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.

[from occupied ga]

Yes - and in that case the people making "a lot of money" are the parasite lawyers...

Think John Edwards. But from what I see the single biggest hit on your money is paying for the people who don't pay. (The great American founding father, Thomas Jefferson's quote, "From each according to his ability, to ehach according to his need." Oh wait that was Karl Marx, not Thomas Jefferson)

[1rudeboy]

Someone needs to nail this to the door of Hillary's Senate office. Obama's too.

[from occupied ga]

The biggest cost is overhead.

Well if you look at the numbers nonpayment is 60% and overhead is 24% so nonpayment is the biggest theoretical problem, but you're right about the collected money the biggest cost is overhead which includes malpractice.

[DB]

Hey I was about to smack you for that "Jefferson" quote ;-)

[CharacterCounts]

Was she foed to take this patient? Was she a volunteer?

She cannot have it boh ways.

amone of those much hated (on this forum) lawyers. I volunteer to accept court appointed indigent cases. I was recent compensated $125.00 for a case which took about 12 hours of my time and rerquired 5 sepearte court hearings. Am I complaining? No - because I was a volunteer.

This whiny doc wants to have it both ways. She wants to accept indigents and have someone else pay her the going rate. That someone else is ultimately you and me the taxpayer.

[from occupied ga]

Doctors salaries at a major hospital I know about range from about %150k to about $300k. In private practice they run higher, but they have to pay their own malpractice insurance which as we know can run as high as $100,000 a year.

[DB]

ICU and ER are constantly busy.

They have no problem with keeping their workers busy.

The problem (at least a major part of the problem) is mandating that the hospital care for people that are not going to pay and then passing the costs on to those who do pay.

Unlike the Dr in this article trying to get paid for her time seeing government insured patients the hospital is required to care for these government insured patients and the government (taxpayer) doesn't pay the full cost of that care. So the next paying person who comes through the door pays for all of the above. That's wrong.

[Just another Joe]

This isn't insurance companies in general.
This is what the government pays the doctor for those people that are on government aid.

I would imagine, but don't know for sure, that a private insurance company might pay quite a bit more than this.

[durasell]

Doctors salaries at a major hospital I know about range from about %150k to about $300k.






Not in a major metropolitan area, I bet.

[ladyjane]

Depending on your location the cost of healthcare is greatly increased by the illegals.

Typical case: mother-in-law in Mexico gets sick. She comes up to USA supposedly on a vacation. She goes to the emergency room, is immediately admitted, she ends up on dialysis, and the hospital bills are enormous. We all pay her bills either through taxes or though higher insurance premiums.

Another medical cost: the illegals have brought in stuff we haven't seen much of in this country for years, e.g., drug resistant TB, tape worms, leprosy.

[freespirited]

She provides no data on compensation for surgery. It's a good bet that there is a reason.

[from occupied ga]

Not in a major metropolitan area, I bet.

You would lose your bet unless you consider Baltimore/Washington area not a major metropolitan area. Rural salaries are generally considerably higher to attract doctors to areas where the lifstyle may not be as interesting.

[DB]

Umm, they aren't "indigents". They are Medi-Cal patients.

What is simply going to happen is that more and more doctors are going to refuse to see Medi-Cal patients which are most older folks.

Maybe that's a good thing. But the state can't expect providers to provide at that rate - which is her point.

And last but not least, give her some credit. She did take care of the patient without proper compensation.

[from occupied ga]

I will say that the CEO of the particular hospital (who is an MD, but does not as far as I know actually practice medicine) gets $860k a year - in line with other big corproation CEOs

[DB]

That could well be true.

What if surgery wasn't needed?

[DB]

Oops... #53 was intended for you...

[ladyjane]

Hospital CEOs are a whole other story. They make a lot. Not as much as college football coaches or professional athletes, but a lot.

[durasell]

I know several GPs who are breaking the half mil mark with their practices in NY. Add on teaching and investments and they are considerably over the mark.

[KoRn]

"Health insurance must be outlawed, seriously."

That's only one of an unholy trinity that includes lawyers, insurance companies, and government. Those three entities are all contributing to the problem in their own equally destructive ways. I would almost say that they were the problem, but the root cause of all of the problems are the individuals who think someone else is responsible for paying their medical bills.

[from occupied ga]

I know several GPs who are breaking the half mil mark with their practices in NY

Private practice no doubt?