Doctor Fees Major Factor in Health Costs, Study Says

[sinkingfeeling]

http://www.nytimes.com/2011/09/08/us/08docs.html

WASHINGTON — Doctors are paid higher fees in the United States than in several other countries, and this is a major factor in the nation’s higher overall cost of health care, says a new study by two Columbia University professors, one of whom is now a top health official in the Obama administration.

“American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom,” said the study, by Sherry A. Glied, an assistant secretary of health and human services, and Miriam J. Laugesen, an assistant professor of health policy at Columbia.

The study, being published Thursday in the journal Health Affairs, found that the incomes of primary care doctors and orthopedic surgeons were substantially higher in the United States than in other countries. Moreover, it said, the difference results mainly from higher fees, not from higher costs of the doctors’ medical practice, a larger number or volume of services or higher medical school tuition.

Ms. Laugesen and Ms. Glied said that among primary care doctors, those in the United States had the highest annual pretax earnings after expenses — an average of $186,582 in 2008 — while those in Australia and France had the lowest earnings, $92,844 and $95,585.

“Among orthopedic surgeons, those who had the highest annual pretax incomes, net of expenses, were in the United States,” with an average of $442,450, the study said. In Britain, which ranked second, the comparable figure was $324,138. Annual pretax earnings of orthopedic surgeons in the other countries were less than $210,000.

Medical students often cite higher pay as a reason for choosing to become specialists, and the researchers said the income gap between primary care doctors and orthopedic surgeons was larger here than elsewhere.

[MineralMan]

1. Yeah, duh...

I think everyone already knew that, really.

[Broderick]

2. So now we want to talk about cutting doctor pay I presume?

Yeah, that's the ticket. So many want out of the game as it is. The young ones are getting burned out and we are importing many of them. So the next step is to cut the pay? Scratching my head.

[NNN0LHI]

6. Yea, the park benches around here are full of discouraged doctors who can't make a decent living

They are everywhere.

Don

[Broderick]

9. My personal physician wants out

He says the regulations and paperwork are ridiculous and the pay considering insurance and such isn't worth the hassle.

[NNN0LHI]

15. Let me know when you see him sitting on a park bench then

Lot of people talk a good game, but talk is cheap.

Don

[Broderick]

17. He is 60 or so

Doubtful we will find him there. They sacrifice a lot of their best years getting to the point of being a doctor in the United States. I want the best and the brightest to work in healthcare. That is one thing I find very valuable. But if money is all someone wants, they can be a gas and oil engineer and make more money for less investment. Going to school 8-12 years saddles these medical professional folks with 100's of thousands in student loans for many years after they go to work. You can't compare someone on a bench without job with no education, bad habits, and if they have a degree it's in something like poly pseudo science. LOL. Not every schlub can be a doctor.

[NNN0LHI]

20. You should have mentioned his age in your post about his high malpractice insurance

I have an uncle who was an OB/GYN. And not just any OB/GYN either. He was the best. He delivered me, and both my kids.

And made a lot of money. I mean the kind of money that most of us here can't even imagine. The initiation fee of $35,000 for the private country club he belongs to cost about half of what my house cost. He made that kind of money. This country club: http://www.usatoday.com/sports/golf/pga/2003-06-10-olympia-diversity_x.htm

And you know something else? I think he deserved every penny he made. But you know what happened? He got greedy and wouldn't retire. Due to his age he began making mistakes that he never would have made when he was younger. So he started spending more time in court than he did at the office. His malpractice insurance costs became unmanageable for him too.

But who's fault was that?

Don

[Broderick]

21. His

Human nature exists no matter what profession. You can't teach greed, nor teach piety to an adult. Many doctors donate time, go overseas to help our forces on little, and donate much to science, the arts, etc.

[NNN0LHI]

32. I retired at 48

One of the reasons I gave consideration to for retiring that early was being worried about hurting someone else on the job.

I wasn't a doctor but my job involved working with very large machinery where one little mistake could cause a fatal injury so fast you can't even imagine. I seen guys get killed on the job and all it took was for one person to not think something thru thorough enough before doing it and a split second later someone would be left dying in about the most horrible way imaginable.

If I had been responsible for something like that I don't think I could have lived with myself. Never gave much thought to how much more money I could have been making if I had not retired when I did. There are a lot more important things to me than money. Peace of mind is one of them.

Don

[OhioChick]

33. Physicians couldn't retire at 48....LOL

Depending on your specialty, medical residency (follows med school) can last from a minimum of 2 years to 6 or more. After accumulating debt over the previous 8 years, you will finally be drawing a small paycheck. The pay starts at about $32,000 for the first year and tops out around $48,000 for 6th year residents.

[NNN0LHI]

38. My uncle the OB/GYN could have done so easily

He was already living in a multi-million dollar mansion(Not to be confused with a Mcmansion), at his private country club long before he was 48. And that is in the mid to late 1960's dollars. Beautiful home. Reminded me of the house the Beverly Hillbillies moved into. Cement pond and all. He had only been practicing about 15 years.

But again like I said above don't get me wrong here. He deserved it. He was a busy man. Busiest man I ever knew. I remember being at his house when he was on call. Phone was ringing off the wall. Had to probably get up thousands of times during the middle of the night to go to the hospital to deliver a baby. Right through the dead of our Chicago winters too. He probably put in about twice the number of hours working that an average person does? I could have never done that. Probably not too many people could.

Don

[Broderick]

35. You can lay your head down at night

and sleep a restful sleep. Sadly, some can trample all over souls and lives and it never affects them a bit.

[NNN0LHI]

40. I feel guilty not adding this about my uncle though

He loved his work. All his patients loved him too. Some drove from great distances because he was known as the best in these parts. And he was one of the nicest people I have ever known in my life. Movie star looks. Gorgeous wife.(My mothers kid sister.) And a great sense of humor. He had it all.

But when I say he loved his work I mean he really did. He was just a great baby doctor. People didn't want him to retire. They begged him not to. I am sure that also held him back from retiring sooner.

But now that he is retired he is still very happy. And still making money too. Owns a couple of medical centers and has a lot of other stuff going on like sitting on boards so he isn't exactly just sitting around in front of a TV every day wasting away. Good golfer too.

Take care and see you later.

Don

[OhioChick]

8. The stage is being set....

My physician makes 80K/year and he's struggling with high student loans, medical malpractice insurance, etc.

[Broderick]

11. But you will have people tell you they are overpaid

and the groundwork is being laid out. The insurance is astronomical to practice and the sacrifice to get there over all the years it takes is long. And not to mention the student loans like you say.

[fasttense]

3. I understand that one of the reasons the AMA and other doctors supported this health insurance

method of payment was because they could make more money. And they seemed to have been proven right.

Doctor's greed is frequently overlooked as a cause of the high health care costs here in the US. Add to that the greed of health care insurance CEOs and shareholders and you have a recipe for out of control costs and people dying from lack of medical care.

[malaise]

4. Doctors earn big bucks in several places particularly

in these neo-liberal economic times.
Here in Jamaica, the car dealers actually have displays of the high end vehicles in the car park of the medical faculty. That alone speaks volumes.

[Gidney N Cloyd]

5. I wonder how fees would compare if universal care covered all the people who can't pay now?

[Overseas]

7. I think this is intended to deflect attention from the much bigger factor-- the insurance companies

with their double-digit overhead versus Medicare's low administrative costs.

Single payer, Medicare for All, would curb healthcare costs a lot more than trimming doctors' fees.

[Broderick]

12. thank you!

Drive by any corporate or regional insurance headquarters and be amazed at the palaces they exist in.

[Overseas]

22. And the multi-million dollar annual salaries for their CEO's

certainly trump the half million for expert surgeons that the article wants us to get angry about.

[Broderick]

25. And the salaries for simple marketing degrees

is phenomenal in comparison to the decade a doctor might spend in secondary education. The insurance companies are the biggest crooks of all of them, and then followed closely by lawyer in my estimation. Not every human that is a doctor is perfect obviously, but most earned their way no doubt.

[OhioChick]

29. Time to look at CEO's

August 19, 2011

Health industry's top earners

For the second consecutive year, UnitedHealth Group's Stephen Hemsley was the top earning health executive, making $6.3 million in compensation and cashing out $43.5 million in stock options, down from $98.6 million cashed out in 2009. Former Aetna CEO Ronald Williams would have topped this year's list after making $71.1 million last year, but he stepped down in November, making him ineligible for the list.

Meanwhile, overall CEO compensation at the nine hospitals to make Modern Healthcare's list in both 2009 and 2010 increased by 58.2%, to reach $101.9 million. HCA CEO Richard Bracken topped the list of hospital executives, making $41.3 million last year. Meanwhile, DaVita CEO and chair Kent Thiry was the highest-earning specialty care executive, earning $9.4 million in compensation and cashing in $6.3 million in stock options.

http://www.advisory.com/Daily-Briefing/2011/08/19/CEOs-of-top-earning-hospitals-see-big-compensation-gains

[Broderick]

30. This is a real appalling travesty to the outright theft in this country

Look at your healthcare and wonder why it's so affordable. And THESE INSURANCE COMPANIES are not against the Healthcare bill at all? Why??

[OhioChick]

31. Why you ask?

Windfall profits, but I think you already knew that. :)

[Broderick]

34. OH HELL yeah

but the NYTimes wants to plant seeds about doctor salaries being too high... This is like saying that the insurance paperwork clerks are being paid too much while the CEO's get TENS OF MILLIONS.

[w8liftinglady]

27. exactly.

as I have said many times before- I do not begrudge doctors one cent when it comes to their salaries. They gave up their formative years to become physicians and are usually hundreds of thousands of dollars in debt.

The insurance executives, on the other hand... are making hundreds of millions of dollars a year while our rates rise.

[bemildred]

10. Gotta pay back all those loans somehow. nt

[InkAddict]

13. When doctors re-neg or fail to provide HC insurance benefits for their

staff, you can bet that "do no harm" isn't a part of their oath they honor. You and/or your well-being are not, I repeat, NOT of interest to them; however, the money they can squeeze out of your wallet to support their and/or their spouse's/family's luxury sure is. Choose another provider and/or employer pronto.

[mainegreen]

14. Doctors here also have higher student loan debt, higher malpractive insurance costs

and less legal protections should they make a non-negligent mistake in running their practice. Doctors here who run practices also have larger practices to manage because of the size of the administrative staff that is required just to run a practice in the US.

I also find it odd to attack the 'high' wages of specialists. Sure 400,000 is a lot. Even 200,000 is a lot! But lets face it, these people can kill you if they mess up. Isn't the lure of high wages to attract top talent especially important in a job where people are chopping up or drugging or diagnosing life and death situations desirable?

The real issues with health costs is not doctors. It's like trying to balance the budget by attacking NASA spending.

[OhioChick]

16. Well said and agreed n/t

[Broderick]

18. but but but

do they live on a bench downtown if they ever want to quit? LMAO. Shake my head at some people. Being a doctor takes away your best years just to reach that goal, and it's plenty more years to be a specialist. I want the best and brightest in those fields, not having them go to gas and oil technology for less investment to make more money.

[OhioChick]

19. Mayo Study: Widespread Burnout Among New Doctors

September 7, 2011 12:32 PM

ROCHESTER, Minn. (WCCO) – A Mayo Clinic study finds that “burnout” and financial debt are widespread among doctors-in-training.

The survey involved more than 16,000 internal medicine residents and provides a disturbing diagnosis.

“Burnout and reports of low levels of quality of life were very common,” said lead researcher Dr. Colin West.

More: http://minnesota.cbslocal.com/2011/09/07/mayo-study-finds-widespread-burnout-among-new-doctors/

This doesn't help matters:

Debt Deal Would End Subsidized Loans To Grad Students

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=439&topic_id=1634392

[Broderick]

23. Let's bash doctors and pay scales and lay the groundwork

to bring their salaries down to where cashier clerks are at. That will fix that problem. :sarcasm:

[renate]

24. it'd be interesting to see the costs of education and of running a practice in those other countries

If it weren't for U.S. doctors' having to pay for their very expensive education themselves (compared with those in other countries where people don't have to go into crippling debt to get a college and postgraduate education) and dealing with a myriad of insurance companies, all with different paperwork (compared with working in countries with a national health service), the salaries here and abroad would probably be more similar.

Edited to add, with a blush, that I got doctors' fees and doctors' salaries mixed up. Their fees may be higher in part because of the costs of processing paperwork, but their salaries wouldn't be.

[Broderick]

26. I agree

[area51]

28. +1 n/t

[Xithras]

36. My daughter will be starting college next fall, and plans on attending med school.

According to AMA numbers, when she graduates in eight years, she will be about $175,000 to $200,000 in debt. If she wants to specialize, tack on another three years, and another hundred grand. She then gets to spend several years working as an intern, making crap wages that won't allow her to even make a dent in her debt.

Which mean, when she's 32, she'll still have an easy $250,000 in debt hanging over her head. Presumably she'll want to buy a house and have kids around that point, so she's looking at a couple hundred thousand in more debt on top of that.

And people want to know why American doctors charge more? How would you like to be a half million dollars in debt by the time you're 30?

[taught_me_patience]

39. My wife is a young doctor and I have some advice for your daughter

#1) Attend a state school and try to keep undergrad tuition and loans down. My wife has 100k of loans, which is very managable... but when you combine my student loans, we're approaching 200k... which really starts adding up. We're paying almost 1k/month for the next 25 years

#2) Your daughter must be prepared to delay kids and home buying until her early thirties. Because of the delay, you constantly feel like you need to run to "catch up" with other cohorts. She needs to understand this going in. She can easily get trapped in huge debts... 200k for student loans, 500k home, 300k to start a practice... she could easily be staring at $1M in debt. Combine that with a late start on retirement and you can get burned out real quick.

#3) If she wants to make good money, she should go into derm or radiology. If she goes into family practice, she should expect 130-150k coming out of residency

#4) In my opinion, the greatest part about being a doctor is per-diems. Often, they can work for hourly wages at different practices before joining. I can think of no other profession that really offers this "try before you buy"... it is really awesome.

[Xithras]

41. At the moment, she's actually considering oncology or pure research.

She wanted to be a pediatrician for a long time, but over the past year one of her favorite teachers died of breast cancer AND one of her friends mothers died of a melanoma that wasn't diagnosed until three weeks before she passed away. The losses, and watching her friend go through the horror of losing her mother at 16, has really hit her hard.

As she said to me, "There are already a lot of good pediatricians in the world. I want to cure cancer."

I'm sure as hell not going to tell her no :)

Knowing her, I'm not sure whether she'll stick to that plan once the pain of these deaths fade, so I won't be too shocked if she ultimately ends up somewhere else. Until this past year, her goal was to become a pediatrician, pay off her debt, and join Doctors Without Borders. She's not really interested in becoming "rich". Because she's always wanted to "get out there and help people", I don't know how she'd do in some stuffy office or in a research laboratory.

[saras]

37. Bullshit. The pay ratio is only two to one, not the thousands to one ratio of executives to workers.

$180k a year simply isn't that much money, certainly not enough to be blaming America's bizarrely bloated medical costs on.

When we have executives taking home millions a year for eliminating jobs and making products worse quality...

I wonder what's really going on - perhaps doctors are talking too much about the effects they see of poverty on Americans?