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Who Would Want to Become a Doctor?
To become a medical doctor in the coming years, a person would need to be extremely dedicated—and a glutton for punishment. I’m beginning to wonder how many people will decide that becoming a doctor is simply not worth the sacrifices.
Many of us already know about some of the costs that a student faces to go to medical school:
The median four-year cost of medical school (including expenses and books) was $278,455 for private schools and $207,866 for public schools in 2013 according to the Association of American Medical Colleges. While grants and scholarships account for some of this total, lowering eventual debt to an average of $170,000-interest accrues while doctors are still completing their residencies, sometimes adding as much as 25% to the total debt load.
Since this study is from 2013, I’ll assume costs have gone up. For the record, doctors end up $416,216 in the hole.
Making their lives even more financially difficult is Medicare reimbursement . Many doctors are simply turning down new Medicare patients. Part of the reason is the onerous paperwork required by Medicare; even worse, Medicare reimbursement only pays 80% of what private insurance pays. As the aging population continues to grow with more health issues, more demands will be made on the health care community and less medical assistance will be available to patients.
But the latest difficulty that affects both doctors and patients are the hidden costs that hospitals are imposing on everyone in order to improve revenue. Doctors are now being pressured, sometimes contractually, to refer patients to services and doctors that are within the hospital system. Losing patients to competitive services is known as “leakage”; keeping patients within the system is known as “keepage”:
The efforts at “keepage” can mean higher costs for patients and the employers that insure them—health-care services are often more expensive when provided by a hospital. Such price pressure and lack of transparency are helping drive rising costs in the $3.5 trillion U.S. health-care industry, where per capita spending is higher than any other developed nation.
I have several problems with this policy:
- Doctors are often told that they aren’t required to refer patients internally for services such as MRIs, chemotherapy, blood tests and to other doctors, but referrals are tracked, and doctors are asked for the reasons that patients were referred and not treated internally.
- Services can be twice as costly, or more, when they are provided by the hospital.
- Patients are often not told that services outside the hospital can be less expensive, or that they can locate a doctor on their own outside the system.
- Physician contracts can restrict referrals except for a limited number of exceptions.
- Doctors may be reluctant to refer patients to doctors with special expertise due to pressures from their own hospital systems.
Some organizations are taking a pro-active approach to the “leakage” problem, trying to determine the specific reasons for referring patients outside the system, and determining options that could put less pressure on doctors to increase revenues. I’m disturbed that most organizations, however, are demanding, subtly or overtly, that doctors must comply with “keepage” expectations. I think that doctors are entitled to maintain a level of independence, given that they can be dealing with life-and-death issues. The question is whether these hospital systems are ethically entitled to hold physicians accountable for helping to increase their bottom lines at the possible expense of the patient.
This paragraph sums up the dilemma:
‘We do not use our referral tracking data to put pressure on our physicians to refer to their partners within our system,’ said Suresh Lakhanpal, president of Phoebe Physicians, the medical group. ‘However, if an employed physician routinely refers patients outside of our group without good reasons to do so, then that physician is not demonstrating commitment to the best interest of the patients and may not fit well within our team of outstanding health-care professionals.’
So who gets decide what “good reasons are?” At what point is a physician “routinely” making referrals outside the system? How is keeping a patient in the system necessarily in the patient’s best interests?
Published in Healthcare
I prefer the ambiguous “Still shopping”.
Or the even more ambiguous “Define ‘guns’, ‘in’, and ‘house’”.😛
Which in many cases is more than offset by double the loan debt, taxes(especially if practicing in a high tax state), and strains on the marriage during residency if they are both in demanding residency programs.
Perfect.
Or “Why? What do you need?”
That’s my experience from the ER end.
“Are you keeping statistics? If so, I have negative 320 guns.”
Yes, and it would be paid for by “sin taxes,” more specifically, a cigarette tax.
Here’s a golden oldie. Sing along everyone!
Yeah I work at Ft Bragg and have worked in many ER’s both in the military and civilian world. I had a patient last week who basically had a mild cold, and said ” I was going to try a tylenol but decided to come to the ER instead”.
This type of behavior is seen in both the military and the Medicaid population who have zero copays.
“No skin in the game”.
Maybe. Well, I know a lot of ER couples. 300k x 2 pays off those loans pretty quick. To the point where after about 5 years many of them start to cut back on their hours.
This kind of behavior really angers me. These people don’t realize that the time given to them takes away from people who might really need to see a doctor, contributing to their suffering or even endangering their lives. So irresponsible.
The wife worked in a South Texas Catholic hospital (also the only hospital around with an ER). Pre-Medicaid. She observes that it was common even then to have people come to the ER that had no business in an ER.
Could some of that behavior come from laziness? Ignorance?
Well, there’s always this. They’ve spent the last few years trying to get individual state medical boards to accept their credentialing and for state legislatures (I think) to stop companies from requiring certification. Certification hasn’t improved knowledge, competence or care as far as I know. But it takes a lot of time and money, a lot of money.
This company is easy and cheap, and new. I’m not advocating it, I’m just saying it’s out there. following is a portion of an e-mail.
National Board of Physicians and Surgeons
Duplicate
I try to avoid the ER. Twice now, I’ve been rejected from the Urgent Care and sent to the ER. On one of those occasions, it turned out that the Urgent Care was busy and they simply didn’t want to treat my kid so they lied to me about not doing stitches on toddlers. The ER was even busier and it was a colossal waste of their time. Still makes me mad.
I don’t know how prevalent lying Urgent Care centers are, but it makes me wonder if people are just afraid they won’t get treatment, while the ER has to take them.
ERs have become the precursors of Universal Healthcare. It’s called free.
Our healthcare system at work. I’m so sorry, @qoumidan. It’s especially distressful when a child is involved.
I think decisions that streamline the system and dump requirements that are worthless are good news.
@qoumidan, Like you, we never use the ER unless it is truly serious: Once in the last five years.
I don’t know much about the norm, but while we lived in Cypress Texas we got good help at two urgent care places close to the house. One has recently opened near us in Lafayette Tennessee. But urgent care facilities I don’t think even existed 20 years ago, not in a big way anyhow.
However, I now regularly see hospital emergency rooms advertising for clients on billboards and things which tells me our idea of an ER is essentially a thing of the past. That may contribute to things like Kozak’s decision not to re-up.
Hard to compete with free!
You live near Lafayette? I’ve been there – now that’s, um, rural! Those of us who lived in Elizabethton, TN don’t criticize, of course. But there’s not much out there…
Typical quality-of-life-enjoying [redacter] behavior. I hope they choke on their lack of misery.
Both. And fear. Fear of being thought unfit, fear of it being some deadly disease masquerading as a common cold.
I’ll say this; no one actually wants to hang out in an ER. Maybe someday they’ll have soft lighting and recliners.
Hey! We even have a Wal-Mart!
And you even have Tractor Supply! At least, I think so – I seem to remember stopping in there to get something after giving a speech in your hospital. Could have my wires crossed – that was a few years ago…
No, your wires are all in place.
Perhaps fear. We’ve all heard horror stories about someone who experienced a headache or fever and the person was dead 24 hours later. If they’d only gone to a doctor or the ER instead of waiting to see …..
No one impetus, it seems. I do agree with the premise, though, that eliminating all the individual’s negative consequences of a visit to the ER is guaranteed to result in negative consequences for society.