Need a surgeon? Won't be able to find one

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News: Medical Malpractice Insurance and Physician Practices » Blog Archive » For some, it no longer pays to be a surgeon

[disneysteve]

Thanks for posting that. I don't think the average person has the slightest clue what is going on today in the medical field.

[cschin4]

Hmmm... I find it a bit suspect when doctors are hawking vitamins and other such things in their offices. Seems to me that they are in pursuit of th Almighty Dollar and forgot why they went into medicine. And, National Healthcare is going to make things even more difficult. If doctors aren't paid well and are on salary vs. "fee based" the number of procedures that they will do will plummet.
And, I do know of an OB Doc who closed up shop due to high malpractice. On the other hand, with the rise of physician owned Surgicenters many of them are seeing their incomes skyrocket as well. Depends which track you get on.

[rennigade]

$70,000 for malpractice? I always thought it was more than that.

It's funny how people compain about how expensive it is to go to the doctors or how expensive surgeries are. These surgeons are saving lives everyday but yet make a tiny fraction of what celebrities and sports figures make. If you can hit 30+ homeruns a year, you can get 100's of millions throughout your career. I'm sorry but there is something wrong with this picture.

As far as I'm concerned, it should be the other way around. Surgeons should get the 10's of millions a year for performing miracles on a daily basis, and pro athletes/celebs should get the chump change. They are nothing more than entertainers.

Halle Berry does a 30 sec makeup commercial and she'll make more than most people do their entire lives. sad

[Scanner]

Hmmm... I find it a bit suspect when doctors are hawking vitamins and other such things in their offices. Seems to me that they are in pursuit of th Almighty Dollar and forgot why they went into medicine.

Here's what I think. . .it's about security more than the almighty dollar although there are exceptions and you can find doctors with a great streak of avarice in them (I know a bariatric surgeon like this).

It comes down to what will offer more security for them and their family. "Hawking vitamins" or doing surgeries. If they are making $1500 per surgery and then $1100 of that is going out into malpractice, it becomes a painful choice.

I don't think anyone makes this choice lightly.

They don't spend 3 years in residency, day in, day out, reading journals, following mentors, going to seminars, engaging in roundtables and one day wake up and say,

"Crap. . .I think there's more money to be had in Amway."

They were somehow forced psychologically into the situation.

And, National Healthcare is going to make things even more difficult. If doctors aren't paid well and are on salary vs. "fee based" the number of procedures that they will do will plummet.

Frankly, IMHO, I have found most MD's would prefer a steady salary nowadays over the risk of being in business in the marketplace.

There are exceptions.

And, I do know of an OB Doc who closed up shop due to high malpractice. On the other hand, with the rise of physician owned Surgicenters many of them are seeing their incomes skyrocket as well. Depends which track you get on.

I think the article was fair and didn't just "boo-hoo" for physicians; you are right. Medicine does have to "redefine" itself - it used to be very surgery intense profession. . .well, that's changing for many reasons and not just because money is running out. People are more informed and understand the informed consent process of risks. vs. rewards nowadays of surgery.

In the 80's, well. . .you just followed doctors orders. If he said that uterus or tonsils had to come out. . .well. . .you just did it. . .necessary or not.

Personally, I think there has got to be more fluidity in the labor market in healthcare.

If there is a dearth of interventional radiologists or cardiologists and a glut of C-T surgeons, then the C-T surgeon should be able to "fast-track" into cardiology or IR. If there is a dearth of nurses and a glut of physician assistants, the same thing. Whatever. . .I am sure a pediatrician can't transfer into being a geriatrician but there are some potential areas of overlap.

This to me is a huge problem in allopathic healthcare. . .overspecialization. There should be a return of the "generalist" concept to allow for some fluidity.

Health care is very rigid and not very "creative" and "reactive" in business. You need some leaders at the top to make things like this happen.

[disneysteve]

Originally Posted by cschin4

Hmmm... I find it a bit suspect when doctors are hawking vitamins and other such things in their offices.

As a physician, I agree completely. I think it creates a conflict and puts patients in an awkward situation, feeling obligated to buy what the doctor is selling.

I do various things to make extra money but I do all of them outside of my practice. My patients don't see them and aren't affected by them.

Originally Posted by Scanner

This to me is a huge problem in allopathic healthcare. . .overspecialization. There should be a return of the "generalist" concept to allow for some fluidity.

I agree, and would also point out that it isn't just allopathic, but osteopathic as well. The problem is reimbursement. It costs the same amount to go through medical school whether you become a family practice doc or a super-specialist, but the FP makes $130,000 and the specialist makes $400,000. Which would you choose knowing that you will finish school with $200,000 in student loans?

We overpay our specialists and underpay our generalists. Much of the preventative medicine and early intervention happens at the family doctor level. If we would encourage more and better family doctors, we could avoid a lot of the specialty needs by preventing the problems. But as reimbursement drops and hassles rise, fewer and fewer good candidates are choosing to go into primary care.

[Aleta]

Your specialty of medicine will determine what you pay in malpractice. I know of some doctors who changed their specialty because of it.

[tripods68]

Technology has changed the way 'old surgery' is now done. This is a good thing. This is bound to happen to doctors, like any other profession, doctors or surgeons, has to evolve to other fields in medicines the marketplace warrants.

But I do think Surgeons in general still commands steep salaries no other professional can't match except sales and executives positions. I recently pulled my wife's boss/doctors salary coz' their public information in California. He performs hips surgery for people. His base salary for UC Davis was $120K a year and the rest of his payout came totalled $383K in 2007. You tell me hip Surgeon don't make any money....cha**ching...

[cschin4]

I am in the health care field and I have seen a big change. I now see more "preventative" procedures being done than ever before such as screening colonoscopies, EGD's etc. I agree that prevention is worth a pound of cure, but there are ALOT of these being done and at what cost to society? It is a fairly simple procedure and a cash cow for the docs as opposed to surgery which is time consuming and labor intensive.

[disneysteve]

Originally Posted by cschin4

I now see more "preventative" procedures being done than ever before such as screening colonoscopies, EGD's etc. I agree that prevention is worth a pound of cure, but there are ALOT of these being done and at what cost to society?

I think we need to shift the focus even more toward prevention and early detection. I'd much rather have colon cancer diagnosed while it is a 1cm polyp found and removed on a screening colonoscopy than when it has spread throughout my body and is too late to do anything about. Look at how survival rates for things like colon and breast cancer have changed over the years and you'll see the benefit of all those screening procedures. It is much cheaper to do a colonoscopy than to do a radical colectomy, radiation and chemo (and then still have the patient die anyway).

[JBinKC]

Disney I know what you are going through. Twenty years ago I would have never have guessed that a dentist now would have a higher earning potential than the average physician.

In the meantime there is overtreatment going on to cover your butt on potential malpractice lawsuits and to enhance revenues.

Unfortuantely, lawyers and the insurance industry are ruling the roost as well as the massive inefficiencies of record keeping in the industry which keeps the inflation snowball in the medical industry keep on rolling (which has averaged 10% per annum since WWII).

Eventually things will have to change. Healthcare in its current form will bankrupt the treasury in 10 years.

[disneysteve]

JB - What I think most people don't realize is that even as health care costs continue to climb, physician income has been steadily falling. The money simply isn't going to the doctors. It is going to the health insurance companies, the drug companies, the malpractice insurers, etc. Doctors have little to do with the rising costs.

As for over treatment to enhance revenues, that has been going on for decades. In fact, it was much worse years ago when most health plans worked on a fee-for-service basis. Do a procedure and get paid. Do more procedures and get paid more. Since managed care came along, there has been much more of a disincentive to do unnecessary procedures because the reimbursement is so much lower. I know a lot of doctors who stopped doing procedures they used to do because it simply wasn't worth it anymore. In our office, for example, we used to do gynecology care, PAP smears, etc. We stopped it years ago because it simply wasn't financially feasible to keep offering that service to our patients.

[cschin4]

I also see a different attitude in today's doctors. The old timey doctors devoted their lives and lived their lives at the hospital. I think that was feasible when we had local small hospitals. Today's doctors are often working at several different hospitals. And, when I was recently in the hospital last year, the hospital had a "Hospitalist" that was on staff and took care of the medical inpatients. I think that is a great idea and probably a much more cost effective way to provide care than when the family doc would do all that as well.
In addition, if we really want cost effective care, then utilizing Nurse Practitioners and Physician's Assistants is a very effective way to do so as well. However, there are often barriers in place that prevent alternative or other professionals from providing care. Often the mantra is "safety" but in reality it is as much a turf battle as anything else.

[disneysteve]

Originally Posted by cschin4

The old timey doctors devoted their lives and lived their lives at the hospital. I think that was feasible when we had local small hospitals.

Why do you think that was? Those local small hospitals were doctor-owned and operated. Those "old timey" doctors were raking in money running those places. It was a golden time. They owned the place so they shared in the revenue for all of those procedures, hospital stays, surgeries, etc. The more they did, the more they earned.

Today, whole different story. Hospitals are owned by big corporations headed by guys in suits, not scrubs, with MBAs, not MDs or DOs. They do everything they can to keep down all costs except their own huge salaries and perks.

I no longer do hospital work. I stopped 8 years ago when I joined my current practice. We use a hospitalist at our main hospital who is excellent. I'd trust her with my life. She does a far better job than I could possibly do. I have no idea how much she makes or how she gets reimbursed, but I'm sure she's doing okay.

[markusk]

A recent mantra among medical school students: "follow the ROAD:"
R adiology: don't have to deal with demanding patients; only interact with other physicains, good income with more and more imaging tests ordered every year.
O rthopedics: high income, calls not as bad as cardiothorasic/neuro surgeons.
A nesthesia: high income, don't have to deal with demanding patients, shift work.
D ermatology: no calls ever since there are no emergency/traumatic derm cases, high income for those who choose cosmetic route ("ask me about botox" signs in the waiting room). Did I mention no calls?

Brillant physicians who can "think a complex problems through" and come up with a diagnosis do not get reimbursed as well as physicians who do proceedures.

[Scanner]

However, there are often barriers in place that prevent alternative or other professionals from providing care. Often the mantra is "safety" but in reality it is as much a turf battle as anything else.

Cshin,

Thanks for saying that Cshin, because I feel as a chiropractor, I don't have the moral authority to say that without being questioned for bias.

There are literally hundreds of chiropractors out there sitting in their offices with their thumbs twiddling, able to take care of carpal tunnel, whiplash, headaches, and other musculoskeletal conditions in a competent, portal of entry matter.

Yet, because of what you said, the turf battle (the orthopedic/PT cartels), they are unable to assert themselves in the marketplace.

In the 1990's, the Canadian Healthcare system issued an exhaustive study (the Manga Report, Pran Manga, PhD) indicating if the system let chiropractors act as PCP's for back pain, it would save the system a billion dollars and actually enhance outcomes. And that was one condition.

You can imagine how the orthopedic surgeons felt about that.

The study was quietly buried.

10 years later, chiropractic was delisted from the Ontario healthcare system from reimbursement.

So. . .here's the other rub. . .what people are wishing for, what they are hoping for. . .is for drugs and surgery to become cheaper.

News flash: drugs and surgery ain't going to get cheaper. It ain't just going to happen.

Policymakers are crying for alternatives. . .but when alternatives are presented. . .the remarks are "Anything but that. . ."

[m3racer]

Originally Posted by Scanner

They don't spend 3 years in residency, day in, day out, reading journals, following mentors, going to seminars, engaging in roundtables and one day wake up and say,

It's more like 8 years to become a cardiothoracic surgeon....and yes I mean 8 years after finishing medical school. 5 years general surgery + 3 years of CT fellowship.

[m3racer]

Originally Posted by Scanner

Personally, I think there has got to be more fluidity in the labor market in healthcare.

If there is a dearth of interventional radiologists or cardiologists and a glut of C-T surgeons, then the C-T surgeon should be able to "fast-track" into cardiology or IR. If there is a dearth of nurses and a glut of physician assistants, the same thing. Whatever. . .I am sure a pediatrician can't transfer into being a geriatrician but there are some potential areas of overlap.

It just doesn't work that way. I hate to brake the news to you but in general here is the rule. The brighter medical students specialize in specialty fields, whether it's in surgery or internal medicine. Do you seriously think any medical student can become a CT surgeon. Just because one has an interest in an area does not mean they are qualified. I remember some classmates that could barely figure out a rectal exam. Needless to say they went into psychology or pathology....LOL

[m3racer]

Food for thought....the average person has absolutely no clue about what it entails to become a surgeon. I hear people bitch about 40 hour work weeks and I just can't help myself but laugh. I remember as a surgical resident I would easily work 90-100 hrs a week.....and that's not a typo. Oh yeah did I mention residents get paid below minimum wage! Thankfully, Congress intervened and residents are limited to working 80 hrs a week...LOL!! They are essentially sweat shop workers!!

I feel terrible for CT surgeons. They are getting robbed by managed health care. I assure you that if the average American had the intelligence and toughness to become a surgeon/physician they would not bitch about health care costs. As a society we need to stop thinking, "Health care should be free for everyone." and "The MD should be sued if there is a less than perfect outcome."

So in a nutshell......1) Insurance companies need to step in line, 2) Health care should not be free for everyone (Go tell that to Clinton/Obama), 3) Frivolous law suits need to come to an end.