patrick.net

As usual, most sound arguments here are being ignored by those too invested in their faulty opinions to listen to anyone else. So here is a simple solution for those who think Drs are overpaid. Don't visit them. Problem solved.

Rin says

And next, in terms of the coursework for the first two years of medical school, did you fellows use a combination of mnemonics & Roman loci, to help memorize the data? Or did you expect that you'd be able to cram 12 textbooks in a year's time w/o any problems when you'd started? In addition, do you practice recall in intervals of 2 days-6 days-30 days, to help reverse the Ebbinghaus forgetting curve (http://en.wikipedia.org/wiki/Forgetting_curve). You see, that's a memory rich curricula and there are ways of being prepared to be able to digest it. On the other foot, you can't cram/memorize for let's say, a Chemical Engineering Control's final, because you need can break the questions into their key components, find the hidden suppositions, develop the design methods, and finally, work out all the math in these steps.

Again, you simply have no idea about what you don't know.

I agree that in terms of pure intellectual power, theoretical physics, quantum mechanics or some esoteric field of math that any a few dozen people on earth really understand trump the first two years of medical school. Yes, there is a LOT of memorization involved and while I've forgotten a lot of the basic science material, I still remember all of it in terms of broad areas and principles. This is enough to help with non-emergent problem solving and diagnosis.

Also, you're never going to convince anyone who's done both grad school and med school that the former is anywhere near as taxing as the latter, so drop it. Like vonah said, about a month into med school you're going to STFU about how easy it is and how anyone with a 30 MCAT can do it.

Only the market can tell if doctors are overpaid or not. Since the profession is heavily regulated, we will never know.

Facebooksux says

Yes, there is a LOT of memorization involved and while I've forgotten a lot of the basic science material, I still remember all of it in terms of broad areas and principles. This is enough to help with non-emergent problem solving and diagnosis.

Also, you're never going to convince anyone who's done both grad school and med school that the former is anywhere near as taxing as the latter, so drop it. Like vonah said, about a month into med school you're going to STFU about how easy it is and how anyone with a 30 MCAT can do it.

I'm in my mid-30s and I still remember most of my undergraduate course in biology because I used the Ebbinghaus principle in improving long term recall. Thus, despite not having heard "Klinefelter syndrome" or "Okazaki fragments" in years, that information hasn't been forgotten. Realize, I only took the general biology as I was an Applied Chem/Chem Eng major. I used graduated recall interval and that's all I needed to get an 11 on the biology MCAT at the end of college.

Plus, I never said that it would be 'easy'. It would be work, like everything else which requires hard work, to master. So yes, perhaps those first two years worth of courses need to be spread out, over a wider stretch of time, for those working in industry but hey, since you're indicating that engineers have too much time to spare on weekends, for barbecues and/or gaming conventions, then perhaps this is a way of staying in top mental shape for medical school later? Ultimately, it's about getting the points on the exam and if one can get the numbers needed for either an Honors, High Pass, or Pass (MD style grading), then maybe that's all the data one needs to determine if this person is adequate to study for an MD?

vonah says

I can assure you that your ideas will change after you go through the punishment that we have had to, and this isn't about some hazing process, but the demands of the profession.

This is a significant issue, and I have to wonder about it. The "demands of the profession" in America seem to involve a lot more barriers to entry than in other countries, yet outcomes are not better here. I understand clinicians have worked hard and suffered and want to reap the rewards, but we seem to have a system designed to require people to overpay for "services" that they don't want or need, performed by over-educated professionals who are constrained by the "demands of the profession" to charge more than people in other countries would pay. By "over-educated," I mean in the sense Noam Chomsky would say, the most educated are the most indoctrinated. (Or as John Gotti would say, "over-educated and under-intelligent," meaning they're book smart but not street smart so they don't see what's really going on because it isn't taught in a textbook or graded on a final exam.) We have a medical academy bought by the Rockefellers and PhRMA, built on allopathy, that excels above all in generating $ not health. I hesitate to put it that way because clinicians might get defensive, but the numbers speak very loudly.

curious2 says

meaning they're book smart but not street smart so they don't see what's really going on because it isn't taught in a textbook or graded on a final exam.)

Book smart vs street smart is a problem, common throughout many over-educated fields, including other science and engineering specialties. In chemical engineering, a lot of non-linearities and anomalies, esp in multi-phasic conditions, exist and thus, they have design heuristics, which factor them in. End result, ppl believe in their tools and don't question or peer into their assumptions.

Buster says

most sound arguments here are being ignored by those too invested in their faulty opinions to listen to anyone else. So here is a simple solution ...

And there also appears to be this sort of aegis, where it's implausible for a bright, hardworking S&E person, to learn the basic sciences of the first 2 years of medical school, without having first enrolled in the program.

If this was the case, then why does Georgetown allow their Special Masters students, who sat in with the medical students, to transfer into the MD class in year number two, if this wasn't a possibility?

Here's that program, http://smp.georgetown.edu/coursedescriptions/132250.html

And likewise, if a one year masters program is adequate for future MD admissions, why can't this spread out to other S&E areas of study, but w/o having to spend excess tuition money?

Buster says

here is a simple solution for those who think Drs are overpaid. Don't visit them. Problem solved.

Not really. Federal law since 1951 prohibits buying Rx drugs without an Rx. (And don't even get me started on the "drug war" that prohibits cheap natural drugs while promoting fraudulently marketed overpriced Rx versions, e.g. OxyContin.) You can buy an assault rifle, but you can't buy contact lenses without an Rx. And, with mandatory insurance, you are required to overpay whether you visit or not.

People talk about Google engineers making $, but if you don't like Google you can always use ask.com or bing or Yahoo! Or you can search for information the old fashioned way, at the library. Google engineers help you find information more easily, but they don't prohibit you from getting the same information some other way. Imagine how much they might get paid if they could do that, and how people would feel about them.

If you think doctors make too much money, then consider a California highway patrol officer or the average police in California. Median wage of a cop is 130K + about 50K into their pension and the countless other benefits they receive, including their ability to retire at age 50. Look up http://www.sacbee.com/statepay/ and in the drop box look at california highway patrol to see their compensation if you think i am lying.
Not bad for only requiring a high school degree.

Why would anyone want to spend 4 years of undergraduate, 4 years of medical school and 5 years of residency to earn about the same amount, especially if you are 200k in debt after schooling and having to worry about all the malpractice lawsuits? Plus I dont think most doctors work 40 hours a week... 50-60 hours seems more the norm.

Oh btw if you think a doctor making 150k is too much, you may be surprised to see nurses making even more than that...

http://www.crnasalary.com/

Meccos says

Oh btw if you think a doctor making 150k is too much, you may be surprised to see nurses making even more than that...

http://www.crnasalary.com/

Those are nurse anesthesiologists and yes, it's a well paid specialty. The regular RNs, however, are clearly not in that bracket.

Physician anesthesiologists (MD holders), however, earn ~$337K with a salary spread between $250K and $450K, depending upon experience and location.

http://www1.salary.com/Anesthesiologist-salary.html

The two chemical engineers, I knew, who went into anesthesiology, never complained about their careers, once residency completed. ORs are scheduled, just like pilot plant trials, and the on-calls are twice per month, as a career average, after residency. And I knew non-engineers (other prior undergrad majors), who also went into this field. If you're willing to shoulder the responsibility of life support and pain management of a person in OR, then I can imagine it being a rewarding career.

And true, the lifestyle of the anesthesiologist resident is rough, prior to starting one's career. 80 hours is normal for those first three years.

BTW, both of these chemical engineers were at $65K-$80K per year prior to medical school, so again, it's not likely that one will earn a high salary in the old fashion, non-"dot-com/Web 2.0" tech vs being a doctor.

I don't understand why all the doctors who post here keep insisting that tech workers mainly earn like Microsoft engineers in the 80s, with huge stock options, or Google/Web2.0 engineers of today? In general, if you work in tech, as soon as you're in the $100K+ category, MBAs start to look for ways to get rid of you or send your R&D cost center to Asia.

Meccos says

Why would anyone want to spend 4 years of undergraduate, 4 years of medical school and 5 years of residency to earn about the same amount

In Massachusetts, once you add in 'details', almost every cop is over $100K. But think about this, one day, you may be staring down the barrel of a gun. Thus, there's a lot of competition and cronyism, to get into a nice suburban gig. But yes, that's a security job and one which is state mandated with great retirement benefits.

As for attending medical school, if you're a person who's good at studying and taking exams, could you name a better profession? Right now, new actuaries are not getting hired as before, as spreadsheet work is being slowly offshored and the established certified Actuarial Fellows don't want to share the wealth with newcomers. In the field of law, outside of Patents, few lawyers get hired by Big Law firms & seldom achieve a partner track. Thus, the options left are to either hang your own shingle (with zero experience), work as a paralegal (no partnership track), or hope for a govt gig. And MBAs in management consulting a/o finance, do not advance by virtue of exam taking skills. Those are BS artists, for the most part. Many persons with some academic bent, can be trained to perform in a health care like area and right now, our science and engineering graduates are best equipped, academically, to serve in ancillary health care areas.

Rin...

I realize how firm your beliefs are on this subject and there is likely nothing that anyone here can say to change your mind, nor do I really care so much to change your mind.

Rin says

I'm a jr partner at a hedge fund, having left pure engineering (then IT), for a monied profession. I'll be applying for medical school, once I've banked my first $2-3M, as I don't see being a money manager, as a meaningful profession, despite the high compensation.

If you truly think it is that easy to become a doctor and that doctors are paid way too much, then you should definitely apply to medical school, go to residency and work as a doctor. Please update us after you have done all these things and let us know if you feel the same. Ill be waiting for your post in another 8-12 years. I do find it odd though that you want to go to medical school as a second or even third career, while over 50% of physician regret going into medicine due to the difficulty of the lifestyle and bad compensation

PS. I hope you will really have saved 2-3 million before you apply since you will have lost about 10 years of earning potential and will rack up 200k in school costs.

Logically, I don't see that the crazy increases in health care costs can be attributed to doctors pay.

Because doctors made as much (more really if you adjust for inflation) 30 years ago than they do now.

I do think that the profit motive in general doesn't have a place in health care, at least not in the direct sense where more money is always made if you do more tests and more procedures.

marcus says

Logically, I don't see that the crazy increases in health care costs can be attributed to doctors pay.

Because doctors made as much (more really if you adjust for inflation) 30 years ago than they do now.

I do think that the profit motive in general doesn't have a place in health care, at least not in the direct sense where more money is always made if you do more tests and more procedures.

Marcus,

you are right. although costs in health care have risen, doctor pay has actually dropped, even without calculating inflation.

doctors in the US only make up about 8.5% of total healthcare costs, which is actually one of the lowest...

Meccos says

marcus says

Logically, I don't see that the crazy increases in health care costs can be attributed to doctors pay.

Because doctors made as much (more really if you adjust for inflation) 30 years ago than they do now.

I do think that the profit motive in general doesn't have a place in health care, at least not in the direct sense where more money is always made if you do more tests and more procedures.

Marcus,

you are right. although costs in health care have risen, doctor pay has actually dropped, even without calculating inflation.

doctors in the US only make up about 8.5% of total healthcare costs, which is actually one of the lowest...

Glad to see this sensible and informative reply to a really misguided line of reasoning. You can name any trade or profession you want, but nobody short of some pretty high public authorities carries a higher degree of personal responsibility and personal liability (in the US) as an everyday physician. No lawyer, no cabinet minister, no professor, nobody, even though these folks may certainly earn more.

It takes years and years of long hours to learn a practice that has immediate impact on people's lives. You must be available 24/7. Make a mistake and you'll tell it to the jury. This function cannot be outmoded by the abusive marketplace-- so instead the HMO MBAs purposefully undermine the authority of doctors (insurance reviewers now wear white coats in hospitals) while ensuring that the doctors continue to bear the full responsibility for any outcome (the law is called ERISA).

Unless you do away with the massive doctor's headaches from trial attorneys and private insurance companies in the US, lowering doctor's salaries would drive those of us with skills into other work, and your care would suffer. Of course I would rather have both happen, but not the second without the first.

curious2 says

Bob, so far your responses (sarcasm, no sources) sound like you're looking for a Jersey Shore GTL sparring match, which you can watch on TV if you want. It isn't my taste, so I'm not going to play researcher to your bombast.

Bombast? I've just been asking time and again for a simple explanation of your statement. Obviously it's not going to happen. Just out of curiosity, how much research is involved in explaining your two sentence statement?

curious2 says

In reply to your latest flurry of rhetorical questions, here is a question that might really help: who controls the Medicare billing codes and payment rates? What is the American ratio, in quantity and price, of specialists to primary care? How do the American ratios compare to other countries? If you care enough to take the time to research the answers to those questions, and post links, you might find the results edifying.

If you've actually done the research you say you have then you have the answers. Instead of playing grade school playground head games feel free to have an adult conversation by putting the answers out there along with your analysis of why and how the answers affect the cost of medical care. Why are you fixated with links? A simple explanation of the how and why of the issues as you understand them would be a good start.

The only rhetoric is yours. The answer you provide to any question anyone asks is just a laundry list of rhetorical bullet points. I'm really wondering if you are actually the professor under another name.

bob2356 says

Bombast?...Just out of curiosity, how much research is involved in explaining your two sentence statement?...Why are you fixated with links?...I'm really wondering if you are actually the professor under another name.

Bob, you need links because your memory drifts so badly, reinforcing what you want to believe. You never acknowledge errors and you never apologize. You also fail to understand causation, supply, and demand. You need links to anchor your arguments to actual facts. And no, I am not an alias for any other user account, if that's what you're really wondering. I'm also not someone who cares to waste a lot of time on you, especially when you get in one of your sarcastic moods with a blizzard of rhetorical questions and expect me to read your mind as to which (if any) you were really wondering about. If you think I've said anything incorrect, then present a source proving that.

vonah says

Also, medicine has taken an incredible toll on my health and life. Not everyone can stay up every 4th night for years....

This is an argument against the hazing process, i.e. the barriers to entry. If the profession is unhealthy even for practitioners, that might explain some of the damage it does to patients - e.g. errors and nosocomial infections. You present your suffering as an argument for people to pay more, when in reality it is an argument for reform. A century ago, bakers worked in such unhealthy conditions that their average lifespan was under 50; that changed due to improved working conditions and shorter workweeks. Today, no profession should take "an incredible toll" on people's health, and it is paradoxically ironic and yet typical that medicine is doing so.

What is all this BS about who deserves more for what kind of work?
Shouldn't all be offer-and-demand driven?

IF I had the chance of being visited by a European doctor paying 1/3 of the price, I certainly would.

curious2 says

This is an argument against the hazing process, i.e. the barriers to entry. If the profession is unhealthy even for practitioners, that might explain some of the damage it does to patients - e.g. errors and nosocomial infections. You present your suffering as an argument for people to pay more, when in reality it is an argument for reform. ... Today, no profession should take "an incredible toll" on people's health, and it is paradoxically ironic and yet typical that medicine is doing so.

And that's just it, the MDs on this forum are arguing for their salaries, by justifying the status quo. They've bought into the current system, hook, line, and sinker.

And then, they argue against letting in others, despite the fact that there are intelligent and hard-working scientists and engineers who can score well on both the MCAT and USMLEs. Back in the 70s/80s, the Univ of Miami did offer spots in the MD class, for years 3 & 4, for outsiders with PhDs. That program was discontinued in '89, despite the fact that it was successful. Now, there are arguments being posted that this wasn't even a possibility to begin with. Here's the link to prove its prior existence ...

http://www.ncbi.nlm.nih.gov/pubmed/20354390

Yes MDs ... please read the above. There was a 2 yr accelerated MD program in the past. And of course, you deny its existence.

Next, if so many doctors are fed up with 60+ hour work weeks, have they ever heard about 'moonlighting'? There's enough demand for MD services that doctors can work 3 days per week and still earn a $100K. In fact, a number of physicians, who'd decided to transition into research careers, moonlight 1 or 2 days per week, to supplement their postdoc salaries. One of which was a person who I'd worked under, back in my early days. And unlike these forum members, he didn't whine about his career in medicine. In fact, he was grateful that he had the opportunities to both see patients (part-time) and work in a research setting (he didn't need an additional PhD for that purpose). All I hear here is sour grapes about a profession, where there are lots of different ways of setting up one's work schedule. If you're an ordinary engineer [ chemical, mechanical, biomedical, electronics ], chances are that you'll be a full time W-2 or contract 1099 full time employee with little leeway, during weekdays, to do your own thing. And for that regimentation, all you get is a salary from $65K to $110K, and as soon as you're in the $100K category, MBAs will look for ways to lay you off and send your work to a cheaper cost center. Only in some sectors of IT, can one consult for half-time for half-pay. But the price for that is earning less than $50K, not good if you're building an egg's nest.

Facebooksux says

you're never going to convince anyone who's done both grad school and med school

Please then explain away this program at Univ of Miami, if grad students can't become MDs in a shorter time frame ...

http://www.ncbi.nlm.nih.gov/pubmed/20354390

Meccos says

If you truly think it is that easy to become a doctor and that doctors are paid way too much, then you should definitely apply to medical school, go to residency and work as a doctor. Please update us after you have done all these things and let us know if you feel the same. Ill be waiting for your post in another 8-12 years. I do find it odd though that you want to go to medical school as a second or even third career, while over 50% of physician regret going into medicine due to the difficulty of the lifestyle and bad compensation

PS. I hope you will really have saved 2-3 million before you apply since you will have lost about 10 years of earning potential and will rack up 200k in school costs.

First of all, I never said it was easy. Any science and engineering person knows that knowledge-based work takes effort and determination.

And then, if one's a bit older, let's say ages 48-53, what alternative work can you recommend? At that age, R&D centers don't want you because they'll point to the resume of a 35 year old with a C.V., exactly fitting a detailed job description. And then what about coding? Sure I can write for open source and be a type of internet persona but c'mon, that's for young adults & is much more a hobbyist field than a profession. You see, for most tech careers, once you hit your mid-to-late 40s, you're done.

Thus, losing 10 years of income means nothing if one's unemployed anyways.

So sure, I can simply retire out of the hedge fund business [ yes, it brings home the bacon, if not the entire pork bellies contract ] and spend the rest of my days in western Mass, volunteering at some of our antique shops or work at a Bed & Breakfast. But as a former engineer, that's a lame way to spend one's retirement years. I'd rather be actively seeing patients (even if it's moonlighting twice per week) and doing my own research, since I won't be needing to carry a grant to do so.

I can't resist chiming in here (I'm not a doctor, but I play one on TV). The first thing I want to address is the comment that our outcomes aren't as good as other countries despite greater barriers to entry. This argument is flawed, IMHO. Typically, people make these comparisons to countries with very homogenous populations. The US is a very large, heterogenous society. You just can't compare infant mortality rates here to that of Sweden. We aren't comparing like populations. And people from different parts of the world tend toward different issues. We are too varied a population to make a fair comparison.

Second, I'm always amazed when people say that doctors are overpaid.

It's easy to point the fingers at the doctors because those are the folks that you see. But the real crime is elsewhere in healthcare. Hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies... These groups play a pretty big role in why healthcare is in the state it's in. Have you taken a look at what some of these people make? Lawyers are particularly impressive. Not all of course, but many make absurd salaries (well above most doctors) and they have absolutely no requirement to achieve a specific outcome. If they make an error, they are protected as a learned professional from anything but flagrant malpractice. A doctor is hardly in the same situation. If they genuinely misjudge something, or a bad outcome happens despite all best efforts, doctors are screwed. Hospitals and insurance companies are about business and the bottom line. Take a look at what a hospital administrator makes. A doctor's salary pales in comparison.

When you compare a doctor's salary in the US to that of a doctor in another country, you also need to consider the personal investment differences. How much does it cost to complete medical training in Ireland, for example? How much does it cost to complete medical training here in the US? Yes, newly minted medical graduates in Ireland start off making about 80k euro/year. But they have no student loans. I don't see how you can have it both ways. You expect someone to pay a fortune to achieve the required medical training, but then you don't think they should earn enough to pay it back?

Let's look at $150/year. You realize that after taxes and health insurance, you're looking at about $3,800 every other week? Okay, that's $7,600/month. Take a grand off for student loans and that leaves them with $6,600/month. It's not terrible, but it's hardly affording anyone the lavish lifestyle of the rich and famous. Again, look at the number of hours put in to earn that $6,600/month.... that's about $25 to $30/hour.

I'm sorry, I think you are barking up the wrong tree if you think that the doctors' salaries are to blame for the healthcare situation in the US. Although I'm sure that the insurance companies, attorneys, pharmaceutical companies, and hospitals are more than happy to see you focus your attention on the doctors.

Anyway... my 2 cents for what it's worth.

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

beershrine says

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

Not true. They are sucking at the Medicare teat. The changes to the Medicare Advantage program are a long time coming, because the providers have made huge profits from the subsidies the program provided.

beershrine says

Doctors, hospitals, insurance companies, healthcare attorneys, and pharmaceutical companies,etc. are all sucking from the same income pool. Your monthly premium.

Most medical care in the U.S. is paid by government: Medicare, Medicaid, and other programs. Your monthly premium, though large and growing, is largely wasted, and in any event pays only a fraction of total spending.

Rin says

despite the fact that there are intelligent and hard-working scientists and engineers who can score well on both the MCAT and USMLEs.

You use the fact that people can score well on MCATs as an argument against high salaries? This is absurd.
The MCATs are just the first step into getting into medical school, let alone completing residency, and then actually working as a doctor. Would you base PhD salaries based on how well most people could score on the GRE's? Or lawyer salaries based on how well others can score on LSATs?

Rin says

Next, if so many doctors are fed up with 60+ hour work weeks, have they ever heard about 'moonlighting'? There's enough demand for MD services that doctors can work 3 days per week and still earn a $100K.

DO you even know what moonlighting means? When most doctors moonlight, they are working a second job after their primary job, hence the reason it is called moonlighting. Thus moonlighting is not a solution to avoiding a 60+ hour work week as you suggest, since if you are moonlighting you are working a second job. Even if a doctor works 3 days a week "moonlighting" as you suggest, its most likely about a 40 hours/week, since most doctors work 10-12 hours a day. Hence 100k is hardly much money considering a full 40hr work week. Do you really think 100k is that much money? I can list a page of different profession who can make 100k, most of them without the amount of education, hours worked, level of responsibility as a doctor.

Rin says

If you're an ordinary engineer [ chemical, mechanical, biomedical, electronics ], chances are that you'll be a full time W-2 or contract 1099 full time employee with little leeway, during weekdays, to do your own thing. And for that regimentation, all you get is a salary from $65K to $110K, and as soon as you're in the $100K category, MBAs will look for ways to lay you off and send your work to a cheaper cost center. Only in some sectors of IT, can one consult for half-time for half-pay. But the price for that is earning less than $50K, not good if you're building an egg's nest.

Sounds like you are bitter about your profession, hence why you are trying to minimize another profession.

Rin says

First of all, I never said it was easy. Any science and engineering person knows that knowledge-based work takes effort and determination.

You are right, its not easy.. and you would actually never know how hard it is unless you go through it. In addition, I find it funny how you always refer back to engineering in your threads. You clearly have a chip on your shoulder...

Rin says

Thus, losing 10 years of income means nothing if one's unemployed anyways.

If you are complaining about high doctor salaries, shouldnt you consider the 10 years of lost earning potential in addition to 200k in debt in becoming a doctor?

Rin says

But as a former engineer, that's a lame way to spend one's retirement years. I'd rather be actively seeing patients (even if it's moonlighting twice per week) and doing my own research, since I won't be needing to carry a grant to do so.

Yes, why dont you just go to medical school and do that and stop complaining and whining about other people's salaries. Do it... if you can. Somehow I doubt you will not have the patience, determination to pull it through however... you will find that engineering is not medicine, contrary to the multiple comparisons you tried to make in your previous threads.

Meccos says

If you are complaining about high doctor salaries, shouldnt you consider the 10 years of lost earning potential in addition to 200k in debt in becoming a doctor?

Again the defensive use of self-inflicted past suffering to justify current compensation from others, even though the past suffering is not the patient's fault and confers no benefit upon the patient. "We chose to suffer, so now we own you and have a right to overcharge you, and you are required to pay us whatever we say, and you're not allowed to take care of your own health." Plus now a counter-attack on engineers, of all people.

BTW, there is a significant mismatch between the amount some doctors collect, and the amount the public are required to pay. A lot gets lost in the mandatory insurance system and the administrative levels, as others have pointed out. So, some of this disagreement results from perspective: patients are paying a lot, but many doctors aren't getting a lot. The disparity is particularly wide in emergency care, where hospital charges are enormous and the amount actually passed through to doctors is often small. But emergency care is less than 10% of total spending, so when people talk about how much is paid, more than 90% is in non-emergency settings.

Personally, I would rather see real healthcare reform based on engineering, expert systems, and at-home devices, instead of the mandatory entrenchment of the existing allopathy and its gatekeepers. Every pharmacy sells at-home devices so you can check your bp, pulse, temperature, weight, and height as often as you like and buying them costs less than a single doctor visit. It isn't necessary to pay a physician for tests you can do at home; the technology has advanced like the digital camera, and yet we're mandated to pay for the equivalent of film and old-fashioned processing. Computerized stethoscopes have been shown to outperform human doctors at detecting certain conditions. If we didn't have the mandatory insurance-driven system, costs could be reduced substantially with probably better results.

But that's just it. Allowing free choice in a free market, where new technology can compete with the existing models, would result in the existing MDs possibly not extracting the same rents in compensation for their past suffering. MDs say they sacrificed to get where they are, and I say (1) I didn't ask them to do that, and (2) I'd rather take control of my own health instead of being treated like a passenger in their revenue-maximizing system. Yet, they do not understand such "convoluted" reasoning - because, as Upton Sinclair said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it."

Mecco and others, you keep insisting that alternate science/engineering persons can't do medicine. Why did the Univ of Miami then offer this 2 yr MD program for PhDs in sciences/engineering in the 70s and 80s?

http://www.ncbi.nlm.nih.gov/pubmed/20354390

So it did exist. Next, you ask if I'm bitter, etc? Yes, I am. And here's why ... today, I work for a hedge fund and I earn a ton of money. Yes, I should be thumbing my noses at you and others, however, I'm clearly aware of the fact that this is 'Money For Nothing', which I why I never bought into Romney's spiel about the well off, being jobs creators, as a default condition w/o question.

I'm well aware of my experience of being a chemical engineer/applied chemist, working 12 hr days for a fraction of my current pay, but yet, society thinks of me today as an immaculate winner because I bring home the bacon. Back then, I was simply a cog in the MBAs' cost centers, always expendable. Who wouldn't look back and feel a sense of angst towards that.

For me, it's those who contribute, regardless of his/her compensation, that are *the winners* which is why I reject MBAs so vehemently. And yes, scientists and engineers have been contributing extensively, to the success of the practitioners of medicine. Just look around you, all the equipment including scanners, life support systems, drug delivery mechanisms, stents, pharms, etc, were once invented by scientists and engineers. Would you really be able to do your work without them?

But enough of this, as it's clear that we're at an impasse. I'd brought up this subject to get people talking about medicine and the fact that it's a waste to have 4000+ NASA engineers (and others) unemployed or underemployed, working for Home Depots, vs re-training them for careers as MDs, PAs, Nurses, Pharmacists, or whatever. Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

Facebooksux says

First off, physicians are not overpaid. In fact, GP's are grossly UNDERPAID for the amount of work they have to do.

To be fair, just about everyone in every field declares them self underpaid.

The truth is that just about everyone in America is overpaid when you consider we live in a global economy. Perhaps relative to your neighbor or another state you are underpaid and overworked, but leave America and you'll see just how good we have it here.

curious2 says

Again the defensive use of self-inflicted past suffering to justify current compensation from others, even though the past suffering is not the patient's fault and confers no benefit upon the patient. "We chose to suffer, so now we own you and have a right to overcharge you, and you are required to pay us whatever we say, and you're not allowed to take care of your own health." Plus now a counter-attack on engineers, of all people.

Wow talk about putting words into people's mouths. Did anyone really say any of this? No doctor blames the patient for their past suffering...I find it funny how you can twist words.
This is not a defensive use of self-inflicted past suffering. However whenever you consider pricing anything, including a salary, you have to take into consideration the cost to produce something, including a profession. Clearly if something or someone could be produced cheaply and quickly, it would be hard to justify a high cost. However if something was expensive and took long to produce, then a higher cost can be justified. Why can a buggati veyron sell for 2 million while a toyota camry sell for 20k? Similar principle. Isnt the whole purpose of this thread to see how a salaries can be justified? If so, why cant the argument that many years of training and thousands of dollars are required to train a doctor be used to justify the pricing for their service? We all know the salaries for the most part correlate to level of education.

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors. may want to get your facts straight.

curious2 says

BTW, there is a significant mismatch between the amount some doctors collect, and the amount the public are required to pay. A lot gets lost in the mandatory insurance system and the administrative levels, as others have pointed out. So, some of this disagreement results from perspective: patients are paying a lot, but many doctors aren't getting a lot. The disparity is particularly wide in emergency care, where hospital charges are enormous and the amount actually passed through to doctors is often small. But emergency care is less than 10% of total spending, so when people talk about how much is paid, more than 90% is in non-emergency settings.

YOu are right. doctors make up about 8.5% of all healthcare costs in this country. Much disdain for doctor salaries come from the fact that people pay a lot of money for services rendered. Unfortunately doctors see only a fraction of that money.

curious2 says

Personally, I would rather see real healthcare reform based on engineering, expert systems, and at-home devices, instead of the mandatory entrenchment of the existing allopathy and its gatekeepers. Every pharmacy sells at-home devices so you can check your bp, pulse, temperature, weight, and height as often as you like and buying them costs less than a single doctor visit. It isn't necessary to pay a physician for tests you can do at home; the technology has advanced like the digital camera, and yet we're mandated to pay for the equivalent of film and old-fashioned processing. Computerized stethoscopes have been shown to outperform human doctors at detecting certain conditions. If we didn't have the mandatory insurance-driven system, costs could be reduced substantially with probably better results.

No one is forced to go to the doctors. If more people were like you, demand for doctors would decrease and perhaps the law of supply and demand may drive down doctor salaries. HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs. IN addition, being in the profession myself, I can guarantee you results would not be better. If you truly think so, i would urge you to try it. Next time your wife or mother has a lump in her breast, lets see you do your own history,exam,testing, diagnosis and treatment. Your clear lack of knowledge of medicine makes your statement here quite absurd...

curious2 says

Allowing free choice in a free market

YOu have free choice in a free market. No one forces you to go the doctors, no one forces you to go to a specific doctor and no one forces you to go to a doctor that you feel may charge you too much. Well.. you had the choice, not so much with obamacare...

Meccos says

HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs.

http://www.washingtonpost.com/blogs/ezra-klein/post/how-1-in-health-insurance-gets-spent/2012/01/04/gIQAuzDmaP_blog.html

says 28%

>Well.. you had the choice, not so much with obamacare

as the law stands now, if you don't like health insurance, just take the penalty/tax, and make sure the IRS never owes you money, since that's the only way -- now, at least -- that the IRS can beat the penalty/tax out of you.

Rin says

Mecco and others, you keep insisting that alternate science/engineering persons can't do medicine

I never said other people cant. Plenty of people I know had other profession before going into medicine. HOwever you insinuate that many if not most people can, which is not true. Having a basic science background means really nothing. Becoming a doctor does not require a lot of intelligence. Rather the difficulty lies in the decade long process of sacrifice, persistence, dedication and delayed gratification, which is the part that most people cannot do.

In addition, the study that you quote took students that already had PhD or some other degree. Medical school is divided into 2 years of basic science and two years of clinical rotation. Since these students already had their basic sciences, they were able to graduate in two years because all they were required to do was the clinical rotations. The results of this study basically showed that students with basic science degrees can graduate quicker. Unfortunately this is pointless since you have to spend years to get a phd anyways. BTW many medical schools have a combined 6 year MD-PhD degree already. IN addition, this studies does not discuss residency, which is where you really learn EVERYTHING. ask any doctor and they will tell you that residency is what is important. Medical school just prepares you for residency, just like high school prepares you for college.

Rin says

Next, you ask if I'm bitter, etc? Yes, I am. And here's why ... today, I work for a hedge fund and I earn a ton of money. Yes, I should be thumbing my noses at you and others,

Clearly you are bitter, we all knew that. Perhaps we should be asking whether you are overpaid. But in all honesty I dont care.

Rin says

Back then, I was simply a cog in the MBAs' cost centers, always expendable. Who wouldn't look back and feel a sense of angst towards that.

You chose to go into the profession... no one to blame but yourself. Trying to minimize someone else's profession without any merit doesnt make anything better. HOWEVER if you did want to talk about big pay checks, why didnt you focus on california highway patrol officers making 300K with AWESOME benefits?

http://www.sacbee.com/statepay/

Rin says

For me, it's those who contribute, regardless of his/her compensation, that are *the winners* which is why I reject MBAs so vehemently. And yes, scientists and engineers have been contributing extensively, to the success of the practitioners of medicine. Just look around you, all the equipment including scanners, life support systems, drug delivery mechanisms, stents, pharms, etc, were once invented by scientists and engineers. Would you really be able to do your work without them?

I appreciate everyone who contributes. I appreciate everyone at the hospital down to the custodians and the cafeteria workers. However, this thread was never about appreciating who contributes was it? Rather it was an attack on doctor's salaries.

Rin says

But enough of this, as it's clear that we're at an impasse. I'd brought up this subject to get people talking about medicine and the fact that it's a waste to have 4000+ NASA engineers (and others) unemployed or underemployed, working for Home Depots, vs re-training them for careers as MDs, PAs, Nurses, Pharmacists, or whatever. Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

You are right. I agree that is sucks to have these scientists unemployed. However if that was your point, you clearly did not express it well... at least not until this very last paragraph.

Rin says

Personally, it doesn't affect me at all, as I'm already well off and soon, will have no problems paying tuition for any overpriced schools but I'm thinking about others, who aren't so fortunate.

Well I wouldnt say tuition is overpriced. Its not cheap to train a physician. BTW, I wasnt fortunate to have money to pay for medical school, but most doctors are not so fortunate. 200k loans are not unusual. it sucks but we all do it...

Bellingham Bill says

Meccos says

HOwever as I mentioned before doctors are 8.5% of healthcare costs and probably wouldnt make much of a dent in terms of costs.

http://www.washingtonpost.com/blogs/ezra-klein/post/how-1-in-health-insurance-gets-spent/2012/01/04/gIQAuzDmaP_blog.html

says 28%

>Well.. you had the choice, not so much with obamacare

as the law stands now, if you don't like health insurance, just take the penalty/tax, and make sure the IRS never owes you money, since that's the only way -- now, at least -- that the IRS can beat the penalty/tax out of you.

YOu got your stats from one insurance company, which is hardly credible especially when their argument is that majority of their money is spent on actual care. These links below totaled the entire cost of healthcare costs for the country. I would say these are more accurate.

http://www.medicalnewstoday.com/releases/226768.php

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

chanakya4773 says

The supply of doctors has been artificially constricted by the Doctors lobby. its one of the most powerful lobby. Its very difficult for doctors from other countries to come to US for practice.

Chanakya,

I am not sure where you got your information from but this is not completely true. Although you are correct in that the number of doctors has not risen significantly, they certainly have not been artificially constricted by the "powerful doctor lobby", which I assume is a reference to the AMA. In fact there have much several studies funded by the AMA to investigate barriers to increases in medical school class sizes. In addition, due to physician shortages, there have been efforts made since the 1970 to increase the number of physicians. In the 70-80's many foreign physicians were recruited, which is why you currently see so many physicians of foreign origin in their 60's. In addition there have been much efforts to actually increase medical school sizes.

http://www.medicalnewstoday.com/releases/30270.php

http://www.remappingdebate.org/article/recruitment-foreign-physicians-zero-sum-equation?page=0,2

Believe it or not, the nursing unions are much more powerful than any doctor lobby, hence the reason why doctors are losing much ground in terms of patient care. You now have nurses who practice independently of doctors. They are able to see and treat patients without doctor supervision, prescribe medications and even perform anesthesia on patients solo. Surely if the doctor lobby was so strong, you would not see any of this.

chanakya4773 says

Its quite surprising that the whole discussion is US is not on the topic of rootcausing the issue as shown in the graph above but its on how we redistribute the high cost.

That surprised me too until I figured out that the policy discussion is dominated by lobbyists and politicians who get a cut of the $ and commercial newscasters who depend on advertising revenue from the same industry. Watch any national newscast (ABC, CBS, NBC), count the commercials, and see whom they're for. I find a clear majority are from PhRMA, and half of those are for drugs that legally require a prescripton ("Ask your doctor!"). Again it goes back to the difference between book smarts and street smarts.

Meccos says

YOu have free choice in a free market. No one forces you to go the doctors, no one forces you to go to a specific doctor and no one forces you to go to a doctor that you feel may charge you too much. Well.. you had the choice, not so much with obamacare.

You are right that Obamacare reduces choice, but you are mistaken in saying there was a free market before Obamacare. The 1951 prescription mandate made prescriptions mandatory for most drugs. People can't even buy contact lenses without a recent prescription, though they are free to buy firearms and fire blindly. (See comment above about gatekeepers.)

Meccos says

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors.

Thank you for pointing out the importance of Medicare in setting prices. To be sure that we have our facts, can you please elucidate, exactly who sets Medicare prices, and who owns the insurance billing codes that will be used in ObamaCare? To guide your research, I'll offer you a hint: they are an Association that endorsed ObamaCare, and their members tend to share a specific degree, though admittedly they do not represent the majority of doctors (only around 10%).

curious2 says

Meccos says

BTW doctors dont set pricing, medicare sets pricing which is used by all insurances companies when deciding how much to pay doctors.

Thank you for pointing out the importance of Medicare in setting prices. To be sure that we have our facts, can you please elucidate, exactly who sets Medicare prices, and who owns the insurance billing codes that will be used in ObamaCare? To guide your research, I'll offer you a hint: they are an Association that endorsed ObamaCare, and their members tend to share a specific degree, though admittedly they do not represent the majority of doctors (only around 10%).

Once again, why not try being an adult and put the facts out along with your analysis and have an actual discussion.

Not that facts matter to you but I'll try. There are two sets of codes, cpt which defines service levels and icd9 which defines diagnoses. Both are an integral part of medical billing. You have to have both and get both right to get paid. Since the icd9 (soon to be 10) are owned and copyrighted by the world health organization I'm going to assume you are talking about the cpt codes.

Cpt codes are copyrighted by the AMA and developed by a committee. Cpt codes are service codes, not billing amounts. There is also the Resource-Based Relative Value Scale codes which are a scale to give differentials for different levels of expense. Physicians get more in NYC than in Moses Lake.

I think what you are groping for is the medicare fee schedule. That's set by CMS (Centers for Medicare and Medicaid Services) which is the federal body responsible for administering Medicare and Medicaid programs. The base schedule is run through the cpt codes for the service level and then rbrvs to get an actual payment amount. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html

The AMA defines the service and the CMS sets the Medicare and Medicaid rates for that service. Hope that clears things up for you. It's not some giant conspiracy.