<p>Most primary care and pediatric doctors make much less than 400,000. The primary care doctors I work with make less than 150k.</p>
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<p>My mother, who is in here late 80’s, has complained that she has trouble finding doctors who will take Medicare patients. She lives in an area that attracts many retirees. Someone else told me that as soon as she signed up for Medicare, she suddenly couldn’t get appts to see doctors who had seen her in the past. On the other hand, my MIL did NOT sign up for Medicare Part B (which covers doctors visits), but she had a very good health insurance plan. She was never turned down by any doctors since she didn’t use Medicare.</p>
<p>Magnetron --</p>
<p>Is NP an abbreviation for nurse practitioner? A quick search online indicates that the average salary of a nurse practitioner is $91K. How is it possible that your wife only makes $15K? Is that a typo?</p>
<p>If she worked 70 hrs a week and only took home $15,000 perhaps she might be better off donating her time and taking a deduction?</p>
<p>I wonder where the average for NPs is 90k? I am an NP and no one I know makes that much. Now I assume those in cardiology or those who are first assists in surgery or in some administrative level might make a lot but the vast majority of NPs are in primary care situations. The average here is probably close to $33 an hour (experienced) which is less than 70k. I made more in Tennessee than I do in NY!</p>
<p>The pay for doctors who have loads of responsibilities, high malpractice costs, years and years of postgraduate schooling and training doesn’t seem excessive.</p>
<p>For me its the CEOs and Insurance execs that make tons that bug me. I really hate the insurance industry (despite my best friends being in it) and blame that on a lot of costs.</p>
<p>The fact that the Pitt CEO makes so much makes me want to throw up. The hourly workers there make so little that they depend of foodbanks. [UPMC</a> opens food bank for struggling employees, misses point completely (UPDATED) | Blogh](<a href=“http://www.pghcitypaper.com/Blogh/archives/2012/12/11/upmc-opens-food-bank-for-struggling-employees-misses-point-completely]UPMC”>http://www.pghcitypaper.com/Blogh/archives/2012/12/11/upmc-opens-food-bank-for-struggling-employees-misses-point-completely)</p>
<p>^^^ and now NPs will have to be DNPs to be licensed. Even more years of expensive schooling to do the same job at the same pay.</p>
<p>Sounds like what they did with PT.^^^^^</p>
<p>Jamiecakes –</p>
<p>Here is a link to the [National Salary Report for NPs and PAs.](<a href=“Elite Continuing Education for Nurses & Healthcare Professionals”>http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/National-Salary-Report-2011.aspx</a>) The average salary for a NP working for a family practice is $89K, internal medicine is $88K, cardiology is $90K, and surgery is $91K.</p>
<p>Perhaps you live in a low cost of living area?</p>
<p>The guy said, “We never change the working parts of the equipment. We just change the cover of the equipment and every year we increase prices 10 to 15 percent a year”.</p>
<p>The patients pay for this… </p>
<p>I have been in the medical capital equipent business for 25 years and strongly disagree with this statement. If we only slapped new labels on, we would have been out of business years ago. Look at the diagnosis getting made today compared to 20 years ago. The discovery rate is staggering. How much is it actually helping??? A valid question. Much is discovered now that may have always been there and we just didnt know.
The imaging products we sell today for 200K, cost about 200k 15 years ago. Technology has made them better faster and less invasive and held the costs the same. The proliferation of defensive testing has had a major impact on costs to the end user. Too many new doctors rely on technology at such a high level that they gain little confidence in their own diagnostic skills. Yes the industry has exploded with technology, and profits are healthy, but we dont only sell it in the US. We profit in the rest of the world too. Even in those countries with “socialized medicine”. So many factors to be considered in a rational discussion. All business try to maximize margins, manufacturers, physicians alike. And all of us have 401K investments in medical companies. Dont we all want double digit returns? We cant all save money on our expense side but want continual increases on our investment side…</p>
<p>Wouldn’t it be great if we could solve this on CC? Great discussion.
It highlights that everybody tries to solve it from their point of view (all valid). But exceedingly complex for a “one fits all” solution. But we’re as good as the wonks in Washington I think.
Anybody keeping a list of things we need to address? Doctor pay, culture, length of education, AMA (basically a union to some people–no opinion here), public expectations, medicare vs private insurance? This list is too long already.</p>
<p>Honestly, if you could pay X and get X results the medical industry would operate like the rest of the free market world. It just doesn’t happen unfortunately.</p>
<p>Penzly it was an anecdote. </p>
<p>I have some of my money invested in the healthcare industry. </p>
<p>Profits are part of the health care issue.
I appreciate your post.</p>
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<p>It’s true, though she now owns her own practice. She made about $90k working for someone else, but she is hugely efficient and has a loyal base of patients, significantly outperforming others in the field. We are hoping that eventually she can make about $75k practicing the way she wants, with 20 minute basic appointments, a clean, well-lighted place, and a focus on full-body health and wellness, a business-class seat for a coach price. The model may be unsustainable.</p>
<p>She was required by law to buy $80,000 worth of compliant computer equipment and $60,000 worth of software, plus about $2k/month maintainence contracts. Taxpayers reimburse doctors, podiatrists, chiropractors, and dentists for the software, but NPs get no break at all. Thanks, Congress, there goes the college fund.</p>
<p>A couple more data points: the average primary care appointment is now 7 minutes. Some docs see as many as 60 patients/day. Hospital run primary care clinics operate at a loss in order to get their hooks into patients and their insurances for when things go sideways and they need testing or specialists. It’s easy to see how quickly they recoup their losses when patients get desperate.</p>
<p>And another thing about Medicare and the insurance contracts is worth noting. She is required to give the same level of care to all no matter what the contracted reimbursement rate is (and Medicare can take their money back at any time, even after you retire). So if an elderly patient needs a shingles vaccine, she gets one. They cost the practice $250 each. Medicare pays $150. The only way to get remotely close to breaking even is to force her to come in for a separate appointment to get the injection.</p>
<p>I have read a part of this article only. But what I get from this article is that, the author argues that, contrary to many people in US believe, the government is less evil than the privatized industry, when all the “greed”, “lobbying” and “efficiency” factors are considered.</p>
<p>When in doubt, follow the flow of money! Whoever trying to convince you otherwise likely has their own secret agenda. This tends to be true independent on whether these people are on the left or on the right (because the majority of them are greedy even though they themselves may not even know it. The greed is human’s nature.)</p>
<p>“I wonder where the average for NPs is 90k? I am an NP and no one I know makes that much.”</p>
<p>And my wife, working in a relatively low-cost area, makes about that much as a two-year RN hospice nurse with five years of experience. No malpractice to worry about, no office, a car (which is reimbursed by he mile), no equipment to worry about. Sets her own schedule daily. Her average patient appointment is about an hour. Never sees the inside of a hospital, never sees a doc, and gives “recommendations” to the doc (who never sees the patients) for meds.</p>
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<p>Exactly what they’d like you to think by making the degree a “doctorate” - but take a look at the curriculum of those DNP programs, many of which are offered online (!!!) - there are lots of courses on statistics, health care systems, “nursing theory”, “scholarly projects”, etc. Hardly the 2 years of hard sciences followed by 2 years of clinical education of medical school. </p>
<p>Don’t want to drag this thread off topic, so it might be best to end this there. That being said, one of the arguments being made for these mid-level providers like NPs is that they can fill the doctor gap. I’m sorry, but no they can’t. There are no shortcuts to becoming a competent physician. Which is why the following statement is very much off base:</p>
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<p>It always surprises me that people hold such views - I had a patient once (details and situation changed, of course) tell me “Oh I didn’t bother taking that medicine - the doctor who gave it to me was only an Emergency Room doctor and they don’t know what they’re doing”. As I picked my jaw up off the floor I wanted to comment that doing what that “dumb” doctor said would have prevented him/her from currently being in the ICU on aggressive and invasive treatments.</p>
<p>In fairness though, Icarus, I think all of us have an at least one experience with a doctor who was completely off base in his diagnosis. My D had a broken navicular that the <em>best</em> ortho foot guy in town took an xray of and said it wasn’t broken. Skeptical, I took her to a podiatrist who diagnosed it in a minute by having her walk on her toes, and was later confirmed with an MRI/bone scan, and then it had to be repaired surgically because it had been broken so long. That is just one family example. I am quite wary of doctors, I must say, even with all the diagnostic equipment you can get several differing opinions for treatment.</p>
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<p>Sure, and I don’t deny that doctors make mistakes. I simply don’t understand how one goes from “doctors aren’t perfect” to “bring on people with significantly less training/knowledge to handle my medical care!”</p>
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<p>But just because there are differences in recommended treatment doesn’t mean that one is right and the other is wrong. In medicine there is often more than one way to attack a problem.
I think that the complexity of medicine and the inherent uncertainty with a lot of things engenders a lot of confirmation bias from people unfamiliar with medicine. You get the “I didn’t believe the doctor so I did x (went to someone else, took homeopathic unicorn tail elixir, etc.) and was cured immediately” - this doesn’t mean the first guy was necessarily wrong or incompetent, etc.</p>
<p>Edit to say that this is not to diminish the importance of second opinions, especially for potentially serious issues like cancer, etc. It is extremely important for patients to have as much information as possible about their health and treatment options. The problem comes when a patient is set on an inappropriate treatment or course of action and just shops around searching for someone to give them what they want - e.g. “No, my child’s sniffles couldn’t possibly be a viral URI - the internet said he needs antibiotics and if you don’t give them to me I’m suing and telling the internet that you’re stupid, then going to someone else who will clearly know that he needs antibiotics” and so on.</p>
<p>I think the biggest improvement we could make in health care would be for medical providers to take more time with their patients.
I’d like to see a study comparing drs who spend 7min per patient but order lots of tests to the outcomes of drs who spend 15 min with patients and order fewer.</p>
<p>"Quote:
In many instances, those inexpensive doctors (100k) are usually family medicine physicians who do not have the knowledge to determine treatment for anything beyond colds etc.</p>
<p>DocT - I’m not sure what kind of doctor you are, but the above statement is absolutely not true. "</p>
<p>What part of this isn’t true?</p>