Stethoscope Blues
Read the comments in our open thread from earlier today on what the next four years have in store -- regardless of who wins the presidency -- and you'll see a lot of pessimism, particularly over the prospect of Washington being able to save an economy weighed down by the cascading entitlement burden.
I haven't quite succumbed to that level of despair about the economy as a whole yet, but I'm certainly there when it comes to health care. And a new report by the Physicians Foundation (made helpfully digestible by our own Ben Domenech's invaluable daily news briefing The Transom) provides no comfort. To wit:
- 52% of physicians have already limited the access of Medicare patients to their practices or are planning to do so.
- 26% have already closed their practices to Medicaid patients.
- More than 50% of physicians will cut back on patients seen, will switch to part-time, switch to concierge medicine, or retire within the next four years.
- 62% believe Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs.
- 59% say PPACA has made them less positive about the future of healthcare in America.
- 57.9% would not recommend medicine as a career to their children or other young people.
- Over one third of physicians would not choose medicine if they had their careers to do over.
- 77% percent are somewhat pessimistic or very pessimistic about the future of the medical profession.
What say the good doctors of Ricochet? Does this track with what you're seeing? Is it reflective of how you personally think about the industry? And what advice would you give to the promising undergraduate who comes to you seeking advice about whether to attend med school?
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Comments:
Dec '10
Re: Stethoscope Blues
The medblogs I follow are all very down on the career aspect for young students and are often filled with stories about physicians making their own ways. And that is an upside, to me.
Personally, I won't use a physician that accepts either Medicaid, or Medicare patients. I don't even like those that accept insurance, though that is difficult to implement, in practice. In either case, prices are grossly inflated and delay is inevitable. In every case, I pay by check or credit card, then deal with any insurance aspects, on my own.
With some doctors, more everyday, you can negotiate significant discounts if you will just agree to pay in full, or set up a payment plan. I've been doing this, for years. I had all four of my wisdom teeth removed by the head of the department of Oral Surgery at a reputable university, for less than half of what my insurance approved through private Oral Surgeons, by paying cash. And I was eating solid food the next day, whereas others went through 3 or 4 days of misery.
Half the price, better care.
Dec '10
Re: Stethoscope Blues
I have an idea!
I am of that age where I need to do that colonoscopy thing. I believe that I will be looking at something like a $4,500 price tag, maybe more, as a typical price.
Here's the idea: What do the medicos think of my price estimate, annnnnnd, what do we think I can get that price down to, if I pay cash?
I promise to get several estimates and to be completely candid with my eventual bill.
The estimates for typical prices will just be informative; the person closest to the actual bill, paid in full, will receive one dozen green eggs from Andre, our Jersey Giant chicken that turns out to be female.
If the original estimates I get from local physicians are around $4,500, I'll bet I can negotiate that down to $2,500, cash. From a highly credentialed, local provider. What say you, Ricochet?
Jul '11
Re: Stethoscope Blues
Well CJRun, I've been down this road. You'll get 30% off for sure but start at 50% and negotiate away. Solid smart move. I have 10 chickens and a few lay greenish blue.
Jul '11
Re: Stethoscope Blues
Well Troy, the folks they're interviewing are mostly primary care docs who are far and away the least paid, most burned out, and buried with paper work. Avg 140 K compared to 250-1,000,000.
That 100 hr rat race was my life until 2005 and it was not what I anticipated as the last decade saw dramatic gimmicks by insurance companies with slow rolling 50 dollar visit payments that comprise lots of what we do.
Specialists are still far better off in all categories of life by medical standards but they are getting hit too. Even so, many of them would not advise medicine as a career unless the person involved is dedicated to serving humanity or in the case of surgeons, really dig sharp toys and bodily fluids.
My two youngest are very bright and the boy is kind and dextrous. He'd make an excellent specialty surgeon. I fear for him if he chooses that path but be so proud of using his gifts from God.
I'd advise the young aspiring docs to think about their choices and take measure of their goals in life.
Edited on September 29, 2012 at 9:41amJul '11
Re: Stethoscope Blues
Here is my final note to those who look at the lower end doctor salaries and think,"Hey, that ain't so bad". It's not bad at all but 150-300K in debt and the prime of your life spent studying, testing and busting ass to begin work at 30 + is a disadvantage. The high drug addiction, divorce and suicide rate is a downer too. A comparison would be some of my friends. One is a nuclear scientist who sold a company for a bundle. He's my junior by two years and here are our cars. Mine is the 2006 Dodge diesel.
Jan '12
Re: Stethoscope Blues
Although Mr. Senik's invitation to comment was given to physicians, may I be permitted to comment;
Unless there is a Republican landslide in November, which will give the Republican politicians enough courage and votes to dismantle Obamacare, by the time any student currently considering medicine as a career completes his residency we will have devolved to a single payer system.
In Canada, where a single-payer system is enshrined, "direct patient payments to providers are banned."
Thus, the 'horse-trading' being jovially discussed above, will not be possible as any doctor wishing to stay in good in good standing with the government (IRS), will not be willing to risk his neck to save you a few dollars.
Of course, there will always be those specialists who can earn a good living in private practice, as some do on Harley Street, London, but for the vast majority of doctors who take a salaried position with a group, owned by a local hospital, they will not have the luxury of negotiating anything with their patients!
Not only will they be working for the 'group' but also, for the government.
We are screwed!
Edited on September 29, 2012 at 2:17amRe: Stethoscope Blues
Even though I'm a physician, I can't secure a doctor for myself. More precisely, each time I find a primary care doc, within a few months he or she --this has happened three times in three years--converts to "concierge" practice.
Under what I prefer to call medical timesharing, the patient pays a monthly retainer--usually about $350 in cash--to a personal doctor who promises to leap in and quarterback any unavoidable interaction with the larger medical system. Expenses incurred by using medical services are added on top, so health insurance remains a necessity.
The irony? My Silicon Valley neighbors, including those happy souls with a fractional physician on the household payroll to complement the fractional jet, overwhelmingly support Obamacare--to help the little people, don't you know. In fact, many regularly wax rhapsodic on the egalitarian joys of the British and Canadian single-payer model. Socializing private industry seems perfectly fair, so long as nobody seriously proposes the same treatment for large tech companies named after common fruit or unbelievably large numbers.
Jun '10
Re: Stethoscope Blues
What about TRICARE, that much-lauded program the takes care of our servicemembers? About that...
I recently had to see a GP for the sole purpose of getting a referral to see an ENT to take care of a ruptured ear drum. I got to see the GP fairly quickly because I promised cash and promised a quick 15 minutes. The doctor, a veteran and one of only a handful of independent GPs in the area, apologized profusely for "making me pay," but he simply can't afford to take TRICARE anymore. He's also seriously considering going to the local hospital because, given the demographics of our area, Medicare and PeachCare (Georgia's MEDICAID) are going to bankrupt him.
Mar '11
Re: Stethoscope Blues
CJRun: I have an idea!
I am of that age where I need to do that colonoscopy thing. I believe that I will be looking at something like a $4,500 price tag, maybe more, as a typical price.
Here's the idea: What do the medicos think of my price estimate, annnnnnd, what do we think I can get that price down to, if I pay cash?
I promise to get several estimates and to be completely candid with my eventual bill.
The estimates for typical prices will just be informative; the person closest to the actual bill, paid in full, will receive one dozen green eggs from Andre, our Jersey Giant chicken that turns out to be female.
If the original estimates I get from local physicians are around $4,500, I'll bet I can negotiate that down to $2,500, cash. From a highly credentialed, local provider. What say you, Ricochet? · 18 hours ago
Just had one three weeks ago. Mine was originally billed at $4268.30, and negotiated down to $1538.67 by Blue Cross/Blue Shield.
Shoot for $1500. I'll be impressed if you can get it, w/o BCBS's buying power.
Jun '11
Re: Stethoscope Blues
Blue State Blues
Just had one three weeks ago. Mine was originally billed at $4268.30, and negotiated down to $1538.67 by Blue Cross/Blue Shield.
Shoot for $1500. I'll be impressed if you can get it, w/o BCBS's buying power. · 57 minutes ago
Right there is one insane part of our current system. I've had some sort of individual high deductible policy for twenty years. I used to pay right away; once in a while that got me a discount. But for lo these many years I have learned I need to let the bill run through the insurance company to get their negotiated rate. So when I hear about those terrible losses to the uninsured that we are all paying for and so we must institute mandatory insurance- I am skeptical, because for sure they are based on the $4268.30 fee and not the $1538.67. And is it not despicable that some poor ininsured sucker will be hounded and have their credit destroyed if they only pay the $1538.67?
Edited on September 29, 2012 at 9:46pmJun '11
Re: Stethoscope Blues
I know a young woman* who has a master's in biology and presently has a reasonably lucrative but frustratingly limited job with a government contractor, administering cancer research grants. She's applying to medical schools because she does not want a life of being an anonymous paper-pusher. She's already 27, not in entirely robust health, and would have to take out, you know, few hundred thousand dollars in loans. Doctors, would you encourage her in that plan? I fear that even if her health holds up she will graduate into chaos. But she is a tenacious one.
*okay, I gave birth to her.
May '10
Re: Stethoscope Blues
I negotiated two tonsillectomies for my sons. It was cheaper than buying insurance.
Jul '11
Re: Stethoscope Blues
Jojo: I know a young woman* who has a master's in biology and presently has a reasonably lucrative but frustratingly limited job with a government contractor, administering cancer research grants. She's applying to medical schools because she does not want a life of being an anonymous paper-pusher. She's already 27, not in entirely robust health, and would have to take out, you know, few hundred thousand dollars in loans. Doctors, would you encourage her in that plan? I fear that even if her health holds up she will graduate into chaos. But she is a tenacious one.
*okay, I gave birth to her. · 4 hours ago
If her eyes are open then it's all OK.
Jul '10
Re: Stethoscope Blues
I'm an old ED doc. I have been in practice for 35+ years. I would not encourage anyone to go into medicine as it stands and looks to be for the foreseeable future.
I have been saying for many, many years that the government has driven up the prices in medicine. I could go into examples but there is a 200 word limit to these responses. MUCH of what is noted above is simply the fact there is government intervention in this market - to the point that now hardly anyone will see anyone without insurance. Cash just doesn't seem to get it.
ED's have been carrying the load of the "uninsured" patients for a long time. It is quite hard to get anyone to take on a patient who has no ability to pay, and the system has gotten them to think they don't need to pay to be cared for. So the ridiculous visits to the ED are, well, ridiculous. But the private MD's are also to blame. Today just about no private MD will see an acute issue; it's "Go to the ED."
The system is broken and in need of repair.
Jul '10
Re: Stethoscope Blues
You want your kids to go into something "medical", consider veterinary school. The medicine is very close to human, and it's a cash business. Like it once was in medicine. And people pay because they love their pets. You have insurance for your pet, like we do, you pay the vet, and then work on getting whatever reimbursement.
Edited on September 30, 2012 at 2:58amMay '11
Re: Stethoscope Blues
The current climate for doctors is as follows:
1) increasing bureaucracy/red tape
2) increasing technological demands (electronic medical records)
3) increasing complexity of care
4) increasing patient/family expectations
5) increasing cost of education
6) increasing demand for care.
What is decreasing? Not much except payments and the number of appointments available.
I am sure a breaking point is coming soon but most people have NO IDEA how bad it is getting, especially for primary care docs. Access is going to become a major issue very soon for just about everyone.
Being a doctor is wonderful but its just too much time and demand and stress if you don't feel you are properly compensated.
I would caution my kids strongly if they plan medical careers. I am a young physician and most of my mentors' kids went into Investment banking and business.
Jan '12
Re: Stethoscope Blues
DocJay
Jojo: I know a young woman* who has a master's in biology and presently has a reasonably lucrative but frustratingly limited job with a government contractor, administering cancer research grants. She's applying to medical schools because she does not want a life of being an anonymous paper-pusher. She's already 27, not in entirely robust health, and would have to take out, you know, few hundred thousand dollars in loans. Doctors, would you encourage her in that plan? I fear that even if her health holds up she will graduate into chaos. But she is a tenacious one.
*okay, I gave birth to her. · 4 hours ago
If her eyes are open then it's all OK. · 13 hours ago
As long as she realizes that the choice, in most employment she will be offered after her residency, will no longer be between working for the evil, for-profit Chevron oil company or Hugo Chavez.
By the time she arrives at this juncture, Hugo Chavez will have nationalized Chevron, and they will be one and the same!