What's Your Doctor Worth?

American Thinker ^ | January 25, 2007 | Linda Halderman, MD

[Arizona Carolyn]

More and more hospitals are closing because of treating people who have no insurance and never pay. The State of Arizona has been trying to collect from the Government to help defray these costs, the Government ignores the situation. Trauma units are closing because of this situation and perhaps when they are all closed people who think we are not affected by the South will change their views on that as well as their disdain for MD's, too..

[Arizona Carolyn]

Absolutely untrue. Medi-Cal is just as paltry for surgery and the paperwork for approval is very timeconsuming. Medicare will not pay conscious sedation for some procedures done in a surgical suite at the doctors office, instead require the patient to have the procedure done under anesthesia in a hospital at a much higher cost...

[Arizona Carolyn]

Coding and billing is what I do. I know exactly what you are saying.

[Mom MD]

The other thing people forget is the cost involved in even getting to be in practice. i make an OK living, and I don't expect anyone to cry for me, but compared to other professionals - lawyers, business execs, heck even plumbers, I don't make a lot.

It also took 4 years of college and 4 years of medical school - took years to pay off those loans. When I finished medical school I had 3 years of residency, making the princely sum of about 25K per year. Not bad for 100 hour work weeks or longer! The hourly rate is truly depressing.

Now I make a respectable income, but I am certainly not rich. In exchange for this income, I work often 12 hour days, and have the constant worries about malpractice as well as being second guessed all the time by utilization management, quality management etc.

I am lucky enough not to have weekend hours, but my husband who is also a physician works 2 out of 3 weekends and holidays, and several overnights per month. All this for less than a lawyer or business exec makes

I am not asking for sympathy - I love what I do and am fortunate enough to work part time to have time to spend with my children. But those who complain at what their doctor makes are way off base. You cannot look at the yearly earnings without taking into account the rest of the equation. /rant off

[Mom MD]

then be prepared to pay the rest of the cost yourself - in higher insurance premiums, higher costs of medications and hospitalizations for everyone else

And while your at it, do you want the quality of care to be aggressively low as well? That is what you are saying if you want the best in practice to decline taking medicare/medicaid - only those that are desperate for patients (likely the more marginal providers) will end up seeing these patients

[Mom MD]

I am excellent at treating chronic disease, and have many treatments/medications that can keep people with serious illnesses alive and relatively healthy for years beyond what they would live without health care.

If some choose to be treated over the internet - well you get what you pay for.

[Mom MD]

and you speak from experience?

Some physicians in highly compensated specialties in urban areas are making quite a bit of money - but most of us, particularly in primary care, make a comfortable living, but certainly not raking it in.

[Fairview]

More and more hospitals are closing because of treating people who have no insurance and never pay.

Yes, isn't it true that three hospitals in California, catering mostly to an indigent/immigrant population, closed last year? And the administrators at Maricopa in your state are extremely stressed; there's been talk of closing it too unless there's some federal assistance.

People in this country need to wake up. The costs of caring for everybody in Central and South America at American standards of care is more than the taxpayers of this country can possibly afford. These people are NOT contributing enough in taxes to repay the government for their own medical care, and they certainly don't pay the hospitals. We have enough healthcare problems in this country without inviting millions of indigents here.

[Mom MD]

Yes in a major metro area. And most will be at the 150 K end.
Like I said, a comfortable living, but work out the hourly rate - its less than your plumber makes

[Mom MD]

You might be interested in this

[durasell]

I used to drink regularly and play cards with a group of doctors, so I pretty much know what they were making.
The exceptions were the docs addicted to ER and trauma.

[Arizona Carolyn]

It's one of the many hidden costs of illegal immigration that people choose to ignore. Fact is we could afford to pay more for fruits and vegetables if we were not paying for the healthcare, schooling, crimes, etc., that come with the workers who "do jobs no one else wants to do." /s

[Jim Noble]

Most Fire Departments are made up of Volunteers

What does that have to do with my post?

[xJones]

Medical savings accounts can be set up that earn interest, patients can pay whomever they want for their medical care at the fees the physicans set.

It would take huge medical savings accounts for a child striken with leukemia, for instance. And it's not the greedy physicians or hospitals, it's much more complicated than that.

Hospitials are shutting down in LA and around the country because illegal aliens have to be given free care, and they don't have to pay anything. In my community, our local hospital has been caring for a 50-something illegal Mexican woman for over 4 months and the bill's over $400,000 already. So they are shutting down subsidized programs for tax-paying senior citizens who pay a monthly fee for services such as pool therapy because they can't keep going otherwise.

Get the system back to physician - patient relationship.

You live in a 1930s American world, today we have lawyers advertising on TV daily begging you to come in if you think your doctor didn't do right. You might make some bucks and your lawyer will take at least a third of it. "Breck Boy" John Edwards made a huge fortune playing to a North Carolina jury about a "birth-damaged" baby when it turned out later that the infant's damages were most probably due to other causes than the physician and his staff. North Carolina is now experiencing an exodus of ob-gyn doctors because the insurance rates are unsupportable. How do you purpose getting rid of the greedy lawyers? Or should the physicians just stay there and suck up the huge insurance costs to keep delivering babies?

Things aren't are simple as you suggest, and Hillary's national health care system may well be next on the agenda because of simple thinkers agreeing with the socialists.

[pieceofthepuzzle]

Anecdotal stories are just anecdotal stories. I know plenty of GPs who don't make six figures, and I know plenty who make around $120,000 - 150,000. The issue of medical expenses goes WAY beyond physician salaries, which constitute a relatively small percentage of medical costs.

Let's take the breast cancer scenario of this thread. When a patient presents to their GP or OBs office for a check-up/exam etc. there has to be an office, a receptionist, a nurse, equipment etc., and malpractice insurance, all expenses part and parcel of that initial visit.

If the patient gets referred for a mammogram there are the costs for the mammography equipment, the radiology tech, the secretaries etc. who administrate the mammography facility, insurance costs, transcription costs, and the radiologists fee for reading the mammogram.

The patient gets referred to a surgeon or oncologist who also has to pay an office staff, rent on an office, equipment costs, malpractice insurance, etc. If surgery is recommended there will have to be a panel of pre-screening labs obtained, involving expensive equipment and technical staff (e.g. chem panels, CBC, coags, CXR, CT or MRI for staging, ECG etc.). Depending on the age of the patient and risk factors surgical clearance may be required (this is driven in part by fear of lawsuit should the patient have a myocardial infarction etc. during surgery because of undiagnosed coronary disease etc.). This clearance may involve a stress test with nuclear imaging (more equipment, more technicians etc.).

Once cleared from surgery and admitted to the hospital there are the people who work in admitting that have to be paid (filling out insurance forms etc.), transport personnel, the people who clean the rooms, the kitchen staff, etc. The patient will have to be seen by an anesthesiologist before surgery to make sure there are no surprises, and they may want further consults. The nursing staff needs to be paid, as well has the nursing assistants.

The surgery itself involves an anesthesiologist, a primary surgeon and possibly a secondary surgeon, scrub nurses, OR techs, and lots of other support staff. There are people who clean and sterilize the instruments. The costs of disposable sterile drapes etc., and the costs of other surgical disposables (e.g. suture, medications etc.).

The tissue that is removed is sent to the pathology lab where technicians prepare the tissue for analysis, and then the tissue must be examined by a pathologist to determine if the margins are clear and if the lymph nodes are free of cancer. There may be several special stains done, and genetic analysis of the tissue. The post-op course will involve 1 on 1 nursing in the post-op area, probably ICU time, lots of labs and dressing changes, meds, etc. etc. This is a very conservative depiction of what's involved, and doesn't even touch on the costs of running the hospital physical plant. And yes, there are the surgeons fees as well.

There are no easy answers, and we need to have an honest, informed, open discussion of the potential options.

[ozzymandus]

Let's see a picture of Dr. Haldermann's house and car(s).

[Lirona]

The last time I was hospitalized, I did a line item audit of the bill. There were things like $20 for two surgical gloves, $8 for a cotton swab, $10 for a box of tissues. My total bill was almost $100k, I was there for 5 days.

In the end, my insurance company, with discounts, paid about $20k

If I hadn't been insured, they would have come after me for $100k and I would have had to pay every dime.

[Apple Blossom]

Thank goodness for someone who knows what they are talking about!

The costs this doctor mentions are real. She must do her "a la carte" plastic surgery services to even keep the doors open for poorly paying patients or insurances companies.

A 99213 visit can be a short as 11 minutes if what you are discussing is complex or involves several "diagnosis groups". The surgical consult shouldn't be as low as a 99243 and the surgical follow-up visit shouldn't be a 99213 either. As soon as you invite in the family, you are treating more that just one patient. Unfortunately our system of medical care allows us to only bill for one patient at a time. Doctors must be good counselors as well as well as good clinicians.

[Apple Blossom]

It's fair to say that doctors may be comfortable, but they are working much harder to be that way.

I work for an endocrinologist (diabetes, thyroid disorders, etc). He's been practicing in the country for about 18 years, close to 30 years total. His wife works with us as well, she has said that he works harder now for the same money he used to get 10-15 years ago...all of their doctor friends do. She says that he will put in a full Saturday in his home office dictating letters to referring physicians who are looking for answers to their patients' condition. This is in addition to seeing patients 5 days-a-week from 8am - 5pm.

What really gets to me is that we have patients that the doctor also knows socially who want to come see him "right away" when he doesn't have an opening for at least 3 weeks. This is usually for a cough, cold, or some other ailment unrelated to the endocrine specialty. They graciously offer to come over the lunch hour; like the doctor doesn't need to eat!

[GregoryFul]

My endodontist charged $1055 for about 1 hour's work of root canal with assistant, was paid $765 by my insurance company, and $230 by me. I feel their pain!