Do physicians have an unusually high sense of financial entitlement?

[Jackmannii]

@athelas

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.

IQ isn’t everything, at least when it comes to being a financial whiz.

“If you’re so smart, why ain’t you rich? Haw!”*
*traditional American anti-intellectual put-down.

[gonzomax]

@DSeid

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?

No college has to cost that much. Colleges are going up in cost every year, well past inflation. In Michigan , which is in a depression, schools go up 10 to 20 percent every year. In Jan. we announce the jumps in tuition rates. Always a jump. Last year with the economy being in the dumps, I thought they would hold the line ,but nope. Tuition jumped again.
Tuition hikes at Michigan universities demonstrate need for reform – Michigan Education Report (2005-03) – Mackinac Center For example.

[msmith537]

@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.

What is weird about it? An MBA from a top 10 business school can (or used to be able to) go to work on Wall Street as a trader or investment banker and be making six figures within a few years, if not immediately. Meanwhile your medical doctor after like 8 years of schooling has to deal with malpractice insurance, HMOs and whatnot and I don’t think they get paid that well initially.

@Jackmannii

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.

In all fairness, most investment bankers would probably have a tough time being heart surgeons. Not having a medical education and all.

@Jackmannii

IQ isn’t everything, at least when it comes to being a financial whiz.

I think what **athelas **is saying is that the intellectual and academic requirements to be a top medical doctor are roughly equivalent to being an investment banker.

[DSeid]

@gonzomax

No college has to cost that much. Colleges are going up in cost every year, well past inflation. In Michigan , which is in a depression, schools go up 10 to 20 percent every year. In Jan. we announce the jumps in tuition rates. Always a jump. Last year with the economy being in the dumps, I thought they would hold the line ,but nope. Tuition jumped again.
Tuition hikes at Michigan universities demonstrate need for reform – Michigan Education Report (2005-03) – Mackinac Center For example.

So it is your belief that these schools are overcharging and that some deans have some big off shore accounts?

Yeah. You just had a colonoscopy.

[gonzomax]

@DSeid

So it is your belief that these schools are overcharging and that some deans have some big off shore accounts?

Yeah. You just had a colonoscopy.

Yes, I believe colleges overcharge. I think the fact that they outstrip inflation is wrong. I think they are one of the reasons in our future the distinction between the have and have nots will just get worse and worse.
As for off shore banking, here is UBS, one Swiss bank with 4500 American hiding assets.
http://www.connpost.com/ci_13228524?source=most_emailed
Get someone to read it to you. And remember Swiss Banks, Cayman Island Banks and many more countries hide foreign assets for their customers.

[CrazyCatLady]

@msmith537

Meanwhile your medical doctor after like 8 years of schooling has to deal with malpractice insurance, HMOs and whatnot and I don’t think they get paid that well initially.

They certainly don’t get paid that well initially. Average pay for a resident is about $35-$40K, and it doesn’t really go up much in higher cost of living markets like LA. To put it in perspective for you, when DoctorJ began his residency, he was making $5k a year more than a friend of mine who had been a tech in a rural Kentucky hospital for 4 years and about $8K less than the friend who had a BS and had been in IT for 4 years. That was the year they enacted the new work hours rules for residency programs, the ones limiting residents to 80-hour work weeks.

Granted, we weren’t exactly tottering down the road to the poorhouse–I was working, we were in a relatively inexpensive area, we don’t have kids, and it’s not like we had the time or energy to really travel or spend a lot of money shopping and such. But the fact remains that he had lawyer-level education and was working lawyer-level hours, and getting paid lab tech-level money.

[msmith537]

@DSeid

So it is your belief that these schools are overcharging and that some deans have some big off shore accounts?

Yeah. You just had a colonoscopy.

Well, I don’t know about the offshore accounts stuff, but I think the tuition rates for colleges in this country are getting a little steep. There is a very real danger IMHO that the huge discrepancy in career opportunities, graduating income, lifetime income and education costs between the top 10, the next 50 or so schools and all the others will create a very real class system, if it hasn’t done so already.

[DSeid]

The question is not whether or not college tuition, and in particular, medical school tuition rates are steep, nor is it how deleterious to society those rates are. The claim has been made that they are artificially set so high, significantly above the true cost of providing the education and running the institution.

A pretty serious charge to level with zero to back it up.

In point of factphysician supply has steadily increased because of federal input. The link also brings this back around to the op’s linked Family Practice doc’s lament.

incentives were given to medical schools to increase their number of medical students, and to hospitals to subsidize residency training.

Since 1960, the number of allopathic (MD) and osteopathic (DO) medical schools has increased from 86 to 141, and the total enrollment has increased from 30,000 students in 1960 to over 70,000 in 1994. (COGME)

Presently, the federal government pays hospitals approximately $70,000 per year per resident that they train (average resident’s stipend: $31-38,000). …

… Between 1960 and 1988, the number of physicians in the United States more than doubled from 250,000 to 650,000. Initially, it was hoped that increasing the total number of physicians in the United States would increase the number of practicing generalists who would provide primary care to the majority of Americans, particularly by serving in underserved areas.

Yet, while the total number of physicians has doubled, the proportions of generalist and specialist MD physicians have changed from 50% generalists and 50% specialists in 1961 to the present proportions of 28% generalists and 72% specialists. When ob/gyn and emergency medicine physicians are included in the generalist definition, the ratio is still 32% primary care to 68% specialists. This decline in the percentage of generalists is likely to continue, as the amount of allopathic medical students expressing interest in generalist medicine in 1991 and 1992 fell to 17% of U.S. medical graduates. (COGME) …

… Some of the factors leading to the increased number of specialists include: higher financial compensation for specialists, decreased prestige for generalists, medical training based in tertiary care centers, decreased exposure to generalist role models, and (for physicians practicing in rural and underserved areas) relative isolation from technology and peer support.

A study by Schroeder and Showstack described how primary care internists, while limiting charges to those allowable under Medicaid, could triple their annual income by providing common laboratory procedures in the office; although they would not be able to treat as many patients. (Schroeder S.A., Showstack J.A. Financial Incentives to Perform Medical Procedures and Laboratory Tests: Illustrative Models of Office Practice.)

Hsiao and Stason demonstrate that a surgeon receives three to seven times more money per hour for time spent in the operating room than for time spent with patients or in consultation. (Hsiao W.C., Statson, W.B. Towards Developing a Relative Value Scale for Medical and Surgical Services. Health Care Financing Review, Fall 1979: 23-28.) …

… our country’s specialist-centered system has also contributed to the high cost of medical care, the discontinuity of individual care and the shortage of physicians in rural areas.

For a specialist-centered model of care to flourish, specialists must work in metropolitan areas where they have a large patient base. As a result, both the number of specialists and the total number of doctors concentrated in metropolitan areas have continued to grow.

Care provided by specialists is more expensive than similar care provided by generalists. A study conducted by Welch and Miller et al. concluded that geographic distributions in physician costs did not relate to the percentage of inpatients vs. outpatients, the number of diagnostic studies conducted, or the severity of patient illness; instead, physician costs related to the percentage of specialists vs. generalists in a given area. (Welch, W.P., Miller, M.E., Welch, H.G., et al. Geographic Variation in Expenditures for Physicians’ Services in the United States. NEJM, 1993; 328: 21-27.)

Residents of low-income areas in Washington, D.C., who often do not have access to primary care physicians, are hospitalized three times more frequently than people in high-income communities for asthma, diabetes, high blood pressure and many other conditions that can be treated with routine medical care (Washington Post, August 1, 1994.)

A good generalist spending the time and moreso, the intellectual energy, to think about a specific patient and the specific circumstance will save the system money while improving the overall quality of care. But they will not be paid for that.

[DSeid]

Another article explaining why there is a shortage of primary care docs despite there being a quite adequate supply of docs overall. In other words whereof the op’s doc is right.

At least 56 million Americans, almost one in five of the population, are now “medically disenfranchised”—having inadequate access to primary care physicians because of shortages in their area … Among Medicare beneficiaries, about 3 percent—more than 1.3 million people—have difficulty finding a new primary care physician, a government survey found last year.

As the population ages, with the first wave of the nation’s 78 million boomers due to turn 65 in 2011, experts say the shortage of primary care physicians—those trained in general internal, family or pediatric medicine—is already a crisis. It’s a factor that’s often overlooked in the growing demand for universal health care. “Ensuring everyone has health insurance without ensuring them a regular source of primary care,” the “Access Denied” report warns, “is like providing currency without a marketplace.” …

… So where have all the doctors gone? “The pickle we’re in is that [primary care doctors] of my generation are stopping practice early and the young people are not choosing it as a profession,” says Jeffrey Harris, M.D., president of the American College of Physicians, which represents 126,000 internists. “To say that primary care is collapsing is not hyperbole.”

The reasons why primary care doctors are retiring early and new doctors are not replacing them are pretty much the same, Harris and other physicians say. Their earnings on average are half or a third of those of doctors in many specialties, yet their workdays are longer and their overhead higher. Hours spent on paperwork and phone calls for prior authorizations demanded by insurance companies reduce the time spent with individual patients—so does the pressure to take on as many patients as possible to stay in business. New medical school graduates realize this: The number going into family medicine declined by more than half from 1997 to 2005. By 2006 only 13 percent of first-year residents in internal medicine said they intended to pursue it in general practice. …

… Because fees are fixed by Medicare and insurers, the only way primary care doctors can generate revenue is to take on more patients, which means spending less time with each—often no more than 15 minutes. “The commonest complaint you hear from patients is: ‘I don’t have enough time with the doctor,’ ” says the ACP’s Harris. “They’re right. You can’t take good care of people with chronic conditions in 15 minutes.”

A recent ACP study compared the U.S. health system with those of 12 other countries and analyzed why the latter had better medical outcomes for far less funding. “The take-away message,” says Harris, “is that systems with primary care as a cornerstone are less expensive and have better quality.” The American system needs new strategies, he says, starting with medical school training, which currently favors overspecialization. Among many proposals for improving the situation is forgiveness of medical school debts for graduates who go into primary care, restructuring the way those doctors are compensated and, above all, establishing “patient-centered medical homes.”

The point of a medical home is for patients to have an ongoing relationship with a personal physician who leads a team that coordinates care. The approach would allow more time for patients, especially those with multiple chronic conditions. The doctor’s compensation would be tied to meeting certain standards and bundled into a “care coordination” fee for each patient. Patients would be able to ask questions by e-mail or phone and schedule appointments on short notice.