Median Physicians’ Salaries – Health Blog – WSJ

Median Physicians’ Salaries – Health Blog – WSJ:

“Good news for med students worried about their debt loads: Physicians coming out of residencies last year reported increases in their starting salaries in many specialties, according to a survey by the Medical Group Management Association, a trade group for medical groups.

“Here are the specialties with the biggest jumps in 2008 from a year earlier based on data from 3,520 physicians:

Neurology: $200,000 to $230,000 –- up 15%

Non-invasive cardiology: $350,000 to $400,000 – up 14.29%

Anesthesiology: $275,000 to $312,500 – up 13.64%

Emergency medicine: $192,000 to $215,040 – up 12%

Internal medicine: $150,000 to $165,000 – up 10%

“And as if we needed any more reminders about why there’s a shortage of pediatricians and family practitioners, the report also contains data on the extremes: The lowest starting salary in 2008 was for pediatricians — $132,500. The other lowest-paid specialties, in ascending order: family practice, geriatrics, urgent care, internal medicine and infectious disease.

The highest specialty salary was for those starting out in neurological surgery — $605,000. Others at the top of the heap, in descending order: radiology (nuclear medicine), thoracic surgery, cardiology and orthopedic surgery.”

I’ve blogged about this before, but coming out of medical school in massive debt, knowing that you are going to make low wages for your three to seven years of training, and still choosing one of the lower income specialties requires some significant altruism. God bless everyone who does this.

But, this should not be such a stark decision. We really do need to do something about reducing or eliminating the cost of medical school to encourage (or at least make it not an economically crazy thing to do) students to enter primary care and other lower paid specialties.

Attacks on Dartmouth Atlas Rebutted

Health Affairs Blog:

“[HA Blog]Editor’s Note: In the post below, Amitabh Chandra responds to criticisms of the Dartmouth Atlas and offers his vision of the lessons of the Dartmouth findings on variations in health care costs and practice styles. Watch the Blog tomorrow for a roundtable discussion on Atul Gawande’s New Yorker article on McAllen Texas and the policy implications of the Dartmouth work. Roundtable participants will include Robert Berenson, Elliott Fisher, Robert Galvin and Gail Wilensky.”

I heard Sen. Judd Gregg this AM on CSPAN pontificating at the Budget Committee meeting on health care, fretting that any kind of health board would result in “control” of health care by “Washington”. If it’s staffed by people like Dr. Chandra, we’ll be OK.

But, more to the point, he still lives in the DC bubble fantasy land where he thinks patients have control of their health care, and not the private health insurers. He worries about a board being formed to guide decision making by clinicians. I think this is absolutely critical to reigning in health care costs, though, as Dr. Chandra so clearly indicates, this is as complex a set of problems as we’re ever going to face in our life times, so it will require multiple iterations of progress to get where we ultimately wish to go.

And that was another thing Gregg lamented: the complexity of the bill. If he wants straight-forward, then HR 676 is his bill. But I’m guessing a single payer system is a non starter for him. So, given that we’re talking about 20% of the economy, it’s gonna be a complex solution!

What we’re up against…

Terry Jeffrey : Obama: “There Are Countries Where a Single-Payer System Works Pretty Well” – Townhall.com

I was going to post over at TownHall on this piece, but after reading the comments, the ignorance is just too staggering to event try to overcome.

This is a hard fight. Many Americans think the opinions expressed at this site (and are articles of faith among many conservatives) are based upon facts instead of the ideologic fantasies that they are based upon

*sigh*

Bill Mann: Americans Who’ve Used Canada’s Health-Care System Respond to Current Big-Lie Media Campaign

Bill Mann: Americans Who’ve Used Canada’s Health-Care System Respond to Current Big-Lie Media Campaign:

“The scare ads and op-ed pieces featuring Canadians telling us American how terrible their government health-care systems have arrived – predictably.

“There’s another, factual view – by those of us Americans who’ve lived in Canada and used their system.

“My wife and I did for years, and we’ve been incensed by the lies we’ve heard back here in the U.S. about Canada’s supposedly broken system.”

Read on…

Health Beat: The AMA Would Make Health Care Unaffordable for Many Americans

Health Beat: The AMA Would Make Health Care Unaffordable for Many Americans:

“The American Medical Association has announced its opposition to a public-sector health plan that would compete with private insurers. Why? Because the AMA fears that Medicare E (for everyone) might not pay some specialists as handsomely as private insurers do now.

“Why do private insurers pay more? Because they can pass the cost along to you and I in the form of higher premiums. Medicare E has no one to pass costs on to—except taxpayers. And taxpayers will already be helping to subsidize those who cannot afford insurance.

“Everyone agrees that primary care physicians are underpaid. Democrats in both the House and the Senate propose raising their fees, as does the Medicare Payment Advisory Commission (MedPac)—the group that might take over setting fees for Medicare. Moreover, the House, the Senate, President Obama and MedPac have made it clear that they do not favor the across-the-board-cuts called for under the sustainable growth rate (SGR) formula. Congress has consistently refused to make those cuts and President Obama did not include them in the 2010 budget that he originally sent to Congress. On that score, the AMA has nothing to worry about.

“Protecting Excessive Fees for Some Specialists’ Services

“So what does the AMA fear? That either MedPac or Medicare will trim fees for certain specialists’ services. Keep in mind that Medicare’s fee schedule has traditionally been set –and adjusted on a regular basis, by the RUC– a committee dominated by specialists.( Private insurers then follow that fee schedule, usually paying somewhat more for each service.) I have described this group in the past: They meet behind closed doors. No minutes are kept of their meetings. They rarely suggest lowering fees—even though as technology advances, some services become easier to perform. MedPac has pointed out that a less biased group should be involved in determining fees—perhaps physicians who work on salary, and are not affected by Medicare’s fee schedule.

“There is good reason to suspect that the RUC has over-rated the value of some services.. MedPac has suggested taking a look at particularly lucrative tests or treatments that are being done in large volume. Often, this may mean that patients who don’t need the service are receiving it; if the procedure isn’t necessary, then, by definition, they are being exposed to risks without benefits. And in fact, experience shows that when high fees are trimmed, volume falls, suggesting that rich fees were, in fact, driving overtreatment.”

There is more here about using medicare to “bend the curve,” or reduce over-utilization, improve use of preventive services, as well as a discussion of how a Public Plan might besubsidezed, etc. well worth reading, particularly about subsidization.

I would only add that the title falls a bit short: The AMA, or rather, conservative physicians, are hardly the only group fighting significant change. The Health Insurance industry, despite conciliatroy noise, will be the big guns or long knives as this goes forward. And behind them will be Pharma, other device and equipment manufacturers, probably home health servicers, ambulatory care centers, and, for purely ideological reasons, all conservatives.

QUALITY: Waiting for …the Cardiologist. And the Orthopedist. And the Dermatologist… | New America Blogs

QUALITY: Waiting for …the Cardiologist. And the Orthopedist. And the Dermatologist… New America Blogs:

“Health care consultants Merritt Hawkins and Associates…looked at waiting times in 15 American cities for nonemergency care.

Overall, the average wait was three weeks—up from 8.6 days since the last survey of this type in 2004 -for a routine heart checkup from a cardiologist, a checkup for skin cancer from a dermatologist, a painful or injured knee from an orthopedic surgeon, a ‘well woman’ exam from an OB/GYN and a routine physical from a family practitioner. But there was a huge variety in wait times, anything from one day to an entire year.”

Going to the actual document is interesting.

Dr. Chris McCoy: Dear AMA: I Quit!

Dr. Chris McCoy: Dear AMA: I Quit!:

“Dear American Medical Association,

“I recently had the opportunity to read your response to the Senate Finance Committee proposal [pdf] for health care reform, and it is clear to me that I cannot remain a member in your organization. Please remove my name from your membership rolls, effective immediately.

“In reading the response, I was frustrated and disheartened by the fact that you couldn’t get through the second paragraph before bringing up the issue of physician reimbursement. This merely highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession. As a physician, I advocate first for what is best for my patients and believe that as a physician, as long as I continue to maintain the trust and integrity of the profession, I will earn the respect of my community. The appropriate financial compensation for my endeavors will follow in kind.”

Read on. I agree with everything he says here, and yet, until the AMA House of Delegates meeting this week has concluded, I will withhold judgement and retain my membership.

If the floor fight at the House of Delegates takes shape as I predict, the old (literally) guard will get reaffirmation of every anti-reform policy reaffirmed and get an anti- public option policy added and will force the AMA leadership (progressive as they might be) to act like the AMA of old and start fighting reform.

We’ll see. I have friends in leadership in AMA and they say it has changed.

We’ll find out very soon.

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com:

“As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.”

I am OK with opposition to making participation mandatory if one accepts Medicare for the obvious reason is that it is coercive, but mainly, because the plan should be able to stand on its own and thrive. If it does not, then something is wrong in the way it was set up, and it should fail.

So I believe we MUST have a good public option, but it must be good in all senses: promoting better use of resources, reducing administrative waste, continuing Medicare’s freedom to choose providers and so on.

Can’t wait for the AMA meeting outcome…

***UPDATE***
Check out the letters in response which, perhaps led to the AMA press release:

AMA COMMITTED TO HEALTH REFORM THIS YEAR
Make no mistake: health reform that covers the uninsured is AMA’s top priority this year. Every American deserves affordable, high-quality health care coverage.
“Today’s New York Times story creates a false impression about the AMA’s position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

Thanks to my peeps at Doctors for America for the heads up!

Winston Churchill, Comm-Symp

NHS at 60: A vision in which we still believe – Telegraph:

“In 1942, he [Beveridge] proposed the creation of a national health service, as part of a system of compulsory social insurance to slay ‘the five giants of want, disease, squalor, ignorance and idleness’.

“Such was the enthusiasm for his ideas that there were queues to buy the report outside His Majesty’s Stationery Office.

The plans were backed a year later by the prime minister, Winston Churchill, but when the Conservatives lost the general election in 1945, Churchill’s Labour successor, Clement Attlee, pledged to introduce the changes, with free medical treatment for all by the establishment of the National Health Service in 1948.

“While the plan was popular with the public, not everyone was keen.

“The British Medical Association famously opposed the creation of the NHS, with the health minister, Aneurin Bevan, later admitting that he had ‘stuffed their mouths with gold’ via a generous contract which allowed them to carry on doing private work, and provided lucrative bonuses.”

Also, from Churchill, March 2, 1944

“The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion… Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

And, in contrast, from the former British Medical Association Chairman, Alfred Cox, “I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany. The medical service there was early put under the dictatorship of a “medical fuhrer” The Bill will establish the minister for health in that capacity.”

Conservatives, always so prescient.

From our friends at the South Carolina Medical Association

Dear Colleague, [This was sent to the members of the SCMA – my comments are in italics below.]

The momentum that has been building in support of a nationalized health care system appears to be overwhelming. With health care overhaul bills on the fast-track in Congress, and with a new and powerful administration determined to pass legislation this year, the deck is stacked against us. We’ve been told to sit in the corner and watch while the “experts” figure out how to fix health care. The problem is that the “experts” who are fixing health care are the same people who have run Medicare into insolvency and created a Medicaid system that is inefficient and ineffective.

The federal government is kicking us down the road toward indentured servitude. Envision a world where each decision you make for every patient has to be approved through the laborious channels of government bureaucracy. Imagine the federal government dictating to you which patients yo can and cannot see and which treatments you can and cannot provide—not just for Medicare patients but for all of your patients. Consider what it will be like to be reimbursed for all of your patients at levels significantly less than current Medicare.

Physicians have been offered a seat at the table so long as we sit still with our hands folded in our laps and keep our mouths shut. Dutiful compliance and inaction are no longer options. The muzzle that the Feds placed on us must be removed and the decibel level of our voices must be raised so that we are unmistakably heard. We’re not suggesting a strike, but anything short of that is the kind of bold and thunderous statement we need to be making right now.

The leadership of the South Carolina Medical Association senses the anger and the building resentment and confusion that physicians are currently experiencing. Our commitment to channeling these strong feelings into action is strong and will not lessen. W will not stand silent and watch while the federal government destroys our health care system. In the next few weeks, we will be laying out a course of action to ensure that our voice is heard. Be ready to act quickly, speak loudly, and fight for your career and the health care freedoms your patients deserve.

[Signed by the President and Chair of the Board of the SCMA]

Wow. They must be practicing in paradise down there in South Carolina. No problems, everybody’s insured, getting great preventive and chronic care, nobody goes bankrupt from health care expenses, etc. Maybe we all should move there. Because, you know, in the rest of the country we have ridiculous bureaucracies, rules, and non-physicians telling us what we can do and who we can see and what we can charge already, only they are our private health insurance companies.

But here is the money quote, “Consider what it will be like to be reimbursed for all of your patients at levels significantly less than current Medicare. ” And that’ really what it boils down to for so many, doesn’t it? And besides, the answer to this question is that, if I don’t have to hire a team of staff to fight with PRIVATE insurers to get reimbursed, to get prior approval, to jump through all of their hoops, maybe that reimbursement would result in a higher net reimbursement. And at least Medicare doesn’t tell my patients whether they can see a physician because he’s not on the right panel.

SCMA, what is the solution? Or aren’t there any problems with the health care system in South Carolina.

Maybe they’re still all practicing in Mayberry in the 1950’s, but for the rest of us, we need to fix this broken system!

I ranted further over at dailykos…

Wow. This is not about healthcare reform with these people. These are like the Japanese soldiers found on islands 20 years after WW II, still fighting against the Yankees. They are opposing a Soviet medical gulag, entirely a figment of their imaginations and deep paranoia. Lively debate, eh?

But, to the letter’s substance, and frankly, its’ ignorance.

Nationalized, or singe payer, if that’s what they mean, is pretty much off the table according to the guys in charge of the process like Baucus. It would be nice to have the momentum for that, but although there are vocal supporters at the grass roots level, the powers that be will not hear of it. But sadly, I doubt they even know what they mean when they say “nationalized.” I am sure they have some conceptual bogey man system hybrid of the UK, Canada, and the old Soviet Union in their heads, but I am equally certain they have not spent more than 10 minutes actually learning any comparative health care, even bothered to investigate the systems in Germany, France, Australia and elsewhere.

“The deck is stacked against us.” Is that against patients, physicians, insurance companies, who? Who is the deck stacked against?

“We’ve been told to sit in the corner…” Really? The message I’ve heard from Congress and the White House is that they value and want physician input. Maybe they don’t want bat-shit crazy input, but they want input.

“The same people who have run Medicare into insolvency…” Um, that would fall quite largely on the shoulders of physicians. We have abdicated our role in shaping health care policy and controlling spending and reducing unwarranted and dangereous practice variation and having realistic end-of-life discussions with our patients and so on. We have also not called BS on the private insurers who steal health care dollars in the name of private enterprise and we have taken the money of Pharma for ou meetings and lunches and pretended they were spending all that money on R & D and not on recruiting cheerleaders. Literally recruiting cheerleaders.
But I’m with them on the Medicaid thing.

“The federal government is kicking us down the road toward indentured servitude.” Seriously? Don’t you guys have private health insurance companies in South Carolina? But really, this letter is not about health care, this is a stale ideology in its last throes.

“Physicians have been offered a seat at the table so long as we sit still with our hands folded in our laps and keep our mouths shut. “
Again, one has to have reasonable views to expect to be listened to seriously Foaming at the mouth like Zell Miller and Sean Hannity does not invite reasoned discussion. But listen, all of the physician supporters of single payer have much more to gripe about than the SCMA. At least organized medicine is participating in discussions, while PNHP has to have a major grass roots insurrection just to get invited to the White House photo-op. If anybody has the right to gripe about exclusion, it’s the progressives, not the conservatives.

“The leadership of the South Carolina Medical Association senses the anger and the building resentment and confusion that physicians are currently experiencing.” I expect this is true. SC represents a far more conservative population than most states (it’s in the top 10 most red states), and so their phsyicains likely are more conservative as well. So, fine, make your case, but we will not sit quietly by and let you screw up the best chance for health care reform we’ve had in this country’s history.

The final line about fighting “for your career and the health care freedoms your patients deserve.” Again, maybe I’m practicing in a dark dystopic bit of America, but around here, that ship has sailed. Our patients, even the insured ones, have little choice in doctors or hospitals. They only go to whom and where their plan allows. No “freedom” there. And our careers? Whose careers? Your primary care physicians careers? Really? I’ll let my colleagues decide who you’re really looking out for. My bet is that you’re looking out for your failed ideology, not for physicians or patients.