What's Your Doctor Worth?

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

[neverdem]

How much money does your doctor earn?  If your doctor is a Surgeon practicing in rural central California, you're about to find out.

First, some background:  Perhaps your 51-year-old neighbor's screening mammogram this year showed a suspicious area.  She is called back by the Radiologist for more testing, including additional mammograms and an ultrasound.  She then receives a call from her Gynecologist explaining that the x-rays are "non-reassuring," and she'll be sent to a specialist in breast surgery.

That's where my office gets involved.  Five or ten faxed pages arrive on my assistant's desk.  She calls the Gynecologist's office to request additional material, including copies of the mammogram report, the patient's contact information and insurance data-if the patient is insured.

As it happens, like more than 60% of the women I care for, this patient is either uninsured or underinsured by Medi-Cal or BCEDP, the State of California's breast cancer detection program for low-income women.

The paperwork piles up.  Now my assistant must confirm eligibility in addition to scheduling the consultation, creating a chart and retrieving x-rays for me to evaluate.  Prior to the visit, I review the chart and create an electronic medical record.

Next, the visit.  Your neighbor arrives at my office.  I speak with her for about 15 minutes, learning her medical and surgical history, asking about symptoms and risk factors, and answering questions.

I examine her carefully, assessing not only for breast abnormalities, but also for swollen glands in eight regions of the body.  A heart and lung exam is done to identify problems that would make her a higher surgical risk, and the neurological, abdominal and musculoskeletal evaluations provide evidence for or against tumor spread.

After my patient is dressed, she asks me to bring her sister and husband in for the discussion of my recommendations.  This is often the most time-consuming part of the visit, requiring patience, repetition and reassurance for a frightened patient and her concerned family.

Although our first visit has ended, the work has not.  I fill out a form ordering testing to further characterize the abnormality seen on my patient's mammogram.  I'll pore over a list of codes required by Medi-Cal to identify the visit, choosing the most appropriate ones and hoping they don't merit automatic rejection of the bill (a frequent occurrence, prompting up to nine months of back-and-forth debate with Medi-Cal).  Because the necessary biopsy requires a Radiologist's assistance, I'll communicate with him as well as the Pathologist who examines the specimen provided.

The diagnosis is Breast Cancer, and it's my job to break the news.

Our second visit is very different.  Not only do we talk about her diagnosis, we review all of the options for treatment, alternatives and their possible outcomes.  There may be tears and anger, self-blame and fear, and the inevitable, impossible question: "Why?"

This visit is the most difficult one for my patient and her family.  I, too, find it the hardest part of being a Breast Cancer Surgeon.  Some wounds cannot be healed with sutures and sterile bandages.

Back to the question at hand: How much is your doctor paid?

What payment will be made for the initial consultation and exam?  What dollar amount is assigned to the time spent with my patient and her family, explaining and encouraging, counseling and comforting? 

Every doctor who practices independently must be not only a medical expert but also a good enough business owner to keep the doors open.  No amount of compassion, however critical to successful treatment, will pay the bills. 

Payment for a visit must cover the rent and utilities to keep the office open.  Office staff needs to be paid, their health and dental insurance premiums covered.  There are additional payments to be made for Worker's Compensation, malpractice and liability insurance.  Office supplies, medical supplies, biopsy equipment and disposable instruments are essential and expensive.  There are also laundry and cleaning expenses, postage and biohazardous waste service.  Your doctor must also pay the 24-hour answering service, the billing company, as well as the bookkeeper, accountant and attorneys.   And, like everyone else, your physician must pay Federal taxes, State and local taxes, payroll, income and unemployment/disability taxes.

Here are the actual Medi-Cal billing codes and payment schedule for central California breast cancer Surgeons in 2006:

For the initial consultation and exam of the lady with the abnormal mammogram:

CPT#99243 $59.50.

For the visit in which she is told she has Breast Cancer and is prepared for surgery:

CPT#99213-57 $24.00.

This is what your doctor is paid.  Now ask yourself what she is worth.

Dr. Halderman is a Board-Certified General Surgeon practicing in rural south Fresno County, California.

[Apple Blossom]

Rural salaries are generally considerably higher to attract doctors to areas where the lifestyle may not be as interesting.

Exactly right. Cost of living is also much lower, so that salary goes farther to buy a lot more house, more car, and private school for the kids. Quite a trade off for not having theater performances or a symphony orchestra in town.

[durasell]

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





I agree with that statement. My opinion has always been in favor of some basic coverage that would also eliminate medicaid, medicare, etc. Beyond the basic no-frills coverage, let the market decide.

[bannie]

Lawyers sue...
Hospitals have to get really expensive insurance...
Doctors have to get really expensive insurance...
Doctors and hospitals have to charge really enormous fees...

Sports and movie stars, however, don't have to pay so much for their insurance.

[GregoryFul]

The dirty little secret is that the insurance companies typically pay 1/10th of the hospital bill - a private payer is screwed - you have to use a medical plan to get anywhere near ordinary, usual, and customary charges for hospital service.

[Conservativegreatgrandma]

If you're an MD, I implore you to keep an open mind about alternative treatments. Medical doctors and their drugs have done great harm to members of my family. Thankfully, we had the internet and probably saved the life of my sister by taking matters into our own hands.

I even had the experience of curing my own RA many years ago after the doctor put me on massive doses of aspirin. It was soon apparent, that would not work. I cured it with Vit C, Pantothentic Acid and Vit E.

Since then, I've had similar results for other ailments.

My list can go on and on.

The problem is that most medical doctors only want to use drugs when their are safer, more effective alternatives.

I will use a medical doctor for an extreme situation, especially like an accident but for chonic disease, forget it. I won't go.

Right now I would love to find an MD who would use intravenous Vit C in the right situation and also use nebulized glutathione. My husband will probably need it some day. I don't know where to find one in the area.

[DB]

This was a healthy 18 year old who works on a small farm with her family who apparently inhaled some form of fungus or bacteria that wasn't ever identified that resulted in severe pneumonia. She nearly died.

[DB]

I defended the good doctor.

But the cost of health care to those who actually pay the bills is way out of control which I do not blame on the doctor.

And yes, I'm sure there are many illegals treated that are a substantial burden here. This is central California about 15 miles from the coast...

[DB]

If the Fed or the state demands that private businesses provide services to illegals that don't pay they should pick up the tab.

[dervish]

The stockholders and executives of the insurance companies are making the money.

Medical schools used to attract the best and brightest now they are filled with foreign medical school graduates.

[dervish]

"She should have billed 99215..."

And then years down the road face an audit from the insurance company with a request for repayment. Can't win.

[Fairview]

Right you are. I'm just saying, she's entitled to a 99215. Not that she could ever get paid for it.

[dervish]

Guess again.

If the insurance company had covered the bill it probably would have paid 75% or more less per their contract with hospital and doctors.

[gcruse]

So, since I was self-pay they knocked off ten thousand.
But you're saying if I had insurance, they'd have knocked off even more for the insurance company. Who is the forty thousand dollar bill supposed to apply to if insured and self-pay reduce it?

[knuthom]

rural pays more than urban

Not here in rural Missouri.

[Cate]

On the savings accounts, they are meant to be for the day to day office visits. A catastrophic policy could be carried with a large deductible - $5000 for example.
The illegal aliens are a problem that have been forced upon on our healthcare system. Bars are allowed to refuse service- this sounds harsh, but reality is- if you don't have proof of citizenship, no care will be given at local hospitals. The illegal alien problem should be handled and isn't by our government. Its not the doctors fault these people sneak across the border.
As for living in the 30's mindset- medical lawsuit caps need to be enacted. If the lawyers figure out they aren't going to be able to live most of a year on one lawsuit, they might be a bit more picky on which cases they take. Also, huge education of the general public needs to be done- your doctor is human, mistakes can and will be made, no one is perfect and they are doing the best they can. Miracles do happen everyday, but sometimes tragedies do too.
As for acknowledging the OB/GYN problem, I've had the pleasure of working for Family Practice, Internal Medicine, and OB/GYN physicians- we had to stop the Family Practice do cs from delivering babies as our clinic could only afford the malpractice on the OB/Gyn docs.
And most strongly for the record : I WILL NEVER AND HAVE NEVER SUPPORTED HILLARY CLINTON AND HER STUPID HEALTHCARE PROPOSALS. My thinking is not simple on the matter, I've lived it and for the sake of time and space, chose to put a few quick thoughts on Free Republic. We need to start somewhere, and putting the physican and patient back in charge of the healthcare system is a great start.

[Ethrane]

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

Why?

Was she fairly compensated for her expertise and services, or are you just jealous?

[ccmay]

their compassion is not in short supply, especially considering that all work done for elderly and Medicaid patients is charity care.

Not to mention the hordes of illegal aliens she will be treating for nothing at all if she covers the trauma service.

These also tend to be some of the most litigious patients around, as anyone who watches Spanish-language TV will soon gather from the quantity of advertisements for "abogados litigantes de negligencia médica."

In some ERs, it is only a slight exaggeration to say that a physician can sooner expect to be sued by any given patient than to collect a fee from him.

-ccm

[Arizona Carolyn]

I agree with you but either way the taxpayers are the people bearing the burden.... and when you have cities and states who are sanctuaries for illegals then we come full circle on who, exactly, should bear the costs. I think it's Mexico. I don't want to pay the costs no matter what direction they come at me.

[ozzymandus]

When a doctor starts crying about how badly they're paid, I get suspicious. You can assume I'm "jealous" if you want, but I think that reflects more on your character than mine.

[Ethrane]

"When a doctor starts crying about how badly they're paid, I get suspicious."

You shouldn't get suspicious, you should be worried.

When you are ill, you should want the best Doctor possible treating you...not the one that's there only because the better candidate did something else that paid better and has less hours.

Everything this physician stated is 100%, exactly true. Why should how much she makes 'overall' determine if she was paid fairly in this one particular case, because the government decided to steal her services for 20% of it's cost?

Is that OK with you comrade?