What does God need with a paycheck?
From this site:
As an employed PCP on a salary, I’m expected to bill for 3-4 times what they pay me. This is partially to cover my share of the overhead and partially to cover the fact that we never actually collect a lot of what we bill for.
The stereotype of the doctor is that he drives a Mercedes and closes his office on Wednesday afternoons to play golf. Most of the PCPs I know work late five days a week plus a few hours on the weekend to catch up on paperwork and drive relatively new Hondas. It’s a good living, but it’s far from rich, especially early in a doc’s career and really especially if he has loans to pay back.
That said, there are a lot of whiny docs out there who feel like $150K doesn’t offer the station in life they deserve, so they either constantly bitch about not making enough money or work themselves into the ground to make more and bitch about that. It doesn’t help that doctors are notoriously awful money managers, so they often try to live the upper-crust lifestyle they think doctors are supposed to live despite their upper-middle-class income.
How do I use multi-quote? I click it and it turns red and that’s it…
My general response to this post is, frankly, so what? It took you 10 years to pay off your college? That’s the avg length of college loans, or in the event that you can’t afford the full monthly payment right out of college (like me) you consolidate and stretch it out over a 25yr loan (like a dummy/me) in the hopes you’ll be making more money in a few years and will be able to make extra payments and get out from under your college debt sooner. Alot of doc’s that work at hospitals have significant tuition reimbursement (which is not PCP but it’s there as a choice). Hell, my sister got out of Pharm school and was offered a job as a Capt in the AF with student loan repayment AND a $40k signing bonus AND $15k/yr bonus for only a 3 yr commitment. I was a 1Lt at the time with 15yrs of service. That made me grumpy…lol.
Anyway, the point I’m making is that most professionals that I know work 50-60hrs a week and make an income less than docs do and they still have alot of career debt like school and accredidations etc… to work off. Docs aren’t special in that regard.
And not turning a fever into a multi-thousand dollar science experiment so you can make more money doesn’t make you a better doctor, it just shows you have integrity to do the right thing when others probably aren’t looking.
Also, I think the article does show a little bit of entitlement expectation as he feels he should be getting more money for doing the right thing. None of us are entitled to more money for doing the right thing. Why should doctors be?
Red-select all the posts you want, then hit the POST REPLY button above and to the left of the Quick Reply box.
Ah, I thought multi-quote meant I could quote different pieces of the same message, not multiple posts. Thanks.
Well, if you want to break up someone’s post so you can respond to individual points, you’ll have to manually add the {quote}{/quote} tags (albeit with square brackets). For example:
When you reply, you’ll get a text box that looks like (again, the curly brackets will be squared):
{quote=somebody} observation 1. observation 2. observation 3.{/quote}
If you want to interject, you’ll have to add new tags (presented here in boldface):
{quote=somebody} observation 1. {/quote}
Your observation 1 is retarded!
**{quote}**observation 2. {/quote}
Your observation 2 obviously lives at home with his parents!
**{quote}**observation 3.{/quote}
Your observation 3 is the product of too much freebased monkey-cum!
This will look like:
Your observation 1 is retarded!
You observation 2 obviously lives at home with his parents!
Your observation 3 is the product of too much freebased monkey-cum!
Anyway, practice and keep using the Preview function until you get it right. If you want to name the source of a quote (important if you’re quoting multiple people, else confusion sets in over who said what), be sure to put “=(source name)” in the tag.
I learned long ago the short answer to this sort of reasoning is: “Yes, it is a pretty good deal. Now go be a doctor.”
What I noticed was how many people suddenly came up with an assortment of reasons it wasn’t for them. But hey: it’s not a closed profession. You think it’s a sweet deal? Take a shot at it. Hurry. There’s many a day I wish I had just gone over to Wall Street and made a fortune there. Beats working. I had friends who were done with their money-making before I started mine.
You’re ignoring the value of money over time. Doctors (as far as I’ve been informed) sacrifice a good 6-8 years of significant income after graduating from their undergraduate programs, a 401k (or other retirement account) and all of it’s investment potential, etc, while in med school and residency (at least, I don’t think most residents get a 401k).
-
Cite the significant tuition reimbursement for MDs/DOs. The only programs I’ve heard that do this are the military and for those phyisicians which contract to work in underserved/rural areas.
-
Wasn’t the point of the article focused on the PCP’s situation, and not the general hospitalist’s, in the first place?
The military is a great option—assuming you’re not openly gay at any rate–but it has it’s flaws. And to reiterate Chief Pedant’s point, what’s stopping you from doing this if it’s such a fantastic deal?
Indeed, they aren’t. The cost and amount of education is only one factor, not the whole picture here (liability and it’s resultant insurance costs, continuing education, workload, etc all playing a role).
Here’s the problem, though. Your doctor can’t absolutely know. Your fever may be more likely to be the common flu, but he can’t absolutely know it’s not meningitis without the very expensive tests. Statistically, the odds are better that it IS a cold or the flu, but without the expensive, extensive tests, he can’t be sure. He can, however, using a history and physical examination, make a reasonably assured best guess, but he doesn’t get paid (usually) to take the time to actually gather all of the facts. He gets paid (typically) on a volume of patients seen basis. And that is the factor the doctor in the link in the OP is lamenting.
Let me just give you the realities of the primary care market. You can’t see a patient every 10minutes and practice good medicine. I could (like many doctors) see a patient with back pain in 10 minutes by looking at his back and handing him a slip for the MRI he is requesting. Or I can spend 15-20 minutes explaining why he doesn’t need an MRI, going over back exercises and conservative treatment, only for him to ask as he is leaving “So you aren’t going to let me have an MRI?”
Let’s also look at the numbers. If I work my absolute hardest I can see 100 patients a week. I average $60 in reimbursement for each patient. Let’s say I take no vacation except the 10 federal holidays. I don’t get time off or extra pay for working weekends. That’s 50 work weeks at $6000 a week, or $300k a year. It sounds good, no? However, you forget that I have to pay staff salaries, rent, utilities, malpractive, health insurance, supplies etc etc. Nurses can make $50-60k yearly. My overhead runs $200k-$220k yearly. Do the math. If I take no vacation ever, I’m lucky to net $100k. Now if I order an EKG with every physical or with every patient who has chest pain, I can make $35-40 for each one. No wonder so many cardiologists do an EKG on every visit and no wonder they are so well paid. It’s a constant struggle if you want to practice good medicine. As they say, it takes three seconds to write out an antibiotic prescription and 20 minutes to explain to a patient that he has a cold and that antibiotics are not necessary.
Also, it’s very easy to say that your doctor only spends 10 minutes with you, but are you counting all the time spent writing or typing in the chart, filling out referral forms, writing prescriptions, consulting with other doctors, reviewing lab results and deciding on a plan of care, and talking to you on the telephone? None of that is paid any extra.
Some days you just want to give in and do the easy thing which is to give the patient what he wants (more tests!), run patients through your office like an assembly line, and make a patient come in for every little ache and pain, because you see, you get PAID for that. You get the same amount for taking out a splinter as you do for seeing a 90 year old lady with heart failure, kidney failure, diabetes, and high blood pressure, who has just noticed blood in her stool and by the way she is getting short of breath every time she climbs the stairs and her left elbow hurts if she twists it the wrong way and while she’s here could you look at this mole? If it were you, and you had 15 minutes to see a patient, which one would you choose? There’s a reason few doctors want to take medicare . (Oh, and you can tell the little old lady to make an appointment for each of her problems but she doesn’t have transportation because you wouldn’t let her drive, and her kids can’t just take off of work every week to chauffer her around and she can’t afford a taxi.)
I’d be delighted to respond to the OP, but I’ll need my $500 fee up front.
This bears repeating.
I have been annoyed from the patient side of things by the tendency to defensively order tests that are “objectively” not needed - like the time I showed up in the emergency department with a classic presentation of a temporary neurologic complaint requiring no workup besides a competent physical exam - and got referred for a CT of the head - because the ER doc was covering his butt in the extremely unlikely event that more serious pathology was involved.
There are also many situations where ordering tests does not make you money. As a pathologist it doesn’t seem like I should request expensive immunostains on a case when the diagnosis is a slam dunk with regular histopathology. But I can’t expose myself and my colleagues to a potential suit if what I’m facing is a rare mimic of the condition I think I’ve diagnosed.
Patient expectations and “the standard of care” are major drives towards expensive and sometimes unnecessary tests.
I don’t think I feel a huge sense of entitlement as far as income goes. When I started out in radio years ago I got paid $550 a month (I did get a $50/month raise after 3 months, which felt like big money). Even though insurance reimbursements have been dropping what I get now is still a big improvement. And I work at least 6 days a week, about 70 hours on average.
Cubsfan, I get that you resent that doctors both feel entitled to a decent income and often actually do earn more than the nation’s median. What I do not get is why you think the lament you linked to has anything to do with that.
That Family Practice doc is whining that his quality work - spending the time that it takes to do the best job possible - is not recognized monetarily.
He’d be paid more if he did a shitty job and ran through rooms quickly ordering more tests without thinking much and bringing patients in for multiple visits. Some do.
He’d be paid lots more if he had chosen to go into a procedure intensive specialty.
Some could say: Oh well. Tough shit. You chose your specialty. If you wanted to make more money you could have avoided primary care. And the thing is that such is what new docs do.
I also do not get this:
Huh?
No jobs are set up to reward good performance? No jobs are set up to reward quality work done?
Really?
I thought the deal was that you choose what you want to define as quality and reward those who achieved it more. You expect workers will work to follow the money. And this doc’s lamentation is that the work being rewarded monetarily, implicitly being defined as “quality”, is the mindless ordering of tests and the performing of procedures. Using judgment and wisdom is, by the monetary compensation metric, not “quality”.
What a surprise that you sometimes get what you incentivize.
Mind you I have no easy fix for that. (Some ideas to address it could take up several additional threads.) But I understand the lamentation.
As an aside - it seems a bit weird to me that some docs are looking at successful classmates/contemporaries who went into the business world as income benchmarks, and feeling resentful that those people earned more in a lot less time.
From what I’ve seen, most physicians would have had a terrible struggle making it as business executives and entrepreneurs. The poor handling of money by MDs is legendary (especially when it comes to investments). Some of this stems from lack of time to properly investigate where they put their dough, but I think a large number simply lack the aptitude and interest that would’ve been necessary to become financial whizzes.
I have my retirement funds safely tucked away in a tapioca mine.
Cubsfan, how much are your malpractice insurance premiums?
Sing it, bruthah. That’s what I do for a living - being their business sense. It ain’t an easy job, and I make about 1/10 what they do. In my experience, a lot of them would actually be pretty good business managers if they could just curb their arrogance and admit they are indeed, not gods OR know-it-alls. 
Well sure, because that’s not what they devoted their training and career to. In terms of raw IQ however the two are comparable; at least when looking at my medical-student and pre-ibanking friends.
(Originally Posted by **Jackmannii ** )
*As an aside - it seems a bit weird to me that some docs are looking at successful classmates/contemporaries who went into the business world as income benchmarks, and feeling resentful that those people earned more in a lot less time.
*
I think any professional has occasions when the grass looks greener on the other side…that’s human nature.
I was making the point above that the physician’s peer group is not all comers; it’s the cream of the crop, which is your point here, I think, athelas.
The number of doctors is artificially held down to keep them in demand. Med school does not have to cost that much. The overprice almost forces doctors to become specialists and live in bigger cities. Medical schools are part of the problem.
A kid I play racketball with is going to have to wait a year to get in. He has great grades but just missed the cut. They offered him a job in a lab to help pay the costs next year.
Do you have any support for that claim or did you just have a colonoscopy and that is what got pulled out of your ass?