patrick.net

Do obese and 'skinny-fat' IM doctors who do not engage in consistently tell their patients to do resistance training and to avoid obvious food choices (soda).

Most times after a blood test revealing high blood sugar, the average primary care doc will say "we have to keep an eye". The RESPONSIBLE doctor, treats a prediabetic like they've already got diabetes by strongly promoting diet and exercise. Alas, so few of those in the primary care industry.

Which doctors even know about vitamins and nutritional supplements? How much are they taught about it in biochemistry? Jack and Jack

MMR says

Which doctors even know about vitamins and nutritional supplements? How much are they taught about it in biochemistry? Jack and Jack

I think the training here involves something other than just making the rounds at a hospital.

For instance, growth hormone secretion is countered by insulin spikes. Thus, for a person to gain the best GH secretion in his sleep, he needs to be a least 3+ hours removed from his prior meal. This is more important than worrying about a sugary donut or waffle, for breakfast. Thus, my mother has now, made breakfast/lunch her largest meal of the day. For dinner, it's basically a half portion of meat and vegetables. She also takes an R-LA pill, with each and every meal. End result, she wakes up refreshed, each and every day & has her diabetes under control.

Homeboy says

A typical wage earner could work for 30 years and still in their entire life, not make anywhere close to what an NBA player makes in a single year.

Keyword here is "typical". How many millions WANT be in the NBA and never make it? It doesn't always look like it, but these are the very best of the very best of the very best. They work from childhood, really, uncompensated and achieve greatness.

Think of it as deferred compensation, and of how many entertain us for next to nothing or nothing.

CL says

Homeboy says

A typical wage earner could work for 30 years and still in their entire life, not make anywhere close to what an NBA player makes in a single year.

Keyword here is "typical". How many millions WANT be in the NBA and never make it? It doesn't always look like it, but these are the very best of the very best of the very best. They work from childhood, really, uncompensated and achieve greatness.

Think of it as deferred compensation, and of how many entertain us for next to nothing or nothing.

I think the way to break this down is this ...

NBA = immediate millionaire to multimillionaire status
European/International leagues = quarter of million to millionaire status
All other semi-prof B-ball clubs = secretarial to junior engineering salaries

Thus, if you exclude the NBA, a.k.a the Monied David Stern Club, 90% of basketball players get paid like every other group of performing artists out there. This is not too different from being a member of an elite rock group (i.e. Metallica, U2, Beatles, Aerosmith) vs playing in your local town's music club, which pays some $100-$200 per gig, which is why music is generally considered a hobby by most persons out there.

Therefore, how much an NBA player gets paid is not relevant to the argument of whether or not they get paid too much. It's Stern's entertainment company and if one doesn't like it, then go watch one's local YMCA leagues duke it out.

Likewise, let's boycott U2 shows and album/mp3 releases, shrink their fan & advertising base, since Bono, Edge, and Clayton don't deserve to be millionaires over a guy who plays out in his hometown's school gymnasium. I mean that's the essence of homeboy's argument.

That's wonderful, I wish I had such compliance with my own mother. Still I managed to get her to reduce her metformin by 50% and she has been exercising with some reduction of body fat, but not enough.

I keep R-Lipoic Acid in the house but she doesn't take it. I managed to get her to take fish oil and vitamin D though.

But since the Doctor gave it to her, she is reluctant to try non-drug therapies which you and I know work with a high rate of efficacy in mild cases.

Absolutely right on the growth hormone

Rin says

She also takes an R-LA pill, with each and every meal. End result, she wakes up refreshed, each and every day & has her diabetes under control.

chanakya4773 says

You tell the firefighter who has to dive in to FIRE to save your precious little life when your house blows up in fire. Tell him why you need to get paid many times more than him because you are going to do a run of the mill surgery in which you personally have zero risk and the rate of success is just another statics.

I think his argument will go something like this ... did that guy gets A's in biology, a high MCAT, and get accepted to an extremely prestigious program plus residency, and thus, gave up his weekends, nights, etc, just to have the privilege of slicing open a person and having the power of God over them, while hiding behind the blanket coverage of malpractice insurance, along with the *code of silence* among peer surgeons?

You see, that's the essence of how premeds and MDs see themselves. I'd worked with plenty of these personality types during undergrad research projects. They are worthy of praise, money, and prestige because their academic accolades awarded 'em with it. Everyone else, those HS "dropout quality" firemen, the NASA engineers who play with circuit boards, the Navy SEALS guy (who works for only a military pension) are mediocre, not dedicated, & not worthy of high pay and prestige.

In fact, I'm pretty sure that if I'd publicly stated, in a live meeting of people, that I'd helped manage my mom's Type 2 diabetes w/o a consulting physician recommending R-LA, that he'd have me charged for practicing medicine w/o a license despite the fact that my mother's IM physicians did little for her.

Definitely! But that doesn't necessarily make it less relevant. There is good research for many dietary supplements, but much of it doesn't reach a doctors consciousness because it isn't published in JAMA, NEJM or Annals of Internal Medicine, for example. For a number of reasons, good research can't make it into the top journals, mostly due to political issues.

The genius author of Jurassic Park, Michael Crichton, MD said it best: I regard consensus science as an extremely pernicious development that ought to be stopped cold in its tracks. Historically, the claim of consensus has been the first refuge of scoundrels; it is a way to avoid debate by claiming that the matter is already settled.

The journals are perpetrators of "consensus science". Most medical students fall for it hook, line and sinker.

Although, on an anecdotal level, none of the drs in my family are convinced enough of the benefit of dietary supplements to actually keep any in their home, other than something along the lines of centrum.

It seems that the vast majority strongly believe in pharmaceutical therapies designed to be taken for a lifetime.

Rin says

I think the training here involves something other than just making the rounds at a hospital.

Meccos says

Stop complaining and go become a doctor yourself.... furthermore dont make stupid requests like the quote above... it only hurts your argument

Actually Meccos, it looks like that I'm gaining more adherents over time than you. Just read all the responses above. You thought that you could make me look sophomoric but it appears that that moniker is slowly fitting you rather well with your pomposity. Yes, I'm not proud of working for a hedge fund but you know what ... it'll make me free/independent and then, I can do what I want with my life w/o needing to justify the shortcomings of my profession to others.

Yes, when (not if) I become a doctor, I will never get online and tell ppl that doctors are a gem of society. Instead, I'll say that unlike some (whose names I won't mention), I've done the best that I could. And if that basically turns me into an adjunct physical therapist or nutritionist then so be it. I'm sure I could survive on my earnings from the HF work for some time.

CL says

Keyword here is "typical". How many millions WANT be in the NBA and never make it? It doesn't always look like it, but these are the very best of the very best of the very best. They work from childhood, really, uncompensated and achieve greatness.

Think of it as deferred compensation, and of how many entertain us for next to nothing or nothing.

There seems to be an epidemic of missing the point in this thread. Shall we review?

I did not ever say NBA players should not be paid what they are paid. I did not say it isn't justified. I did not say it should be less.

I said, complaining about what doctors make is silly when you consider that they save lives, and other people make 30 times more for playing with a ball.

You seem to enjoy arguing strawmen just for argument's sake.

Just to clarify... With respect to doctors, what is your definition of "overpaid?" (Precisely, what is the dollar amount?)

Rin says

Likewise, let's boycott U2 shows and album/mp3 releases, shrink their fan & advertising base, since Bono, Edge, and Clayton don't deserve to be millionaires over a guy who plays out in his hometown's school gymnasium. I mean that's the essence of homeboy's argument.

What's with all the strawmen?

I never said anyone doesn't deserve their salary.

YOU said doctors don't deserve their salary.

Actually, you just refuted your OWN argument. LOL.

Homeboy says

what doctors make is silly when you consider that they save lives, and other people make 30 times more for playing with a ball.

Read chanakya4773's comments on the firemen, in terms of saving lives and the payscale.

As for professional sports, I'll bring up the U2 analogy ... is it not right for a private entertainment enterprise, to pay out their stakeholders, in proportion to what that business brings in, in terms of ticket sales and advertisement money? You are always free to not support U2.

On the other hand, if I publicly tell anyone, in a conference-like setting, that I'd managed by mom's diabetic condition with a mere off the shelf vitamin, most likely, I'd be charged with practicing medicine w/o a license and hence, the information stays within the circle of friends and family.

Situations like that made me pursue medicine instead of listening to crap perpetuated by people who are full of themselves (MD degree holding relatives working in the field) while criticizing me for being right and never having the integrity to research one iota of assertions I ever made based on researching literature and personal experimentation.

Even though I'm full of facts, not one of them has ever "seen the value" or implemented a single one of my suggestions.

My moms side of the family, on the other hand, while significantly less educated, has a number of members who I've successfully managed to lead by example.

My experience is that you can't teach drs anything because they already know it all.

As a former personal trainer, I learned that the two most impossible people to sell personal training packages to were: Doctors and Accountants. Accountants need to really know objectively that they are getting their money's worth and it is nearly impossible to guarantee success without knowing a person's commitment level. Doctors, as stated earlier, because they think they know it all.

In medical school, all I've come to realize is that you learn a lot about pathology and pathophysiology. This is in contrast to normal physiology and improving upon baseline normal physiological function, which is what exercise has been proven time and again to do (both resistance and HIIT or cardio).

Most doctors also don't know the difference between consensus and real science but claim that they practice 'evidence based medicine'.

As for the joe-schmoe IM's: when 40% of the patients are obese you'd think the average internist would have answers for them, regardless of their training. It turns out, however they do not.

One more point. A lot of people are lazy to buy efficacious supplements because their insurance won't pay for them. I made a comment about Aetna having a crappy flex spending account. This is the main reason why. Only up to 2000 dollars a year tax free and the supplements have to be prescribed by the doctor. Even with the doctors (who don't take insurance) who are knowledgeable about supplements, they prescribe supplements that they sell and filling out the paperwork is a pain in the ass.

That genius Michael Crichton said: patients too often shunned responsibility for their own health, relying on doctors as miracle workers rather than advisors.

This is the main reason why most of the threads pertaining to insurance are slightly misguided. It begs the question: What are most of the people starting threads about insurance actually doing on a consistent basis to ensure good health into old age?

The main difference between doctors who take insurance vs those who don't at the primary care level: one is indifferent to your lifestyle other than paying lip service and the other demands 'skin in the game'

Rin says

In fact, I'm pretty sure that if I'd publicly stated, in a live meeting of people, that I'd helped manage my mom's Type 2 diabetes w/o a consulting physician recommending R-LA, that he'd have me charged for practicing medicine w/o a license despite the fact that my mother's IM physicians did little for her.

turtledove says

Just to clarify... With respect to doctors, what is your definition of "overpaid?" (Precisely, what is the dollar amount?)

Shhh.... don't confuse them by asking for actual facts. It makes them angry.

Rin says

Read chanakya4773's comments on the firemen, in terms of saving lives and the payscale.

Oh, I see. You acknowledge the validity of the argument when it's used by someone you agree with, but claim it's an invalid argument when I use it. Nice....

Homeboy, are you a moron? You don't have to support U2. You can support your local band.

I can't tell anyone to take R-LA for type 2 diabetes w/o being charged for practicing medicine w/o a license. Can't you see the difference?

Please, point out the strawman above.

Homeboy says

Rin says

Read chanakya4773's comments on the firemen, in terms of saving lives and the payscale.

Oh, I see. You acknowledge the validity of the argument when it's used by someone you agree with, but claim it's an invalid argument when I use it. Nice....

OK, so how many firemen do you know, who earn from $200K to $300K? Yes, I'm now using your argument concerning payscale.

chanakya4773 says

Very easy to fix it..lets create a third party which will put all these requirements for firefighters given the nature of their work.

1) 10 years over-training with 400K per year tuition ( only one school will be allowed in the whole country to train them to create "high quality" firefighters. only 100 seats will be available.)

2) Need to be 6 feet tall or more

3) should be able to jump 6 feet or more

4) Is insensitive to heat.

Now , when you are stuck in a fire in your house, the firefighter will demand 1 million dollars to save you because he had to do 1) 2) 3) and 4) and also because he is "SAVING LIVES"

you will not have any choice but to pay the million dollars.

Excellent, now you see where I'm coming from.

Rin says

Homeboy, are you a moron? You don't have to support U2. You can support your local band.

I can't tell anyone to take R-LA for type 2 diabetes w/o being charged for practicing medicine w/o a license. Can't you see the difference?

Please, point out the strawman above.

It's ALL strawman.

What are you, a fucking troll? Still going with the strawman, but you added ad hominem and misdirection for the trifecta!

Homeboy says

What are you, a fucking troll? Still going with the strawman, but you added ad hominem and misdirection for the trifecta!

Yah, you've completely lost it. No one's been posting strawmen. You just can't win an argument ... no examples, no line of reasoning, zippo.

Anyways, everyone's already collapsing on you.

Rin says

OK, so how many firemen do you know, who earn from $200K to $300K?

How many physicians do you know who only have a high school education?

Rin says

Yah, you've completely lost it. No one's been posting strawmen. You just can't win an argument ... no examples, no line of reasoning, zippo.

Anyways, everyone's already collapsing on you.

Sure, whatever you say, troll.

Here's a song for you, strawman:

http://www.youtube.com/embed/nauLgZISozs

Homeboy says

Rin says

OK, so how many firemen do you know, who earn from $200K to $300K?

How many physicians do you know who only have a high school education?

You've already heard all the jazz about education in the above threads.

Quit saying Doctors earn their money.

The last time I checked we got a $1200 dollar bill just for the Doctor to tell us what we already knew and give my wife a glorified aspirin. He was in the room for a grand total of 10 minutes. After a three hour wait in the split back gown.

That's the spirit

Rin says

Yes, when (not if) I become a doctor, I will never get online and tell ppl that doctors are a gem of society. Instead, I'll say that unlike some (whose names I won't mention), I've done the best that I could. And if that basically turns me into an adjunct physical therapist or nutritionist then so be it. I'm sure I could survive on my earnings from the HF work for some time.

chanakya4773 says

THIS DOES NOT HAPPEN IN ANY OTHER SERVICE WHICH DOES NOT HAVE PROTECTIONISM.

For a while there, I was beginning to think that I was the only one really fired up about this topic :-)

turtledove says

Just to clarify... With respect to doctors, what is your definition of "overpaid?" (Precisely, what is the dollar amount?)

Respectfully, I look at the issue in a different way. I never bothered much about whether bankers were overpaid until they bankrupted their banks and got bailed out by TARP/QE/ZIRP. Prior to that, their argument was the same as Meccos: they were smart and worked very hard and sacrificed with long hours, so they "deserved" all that the market would pay them. Since TARP/QE/ZIRP, I say they were overpaid and still are, because obviously all their "knowledge" and "work" didn't add up to running a bank successfully, and their "sacrifice" of long hours (that I never asked for anyway) doesn't give them a claim to government bailouts.

With Obamacare's mandatory insurance, doctors are now in the same position.

TARP bankers, muggers, and now alas doctors are overpaid because they (or your own government) put a gun to your head and demand "all your money" (or in the case of Obamacare, "all you can afford") whether you agree or not. At least muggers don't pretend to deserve it, and they are the lowest paid on the list.

Meccos has made several very defensive and aggressive posts about how if you don't like doctors you can always see a shaman. Lately the line has been blurring, e.g. Homefool's SSRIs, but that isn't the only problem. Another problem is bundling and tying, which in retail can be illegal but in medicine is common practice. The Rx mandate prohibits you from buying any medicine without first paying a doctor for permission, and most doctors don't even tell you in advance what they will charge so you can't know if it's worthwhile, and besides there are a million different prices depending on which insurance you're using, and if you don't use insurance they are required by their insurance contracts to overcharge you most of all.

Less than a century ago, doctors made house calls, stated honest prices and stuck to them, worked for their patients, and made a good living. Those doctors were not overpaid, even though of course people complain about having to pay any expense, even options like cable TV. BTW house calls are often the best general medicine, because a doctor looking at your house and the people you live with can see many clues about what's wrong with you, which helps a lot in diagnosis and the best treatment might be to look in your kitchen and tell you which foods to stop buying and what to buy instead. Dr Oz and Matthew Roizen did a great TV series on this, they said they'd saved more lives visiting people's kitchens than operating on their hearts.

Most of today's doctors work for hospital corporations, insurance companies, and/or large corporate networks. They have lost their independence, they charge outrageous fees that they don't even know let alone control, and they have a monopoly on the entire medical formulary. In Germany, where aspirin was invented, you can't even buy aspirin without an Rx. In America, you can't buy morphine, but doctors will happily prescribe you fraudulently marketed OxyContin at 20x the price. To say they are overpaid isn't so much about the numbers, in fact some life-saving doctors don't even make as much as Homefool's pushers; rather, doctors are mispaid, because the amount they make has little to do with the value of the service they provide, and the public are forced to pay whether we want them or not.

We live in an era of lemon socialism, with Fed bankers and the medical industrial complex harvesting Americans like CAFO cattle. If a mugger gets away with $1, he is overpaid. If a dermatologist makes $1 million honestly, quoting prices up front, doing good work, and building up a reputation so that movie stars seek her out, she is not overpaid. The AMA represents less than 20% of doctors, but makes $ on billing codes that nobody can understand and that will be mandatory via Obamacare, so the AMA endorsed Obamacare. In doing that, the AMA abandoned the honest doctors, and cast its lot with the TARP/ZIRP/QE muggers. Muggers are, by definition, overpaid.

Homeboy says

There seems to be an epidemic of missing the point in this thread. Shall we review?

I'm barely in this argument, but I mentioned that only because it seems like ball players are actually paid fairly. People think they live luxurious lifestyles, and sure, some do. But the ones that do don't do so for long, unless they invest wisely. Otherwise, it's a short career with lots of physical damage for an extremely elite group of folks.

I'd rather be an Executive than a ballplayer. Executives (and the Bush administration) tend to fail upwards. And they're knees are in better shape.

In recent years, I thought this was a good idea. But this is something I didn't even think about.

curious2 says

BTW house calls are often the best general medicine, because a doctor looking at your house and the people you live with can see many clues about what's wrong with you, which helps a lot in diagnosis and the best treatment might be to look in your kitchen and tell you which foods to stop buying and what to buy instead. Dr Oz and Matthew Roizen did a great TV series on this, they said they'd saved more lives visiting people's kitchens than operating on their hearts.

I may be incorrect about this but while traditionally, Emergency medicine docs didn't make the big bucks, they are doing significantly better nowadays. It's stressful, but a lot of people working in Emergency medicine like the work schedule. Many places, it is one week on/one week off.

On average, I think that ER docs are doing better than Psych docs. It is certainly more competitive to get an ER residency than a psych residency.

In places like New Jersey where there is a "shortage" of Psych docs, those guys are doing quite well by not taking insurance.

curious2 says

To say they are overpaid isn't so much about the numbers, in fact emergency doctors don't make nearly as much as Homefool's pushers; rather, doctors are mispaid, because the amount they make has little to do with the value of the service they provide, and the public are forced to pay whether we want them or not.

MMR says

On average, I think that ER docs are doing better than Psych docs. It is certainly more competitive to get an ER residency than a psych residency.

Thanks - I hadn't updated recently, and I see now that current numbers corroborate your opinion. This site shows current starting salaries for both critical care and psych around $200k, with psych being slightly lower:

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

So, I'll stop saying that emergency doctors make less than Homefool's pushers. It used to be true, but the numbers have apparently changed recently. I continue though to believe that Homefool's SSRI pushers are overpaid because we are all required to pay them even when they confer no value, e.g. the cost of his disproved SSRI coverage must be shifted onto all of us because he can't afford it on his own, nevermind that it does no good for anyone.

BTW, in terms of medical practice areas, you might want to consider sports medicine or even the military. The patients tend to be highly functional, they might need help with specific problems but they aren't generally self-destructive. I would worry about Lance Armstrong situations though, even at the teenage level kids are trying to bulk up with steroids etc. Otherwise much of current medicine consists of managing self-destructive people as profitably as possible: every complaint results in another test and every test results in another prescription, no time to listen, etc.

Rin says

You've already heard all the jazz about education in the above threads.

That's your argument? Lame.

CL says

I'm barely in this argument, but I mentioned that only because it seems like ball players are actually paid fairly.

Fair's got nothing to do with this, but since you brought it up, if you think $5 million a year (average NBA salary) is "fair" for someone to throw a ball around, but $200,000 (average doctor salary) isn't fair for someone to save lives, then you need to have your head examined. I would suggest seeing a doctor. ;)

CL says

People think they live luxurious lifestyles, and sure, some do. But the ones that do don't do so for long, unless they invest wisely. Otherwise, it's a short career with lots of physical damage for an extremely elite group of folks.

They make more money in a single year than most people make in their ENTIRE LIFE. Then, on top of that, they retire with a pension. If you can't survive on that amount of money, you're a complete fucking moron. What part of that don't you understand?

CaptainShuddup says

Quit saying Doctors earn their money.

The last time I checked we got a $1200 dollar bill just for the Doctor to tell us what we already knew and give my wife a glorified aspirin. He was in the room for a grand total of 10 minutes.

The doctor didn't MAKE $1200 in that 10 minutes. That's what the healthcare company BILLED you.

By the way, next year, when everyone gets insurance under ACA, it will probably cost you about $20 for the co-pay. Hmmm.... $20 or $1200. Which is better?

CaptainShuddup says

After a three hour wait in the split back gown.

Ugh - didn't need that visual.

curious2 says

even at the teenage level kids are trying to bulk up with steroids etc

When I was in high school, there was a kid on the weight lifting team that doped so much steroids that he wasn't even aware of his body's own limitations anymore. Result: he snatched (or was it a clean and jerk?) 750 pounds and blew his large intestine partially out of his anus.

Anyone notice how Rin and MMR say pretty much exactly the same things in exactly the same way?

Hmmm.....

APOCALYPSEFUCK is Shostakovich says

If they got better money kicking you to death in front of your spouse and kids....

Have you seen chemotherapy? Why risk injuring yourself kicking the patient, when you can prescribe drugs and have the nurse administer them, then enjoy watching the patient puke his guts out all over the place. W said it's hard to put food on your family, but probably he never tried projectile vomiting.

APOCALYPSEFUCK is Shostakovich says

If they got better money kicking you to death in front of your spouse and kids, they'd take it.

Mild hip dysplasia would be the only thing keeping me from inquiring...

Homeboy says

Anyone notice how Rin and MMR say pretty much exactly the same things in exactly the same way?

Hmmm.....

I knew that that was the best that you could do. How lame.

It only indicates that your reading comprehension skills of an intelligent conversation is limited.

Ask Patrick if we have the same IPs, if you want to play Dick Tracy, you troll.

BTW, I'm done responding to you, ignore is activated.

I hadn't thought of the military. It's an intriguing choice Younger guys especially might be more willing to listen and most have some concept of exercise. As long as it was a job in Coastal California, I'd strongly consider it. I personally don't want to live anywhere else, even if no one is willing to offer me partnership in an insurance mill.

Sports medicine is a possibility as is endocrinology, diabetes and metabolism, with emphasis on exercise/nutrition.

Regarding the Lance Armstrong situations, I think about that stuff in passing every single day and some days more than others. It's almost as if you read my mind or something.

When you get a chance an good movie (you prob saw it but just in case). Good discussion on the latter topic. Won award at 2008 Sundance Film Festival

http://www.youtube.com/embed/E9lfwIknpAU&list=PLDEC560256566A03A

curious2 says

BTW, in terms of medical practice areas, you might want to consider sports medicine or even the military. The patients tend to be highly functional, they might need help with specific problems but they aren't generally self-destructive. I would worry about Lance Armstrong situations though, even at the teenage level kids are trying to bulk up with steroids etc. Otherwise much of current medicine consists of managing self-destructive people as profitably as possible: every complaint results in another test and every test results in another prescription, no time to listen, etc.