Cliff,
I am sorry, but this just is not accurate.
You are not going to get people to GO to medical school. Why would they? When I started (1993) Not ONE physician told me to go to medical school. Not one. They all said they would never do it again.
Most family docs can barely keep their doors open.
The cardiothoracic surgeons in town make about $250k a year. Do you have any idea how hard they work? How long and hard they trained? How difficult what they do is? There is no way on God's green earth I would do whay they do for that money (OK, I wouldn't work those hours at all). But what are you going to do when you've invested 11-13 years of post graduate training? you are going to do what you can.
There are two places money is going in medicine that is wrong: one, unnecessarily expensive tests and procedures. Two: insurance company profits.
Example one: a Pap smear (one of the most successful tests ever developed in medicine, it took cervical cancer from a leading cause of death of women to a rare event) used to and should still cost about $20. It now costs up to $500, because it has to be a thinprep with DNA analysis for HPV viral type. What's the cost/benefit ratio here? But in the US, you have to have the best, because that's the way it should be.
Example two: Insurance premiums are going up, but reimbursement to (as you say overpaid) physicians has been going down for YEARS. A general surgeon makes now the same thing for a gallbladder removal that they did in the 70s. So where is the money going? We are all paying more for it, but the doctors are getting paid less? Hmmm and insurance companies are some of the most profitable businesses in the US? It doesn't take a brain surgeon to connect the dots.
And lastly, if you think it doesn't take intelligence to be in family practice think again. they have to be the MOST intelligent. They have the least info to go on, they are the least specialized (which means they have to try to know something about everything), and they are the one that has the opportunity to catch something early. If there is anyone you want to be good, it is your GP. In many cases specialization is easier, because you simply get good at what you do.
-J.
Hi J,
Perhaps we could be a little more precise here. What's "not accurate"? Do you mean the salary numbers I'm quoting or something else? For perspective, the numbers I'm quoting are from a semi-urban area (Seattle and environs), not rural, so perhaps that's part of it.
If you're suggesting that bringing down doc salaries will mean that nobody will apply to med school, that's just not credible. Docs get paid substantially less in European countries and there's no shortage of very qualified applicants to med schools.
For comparison sake, there are other professions with similar education and training requirements, but with substantially less wages, that manage to still attract large pools of well qualified applicants.
Related, your statement is suggestive that the primary motivator in the decision to apply to med school is money. I would hope that's not the case. I know when I got my doctorate, money had nothing to do with it. Perhaps that was just youthful idealism however.
I didn't imply that a GP is not a highly trained and intelligent person - of course they are. And, yes, you're right - they're on the front lines with less in the way of diagnostic resources so their smarts and experience are particularly important.
In any case, graduating more docs has no downside that seems credible, as far as I can see.
I would definitely agree that doc salaries are just a component of the total cost to the patient, but it's still a material component.
As far as the cost of procedures, and who is deciding what's appropriate or necessary and what's the right pricing for it I don't know enough of the behind-the-scenes stakeholders. But, I suspect it's an uneasy compromise between insurance company actuaries, docs and hospitals, plaintiff's lawyers, and state and fed regulations = a big mess.
No offense intended J. You can tell me I should get a pay cut any day and I won't be offended.
Incidentally, it's not like offering reasonable levels of coverage to people of less means is going to necessarily add a whole bunch of expense. They're getting some medical treatment anyway (even without coverage) - they're down at the ER right now, getting their run-of-the-mill ills treated for free. I just spent five hours waiting at the local ER to get my son's broken arm fixed up - it was standing room only and I think I was the only one in there with insurance. But, everyone was getting treated!
. Beers, Drinks and dinner on me if you ever make to Orlando.
