ, pay a freakin' neurosurgeon whatever he wants. Perhaps many people equate the health care cost crisis with doctors' salaries.

After practicing law for a while, I'm pretty sure the answer is: a litigous society, insurance companies and drug companies. That's easy to fix, right?

The practical result, in my experience, has been a reduced standard of care.

[dragonfyr]

Add to that a single payer system with rates not coupled to actual costs and the lack of a free market system to encourage competition and efficiency. 'Ain't' government great! (Wait a second! I think that should be a question!!!)

[Jay481985]

Remember everyone as with where the money goes the talent goes. Pay doctors less they will become lawyers or engineers and such. I know most of my friends want to become doctors when they started pre med in college. They did it cause it is prestigous and the money. Take the money and the people wanting to help will go somewhere else. Besides doctors are trained and rigorous not to mess up. Even after 12 hours of surgery or a 24 hour shift. That is why they get paid that. Not many can say they worked that long and not mess up. Also messing up say for instance in business can be fixed with a few peperwork or computer. When you chop the wrong leg off its a little more permanent. Also doctors get paid that much due in very much to skill as most people do not have the mental capacity to remember and do what doctors do. 95% of jobs in the world really you can teach anyone how to do with enough training. Doctors are another breed and thus should be paid that sum. They are the best of the best are they not?

[dragonfyr]

Pay doctors less they will become lawyers or engineers and such... And heaven forbid that we might get doctors who want to be doctors and not those who are car afficionados... And the down side is...

"They are the best of the best are they not?"

No more then anyone who has invested the time to pursue advanced degrees in other rigorous areas of study.

[mandi]

Hmmm, interesting topic. Most doctors I would hope had some kind of ride through the first four years because of smarts or something. I do not think they are overpaid, but I look at the 3 million dollar houses that the ones around here live in and then might think otherwise. gotta love capitalism

We are currently in phase 3 of a 40 phase (stretching the truth there)braces ordeal. Probably at 2500 a phase. Well, we had to have impressions made, cool looing material that in the end made a nice little model of the teeth. Wow, was that stuff expensive (Real expensive). Sometime during the school year, the entire 4th grade went on a field trip to this Drs' Office. They ALL!!!!!! came home with little models of their thumbs or noses or something. Made with the same REAL expensive stuff. THAT KIND OF TICKED ME OFF.

We are currently looking at 2k to move a tooth, insurance will pay to extract but not to move. Oh, and move or extract the insurance will not pay for the annestisia (I know I spelled that wrong, just can't find a dict. handy), which will be about 600 bucks.

Nurses, can make 30 or more an hour. That is pretty good money if you ask me. Some can make $30/hour work 24 and get paid for 40, and when they work past their 24 they are getting time and a half. Get called in on a Sunday that you were not scheduled and they cannot find anyone, double time. I really do not know why more people do not go into nursing. My cousin went to nursing school midlife, after the kids were out of school. Got a job with travelers, and moved around a lot. She loved it, went to work in Hawaii for about 6 months and made enought to purchase a nice little Mercedes with cash when she came back to the states.

[gullahisland]

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On 6/14/2005 7:08:45 PM meuge wrote:

I hear this argument on a weekly basis, if not

more often... even sometimes from people who should know better. A few days ago,

someone showed me a survey which found that >90% of those asked think that

doctors are overpaid. When asked what is a fair salary a doctor should make, an

overwhelming number of Americans thought that $80'000/year is the "fair" figure.

Well, if they all say it, then it must be true

right? Well... I did a little research, utilizing some rudimentary

approximations of tax law and other figures, relating to getting a degree and

practicing medicine in the state of New York.

Disclaimer: I will be using the article "he",

simply because it's faster to type... not because I have anything against women

in medicine.

Now we'll be talking about a specialist, seeking

a career in non-surgical cardiology. I know a bit more about this specialty,

since it's probably going to be my first choice. For those who are not familiar

with the way the medical education proceeds, here's a recap:

1) 4 years of college

2) 4 years of medical school

3) 3 years of residency - after this is when an internist and family practice

physicians take their license exams

4) 2-5 years of fellowship - this is where the specialists get their training...

usually 2-3 years, with the 4-5 years reserved for cardiothoracic and

neuro-surgery.

Let's begin by assuming that a regular student

loan will appreciate to 260% of the principal over a period of 20 years (a

figure given to me by my friend who is an analyst at a major bank).

College - $30k/year = $120k x2.6 =

$312k

Medical school - $50k/year = $200k x2.6 =

$520k

Sub-total =

$832k/

20years = ~

$3400/month

after graduating medical

school (if paying even payments)

------------------------------------------------

Resident (1st year)

makes $50k

After taxes, (25%), he is left with $37.5k.... so he is forced to pay the

$1000/month minimum payments, leaving him with

$30k

, and with an $820k

debt at the end of the year

Resident (2nd year)

makes $60k

After taxes, (27.5%), he is left with $43.5k and again he pays the $1000/month

minimum payments, leaving him with

$31.5k

and a $808k debt

Resident (3rd year)

makes $80k

After taxes, (32.5%), he is left with $40.5k and AGAIN he pays the $1000/month

minimum payments, leaving him with

$28.5k

and a debt of $796k

Hmmm - 3rd year after medical school and he makes the equivalent of $35k/year

(35k - taxes = 28.5)

Fellow (3rd year)

makes $150k

After taxes and loans, he now makes

$50.7k

/year... the equivalent of

$62.5k/year before taxes.

In New York City, a subway booth clerk will

receive upwards of $60k/year + monstrous benefits after 10-15 years on the job.

So after 4 years of college, 4 years of

medical school, 3 years of residency, and 3 years of fellowship, this doctor,

who is now at least 32 years old, and now has a license, makes the equivalent of

what a subway booth clerk makes after spending all that time after high school

selling tokens.

-------------------------------------------------

I'd love to hear your take on this.

----------------

You might wanna' check your math here. It's flawed on so many levels that there's not time to pick apart each assumption.

That said, I believe that doctors DESERVE to make top dollar and, as Allan pointed out, are actually UNDERPAID relative to their predecessors. This has primarily to do with the managed care system and the Drakonian rule of insurance providers and, to a lesser degree, the exorbitant cost of medical malpractice insurance.

But that's our own fault. We blame the trial lawyers, but the real grifters are the citizens (or illegal immigrants...ain't America GRAND?) who retain them.

Additionally, I don't believe that most doctors go into it for the money. There are easier (and faster) ways to make substantially more money. Indeed, the majority of doctors (and all of the great ones) have a passion for helping people.

[3dzapper]

meuge,

Thank you for choosing Cardiology. There is a constant and growing need for good Cardiologists and CHF specialists.

Are MDs overpaid? In a real sense, no not at all. Leaving out the cost of a Medical education, only the brightest among us can survive the rigors and acemedemic requirements of Medical School. An LLD or MBA is much easier to achieve and can be more financially rewarding.

Then on another level, an MD in private practice is a small businessman. If he/she can find a way to make a good profit with all the insipid costs required to run a medical office great!

The personall sacrifices that men and women make to become MDs should reward them with an income which will provide well for their families and future retirement.

Are there schisters in Medicine? Sure, but they are the exception not the rule. Again thanks.

Rick

[DRBILL]

Are DOCTORS overpaid? Very few that I know, myself included. Are PHYSICIANS overpaid? Many are.

My academic history:

Bachelor 4 years

Master 3 years

Doctorate 5 years

Starting stipend (1968) $4,800 A YEAR plus housing allowance and limited medical insurance.

Ending stipend (1999) $40,000 plus housing allowance, auto allowance, really good medical insurance.

Fortunately, my wife, with a PhD, made similar coins.

Go figure.

DR BILL

[meuge]

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On 6/15/2005 10:34:37 AM DRBILL wrote:

Ending stipend (1999) $40,000 plus housing allowance, auto allowance, really good medical insurance.

DR BILL

----------------

Is that what you get as a Ph.D? Sorry - you didn't make that clear (or maybe I misunderstood). If that is true, then you're indeed underpaid. Most non-medical faculty I know make above $50k... and quite a few make >$100k.

What did you get your Ph.D. in?

Oh, and here's what my academic history will hopefully wind up looking like:

- Bachelor's - 4 years

- Medical school - 4 years

- PhD - 4 years

- Residency - 3 years

- Fellowship - 3 years

... that's if I pass everything I need to pass : (

[oscarsear]

To answer the original question M.D.s are not overpaid. While Meuge noted the amount of education requisite to practice he failed to note the actual amount of time spent at the workplace to get there. Interns, Residents and Fellows have NO life. They spend 60 to 80 hours/week on the job and much of the rest of the time at studies.

Now to be philosophical. The thought of socialized medicine chokes health care professionals and avid business people alike. Me too. But think about it: The dollar stream starts in your pocket. By the time it comes down to actual hands-on care, the real meat of delivering health care, it buys pennies worth of service. Why? Because at every level non-practitioners not only take salary but also profit from that dollar. Every medical manufacturer of equipment and drugs, every insurance entity, hospital for profit, administration...and on and on. The result is to get any service at the end tons of dinero has to go in the front. I don't have an answer, but this is a different angle on the problem.

BTW any of you doubting what service providers (M.D.s ,R.N.s, P.T., Resp, O.T.) do make think about the work. Deathly sick people 24/7/365, holidays or no. People who foul themselves, are filled with puss and have rotting limbs; hands-on health care is a very tough, demanding career at all levels...and it's dangerous too. One stick from a dirty needle and there's AIDs, hepatitis...etc. Oh yeah, when you're overworked (I mean plowed under with work) and it's 3 A.M. and you make a mistake...people want to sue you for everything you have or will ever get. There are loads of extremely qualified practitioners who have left their professions cuz it just isn't worth the stress or the misery.

Want to point to people overpaid....LAWYERS, real estate agents, loan officers...etc. A union dock worker makes over 100K annually, has insurance up the ying yang and gets holidays off of quadruple premium pay for working them.

When the baby boomers hit the ill health of old age there's goona be a real crisis.

[meuge]

----------------

On 6/15/2005 11:12:37 AM oscarsear wrote:

Now to be philosophical. The thought of socialized medicine chokes health care professionals and avid business people alike. Me too. But think about it: The dollar stream starts in your pocket. By the time it comes down to actual hands-on care, the real meat of delivering health care, it buys pennies worth of service. Why? Because at every level non-practitioners not only take salary but also profit from that dollar. Every medical manufacturer of equipment and drugs, every insurance entity, hospital for profit, administration...and on and on. The result is to get any service at the end tons of dinero has to go in the front.

----------------

Thank you - that's exactly what I was thinking.

The biggest problem right now comes from the fact that insurance companies, which are very very loosely regulated, have decided that they no longer need to pay out. AT ALL... TO ANYONE.

My pediatrics instructor had to quit accepting Oxford, because they wouldn't pay her. At all. It went something like this:

- She'd take a patient, and invoice Oxford

- Oxford would deny the claim (4 weeks went by)

- The patient would call into Oxford and they'd say that it was a mistake

- She'd invoice Oxford again and they'd deny the claim (4 weeks went by)

- She and the patient would conference call Oxford and they'd say it was a mistake

- She'd invoice Oxford and they'd send a reply requesting more paperwork (4 weeks went by)

- The patient would send the paperwork

- Oxford would deny the claim, saying they never received the paperwork (4 weeks went by)

- They'd have the paperwork delivered to Oxford by courier

- Oxford would send the bill back, demanding new paperwork. (4 weeks went by)

- etc. etc. etc. etc.

And the patient was lucky - because it was her private practice, and not a hospital. If it was a hospital bill, after the 2nd denial it would be off to a collection agency, ruined credit history, and threatening phone calls... all of that for someone who is STILL PAYING $5000 or more a year for insurance.

She said that by the time she stopped accepting Oxford, it was almost 18 months since the last time they paid her a penny.

It's been almost two years since, and she still didn't get a dime. She is suing Oxford because they owe her about 3/4 million dollars.

[Frzninvt]

Oscarsear was spot on with his post - I totally agree. A thankless job for sure.

[gullahisland]

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On 6/15/2005 11:12:37 AM oscarsear wrote:

----------------

Brilliant post, Oscar. Post more often...This forum could use your wisdom.

[Kriton]

OK, now I have to speak up, because, as usual, someone gets to start tearing on lawyers and sucking up what the media (and the insurance companies) have filled the American public with...that lawyers are just these overpaid blood sucking leeches that are causing all the poor angelic doctors to go out of business.

Well buddy, it ain't true, and its pretty sad that everyone buys this guff.

The lawyers in this country are the last line of defense between you and big brother my friend, and these days they are losing ground. Lets look at a few things, shall we? The lawyers have an organization (called the Bar Assocation) to whom they pay annual dues in the hundreds of dollars, and what does this organization do for lawyers? Here in Texas they have two apparent responsibilities, to provide CLE (continuing legal education - required classes to keep the lawyers educated) and to put lawyers out of business through often ridiculous, wasteful and inefficient grievance processes, whereby any schmuck who isn't happy with the outcome of his case can file a grievance and drag the attorney through the mud often for now reason. Do the doctors have an organization soley bent on putting them out of business? Nope, in fact they have a medical association that doesn't keep track of complaints on doctors from one jurisdiction to another (remember the story on 60 minutes of the brain surgeon killing a few people in Pennsylvania, and then relocating to Florida and doing brain surgery on a patient while sitting up, so he could get better video and the air bubbles traveling up the spine to the brain and screwing that person up?)

There is even a civil rule of court procedure in Texas where you cannot inquire into or subpoena records from a doctor's inquisition (you know the meetings the doctors of a hosptial or group will have to look at a questionable call that a doctor makes on a medical case - sort of like what they depict on ER - most of those meetings across the country are taped or stenographically recorded, and YOU can't get any record of them if you are injured by a doctor!)

You know, these attorneys, especially in personal injury cases, take these things on a contingency basis, that is, what ever is recovered is split by the victim and the lawyer sometimes in a large percentage. But UNTIl the recovery, these attorneys are paying for everything out of their own pocket...all of the upfront fees, all of the costs to get expert witness, depositions, paying their staff, paying copy costs and a lot if other things. That is VERY costly, so, beleive it or not, most cases that are brought are NOT frivolous because the attorney would have to pay to bring it, and while they may be a lot of things, they aren't stupid!

A little while ago, I received a call here in Texas to vote what was called Prop 12, which was the Texas version of caps for personal injury recovery in medical malpractice cases. I responded, "I will vote YES on Prop 12 is you will send me a letter signed by any insurance comapany, that should I vote YES for Prop 12 and it passes, that the insurance industry will lower, across the board in Texas, the medical malpractice rates for doctors by a measly 10%. I will vote YES and I will get everyone I know to vote YES, and I will beat the streets and organize my own campaign for it..." Well you can imagine the response that I got...And I tell you, have the rates gone down? Nope, according to the news, the rates for doctors have gone UP...this is a business boys, the medical profession included, and I for one will be damned if a doctor amputates the wrong leg of mine and it only be worth $250,000.00 total for the rest of my life however old I am, to hobble around without legs because of the negligent mistake of a my doctor, OR the lady here in Texas who was told she had cancer, and the incorrect findings of her first doctor was just rubber stamped by the second two she received opinions from, they removed her lymph nodes and both breasts only to find out she never had cancer - now in her early thirties she is mangled, has no breasts, and is subject to every kind of infection that comes along because she has no lymph nodes - and is in her thirties (!) but that is the way it is in Texas. These aren't urban myths folks, this has happened! Let it happen to you and see how you feel about lawyers and doctors. Now, does that mean that all doctors are unconscientious, no of course not. I have had a few who were really cool, but that also doesn't mean that every lawyer is a crook, and no lawsuit has any merit, either.

Oh and by the way, my experience has been with divorce lawyers, you know, the ones you absolutely love to hate...and you show me one with a lot of cash and I'll show you 10 that are starving (mostly becuase their clients pay them), even with 7 years plus education and student loans of their own, and they do not make starting anything NEAR what doctors make, even out of medical school and they get sued all of the time, and are expected on top of that to do mandatory pro bono work for the poor and contribute (also mandatorily) to indigent defense! You got any doctors doing that that you know of? Oh yes, they call it Medicare...well friends it is still a medical subsidy.

Call a local attorney and ask them, you might be surprised. And next time you are in your doctors office and he spends 30 seconds with you and charges your insurance company $250.00, and you wonder why you can't get health insurance...don't blame it all on the lawyers...oh and I would tell you to get a sharpie and mark the GOOD leg off limits...

Just my 2c.

B

[oscarsear]

Mr. Kriton, How very defensive of you. No one here is defending or rationalizing people who practice poor medicine nor the right of litigation to rectify such instances. There's a generalization often stated and misunderstood that the exorbitant costs paid for health care drops directly into the pockets of practitioners...which of course is far from correct.

Now as to attorneys they too require a substantial education (although one can take LCATs w/o a bachelors) and practice as a business the legal profession. In every dealing I've ever had or have heard of involving attorneys none of those fine folks ever said, "lets do it this way. It'll save you some $$". Quite to the contrary they've taken every step to maximize their personal gain even at the cost of their own client in time or money.

So, while I do know there are poor attorneys they're probably the handful who have some form of ethic to their character. The rest are foxes in charge of the hen house...as far as I'm concerned.

[Mighty Favog]

1. I guess a doctor has never had their license taken away before by board of medicine, huh?

2. The grievance process that the Bar Association doesn't cost as many dollars to the plaintiff as one might think. I know plenty of court reporters that absolutley HATE to take those jobs because the finished transcript vitually NEVER gets ordered. The reporter's appearance fee ($40-$50/hr., and no they don't work all the time during a week. Most of that time is spent transcribing what they took down, sometimes till the wee hours of the morning) is minimal compared to what they do.

3. In Ohio, it is perfectly legal to obtain the transcripts of those doctor, hospital meetings. They just have to have been filed with the court not under seal. If there's no seal, anyone can get them.

4. If your a party to a case you absolutley CAN subpeona doctor's records to a case your a party to. It's called a Subpeona Duces Tecum. The doctor may not be the one to present them but the custodian of record can/must. Texas may be different but you can look up Ohio Rules of Civil Proceedure Rule: 30. It's in there.

5. Not all lawyers foot the bills up front either. I have had many cases where I would call the attorney to see if he/she wants to order a copy of a transcript and they would say something to the effect "Let me call my client and get the money from them.". OR we would have an outstanding invoice with an attorney and they would say for us to get it from his/her client. I would then have to remind them of how contract law works and that since he/she (the attorney) called our court reporting firm and ordered the service, then it's the attorney who pays the bill, not the attorney's client. That's not our problem.

Yes, I worked for a court reporting firm for 7 years (loved it too) but this new law that limits the awardings of cases sent me out of a job.

[DRBILL]

"Is that what you get as a Ph.D? Sorry - you didn't make that clear (or maybe I misunderstood). If that is true, then you're indeed underpaid. Most non-medical faculty I know make above $50k... and quite a few make >$100k."

Yes. I was a parish priest (Episcopal) and (for seven years) professor of Ethics on the graduate level. My wife was a school administrator on the state level. Enough said! But we knew before we started. Somebody has to do it.

DR BILL