83% of u.s. Doctors consider quitting.

[Steve]

I agree with Jim R on most of his points. I'm an Orthopaedic surgeon and, like most specialists, we tend to be a more conservative bunch than primary care physicians. We largely disavow the AMA as we don't feel it rpresents our interests. I have yet to meet a colleague who his optimistic about Obamacare and it's effect on their practice. I would also say that less than 20% of my friends (very unscientific sampling of about 50 surgeons) are happy practicing medicine and they are planning for early retirement as a result. This trend in the last decade has resulted in a shortage of surgeons and the trend will be exacerbated by an additional 30 million people receiving subsidized healthcare.

 

[Larry L.]

There are 14 cardiologists practicing in the bldg were my wife's doc has his office. Her doctor told me eight of them are planning to retire (early) when Obamacare fully kicks in. They refuse to put up with it.

 

[Jeff Young]

I agree with Jim R on most of his points. I'm an Orthopaedic surgeon and, like most specialists, we tend to be a more conservative bunch than primary care physicians. We largely disavow the AMA as we don't feel it rpresents our interests. I have yet to meet a colleague who his optimistic about Obamacare and it's effect on their practice. I would also say that less than 20% of my friends (very unscientific sampling of about 50 surgeons) are happy practicing medicine and they are planning for early retirement as a result. This trend in the last decade has resulted in a shortage of surgeons and the trend will be exacerbated by an additional 30 million people receiving subsidized healthcare.

That tends to be because our present system tends to feed you a shit ton more money than PCPs for reasons that are unclear to the rest of the world.

Of course specialists have a vested interest in the current system. They make a ton of money in it at the expense of PCPs, more of whom will be needed (and perhaps paid more too) if we have 30 million more folks with access to health care -- at the expense of perhaps limiting some of the high end procedures so prevalent here in the US that are used more sparingly in other countries.

 

[Bob Fechter]

You see, making too much money is now frowned upon by the liberal youth brigade and obviously undeserved, so you guys might as well become managers at your local Burger King! :~)

 

[Steve]

That tends to be because our present system tends to feed you a shit ton more money than PCPs for reasons that are unclear to the rest of the world.

Of course specialists have a vested interest in the current system. They make a ton of money in it at the expense of PCPs, more of whom will be needed (and perhaps paid more too) if we have 30 million more folks with access to health care -- at the expense of perhaps limiting some of the high end procedures so prevalent here in the US that are used more sparingly in other countries.

Jeff,

I never said the current system works and I know of no surgeon who feels the status quo is acceptable. Most specialists do want change. What we don't want is More federal govt involvement. Medicare and Medicaid are not successful programs (poor reimbursement and runaway costs covered by taxpayers).

We don't make money "at the expense" of PCP's. Blatant lie. We all earn based on an RVU basis that has been adjusted many times in an attempt to better reimburse PCP's.

BTW our training is twice long as a PCP'S.

So what "high end" procedures do you want to ration? Do you have evidence that it will compensate for 30 million new patients wanting elective procedures?

 

[Pete McCluskey.]

That tends to be because our present system tends to feed you a shit ton more money than PCPs for reasons that are unclear to the rest of the world.

Of course specialists have a vested interest in the current system. They make a ton of money in it at the expense of PCPs, more of whom will be needed (and perhaps paid more too) if we have 30 million more folks with access to health care -- at the expense of perhaps limiting some of the high end procedures so prevalent here in the US that are used more sparingly in other countries.

Jeff I disagree with most of your views, but have always considered you Intelligent, but after that comment I'm not so sure. I hope you don't get crook and need specialist treatment in the near future.
These people save lives, how can they possibly be paid too much?

 

[Mark]

Sad sad sad. Inteligence is a funny thing isn't it. There one minute, seemingly non-existant the next!

Health Care workers at ALL levels are paid to little Pete. All of them. Period.

 

[Ian Anderson]

Sad sad sad. Inteligence is a funny thing isn't it. There one minute, seemingly non-existant the next!

Health Care workers at ALL levels are paid to little Pete. All of them. Period.

Correct Mark

Like the old joke about the mechanic doing a valve job on the engine for a surgeon. He charged £50 and hour and said the surgeon should charge that rate too.

Surgeon replied that's fine - but you'll then have to learn to do that valve job with the engine still running

It's all about economics if the job is easy it does not cost a lot to do if it requires a specialist with specialist tools - expect to pay more.

Now perhaps Jeff can comment on lawers fees

Ian

 

[Mark]

Lawyers fees eh?!

But Lawyers defend the innocent and fight for the plebs' rights and all that jazz! And did I mention, they're terribly clever you know!

 

[Tom P]

Maybe we need a government run Lawyer plan with fees and payment decided by the government. To make it fair we can have Doctors write the bill and decide the fees.

 

[Bob Fechter]

Imagine health care without government control and ambulance chasers.

 

[Jeff Young]

Jeff,

I never said the current system works and I know of no surgeon who feels the status quo is acceptable. Most specialists do want change. What we don't want is More federal govt involvement. Medicare and Medicaid are not successful programs (poor reimbursement and runaway costs covered by taxpayers).

We don't make money "at the expense" of PCP's. Blatant lie. We all earn based on an RVU basis that has been adjusted many times in an attempt to better reimburse PCP's.

BTW our training is twice long as a PCP'S.

So what "high end" procedures do you want to ration? Do you have evidence that it will compensate for 30 million new patients wanting elective procedures?

No, it's a blatant truth. If we have X amount of dollars to spend on doctors in the US, and specialists get a disproportionately larger share than PCPs, then yes, you are earning more money at their expense.

In fact, the whole RVU system backs that up as you yourself state -- the rates for various procedures are stacked in favor of specialists. If this was market driven -- meaning that the patient and doctor agreed -- no problem. But it's not. It's a reimbursement scheme developed primarily by insurers, the doctors and government that heavily favors specialists (here in the US).

How much so? Last data I found showed PCPs making 170-180k average. Surgical specialists were mostly in the $500k range and up, meaning nearly 3 times as much or more.

Is this because an MRI an knee scope on a patient is more valuable than a 2-3 hour attempt to diagnose a condition like diabetes or fibromyalgia or so? Hard to say since the market isn't setting the prices.

Clearly doctors should be highly compensated, but what lacks intelligence is to say "give them whatever they want!" and then complain about healthcare costs in teh US. THAT is dumb.

And proof that curtailment and rationing of high end procedures will provide savings to staff and provide primary care for 30 mil newly insured?

It exists in every country in Western Europe, and Oceania. Health care costs per capita in those countries are generally 30% less than in the US with similar if not better results -- life expectancy, infant mortality, etc. How do they do it? Yeah, you wait for and may not get your knee scoped in all cases, and when you are in your 70s and 80s it may be impossible for you to get a heart transplant or a hip replacement. In return you get much better access to primary care at all times, and to specialist services when you are young and productive. Scream death panels all you want, but when you have a system where you spend something like 95% of all your lifetime health care costs in the last six months of life like we do in the US, primarily on specialists, you have a problem.

And that is why specialists want zero changes to the existing reimbursement system.

 

[Jeff Young]

Maybe we need a government run Lawyer plan with fees and payment decided by the government. To make it fair we can have Doctors write the bill and decide the fees.

For a large portion of the bar doing criminal defense work that is already the case. I have many friends who get paid $65/hour and less (and that's before they pay for their office space, computers, etc.) by the government for some of the most complex legal work there is. On average, they take home $50-70k.

That said, I agree that many lawyers charge exorbitant rates. $800/hour and up in the large cities for an experienced partner on finance, regulatory or litigation matters is pretty much the norm. That said, unlike the health care market, at least the consumer and the supplier are setting those prices in an actual market, rather than separating the consumer from the price setting function and having third parties set prices as we now have in health care.

 

[Ian Anderson]

For a large portion of the bar doing criminal defense work that is already the case. I have many friends who get paid $65/hour and less (and that's before they pay for their office space, computers, etc.) by the government for some of the most complex legal work there is. On average, they take home $50-70k.

That said, I agree that many lawyers charge exorbitant rates. $800/hour and up in the large cities for an experienced partner on finance, regulatory or litigation matters is pretty much the norm. That said, unlike the health care market, at least the consumer and the supplier are setting those prices in an actual market, rather than separating the consumer from the price setting function and having third parties set prices as we now have in health care.

Jeff
$65/hr is $130000 per annum so your numbers do not add up.

Ian -accountant by trade!

 

[Jeff Young]

Jeff
$65/hr is $130000 per annum so your numbers do not add up.

Ian -accountant by trade!

Ian:

$65/hr is this number called GROSS. Did they teach you that in school? Because from that you deduct your expenses. For a self employed lawyer, that involves rent, computers, secretary, malpractice insurance, office supplies and so on.

Which gives you the NET. Another complicated, fancy accounting term you apparently missed.

It's possible you did so because I used that crazy short hand terms "take home" pay, which involves subtracting expenses from the gross.

So yes, my numbers hold up and holy cow I feel bad for your clients.

 

[Mark]

Seriously now, please.......

 

[Ian Anderson]

Ian:

$65/hr is this number called GROSS. Did they teach you that in school? Because from that you deduct your expenses. For a self employed lawyer, that involves rent, computers, secretary, malpractice insurance, office supplies and so on.

Which gives you the NET. Another complicated, fancy accounting term you apparently missed.

It's possible you did so because I used that crazy short hand terms "take home" pay, which involves subtracting expenses from the gross.

So yes, my numbers hold up and holy cow I feel bad for your clients.

Nope
They take home a gross amount of 130k
If they then choose offset half of their gross earnings before paying tax that is their choice as they have manipulated the system to their benefit.

The same employed motor mechanic is not able to set off expenses before paying tax. If he wants a new computer it is out of taxed income etc.

Get real they are playing the system. Quite legally in most cases, but still playing the system but their gross earnings is 130k

Ian

 

[Jeff Young]

Good lord.

NO.

Most law firms and lawyers set themselves up as some form of limited liability company.

They are not "offsetting earnings with expenses.' It's not a choice to have an office, CLE expenses, office supplies expenses, and so on. The LLP generates the 130k gross, the expenses are deducted, and the remainder is WHAT THE LAWYER TAKES HOME AND PAYS TAXES ON.

In other words, it is the functional equivalent of the salary paid to someone employed by a company, or a doctor employed by a medical practice or whatever.

No one is "playing the system." This is basic, basic, basic business accounting.

Again, I feel very sorry for your clients.

 

[Jeff Young]

.

The same employed motor mechanic is not able to set off expenses before paying tax. If he wants a new computer it is out of taxed income etc.



Ian

And that highlights the either (a) fundamental differences in the UK v. US tax system OR (b) the fundamental error in your thinking.

Business expenses are deduted off of gross income before net income is generated to determine the applicable tax. maybe they do it differently in the UK, but I doubt it. You don't pay tax on the money you spend on implements necessary to generate revenue.

Holy cow you are scaring me. You are certified???

 

[Mark]

No share dividends then Jeff, no 'partner benefits of any kind? Just good old johnny do-gooders, representing the meek, just so they can get past St. Peter on the day of their calling eh? Lawyers working for 65 bucks and hour are either
a. beginners,
b. shit
c. greasing the pole so they can put 'public defense pro-bono work down on the old CV
d. shit
e. earning elsewhere and the cheap shit just sounds good when they want their Lawyer mates to think they are sainted

What a load of cods-wallop.