Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
“Jackson & Coker’s 2008 Physician Compensation Survey”
Always interesting to see what people are making, and more interesting to see how they feel about it.
From my perspective, I will only offer that physicians, on the whole, work very hard and under very stressful conditions. I think we perceive others in our income range, and (horrors), those making loads more, as not having payed their dues as we have and continue to do…
FRONTLINE: sick around the world: interviews: uwe reinhardt & tsung–mei cheng PBS
Wow. I can’t say enough about this interview. It is so on the mark in so many ways, and it is a pleasure to hear knowledgeable people discuss comparative international healthcare like this.
There are great bits on the real meanings of “socialized” medicine, vs socialized insurance, the German (!) perspective on the dignity of every person, the Canadian perspective on humanism, the leadership of Tony Blair turning around a system on the rocks, how terrifically well America does in training its healthcare providers (especially doctors), but the best is Reinhardt’s take on “Consumer Driven Healthcare“, quoted here:
We’ve heard some people have proposed that a solution for America is something called consumer-driven health care. How does it work? What is it?
… Well, the name “consumer-driven health care” at this time is a deceptive marketing label. What we’re really talking about is an insurance policy with a very high annual deductible — up to $10,500 per family, and less for an individual — and then coupled with a savings account into which you can put money out of pretax income; you don’t have to pay taxes on such income.
Now, this has the advantage … that people faced with this deductible will think twice before going to the doctor for trivial issues or drugs they don’t need, etc. But of course the problem also is that they may not go when they should or may skimp on the drugs they should be using, like a blood pressure drug, so that one would have to be solved by saying preventive services will have first-dollar coverage. So you could solve that problem.
But then what I argue is, yes, it may have the economic effect of cost control, because you then would have to know the prices different doctors charge, and hospitals and pharmacies, and something about the quality. And that information at this time exists only in a few areas. The insurance companies are beginning to work on Web sites that will give you that, but it’s still very primitive and fairly unreliable information. So that is why I compare it really more like thrusting someone into Macy’s department store blindfolded and say, “Go around; shop smartly.” …
The other problem that I see with it, though, is it has ethical dimensions to it that people don’t appreciate. If I make anything tax-deductible, then a high-income person in a high tax bracket saves more than a poor [person]. So supposing a gas station attendant and I each put $2,000 into a health savings account, and we get a root canal — about $1,000, just the drilling. It costs me about $550 because I’m in the 45 percent bracket. The gas station attendant may, in fact, not pay federal income tax because the income is so low but may only pay Social Security, so he saves 8 cents on the dollar. So a root canal will cost me $550; will cost him $920. …
Secondly, think of a family of two professionals, each making $140,000, close to $300,000 income, and they have, say, a $5,000 deductible. Would they deny their child anything that they think the child needs over a lousy $5,000? … But think of a waitress who makes $25,000 with a $5,000 deductible, and her kid is sick. It will certainly make her think twice. She’s likely to say, “Maybe not.” So therefore we’re asking the lower half of the income distribution to do all the self-rationing through prices. …
And the third issue is this deductible. If you’re chronically healthy, you don’t actually ever spend as much as that; you have a tax-free savings account. If you are chronically ill, on five drugs, you’re going to spend that deductible year after year. So the proposal is to shift more of the financial burden of health care from the shoulders of the chronically healthy to the shoulders of the chronically sick.
And I would say, imagine a politician coming to the people with a platform that I just described in ethical terms. … You think that would sell? So they say, “We’ve got to find a better name. Why don’t we call it consumer-driven health care?,” and have all these deceptive labels that even George Orwell wouldn’t have thought of. That is what I find troublesome. Yes, it’s an approach to health care, but could you please describe it to the American people honestly, in all of its dimensions — not just economics but information and ethics? And that’s not done. …
One answer he gave about physicians income left me with more questions that when I started:
Yes, American doctors get paid more, relative to average employees, than doctors in other nations; that is true. It’s about five times average employee compensation, and in England it’s about two, and in Canada it’s about three. So that’s certainly true.
Given the unprecedented income disparity in this country, it is hard to know what to make of these figures. Comparison to the median would have been more helpful, but I think the most interesting would be to see in which decile physicians place in each country. I will try to find that data.
This Frontline Website is a gold mine. Thanks to the indispensable CPB.
Rent hikes forcing out city doctors:
“‘It’s scary,’ said Dr. Linda Slocombe, president of the Calgary and Area Physicians’ Association, who notes that doctors, unlike most other small businesses, can’t raise their prices to offset rising costs. ‘In another two or three years we’re going to have a real drastic shortage of family doctors.’
The study, which was commissioned by CHR last summer but only became public during a recent meeting of Calgary family physicians, comes as the city already struggles with a doctor shortage.
An estimated 200,000 Calgarians don’t have a regular family physician, a problem that has been compounded by at least 41 doctors who have closed their practice in recent years.
Experts say the physicians are retiring or leaving to pursue other jobs in medicine, where they earn a good salary and don’t have the hassle of operating an office.”
Posting this in keeping with my “warts and all” policy of reporting the good and the bad of other systems.
BUT, does any of this not apply to PCP’s in America? Can’t raise our prices? The hassle of operating an office? (And they don’t even have to deal with dozens of private health insurers, so they are mainly talking about the other hassles.)
Cheers
CITY HEALTH CLINICS NEED A BOOSTER SHOT Philadelphia Daily News 04/04/2008:
“How they don’t work: The system is far from perfect. According to a report released by the Philadelphia Unemployment Project last year, it can take up to five months to schedule an appointment with a doctor at a health center. Advocates say the centers need to extend evening hours and add staff to shorten waiting times. The mayor’s proposed funding increase is supposed to deal with some of these issues.
One of the biggest challenges that health centers face is offering competitive salaries to attract qualified staff.
The salaries offered by the city for three critical positions – pharmacists, dentists and physicians – are relatively low when compared to industry averages.
The highest-paid pharmacist working for the city makes $77,013 – well below the national median of $103,000. The same is true for dentists who work for the city. A typical dentist makes $130,000 a year. That’s significantly more than the $95,630 made by the highest-paid dentists at city health centers.
The largest discrepancy can found in the salary paid to doctors. The average physician working in a family practice makes $204,000. The highest-paid physician working for the city makes $109,820 – a difference of more that $94,000.”
Just had to post this for all of those who insist we don’t have to wait for healthcare in America and that “everyoine in America has access to health care.”
New Focus of Inquiry Into Bribes: Doctors – New York Times:
“Once companies begin to develop the devices, leading doctors are hired as consultants to help modify the implants and related hardware. When the products are finally brought to market, companies also hire many of the same opinion leaders to train other doctors and sales representatives how to use them.
As a result, Mr. Christie has had no problem finding large sums of money — in some cases, more than $1 million annually — flowing from companies to doctors who use their devices. But doctors say it is far too simplistic to conclude, as Mr. Christie claimed last fall, that “many orthopedic surgeons in this country made decisions predicated on how much money they could make — choosing which device to implant by going to the highest bidder.”
For the most part, the hip and knee joints sold by the major companies are similar in performance, but getting surgeons to switch is a lot more difficult than persuading an internist to prescribe a prescription drug rather than aspirin.”
AlterNet: 10 Myths About Canadian Health Care, Busted:
“2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning — and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.
I’m both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I’m in a unique position to address the pros and cons of both systems first-hand. If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.
To that end, here’s the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they’re made of.”
Doctors endorse single-payer Philadelphia Inquirer 12/04/2007:
“Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.
The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.
Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country’s health system compares poorly. ‘Part of our call is, ‘Look around, guys, and see how other people are doing,’ ‘ he said, ‘and they’re doing better than us.’ “
Nicely done summary of where most of the tension in advocating for single payer lays.
The ACP position paper is here, and I believe free to anyone.
Cheers,
“The average salary or income-guarantee offers made to family physicians increased from $145,000 in 2005-06 to $161,000 in 2006-07, a gain of 11 percent; however, average offers made to FPs who also practice obstetrics remained relatively flat, increasing from $158,000 in 2005-06 to only $159,000 in 2006-07. “
It’s good to see some move towards better compemsation for PCP’s. If reimbursement weren’t so heavily skewed towards procedures, we’d get more appropriate distrubution among specialties.
The states that had the lowest ratios and therefore had the highest
disparities in Medicaid and Medicare payments in 2003 now have the following
Medicaid-to-Medicare ratios:
Medicaid-to-Medicare Fee Ratios for Selected Primary Care Procedures,
Low-Parity States, 2007
New York .29
New Jersey .31
Rhode Island .40
Pennsylvania .42
District of Columbia .48
Read the full report to get the idea, but what we in healthcare have known all along is that Medicaid is de facto rationing. It is a severe economic disincentive to serve this population. And it is worth noting that, depending upon where you practice, Medicare is likely your lowest payer to begin with, so these numbers become even more tragic.
Just 1 quick snippets to illustrate the point about income discrepancy in medicine.
Median salaries
2005 2006 Change
Family practice $160,729 $164,021 + 2 percent (without OB)
Psychiatry $189,409 $192,609 + 1.7 percent
Cardiology: invasive $463,801 $457,563 – 1.3 percent
Orthopedic surgery $428,119 $446,517 + 4.3 percent
Internal medicine $167,178 $174,209 + 4.2 percent
Source: Medical Group Management Association