Instead of making some major statistical argument, I'm posting this article. I'm highlighting quotes from doctors I think are most pertinent to the notion that supply of talented doctors is stretched to a limit and fairly inelastic in the short and medium term, and why you can't cap medical expenses through insurance, regulation or anything else:
• It saddens me that my lifelong enjoyment and enthusiasm for medicine has all but died. I have watched reimbursement shrink, while overhead has more than doubled. I've been forced to take on more patients. I work 12- to 14-hour days and come in on weekends. It's still the most amazing job in the world, but I am exhausted all the time.
--Vance Harris, MD, family physician, Redding, California
• In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don't know anybody who can live that way.
--James Dillard, MD
• Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit.
--ER physician, Colorado Springs, Colorado
• Everyone thinks all doctors know one another. But when we refer you to specialists, we often have no idea who those people are. Generally, we only know that they accept your insurance plan.
--Pediatrician, Hartsdale, New York
• Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered.
--Vance Harris, MD
[Of every $100 in medical practice revenue,]
$41 Amount that goes into the doctor's paycheck
Over the course of a year, that adds up to $155,000, the annual salary of the average family physician. That number rose just 3.3% between 2002 and 2006, while expenses increased nearly 25% over the same period.
The whole article:
From http://www.rd.com/living-healthy/41-secrets-for-your-next-doctor-visit/article75920.html
41 Secrets Your Doctor Would Never Share
Reader's Digest offered two dozen doctors a chance to tell it like it really is, and general practitioners, surgeons, shrinks, pediatricians, and other specialists took the challenge. Some wanted to be anonymous; some didn't care. But all of them revealed funny, frightening, and downright shocking things that can help you be a better, smarter patient.We're Impatient
• I am utterly tired of being your mother. Every time I see you, I have to say the obligatory "You need to lose some weight." But you swear you "don't eat anything" or "the weight just doesn't come off," and the subject is dropped. Then you come in here complaining about your knees hurting, your back is killing you, your feet ache, and you can't breathe when you walk up half a flight of stairs. So I'm supposed to hold your hand and talk you into backing away from that box of Twinkies. Boy, do I get tired of repeating the stuff most patients just don't listen to.
--Cardiologist, Brooklyn, New York
• I was told in school to put a patient in a gown when he isn't listening or cooperating. It casts him in a position of subservience.
--Chiropractor, Atlanta
• Thank you for bringing in a sample of your (stool, urine, etc.) from home. I'll put it in my personal collection of things that really gross me out.
--Douglas Farrago, MD, editor, Placebo Journal
• One of the things that bug me is people who leave their cell phones on. I'm running on a very tight schedule, and I want to spend as much time with patients as I possibly can. Use that time to get the information and the process you need. Please don't answer the cell.
--James Dillard, MD, pain specialist, New York City
• I wish patients would take more responsibility for their own health and stop relying on me to bail them out of their own problems.
--ER physician, Colorado Springs, Colorado
• So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that?
--Douglas Farrago, MD
• I used to have my secretary page me after I had spent five minutes in the room with a difficult or overly chatty patient. Then I'd run out, saying, "Oh, I have an emergency."
--Oncologist, Santa Cruz, California
• Many patients assume that female physicians are nurses or therapists. I can't tell you how often I've introduced myself as Dr. M. and then been called a nurse, therapist, or aide and asked to fetch coffee or perform other similar tasks. I have great respect for our nurses and other ancillary personnel and the work they do, but this doesn't seem to happen to my male colleagues.
--Physical medicine and rehabilitation doctor, Royal Oak, Michigan
• The most unsettling thing for a physician is when the patient doesn't trust you or believe you.
--Obstetrician-gynecologist, New York City
• It really bugs me when people come to the ER for fairly trivial things that could be dealt with at home.
--ER physician, Colorado Springs, Colorado
• Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?"
--James Dillard, MD
• I know that Reader's Digest recommends bringing in a complete list of all your symptoms, but every time you do, it only reinforces my desire to quit this profession.
--Douglas Farrago, MD [Note: I don't know what this guy's problem is. Most doctors I've talked to (my parents included) really prefer lists]
Pills, Pills, Pills
• Sometimes it's easier for a doctor to write a prescription for a medicine than to explain why the patient doesn't need it.--Cardiologist, Bangor, Maine
• Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.
--Internist, Philadelphia
• Taking psychiatric drugs affects your insurability. If you take Prozac, it may be harder and more expensive for you to get life insurance, health insurance, or long-term-care insurance.
--Daniel Amen, MD, psychiatrist, Newport Beach, California
• Ninety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making.
--Internist, Rochester, Minnesota
Bills, Bills, Bills
• Doctors respond to market forces. If the reimbursement system is fee-for-service, that results in more services. If you build a new CT scan, someone will use it, even though having a procedure you don't need is never a good thing.
--Family physician, Washington, D.C.
• I really do know why you're bringing your husband and three kids, all of whom are also sick, with you today. No, they are not getting free care.
--Douglas Farrago, MD
• Doctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten.
--Evan S. Levine, MD
• Twenty years ago, when I started my practice, my ear, nose, and throat procedures financially supported my facial plastic surgery practice. Today, my cosmetic practice is the only thing that allows me to continue to do ear, nose, and throat procedures, which barely cover my overhead.
--Ear, nose, throat, and facial plastic surgeon, Dallas/Fort Worth
Free Advice
• Avoid Friday afternoon surgery. The day after surgery is when most problems happen. If the next day is Saturday, you're flying by yourself without a safety net, because the units are understaffed and ERs are overwhelmed because doctors' offices are closed.
--Heart surgeon, New York City
• In many hospitals, the length of the white coat is related to the length of training. Medical students wear the shortest coats.
--Pediatrician, Baltimore
• Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients.
--Heart surgeon, New York City
The Darker Side
• It saddens me that my lifelong enjoyment and enthusiasm for medicine has all but died. I have watched reimbursement shrink, while overhead has more than doubled. I've been forced to take on more patients. I work 12- to 14-hour days and come in on weekends. It's still the most amazing job in the world, but I am exhausted all the time.
--Vance Harris, MD, family physician, Redding, California
• In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don't know anybody who can live that way.
--James Dillard, MD
• Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit.
--ER physician, Colorado Springs, Colorado
• Doctors often make patients wait while they listen to sales pitches from drug reps.
--Cardiologist, Bangor, Maine
• It's pretty common for doctors to talk about their patients and make judgments, particularly about their appearance.
--Family physician, Washington, D.C.
• Everyone thinks all doctors know one another. But when we refer you to specialists, we often have no idea who those people are. Generally, we only know that they accept your insurance plan.
--Pediatrician, Hartsdale, New York
• In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time.
--Family physician, Washington, D.C.
• Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered.
--Vance Harris, MD
• At least a third of what doctors decide is fairly arbitrary.
--Heart surgeon, New York City
• Doctors are only interested in whether they are inconvenienced -- most don't care if you have to wait for them.
--Family physician, Washington, D.C.
The Sensitive Side
• When a parent asks me what the cause of her child's fever could be, I just say it's probably a virus. If I told the truth and ran through the long list of all the other possible causes, including cancer, you'd never stop crying. It's just too overwhelming.
--Pediatrician, Hartsdale, New York
• Most of us haven't been to see our own physicians in five years.
--Physical medicine specialist, Royal Oak, Michigan
• When a doctor tells you to lose 15 to 20 pounds, what he really means is you need to lose 50.
--Tamara Merritt, DO, family physician, Brewster, Washington
• If a sick patient comes to me with a really sad story and asks for a discount, I take care of him or her for no charge.
--Surgeon, Dallas/Fort Worth
• Though we don't cry in front of you, we sometimes do cry about your situation at home.
--Pediatrician, Chicago
Shocking Stats
60% of doctors don't follow hand-washing guidelines.Source: CDC Morbidity and Mortality Weekly Report
96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...
46% of them admit to having turned a blind eye at least once.
Source: Annals of Internal Medicine
94% of doctors have accepted some kind of freebie from a drug company.
Source: New England Journal of Medicine
44% of doctors admit they're overweight.
Source: Nutrition & Food Science; Minnesota Medicine
58% would give adolescents contraceptives without parental consent.
Source: New England Journal of Medicine
Anatomy of a Doctor's Bill
Just how much of the $100 your doctor charges for taking 30 minutes to investigate your stomach pain goes into his pocket? After paying the bills, he gets less than half. The breakdown, according to Robert Lowes, senior editor at Medical Economics:
$3.50 for malpractice insurance
$3.50 for equipment, repairs, and maintenance
$6 for supplies, including gowns, tongue depressors, and copy paper
$7 for rent and utilities
$11 for office expenses, such as telephones, accounting fees, advertising, medical journals, licenses, and taxes
$28 for secretary, office manager, and medical assistant salaries and benefits
$41 Amount that goes into the doctor's paycheck
Over the course of a year, that adds up to $155,000, the annual salary of the average family physician. That number rose just 3.3% between 2002 and 2006, while expenses increased nearly 25% over the same period.
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