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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsDoctors in America are harboring an embarrassing secret: Many of them are going broke.
Doctors going broke
Dr. Mike Gorman has taken out an SBA loan to keep his rural solo practice running in Logandale, Nev. "If things don't improve fast, I will have no choice but to close my doors," he said.
This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.
Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.
"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.
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Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."
http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3
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arbusto_baboso
(7,162 posts)This is directly the fault of big insurance.
southernyankeebelle
(11,304 posts)up having to have her breast removed because of cancer. Thank god they got it early but none the less she has her own practice and she has people working for her. She had to stay home to convelence but she had to get back to work because she had people depending on her. That is a terrible feeling. A couple of her friends filled in for her but they had their own practices. She had another dentist working for her but he was getting ready to go on to get more training so she had to find a part-time person. Lucky for her she found another dentist who only wanted to work part-time. So it worked out for both. People don't realize how hard it is on the doctors. Something has to be done.
Adsos Letter
(19,459 posts)That's a fact! My daughter and son-in-law are both doctors (Internal Medicine and Ophthalmology). They came out of med school with a combined debt of about $450,000. Both are currently in Residency at a major teaching hospital. They work some hellacious hours, covering three regional hospitals, with a ton of stress. Neither one of them has any desire for private practice.
I know that Pediatricians and GP's have traditionally made less than other MD's, but the inclusion of Cardiologists and Oncologists on that list is an eye-opener.
southernyankeebelle
(11,304 posts)took her about 10 yrs. Now she has twins going to school one wants to be a dentist the other wants to be a teacher in the medical field. I tell you we come from a modest background. My dad was in the military and retired. Sad that he died at 50 and left 2 small children. My sister was lucky and very very smart. She wanted to go to dental school. We all helped her. My mother was a stay at home mom. My brother and sisters made sure she could stay home. We just didn't want mom going to work. Anyone she went through dental school the week she was to walk across the stage with honors our mother died at the beginning of the week and at the end of the week my sister walked across the stage. We were so happy and sad at the same time. She ended up doing a year residency in a hospital. As you well know she put in long, long hours. During that time she found out she was carrying twins. I felt so bad for her. She didn't give up and stuck with it even though she was having serious medical problems throughout. There were times she ended up in the hospital and get out then go right back to work. She was lucky she did have her babies even though one of the had serious problems. They worked with the problems (one of the babies had water on the brain) and today both are in college doing extremely well. But it take hard work. Doctors need to be appreciated more than ever. I know I appreciate my and sometimes I bring them little goodies. I let them all know I appreciate them. I know it is not easy. Good luck to your daughter and son-in-law. I hope for the best for all of us.
riverbendviewgal
(4,396 posts)I live in rural Northern Ontario. I asked my doctor if he liked our system and he said yes. Doctors are paid well here by our health care one payer system.
If they work up north where I live some are even given houses to live in rent free.
We Canadians are on the whole healthier because we go the doctors for annual check ups so the doctor can see something on the start.
I was thankful to have such a system when in September I had a detached retina in my eye. I saw my optomistrist for the problem and he sent me to the Ophthalmologist surgeon the same day, who operated on me that day.. No medical costs for me. The health system even paid for my car gasoline as it was a 4 hour trip, 2 hours each way.
southernyankeebelle
(11,304 posts)sooner or later we will be going there.
Adsos Letter
(19,459 posts)Good pay without the problems associated with private practice.
noiretextatique
(27,275 posts)seems to be a trend.
Adsos Letter
(19,459 posts)Excellent pay without the hassles of private practice. Plus, they emphasize preventive care and health maintenance. We have always gotten good care there.
In the interest of transparency: my wife works for Kaiser, and we have an excellent health care package as part of her benefits (which will follow us after retirement). We both realize that we are very fortunate to have this considering both the expense of good health care, and the hassles of dealing with the for-profits which many people have to contend with (if they can get health insurance at all).
It's long past time to nationalize health care.
noiretextatique
(27,275 posts)i lost my job and insurance over a year ago, but because i had breast cancer, i qualify for Medi-Cal. i have diabetes also, and i haven't had labs in over a year because i did not have insurance, and i didn't know i qualified for Medi-Cal until 2 months ago.
i am supposed to have labs done every three months because of the drugs i take and to monitor my diabetes.
i live in oakland; kaiser headquarters are here, and it is a good company. i hope to get a job there eventually 
it IS long past time to nationalize healthcare...no one should have to go without healthcare because they lack funds.
no_hypocrisy
(54,873 posts)making doctors their employees and running the practices now.
phylny
(8,818 posts)57 years ago.
I know the insurance companies wreak havoc continually..
I am a speech-language pathologist, working in a small practice in Virginia. Some insurance companies reimburse $7.50 per treatment session.
When you are paying therapists between $25 to $35 per hour to treat, who do you think is making up the difference? Our owners are subsidizing the treatment costs for children.
I have to hand it to the owners, they refuse to REFUSE any insurance carriers, despite the paltry reimbursement.
Laelth
(32,017 posts)Lawyers and doctors are very similar in many respects. About 50% of attorneys are sole pacticioners, just like doctors are. Most lawyers graduate from law school heavily in debt, and most doctors have the same experience graduating from medical school. Most lawyers (those who work for plaintiffs, at least) are paid principally by insurance companies, as are doctors. 90% of a typical lawyer's clients are incpapable of paying for the heavy-labor, high-skilled, and high-overhead services provided by the lawyer, and the same applies to doctors. So, in order to get paid, doctors and lawyers alike rely on insurance in order to get paid. Doctors get paid by insurance carried by their patients while plaintiffs' lawyers get paid by the insurance carried by the people who injured their clients.
I can say, from personal experience, that inurance companies are getting stingier and stingier while, at the same time, posting record profits year after year. The corporate model forces insurance executives to improve profits every quarter or risk losing their jobs, so both doctors and lawyers who represent poor and middle-classed people are getting paid less and less every year.
The end result of this process is obvious. If we keep heading down this road in the United States, poor and middle-classed people will simply lose access to medical services and legal services. That's where we're heading.
It appears nobody has a plan to do anything about it.
For my part, I think all insurance ought to be either nationalized or not-for-profit. Ha! Let's see that get though Congess!
-Laelth
librechik
(30,957 posts)sad and scary.
Tierra_y_Libertad
(50,414 posts)Romulox
(25,960 posts)
Adsos Letter
(19,459 posts)My daughter and son-in-law came out of med school with a combined $450,000 in debt.
Romulox
(25,960 posts)The high cost of education is a by-product of the scheme to limit the supply of new doctors.
I remember in the way back machine to the cold war when the news reported on how cheap a profession doctors were in communist countries because the state trained so many doctors there was a surplus.
The thread is interesting as the issue is complex. American doctors seem to make more, but their education is a lot and the for profit insurance system adds huge administrative costs.
emilyg
(22,742 posts)doctor. They deserve every penny.
Romulox
(25,960 posts)Or does the market get to decide only when it's a "good" outcome? 
treestar
(82,383 posts)He could be in a bad location, or a lousy business person. The recession could have hurt business when fewer people could afford insurance or more were unemployed and didn't have insurance or couldn't pay doctor bills.
Doctors are needed in rural areas, but there is not a lot of money in it.
piratefish08
(3,133 posts)doctors are the 99% too.
taught_me_patience
(5,477 posts)Insurance companies are squeezing doctors every year, while costs are rising, necessitating efficiency.
My wife just opened her practice two days ago, so hopefully we can outsmart these damn insurance companies.
mike_c
(37,045 posts)Private practices have been regulated into profit machines by the insurance companies who are driven by ever more desperate avarice to harvest more and more profit for share holders and executives. If anyone else in the chain from patients to insurance executives is making a good living or has anything left to spend after the insurance industry takes its pound(s) of flesh, then some insurance executive has missed a potential income stream, and isn't doing their job properly-- their primary job being to siphon maximum profit from everyone concerned.
Fumesucker
(45,851 posts)
TreasonousBastard
(43,049 posts)enough to keep them in business. Medicare-- the program a lot around here want to run the whole show.
Medicaid wasn't mentioned, but that program is even more of a skinflint.
Other problems barely mentioned were the huge costs of paperwork and running a modern medical practice, getting into a "network" and young doctors saddled with humongous loans.
FWIW. a couple of years ago NPR did a piece on broke doctors, and found some willing to talk about it. One had been practice for over 30 years and now works 60-70 hours a week and haf the time ends up with nothing after the bills are paid.
It's not Medicare, insurance companies, or any other sound bite causing the trouble-- it's the fundamental way our system deals with education and pay for service that's the root of it.
Adsos Letter
(19,459 posts)it's going to effect the not-for-profits as well.
kestrel91316
(51,666 posts)but still can't afford medical CARE because of the out-of-pocket costs.
If we cut out the blood-sucking middleman and doctors actually get paid for the work they do, we don't have a problem.
SINGLE. PAYER. NOW.
Shadowflash
(1,536 posts)
Marrah_G
(28,581 posts)She is all for single payer universal healthcare.
cbayer
(146,218 posts)in support of single payer, universal health care.
In earlier times, when doctors were making lots of money, the majority were Republicans. The AMA even tried to stop the implementation of Medicare.
But now, things have changed dramatically.
We are going to see some rough times, with less people interested in going to medical school, more doctors retiring early (unthinkable in the past) and lower paid primary care tracks being abandoned for the higher paying specialties.
When the wider provisions of the Affordable Care Act kick in, the shortage of doctors will become glaring. BUT, the support of doctors for a new system will continue to grow.
Blue_Tires
(57,596 posts)due to malpractice insurance which had gone up tenfold...
eyeofnewt
(146 posts)I've worked in health care for almost 30 years. I've worked in high volume, high quality facilities to small rural hospitals with low volume. I haven't found that doctors are "hurting". Yes, I've seen a few struggle financially, for different reasons. I don't blame the amount of debt they graduate with, the Medicare reimbursement cuts, nor the insurance industry. Failing physicians and practices existed before these issues were ever issues. Rural areas have long had trouble attracting doctors, as well as other professionals.
I'm not saying they are all rich and living the good life. However, most are. Most feel it is deserved given the amount of time and money they have spent on their education. Wouldn't the debt be relative to the income they will realize?
Idolizing doctors has taken a down turn in the last 25 years or so. No longer do health care co-workers and the general patient population take their advice blindly. Rather, they have been taught to question, to research, and to arm themselves with knowledge.
I well remember the scare of increasing medical malpractice insurance driving doctors to move to states where tort reform had already been enacted. This was floated about in order to coerce legislators to enact tort reform. Some even said they would be forced to give up their practices. I always wondered what they would do to make the type of income they enjoyed as physicians. Ha! Recent articles have pointed out that med mal insurance costs have gone down in the last four years in states with and without tort reform. I also wondered how the people who support tort reform would feel if their mother, brother, child, etc. were harmed by gross malpractice and their settlement after legal fees would not provide care for the harmed person for long. Not a fan of "Obamacare"? Then maybe your insurance company will find a reason to drop your injured family member from coverage, or you might lose your job due to providing care. Then what? Medicaid? Probably (thanks to the government).
Broke doctors, lack of access to care, long hours (really? compared to the nurse who is with the patient 8,12, 16 hrs at a stretch? or compared to a worker performing two jobs to make ends meet?), large student loans - these issues aren't new with healthcare reform nor changes in reimbursement. As for states with tort reform on the books...did it make a difference?
Sorry for the rambling. I lost my blind respect for whole professions years ago. Bankers, doctors, lawyers. Sounds negative, but to me realistic. There are some good doctors out there; money is secondary to patient care, but I think I'll save my sympathy for the truly hurting.
KT2000
(22,136 posts)more and more doctors are working for the one and only hospital which runs specialty clinincs, all testing labs and facilities, same day surgery, cancer and cardiac clinincs, and of course the hospital. They are now using hospitalists. They are aiming to be a monopoly.
They are masterful at padding bills. A consultation with one of their specialists is billed as an outpatient procedure so more of it comes from the patient's deductibles and other such tricks.
eyeofnewt
(146 posts)I forgot about this practice in my prior post. The days of docs getting out of the office and making rounds on their sick patients is a thing of the past. Now hospital employed physicians (hospitalists/intensivists) see the patients during their stay. So much for continuity of care and being there for the patient. The elderly, especially, are befuddled by this.
KT2000
(22,136 posts)said that hospitalists work for the insurance company.
Have seen first hand that they are not necessarily there for the patient.
AngryAmish
(25,704 posts)1. There is no rule anywhere that every medical practice must survive. If the business is run bad then it is run bad. Doctors tend to be terrible businessmen. (They also tend to be terrible pilots but that is neither here nor there).
2. Insurance companies plant these stories every so often to make the case for tort "reform". Look and see if malpractice insurers lower costs when tort "reform" goes through. You will see they do not. The insurance company just makes fatter profits.
3. Go look at the Bureau of labor statistics and see if doctors are making more money over the last twenty years or less money. Hint: there is a reason there are so many Ferraris in the doctor's lot at the hospital.
auburngrad82
(5,029 posts)she was tired of fighting with the insurance companies just to get payed for services provided. I miss her every time I go to my new doctor.
girl gone mad
(20,634 posts)If the little fish can't get enough phytoplankton, the middle fish will starve, too.