From: email@example.com(Steven B. Harris)
Subject: Re: Doctor-bashing
Date: 4 Mar 1999 06:20:07 GMT
In <firstname.lastname@example.org> email@example.com (George
> The average income of a MD still goes up at twice the rate
>of inflation. Some specialists have been losing, but others
>gaining. The average is still up, up and up. Even the AMA
It's not much of an admission, since the economy (U.S. GDP), in
constant dollars, is growing about that fast. Historically (this last
century), the slice of the larger pie produced by increases in
worker-productivity which the average US worker has gotten, has
remained about the same. If you don't believe this, you can consult
any standard Econ text, like Samuelson and Nordhous. I've happy that
doctors have done about average, at least, in that department.
Alas, the amount of money it costs to BECOME a doctor, in constant
dollars, has grown far faster than inflation, or doctor salaries, when
calculated in constant dollars. I started medical school with no
college debts (unusual-- I lived at home, worked, and had
scholarships). I finished med school having borrowed $37,000 over 4
years-- pretty close to 2 years of a resident's salary, and perhaps 8
months' worth of the salary of an internist starting in a good group
practice. That was considered an outstandingly low debt at the time (I
went to a state medical school on early acceptance, and got a resident
break in tuition. I could have gone nearly anywhere, but could not
AFFORD to). Some of my classmate threw caution to the winds, and were
in debt several times worse. Today, it's not uncommon to see med school
graduates with debts exceeding 5 years of their total salaries as
doctors in practice, which they won't START to make for at least 3 more
years. And these are people who are about 30 years old when that debt
hits-- just about the time you have kids too small to go to school, a
mortgage, and you really need the money worse than just about any other
time in life.
All in all, U.S. doctors now have it far harder than they did 15
years ago. If that kind of thing makes you happy, then be happy.
We're doing better than doctors did before the medicare bonanza
1965-1983 created the rich doctor image, it's true. But it's hard to
compare things with the 50's and early 60's since (as noted) the
economy has improved some since then. If you want to look at doctor
salaries you can't look at them year by year-- you need to look at
expected lifetime earning per minus education time/cost. And then
divide by total hours on the job per week. If you do all that in 1999,
the economics of being a physician for somebody who has the scholastic
aptitude to do it (or something comparable) frankly suck. The only
reason medicine gets so many applicants is huge amount of mythos, plus
the fact that it is a satisfying and interesting job (as jobs go).
Though nowhere as interesting as seen in fictional portrayals, of
If I had it to do over again, the next time around I'd probably be a
veterinarian, though, as I like physiology and I like animals. The
economics of being a vet are slightly worse, but the intellectual
challenge is at least equal (think of all the stuff a good vet needs to
know--God), and the opportunity to do varied things each day is
greater. And regarding salaries, I have a feeling the doctor/vet lag
won't always continue. There's something about fee-for-service that
keeps things pure, and wipes out a lot of the paperwork and nastiness
that happens when people put all their goods into one pot, and then
fight for their share of the resulting communal resources (a pathology
which breeds bureaucracy, inefficiency and waste, centralization and
authoritization, mismanagment and overmanagement, regulation, lawsuits,
and just about nearly everything bad one can say about employment-- not
for nothing does socialism ruin economies). The stuff noted about
doctors in cosmetic plastic surgery doing better than ever these days
is quite true. And the reasons are the same.
Steve Harris, M.D.
From: Steve Harris <firstname.lastname@example.org>
Subject: Re: fish oil beats statins for lowering mortality risk
Date: 29 Apr 2005 16:28:27 -0700
>>It's smart and correct if there are a ton of data which support it, and
virtually none that refutes it. This is how science is done: generate a
hypothesis and test it.
If you have evidence to refute the hypothesis that docs are primarily
money driven, let loose with it. Otherwise, I'll stick to this
evidence-based hypothesis. <<
Hey, you're the one with the "evidence-based hypothesis." I would say
burden to present the "evidence" is on you.
Salary is an incentive in medicine, but it's also an incentive in every
field of employment, and when you say "docs are primarily money driven"
do you intend to say that they are more-so than lawyers, engineers,
truck drivers, corporate executives, small business owners, and so on?
How would you tell?
Let me start you with a datum for your "evidence-based" collection. I
am not a surgeon by profession, but I have always had the highest
respect for them. I've done enough experimental surgery in research,
and participated directly in enough clinical surgery in both veterinary
and human medicine, to know how difficult it is. It's physically
uncomfortable. Physically it's terribly demanding. It requires great
manual and mental skill. Emotionally, it's draining. It's fully of
nasty surprises that cannot be controlled. When something goes wrong,
and something goes wrong regularly, it is among the loneliest and worst
places to be, in the professional universe. The responsiblity in the
clinical realm is enough to make the strong weak. You think it's bad to
have to tell Mrs. Jones you just killed her cat during a "routine"
procedure? Think of having to face a surgical waiting room full of
people with the same news.
Now, consider pediatric surgeons. They work, of course, on children.
There isn't much they do, that isn't *more* difficult than their adult
patient counterparts, and the extra physical smallness of what they
work on, is just the beginning of that. Think, for a minute, of the
extra emotional stakes. But uniformly in the US, pediatric surgeons are
paid less than their adult-patient counterparts. Sometimes far less.
(The reasons are simple-- children don't have money, and their parents
are young and at the lower end of the economic scale). So why do
pediatric surgeons even *exist* as a subprofession in medicine, given
your hypothesis?? If you think pediatric surgeons are failed adult
surgeons, you're provably wrong. So that's out.
Over to you.
From: "Howard McCollister" <email@example.com>
Subject: Re: 100 Years of Medical Robbery
Date: 14 Jun 2004 12:13:06 -0500
"Beachhouse" <firstname.lastname@example.org> wrote in message
> Bottom line: there is no conspiracy. The competing problems of physician
> undersupply, overcrowded hospitals, overpriced medications, and older and
> sicker patients, and attractive and expensive technological "goodies"
> require a hell of a lot of thoughtful and reasonable debate. This article
> offers nothing new.
You forgot the very significant concept of rapidly increasing expenses and
rapidly declining reimbursement from third-party payors. This results in
substantially decreased incomes for physicians. All of these factors
substantially augment the physician under-supply problem, and the
inequitable geographic distribution. They are also a major cause of the
maldistribution of specialties - fewer medical students want to work that
hard for an income that they could achieve in a wide variety of different,
less stressful careers.
Who wants to go through 8-or more years of post-college education, rack up
hundreds of thousands of dollars in debt, take a job in a small town without
even a movie theater, work 80+ hours a week, have huge and increasing office
expenses, pay $100,000 a year in malpractice expenses and make $80,000 to
$100,000 per year? And be entirely at the mercy of the federal government
and Blue Cross/Blue Shield et al. I can think of dozens of jobs where that
kind of educational investment and that kind of work week would net far more
income and far less stress than that.
From: "Howard McCollister" <email@example.com>
Subject: Re: MD Wants Pain And Suffering Cap ... Except When He's Injured
Date: 25 Apr 2004 22:38:09 -0500
On Sun, 25 Apr 2004 22:10:05 GMT, "Bryan" <firstname.lastname@example.org>
> >What would he do if they put caps on what he and the rest of the medical
> >community could charge? He'd probably really whine about that.
I assume this is a joke.
Medicare has put caps on what MDs can charge for many years now. As to
private insurance, they don't cap what the doctors can charge, only how much
they will pay them. Doctors can charge private insurance whatever they want
but the insurance companies will only pay what they feel like. And by the
terms of the doctor's contract with that company, they can't bill the
patient for the balance that insurance doesn't cover.
Doctors' fees are most definitely capped.