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    Doctors’ salaries are not the problem behind rising U.S. healthcare costs

    In the ongoing examination of U.S. healthcare costs, one economist has found the lone trouble spot: physician salaries.

    Yes, Dean Baker, Ph.D., co-director of the Center for Economic and Policy Research, says—and I’m quoting here—America pays a “doctors’ tax” via physician salaries of around $100 billion a year “for healthcare that doesn’t make us healthier” in a recent piece for Politico.

     

    HOT TOPIC: 9 ways doctors have it worse than everyone else

     

    Baker gets to this tally by noting that doctors are paid, on average, $250,000 annually (“even after malpractice insurance and other expenses”), meaning that each American household essentially pays a $700 “tax”— also known as salaries for physicians. I point you to our most recent Medical Economics research this April to show this salary estimation is false (see bit.ly/88th-physician-report).

    “Doctors and other highly paid professionals stand out in this respect,” Baker notes. “Our autoworkers and retail clerks do not in general earn more than their counterparts in other wealthy countries.”

    Baker calls U.S. medicine a “cartel,” since the profession has control over the supply, in the form of residency slots, scope of practice for licensure and rules limiting foreign-trained physicians. 

    “Getting U.S. health care costs down is a herculean task; getting doctors’ pay in line is a big part of the solution. It’s time we broke up the doctor cartel,” Baker concludes.

     

     

     

    TRENDING: Physicians struggling to hold on to independence

    Now, Baker’s piece has some merits—although I’m using “some” extremely loosely here. Yes, residency slots can be freed up, and yes, there are some things non-physician providers can do that a trained MD or DO does now, but a large part of his hypothesis is just off-base.

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    • [email protected]
      Again, we as physicians are the targets. The answer as to why is simple. It is the same reason that diesel, a by-product of oil refining to gasoline, costs more than the gasoline: truck drivers are a small group within the population, so are we. Our lobby group, AMA and AOA, both or which have sold out to their salaries and care less about ours. If the save us from a pay cut, then they consider it a win? We know what we make and have always made, 3 cents an hour less than a high school teacher.bestmedicaldegrees.com/salary-of-doctors/
    • Anonymous
      After decades of continued healthcare cost increases despite every plan and idea "experts" can come up with, we are still the most expensive in the world and 34 in quality outcome. I remember at the start of my practice how the HMO model was going to improve coverage and reduce cost. Didn't happen. The problem is all you people are looking at the wrong reason for increased cost. You blame us the Drs. we do too much, we get paid too much, we practice defensive medicine, we order too many tests etc. What I see as an objective, unbiased cardiologist still in private practice and that who loves what he does to this day, is that the problem lies in Washington with both democrats and republicans. The buck tops there. Politicians talk as if they really care about healthcare and are trying to curb costs while improving it. But they are the ones to go along with the needs of the healthcare lobbyists. This includes lobbying from the AMA, specialty colleges and the medical education industry. Why doesn't anyone write about the FDA receiving over $800 million a year in fee's from big pharma in exchange for their dictating what the FDA can and cannot do. The general public wonders why we have such expensive unaffordable medications compared to other countries and why cheaper generics are barred from being imported. Why doesn't anyone write about this conflict of interest at the FDA that also prevents the FDA from negotiating price equity with pharmaceutical and device companies? What does CMS and the U.S. government allow coverage and the payment of practically anything. I see 90 + yr olds for clearance for penile prosthesis. Payment for ophthalmologists for cosmetic eye surgery coded as blepharoptosis and many examples of procedures and services that have been added on to what CMS covers, that has no benefit to save lives or improve any outcome. CMS just seems to listen to lobbyists and adds additional needless services that is then included for reimbursement. Medicare Part D is an example of adding medication coverage which would have been a good idea, had the government been allowed to negotiate prices with pharmaceutical company. in the end, more money and higher profits for big pharma at the expense of the tax payer. CMS gives more and more benefits, while funding for Medicare continues to decrease. I read about the lack of social programs and benefits available to the people in the 20's, 30's and 40's. Government did not provide a rescue net, or handouts and people had to fend for themselves. They grew vegetable gardens, worked whatever job they could find, and relied on churches and religious organizations as well as family. I'm not a Neanderthal and believe that we should go back to those times, but I am suggesting that government has created a society that has become needy and dependent. A society that believes incorrectly it has a right to be taken cared of and given free stuff. Why does government not clamp down on the abuse of disability benefits (given free Medicare benefits) for people that can work, but who milk the system and don't deserve it. Why doesn't it require a government doctor to determine eligibility the way it was before Reagan changed it. Its become a business between a few unscrupulous Drs (who should loose their medical licenses) and lawyers who make millions, paid for by the government to appeal denials. I see hundreds of "disabled" patients like this a year. Why does the US government allow mergers like CVS with Aetna that creates a powerful monopoly that will dictate future healthcare policy? Different nurse practitioners will now be the primary care giver of millions of patients. Loss of continuity of care and many who will get inappropriately prescribed antibiotics, as this is the typical treatment given at these doc in the box clinics. Many will end up at a hospital days later having been misdiagnosed and increase healthcare cost. Will the government be able to stop the future mergers and acquisitions? Acquisition of Humana by Walmart? Amazon from buying another healthcare corporation? As this is happening, executives become multimillionaires. The CEO of Aetna, is expected to pocket $500 million for the merger. What about the increasing regulations, rules and non-stop requirements imposed on physicians in the name of quality? Its not about quality or improvement, its garbage, its lip service. Studies have shown that physicians spend 45% of their day on the computer writing and 25% in direct patient care. Most physicians don't love or are passionate about what they do. 45% dissatisfaction, early retirement, and over 40% would not allow their kids to enter medicine. CMS has made it so that private practice, once backbone of our profession, has become a challenge for many. Over 60% of physicians today have had to close and forced into becoming employees of hospital, managed care or large practice groups. Multiple studies have consistently shown that these economies of scale increase healthcare costs. Yet CMS continues passing requirements that drive physicians out of small group and private practices. Makes no sense, but government and CMS doesn’t care, because they don’t care about finding any solution to the healthcare crisis, they just kick the can down the healthcare industries court. Most physicians are now employees who have a 9-5 job and get a paycheck. There is no incentive for them to care about doctoring, as they have patient quotas to meet and are replaceable by cheaper nurse practitioners. I'm apolitical but have reservations about the new head of CMS, a non-physician, "consultant" who has no clue as to the day-to-day needs of physicians or patients, being in charge of CMS. This will yet be another reason for lack of improvement, as I expect more "business" and political policy decisions that cater to industry and less policies that caters to physicians and benefits patients. It’s politicians and people in political power without a clue of how to run a medical business or to the concerns of patients that dictate policy. Why not confer with a group of physicians on the front lines? Consult with groups of citizens from around the country and mid America? We continue to get the same ole' healthcare policies, that has done nothing to improve healthcare outcome or decrease cost. CMS should be sued by us taxpayers for its negligence, malpractice and misuse of taxpayer funds. The medical profession is dead. The death happened during our lifetime and the death is a result of politicians who cater to special interests, the physician tools that make up the AMA, specialty colleges and Acc Council of Grad Medical Education (ACGME) and us U.S. physicians for lacking the cojones to stand up for our profession, or rights and our patients. The AMA does nothing but try to stay relevant. They do not represent me, nor most of the over 1 million U.S. physicians in the work force. These institutions with antiquated policies are the problem. They should be instrumental in creating and forming unions to protect physicians, but the pander. We still need unions but to protect us not only from the healthcare and hospital industry but the AMA and the medical establishment as well. Corruption. Collusion. Cronyism. Why hasn't anyone investigated the abuse and fraud committed by the Am Board of Medical Specialty (ABMS) and board certification (BC). Theirs’ is the biggest racket and lie ever perpetrated on the American public. While all physicians know there’s been no study to show that BC improves quality, patient safety or decreases healthcare cost, the ABMS, a monopoly, buys favors from legislators and the physician tools that make up the medical institutions. Deans of med schools, journal editors, and academic physicians are the ones that go along with the ABMS, not because its in the best interest of physicians or patients, but because they are interested in their own personal career advancement and professional standing. These physician "elites" are hypocrites. They lack the courage or moral compass to stand up for what is right and defend our profession. Yet these are the people educating tomorrows’ doctors. Osler and Hippocrates are surely turning in their graves. They ignore the fact that If BC was so beneficial why then after 30 yrs of increasing ABMS board exams, are we still 11th of 11th place per WHO in healthcare quality among the top 11 industrialized nations? Why is healthcare cost per person the highest in the world at $9000? Why did John Ritter die at the hands of a BC physician and Joan Rivers die at the hands of 3 BC physicians, just to name a few. Why did a BC radiologist at John Hopkins, who happened to be paid by the coal industry fail to detect a single case of black lung among thousands of miners he evaluated, when a review of his work found he had missed hundred's of abnormalities? BC is given too much importance and standing by a mislead nation. While claiming the BC is voluntary on its website, the ABMS, lobbies states to require BC as a requirement for licensure. At the same time, older physicians were grandfathered in in the early 1990’s in exchange for going along with and allowing ABMS to change to time-limited certificate. A cardiologist trained in the 80's when standard of care was morphine and bed rest, is considered meeting the "gold standard" and all requirements of BC. They have received unfair work & employment advantage over everyone else certified after 1990 when the ABMS developed time limited certificates. This is a gross violation of many laws including anti-trust, as well as the rights of trained, qualified and licensed physicians to be able to work without being encumbered that has gone unchecked for over 30 yrs. No other profession requires BC. Dentists, lawyers, CPA's are not subjected to an abusive monopoly imposed by their own peers. No other country in the world requires BC. It’s only forced on U.S. physicians because it has become a lucrative multi-million dollar business that benefits a few, at the expense of physicians. This business should all be investigated, audited and the physicians who front the organization sued, stripped of their medical license and jailed for fraud. Why hasn’t anyone filed a class action discrimination lawsuit and why hasn’t 60 minutes investigated this abuse??? Did you know that the goal of the Accreditation Council of Graduate Medical Education (ACGME) is not in educating the physicians of tomorrow to individualize medical care, to use their judgment and apply their knowledge on a case-by-case basis? The goal of the ACGME is for the resident to be board certified form the ABMS. Did you know that at every training program in the US, there is time set aside from year 1, to teach residents how to answer questions on a standardized board exam? This antiquated medical training is how residents are taught today and another reason why the art of medicine has been replaced by a one-size-fits all Guidelines. Its appalling, its disgusting and wrong. The fact that we taxpayers pay the $8-$10 BILLION a year cost for GME, we taxers are subsidizing the ABMS! Why does this happen? Because the ACGME allows the ABMS members to sit on the ACGME Board and dictate policy. The ABMS, a BC monopoly that has done nothing to improve quality, dictates and determines that all residents should be BC. A policy that directly benefits the ABMS itself financially. Members of the ACGME board that have been past members of the Specialty Colleges, Joint Commission and academia. There is career advancement by staying quiet, going along even if what these people do is unethical and fraudulent. The collusion, corruption and cronyism is rampant. The Medical Industrial Complex as I call it has become the most corrupt business in the U.S. Reminds me of Dwight Eisenhower who warned of the military industrial complex as he left office. Start here when addressing U.S. healthcare cost and quality.
    • Anonymous
      Ridiculous! The problem with the rising cost of medicine is the insurance companies, Medicare being the worst.

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