Saturday, August 29, 2009

Coburn makes little is he going to help the millions of people that need help? maybe they should all show up to his town hall meetings..

On physician compensation

In the words of Uwe - a health care economist:

The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

Friday, August 28, 2009

I need more...

Dear President Obama,

You are the only candidate I've ever felt strongly enough about to give money to (which is kind of a big deal because as a brown guy... I'm very cheap). I'm a young democrat who was moved by what you said and how you said it. While I think the crazy folk in the town-hall meetings are truly crazy - there are a lot of very real questions that you and your team have not answered on health care. I need more details now about what you're proposing... How are you going to bend the cost curve? The results in Massachusets and Maine have revealed a lot of problems with simply covering everyone or mandating coverage for everyone - the prime problem being an inability to reign in escalating costs. Is there a reason why we wouldn't expect the same with the current ideas that have been proposed? And simply squeezing more savings out of medicare by lowering reimbursement rates to hospitals and providers will not result in more efficient care being delivered. An example: if you reduce payments to all cardiologists by 40% as currently proposed.... The scrupulous folks who haven't been overordering tests get hurt, and the unscrupulous docs whose mantra is - "order a test and ask questions later" will do more tests. I voted for change I could believe why not hit me with some innovative non-per-procedure based reimbursement that rewards quality and not quantity?

Asking the american public to sign on to a program that will make promises we may not be able to keep is just not good sense. Our deficit may hit 70% of our GDP in 10 years.. I believe health care is a right, I believe health care costs must be reigned in, I believe reform is vital to our future as a great nation...but you have to do more than the lip service being given to get me on your side on this one.

Monday, August 10, 2009

Doctors Have Feelings, Too.

I voted for President Obama in 2008. I even registered as a Democrat to support him in the highly contested Pennsylvania Primary. Unfortunately, 2012 may be different.

I am a 33 year-old physician, currently in my seventh year of post-graduate education. What does that mean? It means that after graduating from medical school in 2003, I went through three years of internal medicine residency and four years of cardiology fellowship. How many times have I been asked: 'When will you be done with school?' I cringe—I’m a real doctor!—but the fact is, I haven't really been paid like one since completing medical school.

The average starting salary for an internal medicine resident in Philadelphia is about $45,000 with an annual increase of $2,000. If you hypothetically figure that a resident earning $45,000 works 80 hours per week and gets one month of vacation, that works out to be $12.78 an hour, before taxes. Minimum wage in Pennsylvania is currently $7.25 per hour.

You probably think I'm complaining about nothing. We have 'job security' in these 'uncertain financial times'. We obviously get decent health care coverage. We get to live the excitement of 'E.R.' every day of our lives. And according to the U.S. Census Bureau, $45,000 is an average annual household income. So what am I complaining about? Well, here are a few more numbers for your consideration, according to the Association of American Medical Colleges. $139,517—the average medical school debt
at the time of graduation. 75.5%—the percent of graduates with at least $100,000 of debt. 87.6%—the number of graduating medical students with outstanding loans. This year alone, I've paid more than $4800 for mandatory licensing fees and certification examinations. That’s nearly 10% of my income. Gone.

Obama likes to talk about the discordance between the cost and results of our imperfect health system, yet he doesn’t acknowledge the culpability of our legal system. As our
government tries to cap out-of-control health care spending, he has publicly opposed caps on malpractice awards—the single greatest bane of a doctor's existence. To be sure, there are physicians who commit malpractice and/or order unnecessary tests for profit, neither of which can be defended; but there are many, many more who order tests to defend themselves against frivolous lawsuits. The New Yorker article on McCall , Texas is definitely interesting, but I don’t think it can explain away the possibility of defensive medicine.

So how does the Obama administration propose that we save money? The 2010 Physician Fee Schedule for Medicaire and Medicaid recently suggested a more than 40% cut in reimbursement for certain vital components of cardiology, not to mention cuts in every other field of medicine. While I don’t claim to have the answer, I know that Obama’s approach will only serve to degrade physician morale even further—and put private practice medicine at risk.

How about this instead? Limit malpractice awards in all states. Put physicians in the jury box, so that allegations of ‘malpractice’ can be judged appropriately; and guarantee that any physician who follows established guidelines cannot lose in the courtroom. If you do all three, most physicians will order tests more selectively. The system will gradually correct itself.

I didn't become a doctor to get rich, but I didn't become a doctor to struggle either. I've had to take too many tests, I've had to endure too many sleepless nights on call, and I've had to make too many sacrifices to watch my profession get squeezed in the name of reform. President Obama is worried about a 'brain drain' in finance if we limit executive bonus? Well, how would we all feel about a 'brain drain' in medicine? If morale in medicine continues to fall, we'll all find out very soon.