Musings of a Healthcare Pro
Board: Macro Economics
Hey Buds and Budettes,
Some background will possibly put this into a sharper focus. Myself and the ladies in my life have raised 4 youngins. 2 boys and 2 beautiful ladies. (Really they are). One son just got back from [Afghanistan] after his second tour (one in Iraq and this most recent one in a Hell Hole called Afghanistan). My boy tells me there are beautiful areas mixed in with pure desolation there, but that is hard for me to envision. Maybe it is like my beautiful Carolinas and Death Valley, but me thinks it is somewhat more disparate than that.
Anyway...Suffice it to say I have been fortunate enough to have been graced with 4 healthy children who have made me proud. Teachers, pharmacists, Captains in the Army, and well………………. Still searching……………..
I think of the many jobs we have in our Magnificent country. I have a Father who was an electrical engineer. A sister who is a Loan officer in her local Bank. Another sister who is a CPA. And lastly my older brother who served in the military for 12 years and then with the Post office for 20 more. Now he substitute teaches in the local school system where he raised his own kids. (He graduated Valedictorian in our High School…. Way smarter than me). I come from good hard working folks. The one oddity was my Mom. Now my mom was a drug addict and alcoholic, but we loved her and dealt with that until she died at age 54. Such is life and death. It is a mixed bag is it not?
When I look at the multitude of differing jobs in my family alone I realize there is great diversity. Skilled, educated, OTJ training essential in many of them, but all valuable and quite diverse in hours worked, benefits paid and retirement accoutrements. I doubt anyone would feel the need to try and figure out what they all should be paid. Too many variables. Plus who cares. We do not see any National debate or laws restricting the benefits of our Congressmen after only one term... ahhhhhh but that is another post...
Well, we do care when it influences us. Plain and simple. Whether it is getting a tire fixed, having a legal document signed, sending our kids to school or having our mail delivered; we care when it influences us. We may be benevolent creatures, but we do have to look out for old Numero Uno! Maybe we value more our safety during times like Pearl Harbor or 911? Maybe it is when our health is on the line? How do we determine in those times weak and weary what someone else’s time, skill set and experience really add up to?
Somehow the job of Medicine has taken on a role in society that has become somewhat different form all others on one hand. While at the same time demonized as greedy on the other.
Probably the hardest thing to understand coming from this little Woolybooger is why this profession alone is expected to get up a 2 a.m. and go into the hospital and provide life saving services but also be okay with getting paid Zero for that work many times. Every other job I know the American public understands they will pay for someone else's expertise, time, and skills that they provide for them. Be it fix a tire. (Don’t see anyone getting up in the middle of the night and doing that for nothing.) How about risking one’s life guarding our nation on the front lines with gun in hand and doing it for just room and board? Maybe go tutor students after hours and on the weekends instead of spend time with your husband/wife or kids and do that for free too. These are not straw men we are setting up. It is the reality of what men and women do who practice medicine and for most of us we do it sometimes grudgingly and sometimes with great joy. When we save someone’s life from hemorrhaging to death with a rupture ectopic pregnancy the last thing we are thinking is “gosh I hope they have insurance”. It does come into play later though when we pay our staff, our overhead including supplies, rent, malpractice, licensing, continuing education, and yes……. Pay ourselves.
The truth is most of us make between $175,000 and $275,000. Only a small percentage make more and usually that is some business arrangement that is outside the scope of seeing patients and providing medical care. We have CEO pornography in medicine too and it is a shame.
When folks see those $$ figures they may or may not think it is (1) about right, (2) too much, or (3) not enough. As someone pointed out earlier, the cost of medicine is not high because the Doctors or nurses are making too much. We account for less than 10% of anyone’s lifetime medical expenses.
When factoring in just exactly what it is I myself do, I will just lay it on the line.
I went to 12 years of undergrad. Almost everyone who comes to this board did. I then did 4 years of college. Many if not most who come to this website did the same. I did 3 years of Graduate school, but did not need to in order to get into Medical School. It was my choice, so it is irrelevant for the most part. I then did 4 years of Medical School, which is somewhat more than someone who got their PhD. I’m sure we have some of those here too. Then 4 more years of specialized training in residency to finish things up. Earlier I think it was proposed that $155,000 was a good number to pay someone in my position. That is an out and out ridiculous expectation. My son in law makes more than that as manager/owner of a Chick Filet.
I am on call a lot. More than most specialties and in my little old town even more than in a bigger city. I work about 100-110 hours on average each week. Some of that is “on call” time, but a majority of the time is in the trenches. I made just over the $250,000 that was mentioned in the last thread. That equals out to about $45-50 an hour. Suddenly it doesn’t look quite the same does it? I will deduct vacation time for the year and it gets a little better at $55 an hour. Anyway, you get the drift I am sure.
The Affordable Care Act? Hmmmmm… Sounds great. Health care for everyone. Who could argue? Not me. I already do that here in the United States. Granted most of what I do for those uninsured or not covered by Medicaid or Medicare is emergency things, but I really do not have any more hours left to “do more stuff” in anyway. More patients coming into the office that previously couldn’t afford to do so? Capping what a Doctor makes when we do not artificially cap any other job at all? Why would anyone spend that kind of time, money and effort to get that skill set, then work under that kind of pressure with the expectation of perfection or get sued, when they could just open up a new Chick Filet? Heck they could work ½ the hours and what’s the worst they could do? Burn the chicken? Forget the fries? Of course I am being just a little bit silly.
I have said it before. The overriding cost of Medicine is the business of medicine built up around insurance companies. The number of folks that work in that business is astounding. They are all for profit institutions. They have shareholders. Also the amount of crap that gets done to “insulate ourselves from getting sued”, either in the office or at the hospital is obscene. I have never been sued. Yet I pay nearly $1000 each week for malpractice coverage. Think about that. 30 years times $50,000 is yes fans and friends……..$1.5 million in malpractice premiums. Multiply that for every Ob/Gyn in the country and you see the layers of cost that are strangling us. Wonder how many folks I could treat during my career for $1.5 million dollars? Remind me what other job has this hanging over its head? Right!
So a Woolybooger’s solution is not really where our country is heading.
(1) Kill all the lawyers! Okay maybe a little over the top. Just put them in jail for 5 years when they take on a frivolous lawsuit. Okay, how about we just eliminate malpractice all together as a cost in Medicine. Instead we have panels of retired Doctors who review all bad outcomes and award monetary compensation where it is due and weed out doctors who clearly are not up to the task. We do it in other professions.
(2) Eliminate private insurance! We all accept a compromise of what private insurance has paid and what Medicare is now paying. After all, we could get by okay if we didn’t have to spend so much money filling claims over and over again just to get paid. (Honest…. I really did deliver their baby) (Honest…. I really took our their cancer. I didn’t just make that up)
(3) Eliminate private Pharmaceutical Companies! Place medical research in the hands of men and women who get paid well enough that we have the best and brightest going into those fields as well. Talk about a great work our Government has the opportunity to do for "we the people".
(4) Pay Doctors in accordance with the hours they work and not by some arbitrary “value” placed on their specialty. I speak for myself alone on this. If you are in a specialty solely for the bucks, you should be a dying breed. I know it takes longer to get through a Neurosurgical residency than a Pediatric one, but you knew that going in. Take it or leave it.
Okay, enough for now. Everybody knows I love my job, and for the most part take the good with the bad. I want young men and women who love helping others and who have the skill set, mind set and heart set to be doctors not to be deterred because we treat the workers in medicine different than we treat any other workers.
Affordable Care Act? Hmm... Not sure it was such a good idea to have Congress Critters who can’t seem to “get over” their own self importance to draft a Medical Plan when big business, lobbies for Attorneys and Insurance Companies have such sway.
Wooly…………………. Who was glad he bought some CBI when it was $12…………….