Is a career in medicine really worth it? - Page 19

bluedevilmike · 08-02-2006, 02:55 AM

I was an econ major in college and have crunched the numbers.

I'm not going to argue that being a doctor for the money is unethical. (I happen to believe that, but I won't argue that here.)

I will argue that it is, financially, one of the stupidest possible decisions you could possibly make.

Physician Compensation Economics

fastMEd · 08-02-2006, 03:16 AM

heh. Is it truly unethical if you want to be a doctor solely for money even if you will be a superior doctor in technique, knowledge, and experience? Your motivation may be different, but the patients will ultimately benefit more and it really is ultimately the patient that matters. I may rethink being a doctor then if the pay isn't so hot though. I've always thought you could rake it in like mad cause for a normal checkup most doctors spend a few minutes and collect 60 dollars.

Bigredmed · 08-02-2006, 04:35 AM

I honestly think (and this may be the idealist in me) that the two (in it for money and being the best doctor one can be) are almost completely mutually exclusive.

In most specialties, you can earn much more by being shoddy (at a bare minimum doing enough to prevent you from getting sued) than by being the absolute best (the most notable exception being cosmetic plastics b/c you can charge more for surgical skill/artistry). I mean, paitents rave about my Internal Med preceptor and just absolutely adore him b/c he takes the time to talk to them. Most of his visits are scheduled for 30 minutes even if it's just a follow up. He could be making a lot more money (a LOT) if he was scheduling patients every 15 minutes or even every 8. Is he a great doctor? yes, but that's not what the patients praise him for. No it's always the listening, explaining and time he spends with them that they remember.

bluedevilmike · 08-02-2006, 03:51 PM

Uh... while I'm not going to bother touching your main point (except to tell you that five years is clearly a preposterous estimate, and that the tech industry still has plenty of jobs here in the States), quick econ check here:

1.) Outsourcing is different from offshoring. Outsourcing means asking someone else to do it for you; offshoring is having it done outside of the US. They overlap but aren't identical, and neither is a subset of the other.

2.) It has nothing to do with efficiency and everything to do with the fact that purchasing power parity doesn't hold in a world of inefficient currency markets and high transactions costs. Oh, and because comparative specialties may vary for tradeable and non-tradeable goods.

my$0.02 · 08-02-2006, 06:47 PM

Quote:

Originally Posted by bigredmed

In most specialties, you can earn much more by being shoddy (at a bare minimum doing enough to prevent you from getting sued) than by being the absolute best.

Specialists depend on referrals from other docs. Unless you are the only specialist in your field in your area, referrals will go to the better doc (and, yes, practicing docs and their staff do figure out very quickly who does good work).

Ask your preceptor to which specialists does he refer patients and why.

(BTW, numerous studies have shown the likelihood of being sued to be a function of time spent with the patient and bedside manner, rather than medical acumen or even correct decision making; spending less time with patients will increase daily billing, but it will also increase liability exposure).

truthteller2006 · 08-04-2006, 10:06 PM

okay- i have three older brothers- 1 psychiatrist, 1 laywer, 1 doctor, im going for an MBA (harvard or wharton).

The reality is that medicine is extremely lucrative if you learn how to work the system. There are a million outside opportunities to make extra money moonlighting, lecturing, consulting. The money is there. It is also and extremely expensive field, beacuse of all the insurances, but also med school and residency tends to leave doctors extremely jaded, aggressive, and power/money hungry, because students have been someone else's lapdog for 10 years and now everyone kisses their butts. I've never met a doctor I could have a reasonable discussion with without their ego or need for dominant approval coming into play. Thats just my experience, however. It is a stressful job, very isolating, and frankly the idea that 'doctors want to help people' is usually propoganda. Doctors become doctors to make a lot of money, security, and bragging rights.

Lawyers also make a lot of money, but the lifestyle, when you have a steady job, is a little better. Work, go home. No insane 36 hour shifts, people calling you at 3am. There is a little more risk involved, because not all lawyers are the same, and some are just better at it. The thing to note here is that all doctors are basically viewed as being doctors, the person's personality is meaningless, the patient just wants a professional opinion. Law is risky beacuse its a little more centered on the individual rather than the degree.

An MBA is a crapshoot of sorts, beacuse yes many successful people aren't MBAs, and many are. Technically, CEO's are split 50/50 with having an MBA or not. The point here is if you have a strong sense of self, you may hate being a doctor or a lawyer, because the rules of conduct are very specific and theres not a lot of room to express yourself as an individual. Business is about network and hustle, so it really depends on the person to make it happen.

At the end of the day, the best and most successful doctors like being doctors (or love making money), and the best and most successful MBA's make a ton of money and love business. If you going for the moeny,you may actually get rich, but you'll be dead inside and end up divorced and dead at 55, so kiss that hard earned money goodbye anyway. A doctor here in NY last week divorced his wife and blew up his entire 3 story building so she wouldnt get it in the settlement. (watch out for gold diggers)

Figure out what really makes you tick- are you money driven, are you community focused, whatever. Get an advanced degree and work hard at something you don't HATE. By the way, most legitimate screenwriters in hollywood are lawyers, because law taught them to write fast and efficiently. GW Bush is the first US President to have an MBA. The degree is no guarantee, but yes medicine is 'safer' because you can practice anywhere. It can also be life draining and extremely boring, and that rubs off on your personal life. Law is very boring, but lucrative, safe, a little better lifestyle that medicine, but a little more risky. An MBA is very very risky, but successful MBAs absolutely love their jobs and make a fortune.

arjuncase2008? · 08-05-2006, 04:17 PM

honest post

PSedrishMD · 08-07-2006, 10:07 AM

absolute drivel.

Pre-medwannabe · 08-07-2006, 04:02 PM

I agree with truthteller, even though people don't admit to it, that's how it really is.

Bigredmed · 08-07-2006, 06:19 PM

Money can make it easier to accept a lifestyle. People will stay in job's they hate b/c the money is good. I still doubt that at least for medical students, money is really a motivating factor. I don't doubt that med school and residency can jade you b/c they are gruelling. But honestly I'd put prestige and ego as more likely reasons for heading into medicine than money.

He's right about the relative "safety" of the various professions.

my$0.02 · 08-09-2006, 04:15 AM

From the August 8 New York Times.

Quote:

by ROBERT PEAR
Published: August 9, 2006

WASHINGTON, Aug. 8 — The Bush administration on Tuesday proposed a cut of 5.1 percent across the board in Medicare payments for services provided by doctors to elderly and disabled patients in 2007.

It said the cut was required because spending on doctors’ services was increasing faster than expected, and faster than the annual goals set by a statutory formula.

The increase directly affects beneficiaries because their premiums are set each year to cover about 25 percent of projected spending under Part B of Medicare, which pays for doctors’ services and other outpatient care.

Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said Tuesday that the premium would probably rise to $98.40 next year, up $9.90 or 11 percent over this year’s premium. The figures do not include separate premiums paid by many beneficiaries for prescription drug coverage.

“Our current system of paying for physician services is simply not sustainable, from the point of view of taxpayers or Medicare beneficiaries,’’ Dr. McClellan said.

The White House, Congress and doctors have been talking for more than a year about ways to link Medicare payments to the quality of care doctors provide. To date, they have not offered any specific proposals and are still seeking ways to measure the quality of care, particularly for medical specialists.

More than 42 million people are insured by Medicare. Officials estimate that the program will pay $61.5 billion to 875,000 doctors and other health care professionals next year.

Such spending has increased sharply in recent years, Dr. McClellan said, because of “increases in the number and complexity of services furnished to Medicare beneficiaries, including more frequent and intensive office visits, and rapid growth in the use of imaging techniques, laboratory services and physician-administered drugs.’’

Budget estimates are based on the assumption that doctors’ fees under Medicare will be cut in 2007 and later years, as required under the statutory formula. Congress often steps in to block or moderate such cuts, but it normally looks for some way to offset the cost of its action, often by trimming payments to other health care providers.

Dr. McClellan said it would cost the government $13 billion over five years if it blocked the cut scheduled for 2007, without giving doctors any allowance for inflation. The costs would ripple through later years because future updates would be computed from a higher starting point.

Carthaginian · 08-20-2006, 04:09 AM

There's a lot of comparison about doctors and CEO's here...

I'd like to point out that, in general, a doctor, once finally out of school, generally can get a position and be assured of making a decent, or indecent, income from his investment right away.

An MBA on the other hand general is not awarded a CEO position right out of school unless they start their own business which usually is not immediately, if ever, successful enough to pay anywhere near physician salaries. You can't look at the top 1% of MBA's and compare them to the 99% of physicians.

In any event, quit farting around with how much you think you're going to make in a field (whatever it is, you're likely wrong) and go for whatever it is that you think you will enjoy doing. Even if you make a pile of cash, if you don't like what you are doing it's like taking aspirin for cancer....though I could be wrong, there are probably a fair amount of prostitutes that just love their jobs because it pays so well...

Carth

ubi_sum · 09-13-2006, 08:17 PM

Well put.
If you want to make money, DON'T GO INTO MEDICINE. There are easier ways to make money than this. Want to make money? go into banking and investments. I was talking to a 2nd year med student @ brown plme prog and she said you're one dumbass if you think med is the easy way to get rich. you better love med, 'cause you'll 'die trying.'

hye345 · 12-17-2006, 07:06 PM

Bookmarking

my$0.02 · 01-17-2007, 08:02 PM

From the January 15 AMA News
http://www.ama-assn.org/amednews/200...5/prl20115.htm

See the survey results at: http://www.acpe.org/education/surveys/morale/morale.htm

Quote:

Doctor morale shaky as practice stressors surge
Support from spouses and other family members is important to prevent burnout among physicians.

By Damon Adams, AMNews staff. Jan. 15, 2007.

Doctors are singing the blues. They're down about low reimbursement rates, loss of respect and too many patients.

Many suffer from sagging morale, burnout and depression, according to a new nationwide survey of physicians. Six in 10 doctors have considered leaving medicine because they are discouraged by the health care system.

Some struggle to put a bright smile on what they see as a grim reality.

"It's getting worse. It's almost like a snowball rolling downhill," said Gregg Broffman, MD, medical director of Lifetime Health Medical Group in Buffalo, N.Y., who is familiar with the survey and has practiced for more than 25 years. "No one ever taught us this in medical school. No one ever said, 'Folks, the world is going to change professionally for you, not only technologically, but also in the way that business is done.' "

The American College of Physician Executives queried 1,200 physician executives -- most of whom see patients -- about their morale and published the results, with related articles on stress and burnout, in the November/December 2006 The Physician Executive.

Low reimbursement rates and loss of autonomy were the top two reasons for poor morale.

Bureaucratic red tape, patient overload, loss of respect and the medical liability environment were among the other reasons physicians cited.

Those work problems caused fatigue in 77% of physicians, emotional burnout in 67% and marital/family discord or depression in about one in three physician respondents.

One emergency physician who answered the anonymous survey contemplated suicide and reported to be close to filing bankruptcy. "I am working every day, sometimes double shifts multiple days of the month, just to keep up with the bills. HELP!"

To combat their troubles and stress, more than half of the discouraged doctors talked to colleagues about their morale problems. About one-third searched for a job outside health care. Others received counseling or sought relief by lobbying local, state and federal authorities for changes in the health care system.

"The things we see affecting [morale] are the frequent frustrations with trying to provide the kind of health care you want in the current health care system," said Lynne Kirk, MD, of Dallas, president of the American College of Physicians. "It makes us concerned about how many internists are throwing in the towel."

Making changes can help

In a related article, physician executive coach Manya Arond-Thomas, MD, of Ann Arbor, Mich., writes that stress is an occupational hazard for doctors, and they shrug it off without realizing its impact on their well-being. Physicians should recognize that a successful life is based on more than accomplishments and productivity, she said. She suggests doctors give themselves multiple vacations, both short and long, as a way to rejuvenate.

"Part of it is to help them reconnect to what is it that gives them a sense of passion and purpose about their work life," Dr. Arond-Thomas said. "Managing stress has to be a conscious part of your routine, and you sort of build it into your life."

The University of Virginia School of Medicine offers a stress reduction class to help faculty and community physicians avoid burnout. The course teaches meditation techniques and shows doctors how to relieve stress and deal with their emotions.

John B. Schorling, MD, MPH, who teaches the course, said doctors need to make time for themselves, whether it's meditating, exercising or spending time with family. He said exercise and meditation are part of his routine to alleviate stress.

"I don't go home and ruminate about it anymore. When I'm with my family, I'm really with my family," said Dr. Schorling, director of the physician wellness program and head of the section of general medicine at the university.

Sometimes, doctors don't accept help when it's offered. Physicians and administrators at Lehigh Valley Hospital in Allentown, Pa., created a support group, but few physicians showed, said John E. Castaldo, MD, the hospital's chief of neurology. Many doctors said they didn't have time to attend.

"We're a profession, but we're not a community as we should be. As a physician, there's no one who seems to care for you. Your colleagues never ask you how you are," Dr. Castaldo said. "We have to start looking out for each other."

Medical leaders say support from spouses and other family members is important to prevent low morale and stress among physicians. They said doctors should not neglect their health. And they recommend that physicians reduce work hours to 55 to 60 hours a week to lessen the risk of burnout.

"It's very important to set aside time for things that make you feel happy," said Steven Gabbe, MD, who has studied physician burnout and is dean of the Vanderbilt University School of Medicine in Nashville, Tenn.

Doctors should be open to talking to colleagues and others about dealing with the stress of their profession, physician leaders said.

"There may be something in the psyche of physicians that people rely on us, and we might not be as good at relying on others," said Rick Kellerman, MD, a family physician in Wichita, Kan., and president of the American Academy of Family Physicians. "Somehow we've got to make sure physicians are taken care of."