Doctor, Heal Thy Attitude

Most physicians are hypocrites. They expect the respect owed to benevolent professionals when they’re just glorified merchants. Pro or con?

Pro: Profit-Oriented at Patients’ Expense

It is naive to suggest medicine is still an art and not a business. It has become a profit-minded venture for most health-care providers. Medical advertising has expanded from traditional areas such as plastic and cosmetic surgery, to heart procedures, orthopedic treatment, general and bariatric surgery, colonoscopies, hemorrhoid treatments, and even cancer treatment.

Indeed, the competition for the cancer patient has become so intense that advertising budgets for cancer clinics have skyrocketed. Oncologists, fresh from training programs, are offered salaries well into six figures.

Unfortunately, the by-product of the transformation of medicine from art to business is that profit becomes more important than patient care. The result? The quality of medical care has plummeted, and medical errors have increased.

The share of medical students becoming primary care doctors has decreased substantially, because most doctors choose more lucrative fields. Physicians are seeing more patients in each day and spending less time with each one in order to generate more revenue. In addition, they are utilizing "physician extenders" such as assistants and nurse practitioners to further increase the number of patients shuttled through their offices.

Physicians complain about the cost of malpractice insurance not because the amount is high in relation to their income but rather because paying anything affects their bottom line. The problem is that those doctors who put their pocketbooks first and the patients second are the ones most likely to commit malpractice.

Con: Underappreciated and Overworked Professionals

Today there’s a general suspicion of the medical profession. Medical information on just about any condition is available with a few clicks of the mouse, TV is swarming with prescription drug ads, and lawyers are always standing by to help patients turn suspected mistakes into six-figure settlements. Americans are worried about their health care and rightly so. But this doesn’t mean doctors should bear the brunt of this frustration and be labeled pill-pushers or glorified medical merchants.

We criticize doctors for constantly being late to appointments but then hypocritically expect them to stay with us as long as it takes to help us. We grouse about paying for every minute of their time, but it’s our payments that allow doctors to stay in business. In America, medicine is a market, and prices are set by supply, demand, and barriers to entry.

Doctors pay an average of $160,000 for their grueling training. Counting college, medical school, and internships, it typically takes 12 years before a doctor can set up shop—far longer than it takes lawyers, financial advisers, or members of practically any other field. Physicians spend their 20s napping on cots slightly softer than the average coffee table between endless shifts in hospitals during their residencies.

Of course all this effort doesn’t automatically make every doctor a living picture of benevolence or competence, but it does make physicians far better experts on the human body and what ails it than the average person, and their knowledge deserves respect.

Opinions and conclusions expressed in the BusinessWeek Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

dr. buyakasha

I never comment on these things but just couldn't hold back on this one. Granted, I realize these things are written to stir debate and interest, but come on...asking a malpractice attorney to evaluate quality of physician care is a little like asking Osama Bin Laden to write a new Star Spangled Banner.

I don't particularly like seeing our profession "commoditized" the way it has, whether it's boutique medicine, cheesy advertising, or what have you. The question you should ask though is why. Why are the "best of the best" not opting for certain fields over others? It's simple economics. Why should they?

What's truly naive is to judge another's profession as "a business not an art" without having a clue what it takes to practice medicine well. There are indeed a few bad apples out there and by all means, put them out of business and line your pockets with their legal fees, but don't punish the solid practitioners.

Don't punish the ones who could have done anything in life but chose medicine because of the need to help. Those of us who studied and spent all of our 20s and 30s preparing our minds and our hands so that we practice properly and learn the "art" that medicine is.

The notion that physicians complain about malpractice costs only because it affects the bottom line is laughable. I'd love to see what his response would be if it cost him half a year's income just to cover his malpractice fees. The other three months to cover office fees and the rest to support himself and his family. I know a few OB-GYNs in this exact situation.

logic

Good grief. I don't think I can say it any better than Dr. Buyakasha. My wife is a physician, and she regularly is paged at 2 a.m. to advise on saving someone's life, or even to rush into a clinic to save someone. How many marketing types or lawyers, get called at 2 a.m. to save someone's life and rush to do so? How many MBAs are screened by the DEA for handling of narcotics and other controlled substances, and allowed to do so due to their extraordinary position in our society?

I didn't think so. Physicians are the best and the brightest young people our universities produce, undergo special vetting, and have enormous responsibility. They deserve nothing less than deep respect.

jon clement

For the exceptional few providers worth their weight in gold, you will probably find "whole brain" practitioners. I'm referring to those individuals who have the ability to engage and connect with their patients, to show compassion, empathy, and concern. Unfortunately, physicians who can combine the technical know-how with the right brain qualities are few and far between. It's no wonder that doctors are stressed and unhappy today. They have never really figured out that the medical school training they received is wholly inadequate preparation in a world that demands and should expect much more. The pay for performance model is the biggest joke in the world. What many practicing physicians need most is self-knowledge and self-development, and that only comes from taking a deep look at oneself.

adam t

A necessary part of this debate must be what the drug companies are doing to influence the practice of medicine. Their incentives for pushing certain medicines (vacations, helicopter tours, etc.) clearly affect the advice dispensed by, I'd dare say, every physician--at least to some degree.

dennis

There is no absolute good or bad in this situation. There are decent doctors and bad doctors. Unfortunately, I believe at the hospitals in New York City, there are more bad than good doctors.

Adam is right that the drug companies influence the doctors and some to a great extent.

In 2001, a New York City doctor, the head of his department, gave me two toxic drugs that later I found out were chosen because he had a contract with the drug company. These drugs caused me to get toxic epidermal nechrolysis over 100% of my body (i.e., all of my skin died).

I sued him, and his insurance company, through his lawyers, attacked me beyond belief. For years they attacked me on a personal level so that they would have leverage at trial.

My lawyer and the judge were no better. My highly respected lawyer was in it for settlement. The judge refused to let the trial go to the jury and came right out and asked the doctor how much he would like to settle for. Even though I repeatedly said that I wanted the jury to rule, my wishes were rebuffed. The entire system is broken, and there is no incentive to fix it. Everyone complains, but each party has what the wants.

The doctors do not have to deal with the injured patients realistically. The lawyers and insurance companies make a fortune. The judge has her salary and prestige.

The only one who does not get what he wants is the patient. I remain injured and bitter. I spend $200,000 on a farcical trial and was told how much I would get by the judge.

The doctor got away scot-free. It was not even reported to the state.

Scott

As a practicing physician who has given the problems of health care a lot of thought, I would state this is an enormously complicated problem, but here are a few thoughts:
Physicians (I will give least 4 types):

a. Greedy. Becoming, at least where I practice, a huge problem. These doctors typically have extensive testing equipment in their office and run patients through all the tests. Many of these doctors are not adequately trained to interpret these tests; they do them to bill the patient, insurance, or Medicare. Also their testing and results frequently have quality control issues, i.e., not accurate enough to be used in patient care. Also includes doctors who perform unnecessary and frequent procedures just to make money.
b. Live and Let Live. These doctors like money and may have some testing equipment in their office, but I like to describe them as the type who sees patients, tries to treat them based on what they know but doesn't make an effort to go the extra step and isn't really interested in staying current beyond the CME requirements of the state, probably your average doctor at least around here.
c. Incompetent. Because of age, poor training, etc., they either need to be retrained or stop practicing
d. Good. Rare. Constantly reading, carries a PDA, checks to make sure all medicines are dosed for that patient's renal and liver function, does recommended testing at recommended intervals (like CBC, CMP, urinalysis, fasting lipid profiles). Knows the current ACS guidelines and informs patients what tests are needed based on race, age, gender (PSA, mammogram, colon CA screening, paps, etc.) Does no unnecessary testing. Prescribes medicines that patients can afford. Has a general knowledge of patient's income level, living arrangements, watches for signs of anxiety, depression, insomnia, and intervenes appropriately. If these doctors don't understand will take the time to research or call major universities to talk to the leading authorities if necessary. Always does what's best for the patient.

Other Problems:
a. Huge. Need centralization of medical data. I don't see health care surviving without it. Have no way of knowing when a patient has had a particular test. Recent example, patient asks if I would check his PSA and we had no record of when it was done last. I said sure, and guess what, it was 11 days too early, in other words day 354 (Medicare will usually pay for only one per year; patient got stuck with bill). When most patients are seeing four or five doctors, as a doctor I either order tests that have already been ordered and patient gets stuck with bill or not order, and patient is at risk for not getting proper care.
b. Government. Do the people in Washington have a clue? Primary care doctors, including the good doctors above, may receive $100 to $125 from Medicare for the workup above with pay cuts done on a regular basis, while services like home health, hospice, and medical supplies are wasting money by the boatloads. I bet 90% of my patients have home health yet are not homebound and have no skill need. It's not unusual for the home health aides to go see a patient and ask, "Did you check your blood sugar and blood pressure this morning, Mrs. Smith?" She responds yes. They ask, "What were the readings?" and Mrs. Smith tells them. They write it down instead of doing it themselves, leave, and then bill Medicare. I had a patient on hospice and looked at her diagnosis, which was listed as CHF. By law this requires an LVEF of 20% to 25% with expected death within six months. I did further checking, her LVEF was normal at 60%. I called the state and he sympathized, and was told to report it to Medicare Fraud, which I did. After multiple phone calls talking to people who I could barely understand because of their foreign accents, they informed me that they really were not interested. A friend of mine who was an insider in the health care industry once said, for every $1 spent on investigation they need to get $3 back. In other words, the fraud investigators want to go after the multibillion dollar corporations while the multiple fraud done by individuals and small companies go unchecked. That experience alone taught me that our government is so big and bloated that it is barely functional and needs to be broken down and rebuilt in a small and efficient manner.
c. Affordable Access to Health Care. Briefly, this is another huge problem. I'm self employed and my insurances premium for my small family is $1,500 to $2,000 per month. Too many working poor have nowhere to go; a one-night stay in the hospital will set them back $10,000. I recently met a couple who both work, and the man who works every day as a handyman at a resort presented ill. He had been hospitalized in Arizona with renal failure, heart failure, and anemia. I looked at his records and he was extremely ill with CHF and renal failure. He needed hospitalization, but the family refused and he was still working every day. I have a lab account set up for the working poor, so I was able to get very cheap labs. So by manipulating some of his medicines, including massive diuretics, he started turning around, and by the grace of God, his renal function improved, his anemia improved, and within a diuretics / nitrates we were able to greatly improve his CHF symptoms and he is now able to work a full day. I think I have seen him three to four times, charging no more than $30 a visit.

Anyway, that's my 2 cents for whatever it worth.

Dr. Bob

The things that are mentioned above are an unfortunate byproduct of the gradual commoditization of large parts of medicine with doctors running to find new pathways for income. Insurance companies run the markets in all 50 states and basically set rates and procedures with little to no oversight. Fees for traditional services get cut with practices, who have largely fixed overheads due to necessary record keeping, staffing for medical services, etc. Add to this another fixed overhead of cost of medical training as well as malpractice. Many physicians are running to set up surgery centers, procedure centers, and infusion and imaging centers, all designed to take the money that used to go to hospitals and supplant their lost income; the hospitals are left eating the costs of overhead and care for more complex patients. All in all, this is a death spiral for medicine as it is currently structured. Medical costs are the one huge, off-budget, unaccounted tax on the entire society. What the insurance companies do not pay for, the federal government or state governments have to pay via Medicare and Medicaid, SCHIP, etc. As those entities become less fiscally sound, this could lead to a situation similar to what we are seeing in the market and Wall Street right now.

Carol

Physicians do deserve to make better than the average worker on income with all of their loans. Where I see the problem is fraud and abuse in the health-care system as it is in the millions of dollars. If a physician is doing everything by the laws and rules and hiring people who follow the rules and laws, then physicians are paid accordingly to the services they render. Therefore, the more physicians work (and bill honestly), the greater the pay they deserve.

woods3

Jim Leventhal obviously has little idea how physicians practice in this overly regulated and highly litigious society.

Anthony Cirillo

Blame all around as far as I can see. As a health care marketer married to a health benefits director, I see a couple of sides of the story. I think physicians just want to practice medicine and have had to co-opt themselves because of our litigious culture and the cost saving (maybe greed) of insurers. That is why models like the one Jay Parkinson is conceiving are worthwhile to consider. Then the other extreme is selling out completely and being owned by your local hospital. That in some respects is probably in physicians' minds getting them back to medicine, but you have to sell your soul on that side of the equation as well. Now add employers, feeble attempts at wellness, and medical tourism, and the whole thing is a mess. Demands by so-called educated consumers with entitlement attitudes will make the whole demand for a health-care experience even more acute. So bedside manner or not, you may have to adopt one or perish, because you are being judged on it. Bottom line: We all need to suck it up and contribute to a solution. No new president is going to solve this in the current crisis.

Dr. WhiteCoat

Mr. Leventhal,
Hmmmm. Did your little rant take you, oh, about 0.5 billable hours to concoct? For many attorneys, that would amount to $150. For most physicians, that would amount to an extra 45 minutes on the phone arguing with the insurance company, filling out three extra forms documenting medical necessity, then resubmitting the claim twice because the first two submissions were lost. Then the insurance company would state that the time spent in rebuttal was due to a "never event" and deny the payment completely.

You choose examples of competitive markets to bolster your argument that physicians are "money hungry," yet fail to enlighten everyone on the other side of the coin.

For example, you fail to mention that government reimbursement for medical care is often less than the cost of malpractice insurance to see patients. Unless it has recently changed, New York Medicaid pays $17 for evaluation of any medical condition in the emergency department. How would the noble legal profession treat potential litigants if the attorneys only received $17 for the case? Oooops, that's right, attorneys can--and frequently do--refuse clients. Emergency physicians cannot. If a litigant has no money, very few attorneys will take their case. The name of the game in the legal field is "retainer." Money up front or no representation. A patient with no money whatsoever can walk into any emergency department and receive tens of thousands of dollars in care. Hospitals are forced to provide care under threats from federal legislation and under threats of malpractice--from attorneys.

Increases in medical errors are multifaceted. With more patients, more fragmentation of care, and fewer providers, are you naive enough to expect error rates to go down? How would your office respond if you were required to handle 50% more cases with a 25% smaller staff?

I suspect you'd hire "attorney extenders" such as secretaries and paralegals to try to keep up with the work. Oh. Wait. According to your argument, "extenders" such as nurse practitioners, physician assistants, and paralegals appear to be a bad thing. Sorry.

Physicians complain about malpractice insurance, because the rates are outrageous. Legal malpractice insurance costs 10% to 20% of medical malpractice insurance. If legal premiums increased fivefold, attorneys would complain as well.

You are a hypocrite if you argue that medicine has become a business and that law has not. Individuals need a substantial down payment for their "legal care," a solid case worth hundreds of thousands of dollars, or a case worth millions with nothing more than a favorable opinion from hired-gun experts before an attorney will take it on a 40% contingency. Just because our Congress of elected attorneys has not conferred an unfettered right for citizens to have any law firm represent them for any reason regardless of their ability to pay doesn't mean that some doctors are villains for trying to survive in the medical version of such a system. Wait for the advent of "LMOs"--Legal Maintenance Organizations.

Your opinion about the inner workings of medicine is biased and uninformed. BuisnessWeek should be chastised for allowing you to perpetuate such vitriol.

W N

The biggest difference between a doctor and any other professional is that mistakes made here costs lives. In every country in every profession in the world since time immemorial, there have always been the good, the bad, and the ugly. Everyone else should not suffer because of one bad apple. Bankers can also be considered overglorified salesmen, but they don't have drug pushers bribing them to sell new products. At the end of the day, it is up to the very human doctor to choose to his destiny. Hopefully keeping the best interests of the patient in the forefront as do all other professionals, right?

Mike

My doctor is pretty good, now. When I first met him face to face, I let him know up front, I will not take any BS and he should tell me what I need to do to control my diabetes the best way. So far, after going through at least 10 doctors before this one, he seems to really care. So my recommendation is to tell them up-front what you expect, and if they act like God, then move on down the road until you find one who cares.

You don't have to accept their BS. I would rather suffer than give in to a doctor who thinks he or she is God's gift to mankind's problems. Just my opinion.

TomV

Having read all the comments, I think another point not addressed but should be is this: If the pro side is correct, then we their patients made them that way. How? 1. We all want insurance, but like everyone, we want it cheap. Quality usually does not enter into it, and whether it's our employer or we are self-employed, we want to spend bottom dollar. As noted in both comments and arguments, becoming a doctor is not cheap or easy, but we expect them to get paid chicken-feed because that's what we want to pay, so where do they make up the difference? 2. Malpractice insurance. Everyone reads about the sensational stories of the few bad apples, and we applaud the guy who sues and wins millions, but we the patients never see the malpractice insurance payments doctors make. My uncle practiced medicine his entire career, but finally quit about five years ago. That year his premium was $250,000 for malpractice insurance. 3. Lawsuits. Everyone reads about poor little Betsy or Bobby and the suit their parents are bringing because the vile, nasty insurance company won't cover the major operation or experimental treatment, despite the fact it's spelled out in their policy that they don't. And juries side with them, regardless that insurance policies are contracts, and the insured is trying to break the contract even though he or she agreed to it. All this does is make #1 and #2 above hit even harder. So you don't like the current health situation? Well like Dr. Frankenstein, we patients all made the monster, so live with it.

CTRL-ALT-DEL

How do you explain the salaries of doctors elsewhere in the world? I think this is a big scam. Doctors don't deserve to be paid any more than engineers.

mp

In 1970, prior to the enactment of federal legislation mandating emergency care, hospitals routinely denied emergency care to individuals who didn't have proof of insurance. I know they did this because my father was one of the practice's victims.

Don't tell me it's not about the money.

D. Ramsey

Did you ever take your car to a mechanic for a check-up and be told there's nothing wrong, no charge? No way. They have to find something to fix or they're out of business. Same with doctors. If they don't find some ailment that requires immediate, painful, and expensive therapy, medication, surgery, etc., they're out of business, too.

And don't even get me started on Big Pharma. Ever read the tiny, mice print disclaimer at the bottom of those slick ads for their latest drug? Do these guys sit up nights inventing drugs that come with horrific side effects that are far worse than the condition they're supposed to treat?

When Americans stop overeating and popping pills and take control of their health, we and the medical industry will be better off.

marta bunuel

Jim Leventhal clearly does not have the capacity to think logically and critically. Or perhaps he simply chooses to be selective of the information he presents his readers for personal reasons. While there are money-hungry doctors with God complexes running around, they are not in the majority. Insurance companies pay well for procedures and pay little for family physicians and internists who are the "brain power" that identifies and manages medical issues. Most patients are in the care of the family doctors and internists. It's not a coincidence that they get reimbursed less. If they got paid for what they provide, it would be much more expensive for the insurance companies. On the other hand, procedures are defined entities, limited in nature, and less frequent in need. Therefore these are less costly overall than seeing someone for ongoing management of diabetes or any other chronic disease. Insurance companies require you see a family doctor or internist and be referred to the one who performs the procedure. The front door is controlled, and that doctor paid less. Again, a conscious way to decrease the insurance companies' cost while increasing their profits.

Malpractice companies save themselves money by settling out of court even when the lawsuit is frivolous and the doctor is innocent: It costs more to defend them than settle. Then they turn around and increase the cost of the insurance to the doctor. And the attorneys? They know how to play both sides of the game: They made the laws that ensure they will always have plenty of work and money to keep them going. The sad thing is that they are so very effective at keeping the doctors scared about being sued justly or unjustly that in the end, patients end up paying the consequences in terms of higher prices and burned-out practitioner. Ultimately, we all pay for their manipulation of the system. Nevertheless those attorneys would do well to remember that they are part of this community and that they, too, will end up in the hands of one of those avaricious doctors described by Mr. Jim Leventhal. It's not a good idea to bite the hand that treats you.

Dr. H

How many doctors do you see on the Forbes list of billionaires? If most doctors were only interested in money, they wouldn't have gone into medicine. How about Medicare cutting back on surgical fees for cataract surgery 70% over the last 10 years? How would attorneys or business owners feel about the government forcing them to take 70% fee cuts? Restoring and improving vision in patients is why I am a surgeon.

Dr. P

Medicine in the U.S. is a business. Make as much as you can, while you can avoid getting sued, before you retire.

DocPoverty

"The quality of medical care has plummeted, and medical errors have increased."

This is a bold statement. Where is the proof? Evidence-based medicine, which is the prevailing modern approach used by allopathic medicine, backs up its statements. I see no such proof offered here.

Patients rights

Medicine is about money, unless you're a GP or an ER doctor. As someone who has a couple of specialists in her family, I am well aware of the overcompensation within the medical profession. Quite frankly, the profession has outpriced its worth.

How can doctors possibly defend their salaries against the outrageous cost of medical care? We have been spoon fed (and accepted) the premise that doctors save lives; therefore they should be well compensated. This logic is highly flawed, because it fails to acknowledge those outside of the medical profession who save lives without similar compensation.

For example: Those who design safety restraints and airbags do not receive similar compensation. Millions of lives are saved each year, but they are not paid nearly as well. Is there any doctor who has the capacity to save more lives? Furthermore, could they save the life of someone in a high-speed car crash, if the safety belt and airbag failed? The answer is no. Perhaps we should consider how we bite the hand that protects us, rather than worrying about the one that treats us.

In truth, doctors have been given a free ride in this country and the patient is suffering.

Finally, cost reduction and price regulation is necessary, due to unparalleled greed in the medical profession. Where else is the consumer forced to pay for services without knowing the cost ahead of time? This industry is responsible for countless bankruptcies across the nation, yet somehow the medical profession feels justified in perpetuating this practice. Thanks to this unparalleled greed, the average American is often forced to choose between their money or their life.

LAO

I don't think most doctors are greedy or overvalued. I already expressed what I really think to the American Medical Association, paraphrased below.

Dear AMA,

If I were a doctor, I would be bitterly disappointed by what you have allowed your members' lives to become. You have allowed doctors to be treated as mere technicians in the eyes of the big businesses which have taken control of the profession.

By standing by while the American system of health care has become a quagmire and a gamble, increasingly out of reach for the average person, you have abandoned your oath--you have done great harm to the health of the very people you are committed to care for and protect. There are now groups of U.S. citizens whose life expectancy is dropping. People and their employers pay an exorbitant amount for insurance which can fail them when they most need it. You have allowed the National Institute of Health to become an arm of big pharma and academia, instead of an advocate for the population's health. Research toward a better system is never done. The FDA is more interested in constraining birth control counseling than in assuring that a 65-year-old can actually make a claim against the insurance that was paid for throughout working life.

You are doctors! You are smart and you are monied. You surely have the intelligence and insight, more than anyone else, to design a better system. You surely could garner the power and money to outlobby the most powerful lobbyists, in the interests of the health of this nation.

As doctors, I am grateful for all you do. As protectors of our health, I am outraged by your uncaring ways.

Regards,
Just a Citizen

candide

Well, if the first thing you or your nurse or receptionist asks when you arrive near death is, what is your insurance? Then it is obvious that physicians are just money grubbers like everyone else. The AMA has a new ad campaign to explain its great concern for the uninsured, when for decades the AMA lobbied ferociously vs. health insurance schemes by the government. But Medicare, the biggest boondoggle yet, changed their minds. They now love socialized medicine for the profits it can bring them.

Proud Engineer

More respect should be given to the people in engineering. Engineers develop the machines, methods, and medicines that medical doctors use. Engineers as a whole commit more of their brain power to improving and saving people and the world we live in. Doctors just memorize books and regurgitate information that we can all find ourselves on the Internet.

Bikrant Kumar sharma

Well, doctors are also human beings. They have families to think of. It sounds great to do a social service when you are not the one doing it. Doctors are not greedy, but they require something of their profession. Well it's true one's life may be at stake, and one should keep some sympathetic values to himself but with a little professionalism.

DrB

People in America are supposedly reimbursed for their value to their employer. We accept unbelievable income for celebrities, CEOs, malpractice attorneys, sports figures. We gripe about salaries for firemen, teachers, and police.

Are any of these groups subject to salary limits, caps, or schedules because they provide a service that is considered a right? Physicians represent a select few people who have the intelligence and fortitude to endure many years and much cost to train to provide a valuable service. Should they be penalized or rewarded for their service? How many people with the ability to become physicians will continue to do so under these circumstances? How many physicians in today's America encourage others to follow their example? As a 59-year-old OB-GYN, I have greatly simplified my life to avoid the harsh penalties of practicing under the restraints of government, insurance, lawyers, and demanding people who have no concept of what it takes to become and remain a physician.

kittyfool

The remark that "lawyers are always standing by to help patients" is the most ridiculously statement I've seen for quite awhile. Although, I've been a survivor of the required police state mandated "health care" that we have now, I've not even been able to find a single lawyer who would even try to find a way to get his cut from my misery. If a person is lucky enough to get a lawyer to represent you, then you have years of persecution and thousands of dollars wasted, and you probably will have to cough up the money to pay for this stupidity and still don't have the money to pay for the damage. If you hear about one paltry settlement, there are many more who have no day in court, no way to pay for the damage done, no way of giving subsequent patients a warning.

DocPoverty, the medical industry mandates proof from vitamin selling, nutrapaths, and true health care--even pushing jail time for these "crimes." Where is the proof from your industry? I would like to have the proof for the Big Pharma, FDA, invasive procedures, statins, Vioxx for starters. The proof for jail is what you have been doing to people.

Yes, Dr. Whitecoat, money is the name of the game. How many of your emergency patients have the money to pay a retainer for legal representation to see a doctor? I don't know where you live, but in this state I've read that doctors are actually profiting from their insurance. And yes, Marta Bunuel, lawyers are threatened by doctors as well, and it is the infrequent lawyer who has the fortitude to stand up to the behavior your industry and you today have displayed.

The medical industry weeps for the "few bad apples." Yet if a patient tries to get a little justice for harm done, there is an abundance of doctors jumping to the rescue of the "peers." Any attempts to get some transparency of a doctor’s history are hastily blocked by the medical industry.

I've read that your industry punishes the brave doctor who tries to do the right thing. Yet every single blog from a doctor I've seen defends this system, because they are so intelligent.

Everyone, including the medical industry, complains about the "mistakes" and "adverse reactions." Yet any attempts to get some intelligence from the drug pushers are met with numerous doctors whining that they "didn't know" or "they lied to us, too" or "it's too hard to know about everything." If I'd whined with these excuses, I'd have been fired long before I was.

Adverse reaction complaints are shoved under a rug. The patient complains about life threatening adverse reactions, and they are told you are a "difficult" patient.

Yes, Dr. H, doctors whine about the cost for them. Yet I've paid for their incompetency with 38 years of working two to three jobs and years of paying for insurance payments. What was my payout? My health has been ruined by mandated unnecessary tests. I've been labeled "disabled" by the stupidity, greed, and egotism of your system. I've been fired from my job. I'm barred from getting any other job. My retirement has been stolen by governmental mandated insurance. My life's savings have been depleted. The medical industry has threatened to take my home (Yah, tell me about the "compassion" of your industry). I'm in unrelenting pain. The doctors didn't even trouble to quit partying for 12 hours after they had put me in danger. One finally showed up with her party clothes on. As with Dennis' case, there has been no report against these doctors. They still have time to play, collect $300,000 a year, are free to harm as many people as they want to, and still turn off their beepers when they want a day off. They can still pan off the costs of insurance to their patients. They still have retirement accounts. Who is going to pay for the costs that your industry has cost me?

Whining about being helpless against the system? You should have no health left, you should have all of your money stolen, you should have no way to make any money. You're probably thinking I've given up. You would be wrong. I'm still fighting with the days that I have left to try to get someone who is not brain dead from drugs to listen. I'm doing everything that I can to try to stop the insanity, because I know that there will be others tomorrow who don't have the means to do even that. What are you doing to help, Dr. P?

Doctors loudly whale about the cost of insurance. Yet they do everything they can to make it mandatory for us as well as for themselves, paying lobbyists to get more insurance, more treatments, more pills, more government, more regulations for everyone.

I definitely agree with the comment that doctors do absolutely nothing to make anything better. A patient has very little input in the system that doctors utilize to harm other people, yet the only response we see on these types of Web sites, is "It's not our fault--it's just the system"..

Doctors cry about the negligence of the training that they paid for. Yet, I don't see any doctors trying to get a refund. I haven't seen a single move from the medical industry to try to get change the education system.

Doctors whine that they don't have a single source to find information about the drugs that they push. Yet even Wal-Mart has a system that can find adverse reactions and interactions.

Doctors bawl about the costs of tests. Yet who scribbles their signature to get these harmful and unnecessary tests? Who profits from this? Who orders the latest and newest untested tests? Who buys the exorbitant expenses of questionable equipment to prescribe more harmful, unnecessary tests?

We are pelted by commercials from the industry about how sick we are and how many drugs we need. Beautiful music, smiling young people frolicking in the sun-shining days blare from screen. Hell, I thought that I have prostate problems for awhile. "Just see your doctor--he knows what's good for you! See your doctor, if you have these symptoms." All of the media is jumping to "report" the newest "cure" for what ails you. Where is my commercial? Where is my voice in this travesty? Who is going to pay me if I harm them?

Your system of sick equals money, is an outrage. You didn't build it to help or even to protect your patients. You built it to protect your money. You've built it to bleed every penny from everyone else. You didn't build it so that you can get some needed criticism. You've built it so well that no one else can survive. And that, my dear comrades, might be your downfall. You built it. Now listen and learn from the concerns and fix it, or follow the path of Fannie and Freddie. I will not shed tears for this Ponzi scheme.

Sally

Wow. I really can't believe the vicious attacks on doctors as a whole being spewed by people ignorant of what it takes to be a doctor. Doctors shouldn't be paid more than engineers? Are you kidding? Maybe the worst doctors shouldn't be paid more than the best engineers.

My husband is 32 years old and still not finished with his training. I have a bachelor's degree, and at age 27 make more than he does as a surgical fellow. He has a bachelor's, medical degree, five years of residency training, and is now in fellowship. During his residency, there were routinely nights during which neither of us got any sleep because of his pager going off constantly. Show me an engineer who talks to a patient at 2 a.m. who is worried because she has hiccups. When we actually did the math during one of his trauma rotations, he would have made more per hour if he had inquired about the help wanted sign posted at the gas station down the street. During all of this modern day slavery, he has to attend journal clubs and conferences and labs and grand rounds to learn more about his profession. When someday he finally, finally gets to be compensated for his work, he will have to pay off student loans, pay for medical malpractice insurance, buy into a practice, etc. Not to mention we'd like to buy a house someday, and maybe drive cars that are less than a decade old. Anyone who thinks he doesn't deserve to be compensated for the economic costs of schooling and training and not using his intelligence to make millions on Wall Street is a fool. And to the engineer who thinks doctors shouldn't be paid more: Get real.

Spencer Dodge

Doctors practice a noble profession, unique because the product is improving the one thing money cannot buy us, our health and our life. Until and unless you or a loved one is very sick, you may not appreciate this. I have not met anyone more honorable, intelligent, or hard working as any doctor I met in a teaching hospital. They are attacked, like Gulliver, by smaller people from every direction. They and drug companies are doing amazing things that improve our lives. I admire people who care for other people, each in their way and capacity. The kindness I witnessed at the hospital where my mother's life was saved was unforgettable.

Dr. L

Sad.

I am happy I moved to Singapore two years ago.

Just got tired of having my time and dedication rewarded with comments such as those seen in these pages.

Transaction Culture

Medicine these days in the U.S. is simply about maximizing the number of transactions (money), doing enough to cover liability (keep making money), and making a very feeble attempt to cure disease (word of mouth marketing) from which the body will anyhow recover itself.

Most real diseases they don't want to cure. They call them autoimmune but sell drugs to manage the conditions for eternity. Annuity for doctors and drug companies.

That in a nutshell is the U.S. medical business. It's time we outsourced our health care just like our manufacturing, software.

Hey, at least we can save a lot of money. I am sure the quality will be equal and even better based on what I have seen in India during my recent visit.

Greg Fish

Writer Greg Fish Responds:

"Engineers as a whole commit more of their brain power to improving and saving people and the world we live in. Doctors just memorize books and regurgitate information that we can all find ourselves on the Internet."

Proud Engineer, I would be very interested to see you attempt a double bypass armed only with whatever tools you design and what you can access on WebMD. If doctors are indeed as useless as you say, it shouldn't be a problem for you to do so.

Mike

I suppose one could debate this for an eternity. I'm a survivor of lymphoma and the chemotherapy that was used to treat it. I've got nearly textbook classic evidence of fibromyalgia that the network rheumatologist failed to find (didn't bother to do a history and wouldn't read mine), but I and my GP could. My take: Do your homework, keep good records, and persist. If you don't demand and pursue an action plan to managing your health issues, no one else will. And I say that coming from a family with many doctors and other health professionals among them.

Randolf

From my experience, 25% of the doctors out there would treat patients for free. These are the true healers. Typically these are the hard working sons and daughters of the middle class (no you're not middle class if you make $250,000) and attend state schools.

The rest are the children of wealthy elite who believe they deserve unending admiration and expect riches from a sure thing profession. They live in homes bought for them by their parents and drive fancy cars till the "medical thing" starts creating revenue. I see these sociopaths as being no different from the executive elite who have run this country into the ground. They do anything the insurance companies tell them to and view their patients in the same way a farmer views a cow to be slaughtered. They are demonic.

The solution? Lie detector tests and intensive psychiatric monitoring of all those who proclaim to care about the health of strangers. If you've never suffered, you have no business attending to the cares of the sick (I don't care what your IQ is). Just say no to the Ivy League.

Stringer

What do you call the person who graduates last in their class at medical school? Doctor...?

G-sizzle

Doctors are terrible. They make you wait forever. Get a watch!

Charlie H

Personal experience: When I first moved to the Southwest I contracted "Valley Fever," which everyone and their pets get out here. It eventually developed into pleurisy. The physician who tended me in the Emergency Room told me it was incurable and suggested a prescription for a barbiturate for pain. I looked up pleurisy in a book, Back to Eden and found a listing for a root called pleurisy root. I bought some, brewed tea, and drank it as recommended. Ten days later I was fine. I went back to the hospital to show the physician the entry in the book. He called me a fool and had security remove me. Want some more?

Charlie H

My step-mother went to a hospital in CT for an angioplasty. The surgeon used a coil too small, so it traveled through the body and, after four hours, was recovered from the femoral artery. The "proper" coil was applied, and four days later she came home to New York, took a shower at home, and died of a heart attack. The CT doctor tried to perform the autopsy, although he wasn't licensed in New York.

KHD

I am a young physician who graduate in the year 2000. It took me 12 years of school and residency training to even begin treating patients. 12 years. 12 years! And that's the minimum as I am a family practice physician. I would say about 80% of my colleagues have a a debt load exceeding $200,000. I know I speak for other physicians when I say that about 30% to 50% of my time at work is not related to direct patient care but rather excessive legal-medical documentation and insurance-related issues.

For me, there is no joy in practicing medicine. It is dictated by pharmaceutical companies and their research, insurance companies, malpractice lawyers, and government. The doctor has become a slave to debt and insurance companies. I make it a point to tell all aspiring premed students to expect complete enslavement, high debt, and minimal compensation.

I predict a major shortfall of physicians in 5 to 10 years as many will simply get out. I am so disgusted. I am so disillusioned. I am so disheartened.

indian

Well, interesting debate. I guess this profession has become more business-minded. Not to say there aren't good, caring doctors as well. For one, why would anyone spend 12 years or take tons of debt and be awakened at 2 a.m.? Social service? Of course, they go through all this so that they can make tons later on. I am not saying that doctors shouldn't be compensated well; they do spend a lot of time training to be one, but there is that thin line between being compensated well and getting greedy. Over the years, this has been made into a cartel by doctors, pharma, and what not.

I have seen cases of doctors not picking up the diagnosis rightly and then it leading to complications later on, misbehaving doctors who think they're God and are simply incompetent ones. And for all those who think there will be a major shortfall, rest assured that will get filled up by tons of them arriving from foreign lands.

It's a dicey situation, and there is no rule that can correct this--except that each of those doctors out there decide to spend 12 years and be woken up at 2 a.m. only because they want to be a doc and expect a good compensation, but not a money-making business. If you want the latter, go to a b-school and join up what's remaining in the investment banking world (another wonderful greedy world that dug its own grave) and make millions with no malpractice insurance. After all, the Fed will bail you out if you screw up.

Guys, I am not an American, but I think the way things are here, its pathetic.

slj

Connecting educational costs to pay is preposterous and a fine example of hubris. Very few fields are allowed to justify compensation based on educational costs. In about every other field the cost of education must be borne by the parents, not the future employer. Other fields don't even get to base compensation on cost of living now, let alone the cost of living prior to working at the company. Mainly they have to base it on what the competitive market can bear. It's the ability of using a scapegoat like educational costs that hides the true villains: insurance and lack of competition and even playing field for qualified students and candidates (think foreign medical graduates).

With insurance, the ability to spread the cost of a service over a large number of potential consumers instead of the persons actually receiving the service allows for a gigantic markup in the cost of service (in fact, the total medical costs charged magically tends to be whatever the total amount of net premiums that were collected that year); to make it worse, they penalize anyone who doesn't play the insurance game by charging them more (sometimes a lot more). If there is a price difference, it reminds me of extortion.

By blocking a swarm of highly qualified medical students from other nations, the U.S. medical institutions and Congress (which prevents immigration of the qualified students en mass) effectively act like a union preventing the supply of additional workers to allow for the price and salary of existing workers to rise as demand swamps the supply of qualified workers. Imagine how far the salaries could fall if you let legions of qualified students "invade" the U.S. looking for medical residencies and employment.

The willingness and ability of parents to overpay for U.S. institutions amounts to a bribe to ensure that their children get priority access to U.S. medical jobs over similar or even more highly qualified students outside the U.S.. The internationally comparative costs of medical education outside the U.S. can be dramatically lower. If competition were "free," the parents could pick from all institutions that offer accredited medical education looking for that best education at the best price. U.S. schools will not compete on price, at least until the dollar collapses. Due to the protected status of U.S. medical graduates in the residency match program as well as general rules of immigration, the U.S. institutions will continue to demand the high tuition as long as parents are willing to pay it. Some endowment funds are now large enough that students may have attended school free. Does your idea of pay based on education costs imply that the medical professionals who were children of poor parents and attended Harvard get paid less since the endowment fund now covers the cost of their tuition? Live by the sword die by the sword?

If this were the simple formula, then an insurance company should start its own medical school, charge nothing, and allow students to enter directly from high school thus reducing the time to graduate blocking your scapegoat reason #2.

Your arguments break down to two things:
#1 Cost
#2 Time
Having recently helped a young medical student from China along her career path to the U.S., I can attest to the fact that her total educational costs for attending an accredited institution in Zhan Jiang China ran about $3,000 per year (inflation has probably increased that to $5,000 per year). She was able to pass USMLE Step 1 in China after studying for the exam on her own time. She was "forced" into taking the engagement visa in order to pursue step 2, which led to her residency. Her USMLE scores were much higher than most U.S. graduates. In China you go straight to medical school from high school so she saved at least four years of time. She gave up one to two years of time to study for the USMLE; part of the time was in a Chinese residency and part of the time at home.

Bottom line: Due to regulations and industry protection, U.S. tuition is probably way overpriced relative to foreign competition, and the number of years of education required is substantially higher. I'm not sure if the U.S. would be "allowed" to have medical schools that don't require undergrad, but that would be a big stab at your #2 point.

I would also like to say I don't agree with counting on the job training as "years of education." I think you disrespect all other forms of employment if you don't think other people can end up working insane hours who also learn on the job.
Do I get to suggest that all the Chinese working 16- to 18-hour days of grueling work should be paid 6 digits if residents do? I didn't think so.

Bottom line: We can reduce the cost by outsourcing medical education as well as reducing the time taken to complete it overnight by throwing out the requirement for undergrad education. Yes, this will push all our high school kids into cram schools like India and Korea, but isn't it about time we competed globally and fairly with the rest of the world? The consumer can no longer afford to pay high health care or high educational costs, and we need more health care than ever as our population ages. We have very simple solutions--fair international competition and eliminate the undergrad requirement.

I wonder what your excuse will be once the cost of education is dramatically eliminated through fair competition internationally and when we let medical students enter medical school directly from high school.

After eliminating scapegoats #1 and #2, perhaps health care costs can come down, but I just think that the medical community will not give up their 6 figure salaries over their dead bodies.

The only way I know to tackle this without nationalization is to swing the doors wide open on immigration for medical care professionals and let more qualified people compete for those positions. Let more competition solve this problem, not less. We are not graduating enough workers for the demand to lower prices. Let free markets work. Don't block competition in order to prop up medical worker compensation.

Ian

Politicians these days constantly debate national health care. But no one seems to look back at times like the 1930s when it worked

It was consumer driven. No appointment needed many times, because the waiting rooms were not crowded. Physicians enjoyed their work. Not rushed.

Doctors were respected because they cared, not because they had money. The patient paid out of his pocket. So charges were based on that ability to pay. Health care in the 1930s worked for the doctor and the patient. Both were happy with the situation. Then insurance entered the picture. Unthinking people said, "I don't care what Doc charges. I have insurance." And it all went crazy.

Why can't political candidates be statesmen and have the American public look back to a time when the system really worked?

pilot

I work in health care and not as an M.D. They, the M.D.s, are getting screwed. If you did a business plan and used existing projected numbers, you wouldn't do it or invest in the "company" that did 24 hours on call, 10-hour days, worst kind of pressure possible.They are underpaid.

Stuart Wilbur

Another hilarious debate topic. What's next, "Man, good or bad?" There are bad doctors, just as there are bad lawyers. I think most patients are happier to see their doctor than litigants are to see their lawyer. If lawyers are so great, why are there so many really rude jokes about them? And so many cheesy law "schools"? Even if some doctors are excessively self-impressed and rewarded, the incredible time investment seems to keep the number of applicants to medical schools reduced.

Donald Steier

While I do not believe that all doctors are money grubbers, I do believe that some doctors are out there for only the money. I also believe that our current system is failing to provide the service that Americans need for medical coverage. I wrote my Congressman about the problem.

To the Honorable Kay Hutchison,

It was nice to receive a response from you about my Energy e-mail. I normally don't hear back from my other representatives when I write to them via e-mail. But what I am writing about now is just as important. My wife, Azucena Yamid Steier, recently passed away from complications from AML Leukemia. When she was first diagnosed, we had the misfortune of not having medical insurance coverage. The hospital, Richardson Hospital in Richardson (Collin County), did not do the follow up consolidation therapy and the doctor was not under any obligation to give her follow up treatments and refused to do so. We were eventually able to move to Dallas County and get her into Parkland for the treatments she needed, but still the Leukemia was not in remission. I was able to get medical insurance at that time and was able to get my wife Azucena into UT Southwestern for chemo-therapy and a transplant. I suspect that we may have been too late because the Leukemia came back again and again.

I am left wondering at this point in time if the doctor or the hospital had been obligated to give my wife the consolidation Therapy, if she would be alive today. I have heard a lot of talk about what should be done about the situation, but I haven't seen any action on it. Of the plans that I did find, only one looks reasonably viable to me. It's called the Single Payer Plan (the link to their site is below).

http://www.pnhp.org/facts/what_is_single_payer.php

I looked at their plan and it is the only one that makes sense to me. It lowers costs to all tax payers and covers everyone (all 300 million Americans) with necessary medical and dental coverage. When 13,000 medical professionals propose a plan, it's not something to ignore. I would like to suggest that you get together with Mrs. Hillary Clinton about this and see if you can rally support for this plan.

I don't care who is in what political party, what I do care about is the 18 thousand people that are dying each year or others like me that are left wondering if their loved ones would have survived if only they had coverage sooner. I am feeling miserable right now because of my loss and feel the need to get things changed. So I am asking you to please take a look at the plan and move on getting a single payer plan in place. I don't want anyone else to go through the pain of my loss that I am feeling now and wondering if things could have been different if the treatments were done sooner and not later.

If you have any doubts about the authenticity of my letter, please go to the following links below.

http://www.legacy.com/DALLASMORNINGNEWS/Obituaries.asp?Page=LifeStory&PersonID=116028337

http://www.legacy.com/DALLASMORNINGNEWS/GB/GuestbookView.aspx?PersonId=116028337


Respectfully Yours,

Donald E. Steier

burnt

As a physician, I will be the first to tell you that most physicians make a great living. Like most Americans,they would like to make more, and some are greedy. But most recognize they make great money and are happy with the compensation. Health care in general is a mess. No great debate here. If I did not have to chart for the insurance companies, federal government, and lawyers, I could easily see 20 more patients a day. A lot of my time is wasted. The reason you see ads on TV and billboards is because hospitals and surgery centers make money on these patients. A lot of patients lose money. Pneumonia is a classic example. I don't like this one bit, but heart caths and hip replacements pay the light bills. No intense reasoning required to understand this one. Bet your town doesn't have a billboard advertising treatment of HIV complications or a COPD exacerbation. It's simple economics. In the coming months and years, all entitlement programs will be forced to embrace great change. The system cannot support them any longer. Some changes will work. The bottom line will be everyone will shoulder some cost of health care. A single payer system is not where we want to go. Almost no providers in my area accept Medicaid any longer. Most limit their number of Medicare patients. This leaves the BC/BS bunch who will only be able to afford the $1,200 monthly premiums for a few more years. I don't know what the solution is. We need a better system, but a single payer system under the federal government is not the answer. Personally, I think we should get a group of 20 or 30 of the smartest people in health care and finance and lock them in a room until they come up with a solution. No Congress. No lobbyists. No one leaves until two or three good solutions are proposed, and then we vote on one of these during a general election.

Incidentally, before I finish, I do think it is pretty damn amazing that a lawyer wrote the first part of this debate. Are you kidding me? I also think it is crazy that some assert that in general engineers should be paid the same as physicians. Totally different ballpark, my friends. Different skill set, different pressures. Plenty of engineers (or lots of professionals) are as intelligent as physicians, no debate here. If you want to be paid a physician's salary, just go to medical school. I know plenty that did it and did well. Just my thoughts.

nrk

The money is absurd. A doctor in the Portland, Oregon, area asked for more than $1,100 per hour to testify in court.
,
I have lived in Europe (you will not become a millionaire as a doctor there) and the U.S. The care was equally good in Germany at 10% of the price for major surgery (my wife's thyroid removal was about $8,000 for surgery and eight days in the hospital, and the surgeon was the professor who wrote the book on thyroid surgery in German. Medical care is right in Europe and doctor compensation is controlled. The doctor cannot decide that the controlled rate is not enough and charge extra. And there is a cap on total yearly compensation to a doctor from public insurance, but the doctor cannot refuse to see patients.

Brijesh Sharma, Kathmandu

Being an engineer, I have the same opinion that doctors are doctors because of the engineers. Their treatment is based on the tools and instruments engineers design. Doctors please choose: respect or money.

An observer

I want to start off by saying I'm not a doctor; I'm just a college student.

All you people saying doctors deserve to be paid only as much as someone with a bachelor's degree, Isn't this just like saying people who graduated from college need to get paid the same as people with only a high school diploma? If you can't understand the fact that doctors get, at the minimum, an additional seven years of training (for the shortest residencies without fellowships afterward), I don't know what to say. I don't know where this idea stems from.

As for the engineers saying that doctors wouldn't be where they are without their tools, yes, you're right. But you can't think that doctors are useless. Like someone mentioned earlier, if you (engineers) are making the tools, you should have a ton of knowledge about that tool, so why don't you step in the OR next time someone needs a major operation? Can you do it? I don't think any of you engineers would have the guts to use the "tools that you designed" in a situation that can mean the difference between life and death.

Also, medical school, residency, and beyond take up a ridiculous amount of time. Why should a doctor working for around 80 hours a week make only the same as someone working 40 to 45 hours a week? Can you guys seriously not see that difference? If you can't, will you, as an engineer, work double the amount of what you work per week for the same pay you get? I highly doubt any of you would. Doctors don't make a ton of money because of greed; it's simple economics. If you don't understand, go read up on it or take a class or something.

So don't complain when you get paid less than doctors who work many more hours than and spend many more years in school than you.

P.S. This is ridiculous that a malpractice lawyer wrote this article. It's because of the fear of getting sued that doctors practice defensive medicine (i.e., ordering all tests possible to rule out any missed diagnosis).

Donald E Steier

Dear Burnt,
You say that a single payer plan is not the way to go, and yet it is a proposal set forward by doctors, nurses, and other medical professionals. A single payer plan means that you don't have BC/BS, United Health Care, etc., to pay your medical bills and play the odds that you won't get a major disease. In an SPP, everyone shoulders their share of the burden. Under the current system, which you yourself do not argue is flawed, 18,000 people each year die from not getting necessary procedures and 15% (45 million) do not get medical services unless they go into an emergency room. Even then, there is no guarantee of complete service. You don't offer SPP as a solution since you see the number of Medicaid/Medicare patients being limited by the doctors themselves. If the SPP plan limited doctors' legal liabilities, then the plan would be acceptable. Please do a Google search on single payer plan and read up on what your fellow medical professionals are proposing. HMOs failed, current insurance to pay for medical benefits, failing. As NRK pointed out, the service he received in Germany was better than what we have here, and at 10% of the cost and no one is refused service. An SPP is a good solution if you do your homework. Don't listen to propaganda saying you have to wait for necessary medical services that you apparently don't in Germany. It would be nice to hear from others about national medical plans in other countries and how good or bad they seem to be. But to say that an SPP is simply no good because based on current standards, the doctors won't make as much money and still have to pay high malpractice premiums is absurd. Under an SPP, the rules would be changed to keep the liabilities limited along with the incomes of medical professionals. If you want to put this into classical economic terms, the government is here to protect its citizens and is thus responsible for the military. Protecting your citizens' physical health is just as important as protecting them from foreign invaders. More so since our citizens are among the most productive workers in the world. An SPP is a very good way to protect their health. Other proposals, including the one currently out there by the AMA, fall short of promising universal medical coverage, and none of the plans propose to save anyone money. You don't offer a solution, but others already have one if you would be willing to give it a fair appraisal.

Your proposal to lock 20 to 30 of the most brilliant minds in the country in a room until they come up with a good plan is interesting except I have heard that you can lock 20 to 30 monkeys in a room with a typewriter and paper and eventually have something come out looking like a novel. Neither of them will be interesting reading in the end.

James

"The only way I know to tackle this without nationalization is to swing the doors wide open on immigration for medical care professionals and let more qualified people compete for those positions. Let more competition solve this problem, not less. We are not graduating enough workers for the demand to lower prices. Let free markets work. Don't block competition in order to prop up medical worker compensation."

Nonsense, the whole financial world is on the brink due to unregulated, free markets (or haven't you noticed?).

We need more regulation and more introspection. We need trade barriers against India and China, and decreased immigration from these countries for "jobs that don't exist."

The medical system as a whole stinks, and that's because it has been largely unregulated.
We need to take care of our own. I'd suggest a free medical education to any U.S. citizen with the ability and compassion.

Mass immigration has already annihilated the engineering, computer sciences, and physical sciences (chemistry, biology, physics.) professions. Only deans of colleges and tenured professors push for more, more, more, more, more people for fewer and fewer jobs. This gives the tenured elite a greater pool of slaves to choose from. It also unjustly diverts government money to expand university science programs for, again, "jobs that don’t exist."

No need to allow in more foreigners with dubious academic credentials. Plenty of human resources here to be exploited, if it is done in a systematic manner with the best needs of the patients in mind.

Adam

"No need to allow in more foreigners with dubious academic credentials. Plenty of human resources here to be exploited, if it is done in a systematic manner with the best needs of the patients in mind."

So what you're saying is that Americans can't even compete with foreigners with "dubious academic credentials?" Either that or you're thinking that anyone trained outside of the U.S. cannot be comparably close to the academic level of an American? Neither of that makes any sense.

If you're so worried about foreigners "taking over" jobs, then stop whining and complaining and work harder than them, get better grades, whatever, so that employers will hire you rather than the foreigner.

TX med student

I am in my last year of medical school and will officially be called "doctor" in another 6 months. A little background, I come from a family of hard-workers who live in a rural area. My family is not what I would call rich, but we did not grow up living month to month either. I have worked with mostly primary care physicians and am applying to general surgery for residency.

The health care system is a mess, no debate there. But the question is how do we fix it? Patients need health care. Everyone needs health care. It shouldn't be based on ability to pay. We live in an advanced country that has the knowledge and the ability to help and/or cure many illnesses. Our citizens should have access to those resources.

At the same time, it all costs money--lots of money. The research, development, advertising, and training all require many man-hours and much money. Any company that signs on for developing something like that is going to want compensation; enter the pharmaceutical companies. They want to work on projects that offer bigger profits at the end. Vaccinations do not fall into that category, especially if not everyone will need them. The company will work for years to create the vaccine; then, the patient will receive a few doses and never need it again. Better to make a drug that will be required several times a day for a patient's entire life. There is corruption in their system; they are a huge industry trying to make as much profit as possible, just like in any other industry. The clincher here is that people's most basic asset is at stake: their health.

Then there are the insurance companies. Again, an industry that tries to maximize profit and minimize expenditures. It's only natural for a company to want to do such a thing. One problem among many with this industry is Medicare. Medicare is a national program that provides health care for patients over 65 that have worked in the U.S. long enough to have enough credits. With the baby boomers aging rapidly, Medicare is feeling the strain. The oldest of the population uses the most health care dollars, not a surprise: As we age things start to wear out and break. The problem is that Medicare is such a big power in health care that other insurance companies use it to guide their practices. If Medicare won't cover a procedure or treatment, then, it's unlikely that any other company would. And if Medicare decides that it's going to cut a reimbursement, other companies follow. Medicare requires that proposed treatments have to have adequate necessity documented, and will only reimburse a certain percentage of a doctor's bill for the treatment. So then the doctor bills high for the procedure knowing that he will only see $40 for a $150 bill and an hour's worth of his time. Medicare also says that a doctor is not allowed to charge Medicare one charge and charge a patient differently, so that if a patient wanted to just pay out-of-pocket he would see the $150 bill. Better for the doctor, worse for the patient. Furthermore, Medicare, either through work overload or a secretive cost savings program, will often not end up paying some bills. Granted, sometimes it's doctors not justifying procedures properly or not filling out paperwork properly or not filing or refiling within the correct time frames or an exam not falling within the coverage dates, etc. Eventually, it reaches the point where it takes so many man-hours to follow up on Medicare payments and bill kickbacks that it's not worth the $40 that Medicare would have ended up paying, and doctors avoid Medicare patients.

It's all double-edged swords. You can't blame Medicare: They are looking at increased patient demand that they can't afford but are required to try to cover. So they're staying in the black by essentially not paying some bills. You can't blame the doctor: Many of his patients have Medicare and in order to continue seeing them, he has to follow Medicare rules, even when dealing with other insurance companies--or Medicare will drop him. And he can't offer discounted bills to pay-per-service patients due to Medicare regulations.

All of these dilemmas reach a zenith where the patient meets the doctor. In general, both sides want the same thing: to maximize monetary savings and maximize health. When the patient and doctor finally meet, the doctor is overworked, trying to document and fill out all forms in their entirety to make sure he can get his $40. He is running behind schedule, because the previous patient had five different medical conditions and a long medication list, and as a good doctor he tried to address current issues and make sure that his plans for intervention would not cause harm to this complex patient. The doctor now has a dilemma: He can hurry through your encounter to make up the time, or he can give you your allotted time and allow patients for the rest of the day to wait longer. Either way someone is not happy, and it happens daily.

The patient in the encounter is concerned for his health, but also about the cost. Doctors order tests to evaluate or to justify "necessity" to insurance companies before an intervention is implemented. Sometimes the doctor doesn't even know what the patient will be paying. Insurance companies differ in copayments and what they cover, and some patients get private-party or government discounts. And unless you bring the bill to your next appointment, the doctor does not get to see what you are being charged.

I knew the U.S. health care system had many flaws, but I joined anyway. The best way to implement change is from the inside, because how can you understand all the players and their interactions unless you observe them first hand. I don't think that there is a quick fix for our system. It will take years with countless personnel and funds. In the meantime, can I suggest a cheap 'patch' to help hold us over? Communicate with each other. Don't assume that the other side knows exactly what's going on with your life. Patients: Tell your doctors specifically how the monetary part is affecting you, come to the office organized with medications and a list of questions. Doctors: Explain to patients why you need to order things and your thought processes behind it, and keep in mind that patients have other obligations to tend to after their doctor's appointment.

We can make things better. Let's start by working together to help each other save money and improve health.

John

Am a physician in 30 years of medical practice in New York. Thirty percent of estimated costs are driven by defensive medicine protecting your ass from potential suits. Stated figures above regarding costs are incorrect. The average debt of graduating medical students is now $180,000. After training, one is starting a career at age 27 to 31.

CompEng

I'm almost as concerned about that the fact that health care remains more an art than a science. When I see a doctor and he or she has to cram into fifteen minutes observation, analysis, potential diagnoses, and any prescription for test or medication (often test by another name), then see me for another fifteen minutes weeks later. I'm frankly amazed physicians can solve much of anything.

Thankfully, most physician visits fall into very well known territory, and so visiting a physician is actually a wise thing to do. But if you veer out of you physician's area of deep expertise, good luck even getting a proper triage. It's not that the physicians are bad per se, it's just that they operate under the worst possible conditions for applying real problem-solving techniques.

Fix information sharing, fix triaging, and advance technology to make tests fast and dirt cheap, and maybe we can expect some serious advancements out of healthcare. Until then, we have the best efforts of an overburdened set of individual educated guessers.

Sam

I would like to start with bringing down 1)Education Cost 2) Process cost.

With education cost coming down, you can have more doctors with less debt. Share resources and use efficiently while training to keep cost low. Also efficient use of technology can keep cost low.

With process cost coming down, I mean:

1) Insurance can efficiently process claims and with less overhead, in turn translating to less premium, less control in medical procedures and determinations.

2) Simplify process of delivery for Hospitals and health care providers would reduce cost. Efficient use of technology will benefit here.

3) No one can equate life with money. Lawyers need to simplify guidelines for malpractice claims and help reduce malpractice Insurance cost

4) Pharmaceuticals need to speedup conception to market process of a drug and not aim at using patents and forceful marketing to recover the cost.

5) Govt can come up with standard way to insure basic health care for all individuals

6)Any exhorbitantly priced procedures, usually at whimps of rich people should come out of their pocket and not insurance or government funded.

Such thought can be applied to other institutions involved with health care. I am sure intellectuals of our country have through through lots of other ways. At this juncture, everyone needs to keep personal agenda aside and think of "Country and people first." None particular can be blamed but at the same time everyone is responsible in some way or other.

Good luck.

Squeezebox

Nobody has mentioned the high prices of medical equipment and medical supplies. Why should a patient be charged $100 (by a hospital) for an aspirin? Why does a hospital have to have the latest CT scanner? Why do some drugs cost more than $30 a month? Then there's the professional liability cost. Does anybody remember the lawsuits over the pacemakers? Then there's the deliberate rationing of medical school admissions by the colleges in collusion with the AMA. Is it any wonder insurance companies want to give you a round trip ticket to Bangkok for your gallbladder surgery. I'm surprised they're not outsourcing long-term care patients to nursing homes in Mexico.

Kentk

As an engineer who recently had a kidney stone removed, this article brings to light the fact that financial professionals have been grossly overpaid over the past several decades. Being a doctor is a demanding job, and I don't have any problem with my urologist earning $200K+ a year. This country needs to get its priorities straight and pay people more in line with their value to society.

Victim

The whole medical structure has been set up to perpetuate and advance making more money over quality and quantity of care. Singapore, which has costs higher than the US, delivers far superior medical care for about a third the cost. In short, US medical is all about money and not care or solutions. It extends from physicians, nurses, pharmancutical companies, hospital builders, government officials all perpetuating a failing model for self-interests.

The whole system from education, certifications, regulations and administration is all about maximizing return and has almost nothing to do with care. Excessive qualifications and regulations at every step have led to the worst medical values of any country in the world by far. The medical industry has a code of silence to protect mistakes and the status quo that would make the Mafia jealous.

The whole system is rotten to the core. Medical waste and outright fraud is the biggest criminal business in dollar terms by far. The system cannot reform itself and has to be attacked just like any criminal organization that handles a legitimate product in a criminal manner.

verdugo60

Your car has a little rattle. You take it to the repair guy. Does he say, "It was a loose bolt, I fixed it, no charge."? Or does he say, "Lucky you came in. This could have been disastrous. It's gonnna be at least $1,200 to fix it." If he tells the truth, he'll soon go out of business; so he profits at your expense.

Now consider doctors. When you go in for a small complaint, do they say, "Eat less fat and exercise and you'll be fine."? No way. They will stick you with every ailment they can find and put you on perpetual medications that have side effects much worse than any disease. That way, they are guaranteed return customers who actually believe they will expire without all that stuff.

Doctors are mechanics with better waiting rooms. Period. If you want to live long and prosper, stay away from them.

gabe, san diego

Doctors are the only profession in the world that I know of where it's normal to be late for an appointment with a customer.

I think they are overworked because they are greedy. You are just a number to them: an insurance number. As a matter of fact, if you don't have insurance, you can die on the stairs of the hospital (it's happened before in this great country of ours). Perhaps doctors should take on less clients and care for them as a normal human being would.

BW Writer Greg Spielberg

I think it's difficult to make generalizations about the industry as a whole. But I'm interested to hear specific examples on either the pro or con side.

Ron Mepwith

Sure, most doctors run a business. Like airlines, they overbook. Their premise seems to be that their time is very precious and a patient's time is worthless. They use shotgun medicine--such as pushing colonoscopies, statins, etc. for everybody regardless of the patient's heritage, health history and symptoms. Dentists act in a similar fashion. Both doctor's offices and dental offices resemble factories with the bottom-line controlling.

JMA

Medicine is obviously a business; it is a business to provide a service to society to prolong life. You cannot honestly think that someone shouldn't get compensated for what they provide just because they are supposed to have your interests at heart. More intensive services obviously cost more than simple services. As for the compensation of doctors, I honestly cannot think of any other industry that is as regulated in setting compensation limits and levels like medicine. "Simple" cases for lawyers cost thousands of dollars or more and are set by the hourly fees of the lawyer. The compensation for "simple" procedures for doctors are regulated by the insurance companies and government, and these compensations are cut all the time.

The fixed overhead that doctors have (receptionists, offices, nurses, equipment, training, insurance, etc.) can’t change as quickly as the compensation does so seeing a higher number of patients is the only way that doctors have to keep from firing people or going bankrupt. Throw in the hypochondriacs who waste doctors' time over the sniffles, the druggies just looking for pills, the people who think they know better than the doctor and the people who are just looking to get an unnecessary procedure to sue and get a malpractice settlement. It’s a wonder why we still have any doctors left.

The reason that there are any restrictions on doctors is because if someone can’t pay and a doctor refuses treatment, the person may die. No other industry has the responsibility that the health services industry does, so comparing it to anything else is an unfair comparison. Personally I want a doctor who is compensated according to this great responsibility.

Doctors have to go through four years of college where the competition is so cutthroat that people won’t help each other to improve their class ranking and get into a better medical school. Then they have four years of medical school, they then have a residency that can last anywhere from 3-9 years depending on the specialty. Show me anyone else that has eight years of post-high school education and up to nine years of what basically amounts to an apprenticeship.

In any career, the more education that you have had, the more money that you will demand for your services, even if someone else with less education could do the same job. The reason that we pursue these higher degrees, most times, is to make more money to better support ourselves and our families. Should we punish everyone who has a post baccalaureate degree with government restrictions on what you should be compensated? Obviously the better students get the better opportunities and the better compensation, but you shouldn’t hold that against anyone, regardless of their industry.

paulvard

The doctor-patient relationship has been broken a long time ago, probably in the 60's, thanks to ambulance-chasers and patients who have seen dollar sign every time they see a physician. Medicine then became a big business. Medical practice is basically defensive medicine, resulting in enormous expense for tests after tests. The winners are the lawyers and the big drug companies. The losers: patient-doctor relationships, brilliant students who wrongly chose to become doctors dreaming of becoming super-rich, and the government, which has to pay for tests done basically for defensive medicine purposes. There is no trust between doctors and patients, and rightfully so. Patient's secret thoughts: "one false move buddy and my lawyer's on the telephone." Doctor's thought: "I know what you are thinking. You better believe you're gonna have all the tests in world, repeated as often to document what your lawyer is going to ask. Why did I got into this? Seeing people at 3 a.m and Medicaid is going to pay me $200, while these bankers are earning millions working 9 to 5. Oh, this rep is giving me tickets to see the Knicks? Might as well. This drug rep's never stop bugging me about his new drug. When something goes wrong with this drug I get sued after getting paid $50 while these companies earn billions. Man, this insurance premium is killing me. Office expense? Oh my."

retiredoc08

Some radical opinions will change when the skills and dedication of those "hypocrites" and "glorified merchants" are required some day to save a life or a family member's sufferings.

Danith

Are we a capitalistic society or are we something else? Like everything else in the world, it could always be improved. Why is a single profession being singled out? Doctors deserve all the respect and compensation because they impact lives on a daily basis. That's just a fact of life.

Cancer Doc

I am a young oncologist in my 30's who recently underwent a life-threatening heart surgery. It's humbling to see things from "both" sides as a physician and patient.

You know that the US medical care system is flawed when the insurance payment for the thoracic surgeon who performed my 4-hour surgery and all of the post-op care was similar to the cardiologist who did my 15-minute cardiac catheterization as well as for the anesthesiologist's fee. And I won't even offer a solution how to fix this problem--I'm just honored that I received first-class care from a superb team.

Now there are both good and bad docs, just like in any profession. In my field, there are cancer docs who make millions of dollars billing medicare and private insurance for unnecessary chemo. But the same goes with just about any specialty, there are always a few bad apples.

But the majority of us aren't in it for the money. Every day in my profession I deal with dying patients and their families. Not only am I the doctor, but also their friend, counselor, even bad guy if it's awful news to give that day. And I may only get paid something like $50 for a 30-minute visit. That doesn't include all those phone calls I make at the end of my day to their loved ones, to the insurance companies trying to approve a X-ray test, etc. And I, like most other doctors, provide charity care to the growing numbers of uninsured patients seen daily in the hospitals, which is easily an hour of my day.

It's easy to try to limit health care spending, but when it's your own life on the line, do you have the guts to do that?

JT

When will we admit the AMA is run by the drug companies (most of the members also take huge "conslting fees" from the likes of Lily, etc), and through them the doctors. I have a great doctor, but he still tries to throw a drug at me every time I say I have an itch.

DNR

Endless tail chasing discussion. Fault is doctors, no, insurance, no, government, no irresponsible people, no, doctors and government, no, insurance and people, no, no, wait, the drug companies! Well, drug companies and insurance, or, well, and doctors, too, well, and patients and government.

New thinking. Doctors are highly educated. Let me also say doctors are over-educated for what they do in most applications. Leading edge medical science, perhaps. But, built around a medieval economic system, and a pre-historic educational system. A doctor has 16 years of university education. So, why sit in an office looking at patients who can be diagnosed in 5 minutes and sent out the door with a script? Like asking the world's top chef to bring two dozen peanut-butter-jelly sandwiches to a picnic.... and for someone to give him $10,000 to get supplies to do that.

The answer is in understanding that very problem. The answer then is pulling it apart and creating something more sensible.

What are other professional specialist with that amount of education doing? A physicist, an engineer, an IT specialist, an economist, an agronomist? Much more than many physicians do on average with their extensive training. That is because the corresponding economies are more rational.

Physicians should be removed from most of the primary care scenario. What are now Nurse Practitioners and Physician Assistants should consolidate to be Primary Health Agents. Somewhat like what a solicitor in UK is to a barrister. The solicitor is the legal agent, the legal coordinator. Likewise, PHAs would coordinate health needs of individuals. The PHA would coordinate the medical expertise as needed. This would put physicians into the specialty realm best suited for such highly sophisticated education and skill. This would also make for a more logical health economy.

It would be $50 to walk in the door with a headache, not $150. And, in fact you would be subscribed to such providers, who eventually would be largely franchised. The relationship wouldn't be based on seeking help when you feel ill. It would be that, but more importantly based on that you are alive. A PHA would have as much in common as an academic advisor. You don't seek advice from such an advisor when you are failing grades. You see such a person at the beginning and throughout your progressing education to guide your choices. Almost nobody goes to a doctor to arrange an exercise or diet plan. Even then, a doctor certainly wouldn't monitor any such data. A PHA would.

This is important because most disease such as Type 2 diabetes wouldn't exist. But, this does require a "regime" change. That is to say, a social revolution. Medicine economically is most lucrative where morbidity is optimized. That paradigm has to change in order to lessen morbidity, in order not to reward a service based on such morbidity. Something must exist to compete against morbidity, to optimize health.

Those who say "medicine" is a business are ignorant. Medicine is a science. The business of using that science is not itself "medicine." Doctors primarily are functioning in a role of applied science, which is to say merely one of a medical technician.

The social revolution also necessarily must decide boundaries of freedom. Are we free? Does society let you commit suicide without interference? So, there are always boundaries. The revolution must readjust those boundaries. For example, is the health cost of my smoking neighbor my shared financial responsibility? How to adjust that? Bear down on the individuals to bear the consequences fully? Or, perhaps just get rid of the whole tobacco industry? I favor the latter since by nature, many human beings are stupid, irrational, and irresponsible, whereas corporations are concerted enterprises using clever devices to extract any and all economic gain.

It's all a matter of which will come first. The revolution which brings progress? Or, the catastrophic economic collapse, rampant death and demise, and then revolution and progress?
One way or another, we will get to progress... the hard way, or the catastrophic way.

Dr. Tom Beatty,DD,BFHM

Note: I am not a medical doctor.

My frustration is with the simple fact that we have the most expensive health care system in the world, yet it ranks from 34th to 38th on several indices of quality care. Examples are life expectancy, infant mortality, persons older than 65, and others.

I lay the blame, not exclusively on medical doctors, but on the insurance companies, HMOs, MBAs, and CPAs. These villains have taken control of and have destroyed our health care system while at the same time making it costly beyond belief. This corrupted, inefficient system consumes 16% of our GDP.

"Gentlemen, have you no shame?" to coin a phrase.

PhD

I have to disagree with many people pointing to the length of time correlating to an increase in pay once you finish training.

There are many medical researchers, such as I, who spend as much time, if not more, than MDs building our careers in school and post-doctoral training making little to no money. By the time many finish, we will have spent 8 to 12 years in grad school and what amounts to apprenticeship programs. When we finish, we don't expect six figure incomes. However, there are high expectations, both internally and by our peers, to contribute to our field, general knowledge, and benefit humanity.

Similarly to medical students, we are the best and brightest and many of us have specifically chosen to not go to med school because of the commercialization of medicine and the feeling that it is no longer about helping--it's about the bottom line.

Sowri

Agreed that the doctors are very smart and perhaps very intelligent too, at least some. Some are good care givers including my internist, even though he never looks up the chart until he walks into the room.

A few years ago, I was having dinner at a restaurant in Lexington and happened to overhear three residents (two men and one woman) discussing about what to do. Over the next hour or so they discussed extensively about which particular specialty makes more money. And one of them (man) pointed out that neurologists make a lot of money even though they end up paying a lot of malpractice insurance (do not know whether it is a fact or not).

I only wish that all the doctors used electronic records.

kris

Insurance companies and lawyers began polluting the medical profession, and now it is all one stream.

Chris

I think doctors are overpaid to begin with. Doctors are no better than they were 100 years ago. The only advances are the advances in technology. If medical school didn't cost 200K, and we didn't pay doctors 300K a year, then we wouldn't have to worry about overpaid doctors or doctors going for the bank economically. What about teachers and soldiers who give their lives to the betterment of society. I haven't sat down with many doctors who would practice for 30K a year for the betterment of society.

The medical industry is just like any other industry in America. It has turned into a business, and young college students are only in it for the lucrative paybacks and lavish lifestyle they see in movies and on TV.

Nomore

The best comment I've seen here:

"Doctors don't deserve to be paid any more than engineers."

We also need to ditch the bad drugs, pharma sales reps, and lobbying, fraudulent government programs (Medi-x), and outrageous educational expenses that lead to desperation and greed.

MD

This article is nothing but attempt to stir traffic flow to the web site. Authors for pro and con hardly did any serious research. For instance, it may be true in Africa, but even the community hospitals in the USA have on-call rooms equipped with private TV, bed, study-desk, and other amenities. With the economy in doldrums and nothing investigative to report, these authors have resorted to writing upon any passing comment.

Fred

Art vs Business?

What art offers its products free of charge? Even the starving artist of story and song starves because no one wishes to buy his art. The comparison is a false one. The doctor in all systems is paid. The question is does the patient benefit by being the customer or is it better from a patient's point of view for the customer to be a third party? Is there something about the purchase of medical services and products that makes the consumer better off if he/she is not also the customer? I think so long as the customer is not allowed to control cost and delivery, yes. As soon as the customer is able to restrict choices based upon cost no. I do not believe that it is possible to create a system where patients can consume indefinitely and customers are allowed no control over cost so I like the market approach.

voice from far

I come from a country (Ireland) where the longevity of both men and women now on average exceeds that of Americans despite spending less than 60% of the per capita amount on health care. One reason is that health care access for all is available in Ireland but not so readily available in the USA to a significant proportion of the population. It is my hope that President Obama and his administration rectify this anomaly ASAP. Best wishes.

NANDLAL KANJIBHAI PANCHOLI

I endorse the view that doctors of today have totally done away with medical ethics. Most people stray into medical profession for fast buck. Many even think that, as they have spent hard-earned money in acquiring medical qualifications, it is their birth right to overcharge their patients. Worse still, many hospitals refuse to hand over the dead body of a dead patient to their relatives till the pending bills are paid. Hundreds of Caesarian operations are performed every day solely for lucrative purpose, where in fact normal delivery would have been more convenient. Many doctors have an unholy nexus with pathologists and advocate exorbitant tests that are totally uncalled for.

To make matters worse, the medical profession is totally prejudiced toward fresh and epoch-making research in the field of alternative medicine. Prior to the death of Jade Goody, I had faxed to Gordon Brown (Prime Minister of UK) offering to save Goody's life, but it was thrown into the dustbin.

Rod Porter

I don't buy the selfless doctor argument. For centuries doctors made house calls and attended emergencies at all hours and got paid whatever they could negotiate.

Many U.S. physicians today are in it for the prestige and the lucrative pay scale for many specialists. What we need is nationalized, one-payer health care in the U.S., i.e. the U.S. government. This will discourage greedy yuppies interested mainly in becoming multi-millionaires at the public's expense.

Oliver

How much do the readers think the average annual job income should be for any professionals who spend $150,000 and an average of 9-10 years after college to learn the trade?

F.A. Hutchison

I haven't been to a Western medical doctor or hospital in 50 years.

The reason at 69-years is that I can cycle 200KM in one day on a loaded bicycle. In the past three years I’ve gone 20,000KM all over China

Check out “Discover China (by bicycle),” either at youtube.com or haaqi.com

And stay away from doctors.

James H.

I work for Blue Cross Blue Shield of Georgia and I am also chasing a nursing degree. The insurance industry does nothing but complicate a doctor's life--end of story. With insurance, the doctors can bill any amount they want but they will only get the contracted rate. The rest is written off and is there primarily to help make the taxes they pay more bearable come April 15th. I personally think the doctors in America should band together in some form of union and unilaterally quit accepting insurance once their contracts end. I also think people need to quit whining in general. You do not deserve anything. There are plenty of doctors out there who will help people who cannot afford it, but you cannot expect them to work for a pittance after all they've gone through to get there. If you don't feel like the doctors' services are worth it then vote with your money and don't use them.

Would you spend the better part of your 20’s and early 30’s sleeping on a cot that’s only a little bit softer than your kitchen counter while you complete an internship? Would you pay $150K for your education if you thought it would take you the rest of your life to pay it off? It varies, but for an OB in GA with an average salary of $150-175K the premiums alone cost around $35-45K…then you have the cost of the staff’s salary, the rent, billing costs, and all other equipment and utility costs. Let’s not forget the deadbeats who would rather pay their cable bill than their doctor’s bill.On top of all of this they have to set aside for the future…and they have to do it in less time than most other professions because they can’t really start earning until after they’re in their late 20’s or mid 30’s. Let’s also not forget that a doctors practice isn’t necessarily established overnight—it takes a while to build a profitable practice from the ground up.

I’m just training to be a registered nurse and it takes a lot of grueling work …I have NO desire what-so-ever to go through the crap that MD’s go through to get their title. I’ve noticed that most lower and middle class people act like they would behave differently if they were doctors. I say put your money where your mouth is and get started on that medical degree. If you’re not willing to do it yourself then you can’t reasonably expect others to do it, so show some respect and shut your mouth. Doctor’s are pretty comfortable under their current billing methods but they wouldn’t be if they billed like the “self-entitled” want them to—they’d be just as miserable as the rest of us which is what most of you actually want. If you can’t be comfortable then you don’t want anyone else to be comfortable either. My doctor deserves every penny that he is paid, if yours isn’t find one that is…and before I start getting hateful replies you need to understand that I do not condone irresponsible/incompetent doctors who knowingly price gouge and/or commit malpractice. I’m not sticking up for the crooks, the cheats, or the liars—I’m sticking up for the largely respectable majority of doctors that are there to help people in exchange for a comfortable lifestyle.

Bethany Taylor

A wealthy friend of mine who is a very young 80 wanted to take her family on a 4x4 African safari. But had for several months suffered with a severe shoulder strain, which was in danger of jeopardizing the trip. She went to see her doctor to see what treatment was available. To her horror the doctor said "at your age it would be a waste of time and money." As you can imagine, she was flabbergasted. What happened to doctors' bedside manner, or have they become cynical like most other professionals?

Bill

How much do you doctors really know is my question? There might be far and few doctors that are truly good at their job, but let's face facts. Doctors do not create medicines, and they don't cure cancer, or HIV, or any of the major diseases in current times. These issues are extremely complicated, and doctors serve mostly by performing, not researching. Actually, recently with the advent of the Internet you can simply do your own research. So truthfully, I find it very unfair that the true researchers, who spend quite more time learning the "details" most of these pre-med students in their undergrad years found "unimportant." Our society rewards the people that they see not the ones behind the scene. The truth of the matter is what does a doctor really learn these days in medical school? And is that really worth the $200,000 salary they receive? There is an important role for them in society; however, I feel they don't need to be making more than other hospital workers such as RNs or PAs. Actually it's quite funny from my perspective, when MDs usually give talks about biochemistry or cellular level event we always find that they have no clue what they are talking about, and their presentations are quite lacking. I mean it's really not their fault since they only take a year or two of real graduate level classes. However, I do have to say if I needed a bone fixed I'd go to a doctor. But if I had cancer, good luck. If there are any doctors that would like to tell me I'm wrong, please enlighten me.

James H.

@ Bill: Spoken like someone who truly has no idea what it takes to become a doctor.

Since WebMD is the leading source of quality health information on the Internet, we will explore the process of self diagnosis. Let us just consider the lower abdomen: Is there pain or discomfort, diarrhea, nausea and vomiting, painful bowel movements, muscle cramps, upset stomach, bloating, and constipation? These are just some more common symptoms found there. We'll just pick diarrhea and muscle cramps--the most common pairing of symptoms. Now, is the diarrhea bloody, watery, greasy, mucus laden, or especially foul smelling? I don't know how to specify whether my diarrhea is "greasy" or not so we'll just stick with watery and especially foul smelling (since the stench is positively dreadful). Okay, now decide if the diarrhea is mild, moderate, or severe? I'm not really sure how to differentiate between the different stages, but let us just say moderate since it doesn't seem particularly mild or severe. Okay, now we're done and we've got our possible candidates for the diagnosis: good old fashioned food poisoning, giardiasis, irritable bowel syndrome, viral gastroenteritis, campylobacteriosis, shigellosis, inflammatory bowel disease, amebiasis, lactose intolerance, celiac disease, Crohn's disease, cystic fibrosis, or even colon cancer, and let's not forget that it could just be a side effect of a medication/multivitamin you're taking. There are a few of these that could be weeded out by more in-depth research, but the majority of them would remain on the list. Which tests should I have run at the lab to help specify my issue? What medications should I take to fix it? Will this new drug interact negatively with my cholesterol meds or the methylprednisolone acetate I was prescribed to help treat the pain in the soles of my feet? Who would you really trust? Dr. Jones with a degree from schools like Emory University or Dr. Google who received his degree from the World Wide Web? I'm willing to bet that, as someone who values yourself, you'd be on your way to Dr. Jones or one of the other extensively trained medical practitioners in your area.

The more I study to be an RN the more I realize what I don't know about the human body, and it's a lot. I used to think I could self diagnose as well, but it was simply a sign of my former naiveté. You cannot possibly understand what you are talking about unless you actually attempt to train as a doctor. If you truly want to know what they learn in medical school--go give one a visit. There is a good reason not everyone can be a doctor. Some RNs know a good portion of what the doctor knows, but this generally doesn't happen until after they've been around awhile, and this is because they learned more about medicine from the doctors with whom they work. Also, if you think cancer and HIV will be cured by someone other than a doctor (in a lab or elsewhere) you are suffering from delusions of some sort--you'd better consult Dr. Google before the symptoms get worse. I also feel it necessary to point out that doctors of medicine rarely get the opportunity to both research and practice medicine simultaneously (whether they want to or not). There aren't enough hours in the day to run a practice, do substantial research, conduct multi-stage clinical trials, and have a life all at the same time. The days of good ol' Doc Smith grinding his own herbs and mixing his own elixirs have been dead for a long time. R.I.P., Old School Medicine

ditcher

As a contractor with many opportunities to do work for doctors, I have found that most I have encountered, especialy surgeons, have a fairy large opinion of themselves.

I have found them to be demanding and penny pinching. They do not extend the respect they demand.

They do have lovely homes and wonderful lawns.

seroquel

Thanks for tris interesting information! I found it very useful =)

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