With all this talk of gloom and doom over the economy let's make it worse

I think we may be going on strike and all getting fired next week. 2 years no contract., silly union head, angry, but extremely well dressed superintendent (who got fired from his last job). All these things now conspire to make me want to go back to shovling lion crap.
B
 
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What am I missing... seems like a damned great paying industry... I have tons of docs in the family and they all say the same thing... but they are all extremely well off so the complaint rings hollow with me. I don't see them risking capital, I see tons of demand, I see an industry where customer service isn't really a driver... I'm not anti-doc, I just would love an explanation why docs complain about pay so much...


From RI

Because I don't know their situation/background, where they practice, what type of practice, etc.

When I finished fellowship 5 years ago, I was $220,000 in student loan debt. I was "above average" (only area where I was above average...) The average loan debt of a student coming out of medical school today is >$150,000 (another figure I recently read was $180,000). Reimbursement continues to decrease; expenses continue to increase. That is risking capital.

When I opened my new office 3 years ago, I took part in a $300,000+ loan for start up cost. In 2007, I worked the hardest (posted the most charges) I ever had in my career, and made less income. That is risking capital.

Thus far for 2008, my overhead is now 47% (17% increase this year), but my income went up 1%. Yeah, I complain about that.

"Customer service" will become a driver very soon in the next few years as pay for performance is put into place. That certainly will solve a lot of problems...

You live in an area where the "new" model of health care is evolving. Physicians as employees. Phyisicans doing shift work, as ER physicians, hospitalists, surgicalists etc; essentially hospital employees. That can work because in New England you have a high population density, and a large number of young physicians that are willing to work in that model. Within the southeast and midwest, an "older" model of fee for service still exists, but is a decaying dinosaur because of increasing overhead expense and decreasing reimbursement.

In our area, we can't recruit a new young physician, because no one wants to work in an environment where you are on call every 3 or 4th night and weekend with high volume. In western KY, we have 4 nephrologists that cover a population area of 225,000 people. In Nashville, there are 40+ nephrologists covering 600,000 people.

The gray haired docs worked in the golden era. The younger guys are working in a totally different world.

Lee,

Check out this link to Humana, a health insurance company based out of Louisville, KY. Pay close attention to page 3. That is why you are paying more and getting less service.

http://library.corporate-ir.net/library/92/929/92913/items/283556/2007_AR.pdf

Another cool sight to check out your favorite hospital is:
http://www.wherethemoneygoes.com/

Like I said, it is a complex beast and no one thing or one person will fix it.

Best,
Steve
 
Wow health care. When I was working for some one else $11,000 a year. That was in a self insured group. I just read the average is $12,500 a year for an employer. Our school system cost is over $15,000. a year. The real poor have insurance It's the working people that make less than $50,000 that are the ones that don't have a company policy that don't have insurance. We are talking Millions of people. We all know the hospitals can't do it for free so they pass the cost on. The price of insurance just keeps going up. When it goes up more people drop there insurance. Endless cycle. Being a optimist there are solutions it just will take political will. Millions are spent by special interests to keep things the way they are.( : ( )
 
First hand experience with our health care system. With a wife on dialysis 3 times a week, congestive heart failure, diabetes and in a wheel chair. All I can tell you is the healthcare system in this country is nothing more than a money making machine. I have some of the best insurance you can get Blue cross. I see the bills the hospitals the doctors the labs all submit and then see the negotiated price because of contracts they have. Its un real they charge the insurance 75 - 80% over what the unsurance contracts are. You get bills from the hospital, from each doctor for a 1 minute visit in dialysis, "Oh how are you feeling" theres another $500 billed! I have the hospitals, doctors offices hounding us for what they say is our share of the bill which insurance says it isnt our share. You spend hours on the phone refutting bills everyday. 4 different collection agencies for the same hospital. they make it so complicated that I had to get my buddy, an accountant to help me get thru the mess of bills and paper work. The under handed sh*t that the offices labs and the hospital pull trying to get more money is incredible. From my view point its nothing but a money making system. Six year waiting list for kidney transplant that you cant even get on the list in the first place. We have had social workers try and get my wife on the list only to be put on hold for hours on end. Then there finally told that someone will get back to you and they never do! Yes thank God that we do have the best healthcare, they have given me, hopefully, a few more years with my wife. But the administrative side, the billing side, the money making side can go to he**!
 
Anyone who knows about politics in IL knows what is happening or what is not happening. Last year funding for the area I work in was released 10.5 months late, offices in some counties closed. This year 50% of the operations money was eliminated in July (the new fiscal year starts July 1). All of the money for our health insurance was eliminated in July. Not only did much of the state funding go away, the money we generate for work we do is way down due to the economy. They are going to start cutting hours soon.
 
Rhett, may I recommend Wellbutrin....no sexual side effects....YIPPEE!!!!

One thing is for sure, you aren't going to see this kind of braintrust on the refuge forums! Seeing as I've been the guy taking the doctors, the lawyers, the stock brokers, the engineers money for years it oughta be interesting when they finally run out of money to blow on stuff.

My circumstance is similar to Shawn's. Over the past 18 months I've strived to "diversify" my income. This way I won't throw all my eggs into one basket. My first venture was selling real estate....I started with a gigantic, mega-brokerage that is known around the world in the commercial circles selling recreational properties under the "Cabela's Trophy Properties" banner. My grand total in sales for less than a year that I worked there was a gross of about $8500.00. Of course, I talked them into paying me a draw so I still owe them money now(they dropped the recreational branch from the land division plus I couldn't take the FN corporate atmosphere much longer anyway, yes I did put the suit on and take the train in to downtown Chicago every couple weeks to check in...I resigned the day they dropped my division). I figure this little venture cost me about $15K if you count lost guide income but EVERYTHING has it's benefits and this venture was no different. I developed a good relationship with many farmers and other brokerages and I've been offered part-time positions at a couple of very well appointed brokerages which I will probably eventually jump into but right now everybody is holding tons of inventory and not selling a damn thing. I still have some referrals coming in so that's almost effortless income.

After the real estate debacle it occured to me(again!)that sportsman always spend money. No matter how bad shit gets, they figure out a way to spend money. It's like being a junky...they'll figure out a way to get that fix. So I ramped up my guiding and started to market myself to the Chicago shops better and started fishing for other species like largemouth and not restricting myself to fly fishing. Most importantly I'm independant and will only work daily under contract. Never again will I trust my guide fate to somebody elses management skills.

I also started writing again....I've been writing the weekly outdoor column for the local newspaper as well a feature story for the counties two largest newspapers. This isn't a money thing...it's peanuts but it'll bring the writer in me out again so I can start to submit to the bigger magazines.

And I've also started to do some restoration management work. I've been doing side jobs spraying phragmites and honeysuckle etc. Typically there are state and federal grants for this type of work and some of the folks that I worked with on the real estate venture expressed interest in having this work done at a reasonable expense. I worked for an RM outfit a few years ago and I'm still certifide. So, I'm doing that and I'm going to start a company with a friend that owns 100 acres of WRP and started to do his own work and realized there was a niche here. I told him that "it was so easy you could teach a one armed chimp to do it" and it could be done on the side in conjunction with other jobs. Thus, One Armed Chimp LLC was formed.

In the meantime my house is wrapped up in an ARM that is strangling the life out of me too! So, this oughta be an interesting ride for sure. I wish everybody the best. My advice, diversify!!!

And now you know the rest of my story!
 
I've already lost a job to the need by the armed forces to pay for the war (remember the war? It's sort of funny how little coverage the war's gotten in the news of late, isn't it?). I was lucky and landed another pretty quickly, but thir budget was shrunk, contracts deferred or stretched out, and they're doing everything they can do to keep the development efforts going so that we can get the warfighter something he needs. So, all in all, I've already taken a $1500 a month pay cut by having to maintain a second household in another city, get to see my wife on a limited basis, I'm looking at slim-to-none raises, increasing costs for food, gas, and other necessities. And now, the government wants to hit every household in the US with a bill for $10,000 to pay for this mess. Oh, and by the way, I bought a home that was within my means (it's payed off). So why do I have to pony up for the other guy who bought much more than he could afford?
 
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Ill have a job for life if I stay in Jersey , that is unless we start executing criminals instead of putting them in prison,, personally ,,Id rather hang them all, I can always pump gas.. LOL
 
A week doesn't go by I don't have a couple of patients in the hospital who are so obese that they don't have the muscular power to move the fat on top of their chest far enough to adequately expand their chests so that they can breath, they are actually smothering to death under their own fat.
Ed.
Click to expand...


Ed, that is one of the best, most eloquent answers I have seen. I have 6 of these Obesity Hypoventilation Syndrome patients inhouse as we speak. Mine is the fancy terms, your's however describes it. Oh, none of them have any insurance. Everything I have done today for them is a write off. Out of the 13 I saw today, only 4 had insurance and 2 of them are medicare. So at the end of the day I lost money.

Steve/Ed, how much do you write off a year as a practice in this free care? For us it is several million dollars in charity care.

The unfortunate issue is the fact that those who have insurance are paying for those who have none. But what really chaps me is when Medicare comes out with new guidelines telling me and my partners how we can practice and what they are willing to pay for. Does it matter that it is good care? Does it matter that fatty needed this to stay alive and if I didn't do that I would be sued? Nope, but since they don't feel it mattered, it was all for free.

Andrew,

Our partners tried to invest 40 MILLION in capital to build a new complex where all the specialities would share space, equipment etc in a huge co op type environment to save money for the patients. Medicare came out with new guidelines saying NO, you can NOT partner with others to save patients money. That is forbidden. They were so aggressive with it, they spent the time to write 1500 + pages of document to close every single loop hole there may ever conceviably be so that we may not ever benefit from helping patients and taking a finacial risk.

Funny, if a guy works hard in business and does well, people congratulate him and don't bat an eye at his house, truck etc. "he worked hard for it!!"

Yet if someone in the medical world works hard, people complain they should live in a hovel and walk to work. I just don't get it.....

If your loved one is sick and dying, you want qualified, compenent providers there to help them, save them.....yet you want it for nothing......Try asking your car dealer to fix your tranny for free, hell just drop it off at the shop and leave it then come back in 2 weeks to pick it up and just scream and yell at them since they did not wash it too....

Every industry has their issues but since when in America if you work hard and do the right thing should you be penalized for it and not make money?
 
Eric, Ed & Steve...

First off, I would never make it as a Doc as I'm not smart enough... I'm not suggesting that the job isn't hard and the hours long (esp. in the early years) and the patients aren't horrid.

I just believe that the typical doctor doesn't experience a bad pay scale... and compared to the average income (net, net, net of all the freeloaders and admin Overhead) it's a damned good living. And yes, that living can be enhanced by risking capital in a MOBuilding, fixtures and investment-in-practice risk.

With that said, Eric, that's a bad story about the $40mm investment re rules, etc. That's NOT a good thing and imagine what it's going to be like when/if Obama covers everyone. A nightmare.
 
Steve, from those links, I gather that there are no payouts for services. I know our little city owned hospital has been under horrible fire because they lost 2 million last year. Most of the letters to the editor were from "peple hoo cant spel rite". If I was smart enough to be a doctor....I guess I'd become a lawyer or ceo of an investment bank or insurance company.
 
I hear doctors complaining about this all the time. One of my best clients is a Harvard Med grad and worked at Northwestern in Chicago. He quit a few years ago and became a hedge fund manager. He made shit tons of cash...new Ferrari and limited edition Audi. A fancy second house on the beach in Michigan...etc etc etc. He has a good sized family and when I spoke to him yesterday he was riding the current economic storm out and booked a trip for next week.

He told me that the liability insurance alone should be a big obstacle for lots of the young doctors out there. Told me that he would hardly recommend it to anybody considering the current state of affairs. I had another guy in the boat a couple years ago that had just "retired" at about 55 years old...sold his practice I guess. He told me that one single malpractice suit that was utter BS basically put him out of business. He'd had enough. He said he looked back on med school and how proud he was when he started to help people and thinks it was all for nothing. Very sad if you ask me. I know they do well but it does take a special kind of person and tons of commitment. My neighbor is an anesthesiologist(did I get it right?!)and I hear her leaving at all hours of the night to run to the hospital. She has 6 kids and it's amazing how often she's is running to the hospital on short notice.

Incidentally I explained my situation in my post above with great detail because I figured most of you had no idea what I do for a living other than guiding.
 
Eric,

I have family members that had been employed in hospitals since I can remember. My dad in data processing making sure everyone from my mom who was HR administrator to my brother who worked in central sterilzation got a pay check. My mom got out of HR and went to being a patient advocate because she seen a need to help those that were lost in the health care coverage industry. My wife is a product manager for a health care provider which is a nightmare in it's self. My cousin is an anethisiologist and in every discussion I've ever listened to when they all get together is the health care of this country went to hell in a hand bag when hospital boards were convinced to replace doctor and surgen hospital administrators with bean counters promising streamlining that would provide large profit margins and provide cutting edge technologies and services. One of those streamling avenues was the introduction of kitting. This is just one of the things that chaps my ass. When I get an EOB I can't understand and ask for an itimized list and it's calling out:

• 1 bag bedside white 6.6X3.5X11.75
• 1 bag poly 6X9 2MIL
• 1 basin emesis 700CC
• 1 basin placenta blue
• 1 blade No. 20
• 2 blade No.10
• 1 blanket baby white with stripes
• 1 bowl 32oz graduated
• 1 connector TBG straight
• 1 container specimen 4 oz.
• 1 cord clamp
• 1 CSR wrap 54X54 Kimgaurd
• 1 cup medicine 2oz (AIN)
• 1 drape C-section w/PCH & FEN
• 4 drape until w/tape economy
• 5 gauze * 4x4 12ply (indexed 5)
• 10 gauze 4x4 16ply Xray 10'S
• 1 gown poly reinf XLG/CSR/towel
• 2 gown prevention XL
• 1 head warmer
• 20 lap spng 18x18 washed
• 1 lbl:dressing pack 2.5x1
• 1 lbl: white .5 x 1.75 9/card
• 1 lid for spec cont. 51778 blue
• 2 light hndl cover soft
• 1 mayo stand cover standard
• 1 ndl 18 ga x1.5
• 1 ndl cntr FM BL 1 mag 20ct
• 2 O.R. basin light blue
• 2 pad ob 11in.
• 1 pad telfa non-ADH 3x8
• 1 pitcher 1200cc w/handle
• 1 ruler for skin marker
• 1 skin marker
• 1 syr 10ml l/l w/o shld-LF
• 1 syr 20ml L/L w/o shld-LF
• 1 syr ear/ulcer 2oz blue
• 1 TBG suction .25 in. x 144 in.
• 1 tbl cvr 50x90
• 2 towel 17X20 ABS White
• 5 towel or blue pretreated
• 1 vacutainer 10ML Red no ADD
• 1 vacutainer 7ML LAV (K3) EDTA
• 1 yankauer bulb tip w/o vent

Excuse me but I had a cyst removed from my shoulder and had 4 stitches......This was an out patient procedure. I think there are a lot of issues that need fixing.

Ed L.
 
Sportsman spending money even when the going gets rough.......

Tonight at the DU waterfowl hunters party in Lake County just outside Chicago there were 389 tickets sold for $25. That's prior to all the money that came in. Unreal! I scheduled ours for next August 22nd.
 
True story guys about how insane family and patient demands can be on doctors and nurses.
Working ER in a small country hospital one night. A family screams to a stop at the ambulance door. Mother jumps out sreaming and flopping on the ground that "Johnny Joe" was dying. She wouldn't get out of the way for anyone to take a look in the back seat. One nurse had to actually rare back and cold cock her to get her out. Sure enough, "Johnny Joe" was dead as a door knob. But we pulled him out and raced into the ER and worked away. Heck, he was already cold, but we tried to show the family something that they could say we tried with. Afte 5-10 minutes we called it off and the doc told the family that little Johnny was in fact dead. He had asthma and died in his sleep.
So they freaked out and went running all through the "hood" yelling "they let Johnny Joe die". An hour later 300 people are in the parking lot in a full blown riot. Bricks fly through the windows and we call the only local law enforcement, one state trooper with a K-9. He pulls up and no one cares. They can't read the words K-9 on the side of the car. Too bad.
Trooper lets King out of the back and King starts eating ass all over the place. Riot ends very quickly. Soon a lot of people meekly show up wanting us to take care of their dog bites from a dog supposedly in the neighborhood.
ER doc who happened to be a 2nd degree black belt ended up having to kick some butt hisself. Everyone ended up caring for their wounds themselves at home.

Now, what does this tell us. It says that people won't accept resposibility for their own families and their health issues. Also, that we are expected to perform miracles and literally bring the dead back from the dead. And when we can't, we are the bad guys and should be stoned, sued, beat up{yes, I've seen attempts at that over bad outcomes} and not paid for as others have commented on, hard work and years of education and experience.
The really bad part of all this, some guy by the name of Keiffer Sutherland gets 1/2 mill. for every episode of 24.
 
Back to where Eric begin, I run a drug task force in North Alabama ( Meth Mountain ). You would think that I wouldn't have to worry about a job. Wrong, I've already been informed from the state head that I will be getting a 70% cut in my federal funding come July 1, 09. The federal funding makes up 50% of my budget which is only $360,000.00 a year for six employees. I guess the bad guys win, again. Oh, by the way, that cut will be to every drug task force which operates of of federal funding, there are 31 in the state of Alabama. Our tax dollars at work!
 
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