I’m the patient concerned.
I assume the doctor knew two things:
The treatment was intensive anti-biotics for several days followed by another couple of days in hospital to check all was well, so it was much better that I had time to pack a bag (there was Wifi at the hospital, so I could send + receive e-mails etc.)
It’s jolly good that you have found a job with that benefit and have made up the rest yourself.
But surely most Americans can’t get that level of insurance?
By “giant corporation” you mean hospital or medical facility? If so, yes the doctor isn’t happy because he isn’t part of the triangle (hospital management/insurance company/employer) that has a say in prices or billing.
But he, the doctor, can open a private clinic and decide his own pay rate.
Median household income in the US is around $65,000. Here are costs of health insurance depending on age and family size:
A family with 3 kids, per that page, might be paying around $20,000 a year for health insurance. That would be a massive sum for an individual to pay per year, the average plan would cost about half of that even for someone in their 60s (and that’s a private plan, someone that old might be on Medicare).
Here is some info on the cost of an ambulance:
As you can see, it’s pretty complicated. But let’s say your plan has a deductible and you’ve already met that for the year. Your ambulance ride might cost you nothing, and you then owe a copay between $100-200 for the ride. So it wouldn’t be all that unusual for someone to pay what doreen paid for an ambulance ride, or even less. Again, depending on multiple circumstances.
Overall, I’d say “yes”, the average American can get that level of insurance. That’s not the issue though; the issue is the burden that paying that insurance costs the average American. Again, going by the numbers, a family of 5 making a median income could be devoting around 1/3 of their gross income toward health insurance. That’s an awful burden.
Sounds close to typical for most decent sized companies, to be honest.
Usually the employer covers most of the cost but that level of premiums is not out of line with many policies depending on circumstances (family size, policy, state - and yes, this can vary from state to state as well).
So, um…yeah. Our health care system has issues.
Or rather, we have a ‘health care insurance’ issue more than we have a ‘health care’ issue.
American doctors make a lot of money.
In most first-world countries, being a doctor is a comfortable but not particularly lucrative middle-class job. The only rich doctors are people like hospital department heads or superstar surgeons. For American doctors over a certain age, though, rich seems to be the default.
I have a friend who is a dental surgeon in solo private practice. He has a nurse anesthetist, a nurse and a business manager (his wife who is a qualified doctor in another country). He sometimes hires temp nurses.
He bills over $3M a year. I’m sure he clears half that. He does not “decide his own pay rate” as most of his patients are in various network plans which are a take it or leave it proposition. He leaves a lot, so in a sense he is deciding, but this is after 15 years in private practice.
He owns two entire apartment buildings (over 100 rental units). He complains constantly about his malpractice liability insurance, which is in five figures. He also complains about tenants rights, property taxes, income taxes, permitting, etc. and how much his property managers are charging him for how little they do.
I suspect his wife is his business manager because no outsider would get involved in his “aggressive coding” practices. So yes, if you want to maximize your income private practice is the way to go.
Yes, I’ve posted about this on these boards before. I have doctors all over my extended family. The ones in UK, Canada and Australia I’m guessing are around the 75th percentile of income, maybe even 90th percentile.
The US and Pakistan ones are in the top 1% easily.
I really don’t know if most can get that level - but when I was working, I paid only about $6000 a year toward my premium and my employer paid the rest. My employer contributed different percentages depending on pay grade and whether you had individual or family coverage and of course, the total premium for individual coverage is lower - someone with individual coverage in a lower pay grade would have paid $1300/yr for the same coverage
I can’t help but think we’re talking past each other in some way - because while I assumed you weren’t in immediate danger ( as I don’t think the doctor would have sent you home to pack if you were) , I don’t understand the need for an ambulance to pick you up rather than a friend/relative/taxi taking you to the hospital. You weren’t under medical attention for the hour or so that you waited for the ambulance and I can’t imagine that you would have needed it for the ride to the hospital after being without it for that time. Unless “ambulance” means something very different to you than it does to me - to me, it involves emergency vehicles with paramedics or EMT’s that provide pre-hospital care and respond to car accidents , heart attacks etc. . Non-emergency transports don’t involve trained medical staff and are referred to as either “patient transport services” or “ambulettes”. These services might be used to take someone being discharged from the hospital to a nursing home or someone from a nursing home to a dialysis appointment. Which sort of service are you talking about?
That’s going to depend a lot on specialty. The lowest number I found for the top 1% was 500K - and a lot of pediatricians and family practitioners earn less than that. They aren’t by any means poor - but they are closer to top 5% than top1%
The average salary for a general practitioner in the UK is around $80,000. The fact that some family practitioners in the U.S. make more than $500,000 just shows how much money is changing hands in the American medical industry.
Family practitioners? I doubt many at all make that much in the US.
That’s one (among many) of the issues in the US system. It’s mainly certain specialties that make the big bucks, and general practice and internal medicine are far from those. It creates a perverse incentive so that the ones who are the most critical for regular care and health maintenance are the ones who are either unable to get into those specialties or have deliberate chosen to forgo significant lifetime income.
It’s possible there are some GPs in well-heeled communities pulling in that kind of money, but they would be far and away the exceptions. And even there, I kind of doubt they’d make a lot - they’d still have to negotiate fees with insurance companies or be ‘out-of-network’ and hope their patients are willing to pony up for their services. That might be possible for general dentistry, which is covered separately, but it’d be a tough sell for GPs or internists.
PCPs might be in the $200k to $300k range depending on cost of living. I don’t think too many are in solo practices in urban and suburban areas. Maybe in very rural areas.
Specialists would be more north of $300k on average, some specialties much higher. Many of them may be in solo or small practices “with privileges” in hospitals and medical/surgical centers. That’s where a lot of the surprise billing used to come from.
No problem - our countries have very different health systems, so some explanation may be needed.
I was taken in an (emergency) ambulance with trained medics on board (they had equipment like defribillators and oxygen.)
They were very reassuring on the trip!
When we got to the hospital, they accompanied me in to reception and I effectively ‘jumped the queue’ with my life-threatening condition.
(This last would not have been available if I had turned up in a taxi…)
As I say, I assume my doctor knew I would be OK for at least an hour or two - and that there wasn’t an ambulance available immediately…
Since we don’t know and don’t have medical backgrounds, I propose we stop making assumptions and guesses.
I once had a long conversation with my GP about this. He was about to move out-of-state, and I was bemoaning the fact that it was hard to find a GP. In addition to the significantly lower income, he mentioned the lack of prestige and said the problem was only going to get worse, as there were fewer medical students going into general practice.
Insurance in the US is much the same regarding vision coverage. Employers may offer optional vision coverage, at your own cost, that basically gets you a free eye exam every year, and a substantial discount on glasses (or free, if you go for low-end ones).
Interestingly, when I see my ophthalmologist, refraction (“which is better, 1 or 2?”) to determine your glasses prescription may or may not be covered - they always make me sign something saying I know I may have to pay for that part. Except, it’s genuinely medically necessary to screen for some medical conditions (like, to follow up on whether my cataracts were worsening, or to diagnose other evolving issues).
My attitude has always been that my GP should be my first line, for practically anything, and should manage most of my stuff with appropriate outside consults as needed.
One of the ways GPs manage, around here (I’m in a very high-rent area) is going concierge. They limit their patient roster to, say, 1000 patients - each of whom pays several thousand dollars a year just to be allowed to be on their roster. That does NOT pay for office visits etc. - it’s a million bucks on top of whatever the doctor gets from regular billing.
Wow. So people pay thousands per year just to be on their patient lists? That’d make GP careers more profitable, but the idea that GP’s would essentially limit their practices to the wealthy is depressing. The GP I referred to earlier was wonderful about calling the various specialists I was seeing and coordinating my health care, but he was also humble enough and wise enough to know that he couldn’t possibly manage my lupus or my complex eye issues. I doubt he’d have gone for the concierge idea, but if he had, I certainly couldn’t have afforded it.
I wonder if the concierge approach is the future of healthcare. I sure hope not.
The New York Times had a great article about concierge health care – the ultimate in economically discriminatory health care …
Ouch!!
I don’t know if there are practices like this in the DC metro area. There ARE enough moderately-well-heeled people in the DC area that in some places, it’s quite tough to find a primary care doctor who has not gone that route, and the typical annual fee is semi-affordable (1800, last I checked, though I’m sure it’s gone up). We could likely come up with that if we absolutely had to but it would hurt.
I’ve actually started threads on this topic in the past. Once in 2007 when my then-primary doc was considering it; she did not make the jump then, but did in 2011.
We went to another practice - two brothers who had set up together. It had been recommended by the former doc, as well as my gynecologist. It was pretty much the only practice anywhere nearby that had not made the jump. I wound up with brother A, my husband wound up with brother B - just luck of the draw when we each made an initial appointment.
3 years later, THEY made the jump. Except then brother B decided to stay non-concierge. Strange. I probably could have gotten switched to his caseload but I was pissed. My gyn had commiserated and suggested that larger practices were less prone to that.
So I actually found someone who was new to our area (but had rave reviews in her last town), and was part of a medical group run by one of the big hospital consortiums (consortia?) in our area.
4 years later, she moved to NY! I tell people “I’m beginning to take this personally!”. I wound up with another doctor in her office.
It’s been about 4 years now. I wonder when the “new” one is going to move to Mars or something!