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Monday, October 31, 2016

Do U.S. Physicians make too much money?

"[D]octors in the United States earn an average of more than $250,000 a year, more than twice as much as their counterparts in other wealthy countries."
Really? From "Inequality As Policy: Selective Trade Protectionism Favors Higher Earners" by economist Dean Baker.

My comment below the article:
Notwithstanding your larger point, the average U.S. primary care physician makes more like $170k annually. Glomming up the data by including all of the specialities to arrive at "more than $250,000" is either naive or disingenuous.
Source: Glassdoor. Current as of September 2016.
The full paragraph context from the Dean Baker article:
For the most part, it is impossible for foreign-trained physicians to practice in the United States unless they have completed a residency program in the United States. The number of residency slots, in turn, is strictly limited, as is the number of slots open for foreign medical students. While this is a quite blatantly protectionist restriction, it has persisted largely unquestioned through a long process of trade liberalization that has radically reduced or eliminated most of the barriers on trade in goods. The result is that doctors in the United States earn an average of more than $250,000 a year, more than twice as much as their counterparts in other wealthy countries. This costs the country roughly $100 billion a year in higher medical bills compared to a situation in which U.S. doctors received the same pay as doctors elsewhere. Economists, including trade economists, have largely chosen to ignore the barriers that sustain high professional pay at enormous economic cost.
Baker on Rx:
...In the case of prescription drugs alone, the United States is on path to spend more than $430 billion in 2016 for drugs that would likely cost one-tenth of this amount in the absence of patent and related protections. While we do need mechanisms for financing innovation and creative work, it is almost certainly the case that patent and copyright monopolies as currently structured are not the most efficient route, even if their negative consequences for distribution are quite evident.
OK, we all know that the Pharma lobby continues to effectively protect their members' lavish margins.

More on health care space compensation.

Whether my Primary doc makes $170k annually -- or $250k -- is of nil concern to me in the face of numbers like those. While a salary of $170k is nearly 4 times the median U.S. individual income (~$44.6k), it pales in comparison to many others in the health care space -- not to mention the compensation of celebrity entertainers and athletes.

to wit:
Of the 1,877 CEOs at 2,681 hospitals studied, the average compensation was approximately $600,000 per year, though this varied widely. CEOs of small rural hospitals earned salaries and bonuses of just $118,000 a year, while those at the largest urban teaching hospitals earned on average nearly $1.7 million per year. And some CEOs earn considerably more than that. For example, in a recent year, the CEOs of Northwestern Hospital in Chicago and the University of Pittsburgh Medical Center each earned in excess of $5 million in salary and bonus. - "Why Are Hospital CEOs Paid So Well?"
Let's say you're an industrious PCP. After 4 years of college, 3 years of med school, and 3 years of residency (and a mountain of accrued school loans), you hang out your shingle. Let's say you see 30 pts a day for a total of 48 weeks a year (with 4 weeks given to holidays and other requisite time out of office), and you somehow manage an (unlikely) average reimbursement of $100 per pt encounter.

Your gross revenue, then, would be $720,000 a year.

Deduct rent, utilities, equipment, supplies, marketing, receptionist and MA salaries, insurance (including MedMal), billing service, EMR expenses, etc etc etc...

You'd be damn lucky to pay yourself $170k a year (gross before taxes).

Below, from the 2016 Medicare RVU reimbursement schedule. 

I'm a 99213, a "moderately complex established patient."


Maybe I'm a 99214 by now (all of $79.18), in the wake of my 2015 prostate cancer dx and tx. Irrespective, no wonder my Muir doc has to whip through our semiannual f/up visits.

More on the cost of U.S. health care. Just in via my daily email alerts:
An Open Letter Healthcare.Gov: I Can’t Afford To Be Sick

The other day, I got several letters in the mail. One was from the healthcare marketplace, reminding me that enrollment for 2017 coverage begins on November 1st. The rest were medical bills, some of which are about to go to collections, that I can’t pay for. This isn’t new to me. When I first got sick back in 2010, I wasn’t insured at all. I have so much outstanding medical debt that subsequently went to collections that I’ll probably never be able to get loans for school, a house, a car, or anything else. My credit is under 600, and I don’t think it’s ever actually been over 600. I didn’t even have enough time to build credit — I was only 19 years old when I got sick.

This is the reality of the United States healthcare system, and I’m certainly not the only person you know who is struggling with it. Although I pay a paltry $83 premium each month for my marketplace-purchased insurance, many pay far more that that, even with tax credits and subsidies.

I’m actually thankful to have the option of buying insurance through the marketplace at all. It’s the only reason I was able to become self-employed. Prior to being able to partake in it, I was struggling to hang on in the traditional workforce because I needed insurance coverage. I worked purely to get healthcare, and that’s what many people do. But the problems with the U.S. healthcare system and insurance coverage exist regardless of whether you buy it yourself or get it through an employer.

When I worked full time with benefits at a hospital, I was in debt to that hospital because I had had some imaging studies done in the emergency room. It turns out that the radiology department was actually contracted out to a third-party, so it wasn’t even covered by the insurance that hospital employees had. An in-hospital service was out-of-network...
Yeah. Goes to my prior post, no?

Also relevant, with respect to Medicare specifically, from a link I provided a couple of posts back:
Although it’s clear that Medicare will need an infusion of new revenue in the coming years, beneficiaries should not be the piggy bank that saves the program. If LBJ’s vision is to be maintained for the community now and in the future, the community as a whole—taxpayers—must protect it. So far the acceptable solution is to make beneficiaries bear the escalating cost of medical care and thereby shift the burden away from government. But this is the swiftest route toward shredding the social compact that Johnson enunciated back in 1965. The burden of cost containment must fall on providers and others in the health-care industry, not on beneficiaries, who are least able to handle the increasing costs... - Trudy Lieberman in Harpers's, “Don’t Touch My Medicare!” Is the beloved program on its last legs?
"The burden of cost containment must fall on providers..."?
Uh, including those greedy, wealthy $170k/yr PCPs?


Just in. From the always fine EHR Science:
Fixing EHR Usability Requires More Than Doubling-Down on Usability Testing and UCD

The rise of scribes is but one sign that many EHR systems, as currently designed, make clinicians less productive and patient interactions more awkward. The main ways touted by ONC and most observers to address usability issues focus on user-centered design and more comprehensive usability testing. However, can these methods alone actually address clinician complaints? I think not, and the reason is the complexity of the tasks that EHR systems must support.

Unlike simpler information systems such as e-commerce sites, music streaming services, or applications such as word processors, EHR systems are intended to handle a wide-range of data types and support users performing varying sequences of complex tasks. As advanced by ONC and others, EHR systems, in addition to recording and presenting clinical data (i.e., basic paper chart functions), must also assist with clinical decision-making and quality improvement. The bottom-line: It is far easier to create objective usability measures for an e-commerce site than to create similar metrics for a system that can be used by doctors, nurses, dieticians, and respiratory therapists with equal aplomb. Every clinical professional has specific information needs and unique workflows, and complex tasks require sophisticated software systems...
I check Dr. Carter's site every day.


In my email inbox. Education is indeed important...

Spelling class apparently not included.


More to come...

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