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The Loony Bin

July 17, 2012

Do doctors charge too much?

This is something that I’ve been hearing a lot about lately, but that turned into a personal discussion this past weekend with one of my neighbors.  He had been to the ER and had finally gotten the bills for what had been a 7:30am-4 pm day:

“My bill for the ER doctor alone was $500.  That is scandalous.  He saw me once for 20 minutes and then checked in on me briefly two other times.  I bet his total work time with me was only about 40 minutes. I bet I made his BMW payment that month!”

I let him vent.  He had been pretty terrified by the experience.  This is where he discovered that he had a heart condition and I know it represented the beginning of what has been a frightening journey.

“How much did medicare pay?”

“$110, and if you ask me, he was still overpaid.”

I couldn’t help myself.  I explained that doctors go to college for 4 years, and then have 4 very demanding years of medical school.  After that, there are the residency programs that pretend to stick to an 80 hour work week now, but often don’t.  When my husband did his training, there was no such thing as an eighty hour work week.  We actually figured out then that with the hours he worked, he made less than minimum wage.  But I digress.  Yes, the doctor only saw him for a total of 40 minutes, but he also had to review his medical history, which likely took a half an hour, examine him, order tests, review the test results, start him on the right treatment, talk to the specialist, talk to his anxious wife, and then … check on how he was doing.

He sat and listened to me.

“Your doctor didn’t pocket the $100 that the ER doc received from medicare.  The hospital deposited it and used it to put towards the disability insurance they are paying for him as a part of the hospital group, etc.  Maybe he saw $50 of that before taxes and social security.  It doesn’t seem like that much now, does it?”

After years of grueling training, what do physicians deserve to earn?  One of my closest friends has a husband who did 5 years of general surgery residency, 2 years of lab work and an additional 2 years of a pediatric surgery residency.  He has to be available in the middle of the night for call, misses birthdays, holidays and kid’s events … and he earns less than the sum of his $200,000 + medical school/undergrad debt.  He works like no one I know to save the lives of a lot of kids who mostly are insured by medicaid.

People don’t complain much about what ball players earn … or famous actors and actresses.  They are still ponying up the money at the movies and for big games when they can … but heaven forbid anyone suggest that a physician not commit to a vow of poverty.

With the changes coming down the pipes now in the healthcare system, it appears that one of the big changes will be in how doctors are reimbursed.  Radiation oncologists are set to take a 14% pay cut, specialists have already seen the elimination of the consult code.  Incomes are going down while more patients are going to need doctors.

I firmly believe that every working American deserves a good form of health insurance.  Should that involve private insurers and a for-profit system that values profit above care?  Should it take on the face of a government that can’t seem to tell its head from a hole in the ground?  I don’t have the right answer, but I hope that physicians won’t be the first ones penalized.

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