Welcome to DU! The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards. Join the community: Create a free account Support DU (and get rid of ads!): Become a Star Member All Forums Issue Forums Culture Forums Alliance Forums Region Forums Support Forums Help & Search

jsr

(7,712 posts)
Sun Nov 24, 2013, 11:28 AM Nov 2013

Doctors Fire up the Obamacare Waaambulance

http://www.slate.com/blogs/moneybox/2013/11/20/doctors_pay_under_obamacare_cut_the_whining.html

Doctors Fire up the Obamacare Waaambulance
By Matthew Yglesias

Medical doctors are highly paid professionals. They earn more money—a lot more money—than your average American. What's more, American doctors get paid more than doctors in any other country. Given how much of health care is financed either directly (Medicare, Medicaid, Veterans Affairs, public-sector workers) or indirectly (tax subsidy for employer-provided insurance) by the federal government, it's natural to make restraining doctors' income part of any program for making health care more affordable. So when you read stories about doctors whining that Affordable Care Act exchange plans don't pay them enough, please throw up a little in your mouth and proceed to ignore the doctors' complaints. The only practical reason to worry about low compensation for doctors in the ACA exchanges is it may cause them to boycott exchange patients. If that happens, the solution is to reduce doctors' payment rates elsewhere in the system. If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we've squeezed too hard. Until that happens, forget about it.

But also spare a thought for the journalists. The Affordable Care Act is a big deal. ACA implementation is a big deal. People should write stories about how much doctors get paid in ACA plans. But people who write stories on this subject without noting the yawning pay gap between American doctors and doctors in Canada, France, Germany, etc. are doing their readers a disservice.

What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were 30 years ago. But that's not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.

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

http://www.washingtonpost.com/business/economy/how-a-secretive-panel-uses-data-that-distorts-doctors-pay/2013/07/20/ee134e3a-eda8-11e2-9008-61e94a7ea20d_story.html

How a secretive panel uses data that distort doctors’ pay
By Peter Whoriskey and Dan Keating, Published: July 20, 2013

When Harinath Sheela was busiest at his gastroenterology clinic, it seemed he could bend the limits of time.

Twelve colonoscopies and four other procedures was a typical day for him, according to Florida records for 2012. If the American Medical Association’s assumptions about procedure times are correct, that much work would take about 26 hours. Sheela’s typical day was nine or 10.

“I have experience,” the Yale-trained, Orlando-based doctor said. “I’m not that slow; I’m not fast. I’m thorough.”

This seemingly miraculous proficiency, which yields good pay for doctors who perform colonoscopies, reveals one of the fundamental flaws in the pricing of U.S. health care, a Washington Post investigation has found.


6 replies = new reply since forum marked as read
Highlight: NoneDon't highlight anything 5 newestHighlight 5 most recent replies
Doctors Fire up the Obamacare Waaambulance (Original Post) jsr Nov 2013 OP
I don't know of any doctors who are... JimboBillyBubbaBob Nov 2013 #1
Writer of first article isn't all that careful. Igel Nov 2013 #2
Nothing new. Just the workings of the Amalgamated A.M.A. DreamGypsy Nov 2013 #3
AMA only represents 20% of physicians bossy22 Nov 2013 #6
he fails to note the cost of getting licensed to practice medicine in the US magical thyme Nov 2013 #4
Doctors also lose about 10 years of income making potential bossy22 Nov 2013 #5

JimboBillyBubbaBob

(1,389 posts)
1. I don't know of any doctors who are...
Sun Nov 24, 2013, 11:37 AM
Nov 2013

...working the prevailing business model who are poor. We all choose, through planning tempered with a bit of the capriciousness of fate at varying doses, work where we do, as a result of total experience to date. If they are struggling so, try another path.

Igel

(35,197 posts)
2. Writer of first article isn't all that careful.
Sun Nov 24, 2013, 12:05 PM
Nov 2013

One instance: We need to open the doors to medical schools to produce more doctors.

Record # of medical students this fall. Increasing numbers over the last decade.

More than 2k more graduates in 2010 than in 2006. #s have increased since then.

The problem is that medical school grads =/= new doctors. Med school grad has to become a resident. The number of internships and residencies has remained about constant for the last decade because of a projected surfeit of doctors in the US by now. So those med school graduates have to find someplace else to work or study because there's US-based path for them to reach being a licensed doctor. (Why no surfeit? More doctors leave the field. More reduced hours because of burn out or competing life goals. Greater demand. Lower supply + greater demand = greater pay. It's how unions work: They restrict supply artificially, thus boosting pay.)


We routinely bring in doctors from abroad. However I've known some doctors from abroad who did other things in the US. Why? Because the licensing requirements are fairly strict. If you have a family to take care of then you can't be retrained or study to pass the exams *and* feed those mouths. Not all countries have the same education requirements. Some countries' doctors have beefed up AA degrees--they're mostly reasonably trained practioners with fairly low skill levels and if there's a difficult case it gets kicked upstairs, if there's an "upstairs" in the area, to a better trained doctor.


I like nurse practioners. Sometimes they've just told me what was wrong and how to fix it. Other times they've been stumped and kicked me upstairs to the doctor. At other times they've consulted with a doctor. They're not doctors and while they're got at a lot of routine stuff and some non-routine stuff they're easily in over their heads.

I liken them to a friend's experience with a midwife. The midwife had training. Was cheaper than a doctor. And a homebirth was possible, something my friend really wanted for her 3rd child. The midwife mis-administered something to accelerate delivery. Because she wasn't authorized to work entirely alone but had to have a sort of sponsoring doctor with admit privileges at a local hospital on call, by the time the ambulance showed up and the EMTs managed to control the bleeding there was a bed waiting for her in an ob/gyn unit with a fully-fledged obstetrician. The paperwork in case of emergency was already prepared. While the midwife was with the family, the doctor was prepping a "landing site" for her and on the phone with the midwife. She paid for this service.

If not for the requirement that the midwife be hitched at the hip to a doctor, she'd have gone to the emergency room, hubby would have been besieged with paperwork as the triage nurse tried to route her to an emergency physician, who would then try to figure out what to do. Instead of having a doctor fully briefed when my friend arrived, they'd have had whatever the EMTs had told the triage nurse. There'd have been no continuity of care afterwards, if care had been needed--my friend nearly bled out.


I also like interns and fellows and strongly prefer teaching hospitals. Sometimes they know more than their sponsoring physicians. Sometimes they just explain things better. They have more time. And during the interchange between fellow and supervisor the patient learns a lot and can also intervene--"no, doctor, the fellow described it better." Doctors, just like the rest of us, tend to hear what they want to hear and believe what they think they hear.

DreamGypsy

(2,252 posts)
3. Nothing new. Just the workings of the Amalgamated A.M.A.
Sun Nov 24, 2013, 12:06 PM
Nov 2013

Phil Ochs wrote this in 1962.

We've divided up the sections of the body
Every day we specialize more and more
But we really love to stitch the diseases of the rich
We are sure there is a clinic for the poor
Hooray for the A.M.A
And for us doctors let's have higher pay
If you can't afford my bill don't you tell me that you're ill
'Cause that's the free enterprise way




The last verse of the song is dated and no longer reflects the options available to U.S. physicians:

And now the government is getting too ambitious
Yes, we know they want to socialize us all
Well our oath was hippocratic but with money we're fanatic
So we'll see you in Canada in the fall


Canada didn't adopt their publicly-fund, mostly free at point of delivery health care system until 1984. Phil couldn't predict the future.
 

magical thyme

(14,881 posts)
4. he fails to note the cost of getting licensed to practice medicine in the US
Sun Nov 24, 2013, 12:32 PM
Nov 2013

versus other countries, and the costs of setting up a private practice here. Until you factor costs in, you're in no position to sugges what is appropriate pay.

bossy22

(3,547 posts)
5. Doctors also lose about 10 years of income making potential
Sun Nov 24, 2013, 08:26 PM
Nov 2013

as compared to many people. Even if you went right into medical school out of undergrad you would still only get your first paycheck when you are about 25. Don't forget that medical school debt as well (on top of your undergrad debt). Yes, Doctors gross salaries are among the highest in the nation, but that doesnt tell the whole picture. Many young docs are caring a debt service load equivalent to a mortgage for a $400,000 house. Don't even start with sub specialists- many of who won't see a "doctor like salary" paycheck until they are well into their late 30's. In the meantime, they will have to support a family and a large debt load on somewhere between $50-70,000/year.

And when comparing doctors from different countries to the US you can't just look at the salary. For instance, french doctors gross salaries are far less than their american counterparts, but french doctors also have a significant tax exemption and much of their medical schooling is subsidized.

It's not only doctors leaving the country you need to worry about. It's more doctors just retiring and less medical school students. Pushing doctor reimbursements down will lead to a large amount of experienced doctors- those who are essential to teach young new doctors- to leave the field? Don't think it will happen- think again. As someone going through the process right now I know many of my attending physicians (Especially those that are closing on 60) have one foot out the door already thanks to all the increased crap that comes with fighting for reimbursements. You lose those doctors, who will teach the new ones?

If we are going to save money in the U.S. on healthcare it should not be off the back of doctors.

Latest Discussions»Issue Forums»Editorials & Other Articles»Doctors Fire up the Obama...