<p>New medical students will have to have realistic expectations. However, it wouldn’t be fair to assume that all doctors went into it for an affluent lifestyle. These students were the top of their class, and certainly there are easier ways to get rich than being a doctor that they would have been successful at. Many went into it to use their intelligence to help people and also for the personal side of it as well as the autonomy to make the best decision for their patients.They had to forgo many things to study for years and work long hours for little pay as residents. They had to take call and forgo time with family which resulted in many strained marriages. They did appreciate being paid well for their efforts and sacrifices. </p>
<p>New docs will train in an era where there is a cap on how many hours they spend at the hospital as a resident. They are learning to practice in an era of evidence based medicine and electronic records, and will not be autonomously making decisions. Call will be different and hospitalists have replaced having ones personal doctor oversee any possible hospitalizations. It isn’t all bad for the new docs. They will make less, but they will have a better personal life. </p>
<p>It’s the older docs who are grieving and it isn’t over just income. It’s the loss of what they trained to do, the autonomy to do it and the personal sacrifices they made to get where they are. It is the loss of personal connections with patients that they used to have time for, and it is the ever annoying interference of paperwork and insurance. </p>
<p>Add to this the psychology of a constantly decreasing income over the years combined with less job satisfaction. It isn’t so much about the amount you make but the idea that you are working harder and getting paid less. Imagine any employee being happy in a job where there is no hope of a raise and the salary is lowered incrementally each year. </p>
<p>Younger doctors are starting practice in a new era. </p>
<p>I was gone this week, and haven’t read the thread (and am afraid to!), but to the original question-- when I am running late, the first thing I say when I enter the exam room is, “I am so sorry to keep you waiting.” The patient (actually, the parent; I’m a pediatrician) always says, “That’s okay.” I say, “No, it’s really not okay. I’m sorry.” And that is almost always that. The patient/parent knows that I know their time is as valuable as mine, and we are off on good footing. But I of course try never to run too late. Kids have a hard time waiting (unless we have really good toys!)</p>
<p>Studies have shown that simple apologies from physicians are important in work flow, patient satisfaction and even wrt malpractice issues. Simple courtesies are important.</p>
<p>“I understand that others want to believe that physicians always use the expensive equipment in their office only when it is really needed. And not just because it there, like some police departments find a need for their military supplied tanks and bazookas. Perhaps the physicians even convince themselves that is the case.
If the test isn’t going to change treatment, why is it needed?”</p>
<p>Oh, clear away your hippie haze and think for a moment. Hmmm. Why might an expectant mother want to know that her baby has (let’s say) Down syndrome, even if it isn’t going to alter her decision to continue with the pregnancy? Hmmm. Any guesses why a woman might want to know that ahead of time? This is a toughie. @@ </p>
<p>“It’s the older docs who are grieving and it isn’t over just income. It’s the loss of what they trained to do, the autonomy to do it and the personal sacrifices they made to get where they are. It is the loss of personal connections with patients that they used to have time for, and it is the ever annoying interference of paperwork and insurance.”</p>
<p>Absolutely. Like I said, H is a dinosaur insofar as he’s in solo private practice and not beholden to a larger chain. His model isn’t really sustainable, though. He’ll be out of medicine in 5 years (he’s 53). It’s not like it used to be. </p>
<p>“Back in the day, the docs were the richest people in my town, the ones who did indeed drive the Mercedes and take the European vacations. That’s not the case today, and I think there’s a lot of resentment and defensiveness on the part of those who embarked on medical school with the assumption that following their “calling” would provide a very affluent lifestyle and now find that managed care means they won’t be at the top of the heap financially.”</p>
<p>No one who has decided to become a doctor in the last 20 years has thought it was the key to riches. Those days you’re referencing are LONG gone. </p>
<p>Doctors have always complained about their income, but even now it is pretty good. Where else can you find 100% employment and an income, working for someone else if you choose, of a couple of hundred thousand a year and up. And that’s without managing others, seeking clients, or taking business risks. In many, or maybe most occupations and professions things were better a few decades ago (think lawyers and factory workers).</p>
<p>Whoa, sorghum. You have NO idea of what is involved in being a physician. Calculate the costs of first being able to earn any income. Add in the hours most college students partied but future physicians were studying to learn as much as they could as undergrads. Then add in the amount to be learned in medical school. Then add in the hours spent in classes/hospitals et al. Oh- and add in a huge yuck factor as well. Plus the costs of doing business- with or without any patients there is practice overhead- including require continuing education, licensure fees and malpractice insurance. Add in an office. Plus personnel to make sure you have time for medicine and not all of the other necessary stuff. Some have calculated the hourly wage for physicians- there are many, many easier ways to earn money. </p>
<p>As a physician I find it disturbing how people who go into business can make tons of money without doing any useful work. I find it terrible when hospital and clinic management makes more than those who provide the actual services- and have jobs that are “9-5” without most of the work. I see too many students on CC planning their future with regard to how much money they can make, not how personally rewarding their career will be. I see too much difference in most employees wages and the top management’s- tons of money for failing to do a good job…</p>
<p>Here’s a secret- I, like all good physicians, have broken the law. Every time a physician writes off a Medicare patient’s share of their bill their fee technically becomes the new bill and the patient still owes, say 80% of it. We can’t legally give discounts without it changing our usual and customary fees (lowering them). At least that was the case decades ago. Let’s not get into the accuracy, changes et al. All I know is that nice elderly lady who found my home phone number to tell me she was going to pay her H’s anesthesiology bill to me as soon as she could needed her money after she gave me the government’s payment for my services more than I did (I’m sure if she had kept the Medicare check portion as well she could have landed in legal hot water for fraud). I was surprised her H was still alive after what the surgeon saw doing the biopsy. Fast forward- if I were still practicing today I might not have the control over my services to be able to give any discounts. I also made sure my accountant knew to send a certain young adult patient to the collection agency- after nearly dying from his motorcycle wreck he had plans to replace the motorcycle but had no health insurance.</p>
<p>The write offs of medical people and hospitals is horrendous. Think of all of the people who get care then are asked for payment. The “customer” does not need to pay for the services before getting them. Is that any way to run a profitable business? </p>
<p>I will repeat- we physicians do NOT have customers, we have patients. We do not pick and choose who to take care of based on the best opportunity to walk in the door. I suppose everything can be reduced to a customer level- public K-12 schools, churches, families… Although I guess churches do treat people like customers- give them a message they want to hear so we can fill the seats and take in the donations…</p>
<p>Emerald… you DO have osteoporosis risk factors. Everyone is at risk for things (genders do make a difference, however- have to have the anatomy… for some things) but some have a higher risk. Women are automatically at risk for bone loss, especially with hormone losses and typically smaller bone mass to begin with…</p>
<p>Anyone ever think about how it is the “practice” of medicine? We never do perfect it. There will always be unknowns. </p>
<p>Any other items we can prolong this thread with? </p>
<p>You can at any time take a salaried job and let someone else worry about office costs and overhead. You get paid 50K+ during residency, not that out of line with other young people. The major cost is the 4 years of medical school, when someone spending that period doing, for example a PhD in engineering would be getting an advanced degree and earning money at the same time. </p>
<p>But there is no job other than physician where the proverbial, on CC, guy who comes last in his class can confidently expect over 200K a year a few years later.</p>
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<p>Nonsense. Disagreeing with you is not proof of ignorance.</p>
<p>People at the bottom of their class in top law schools, IB, etc can make plenty of $. And despite your insistence and self proclaimed astute knowledge of the workings US healthcare system, even though you have not lived in the US aside from a 1-2 year educational exchange stint 20+ years ago, one cannot automatically “at any time” take a salaried job. </p>
You clearly underestimate what is involved in residency, @sorghum. $50K may not be “that out of line with other young people” (somewhat rare and certainly fortunate young people, I would say). The hours, working conditions, learning requirements, and level of responsibility during residency are far more challenging than what most other young people making $50K experience. </p>
<p>"Doctors have always complained about their income, but even now it is pretty good. Where else can you find 100% employment and an income, working for someone else if you choose, of a couple of hundred thousand a year and up. And that’s without managing others, seeking clients, or taking business risks. "</p>
<p>Are you SERIOUS? </p>
<p>Managing others – Do you think that my H’s 12 or so employees just manage themselves? He runs a small business with all the stresses that that entails (hiring, firing, managing, resolving disputes, scheduling, ensuring competitive salary / benefits, etc.).</p>
<p>Seeking clients – You’re on drugs if you don’t think doctors have to spend time seeking clients. Whenever my H is chatting up a patient about how her kids are doing these days or how she enjoyed her most recent vacation, it’s most certainly for the purposes of attracting and retaining patients in the practice. The only way he will “win” is if he makes himself a doctor that his patients want to see, and want to recommend to their friends and family. Just because it’s not putting-an-ad-in-the-local-paper type of marketing doesn’t mean that he’s not in a service business.</p>
<p>Taking business risks – again, seriously? You don’t think there are business risks entailed with deciding, for example, whether it’s best to buy a $150,000 mammogram machine, lease said machine or not offer mammogram services on premises? You don’t think there are personnel, regulatory and business risks that he needs to weigh - just as a small business that makes widgets needs to think through its own capital expenditures? </p>
<p>And you apparently don’t have a clue that malpractice insurance can easily be $200,000/year or more, off the top - even for someone with a spotless record. </p>
<p>"The write offs of medical people and hospitals is horrendous. Think of all of the people who get care then are asked for payment. The “customer” does not need to pay for the services before getting them. Is that any way to run a profitable business?</p>
<p>I will repeat- we physicians do NOT have customers, we have patients. We do not pick and choose who to take care of based on the best opportunity to walk in the door."</p>
<p>Great post.
Sorghum, do you also not get that because it’s health care, there are different moral obligations?
If I have a client who’s used me for X number of years, and her budgets are cut, and she can’t afford me any longer – well, I’m sorry, too bad, but no one expects me to work for free.</p>
<p>Do you not get that if H has a patient who has been a loyal patient, and has fallen on hard times – maybe spouse lost a job, lost their insurance, whatever – he’s not going to cut her loose? Good lord, he’s got patients whom he’s said to them – tell you what, “pay” me in a batch of homemade brownies every month until your household is back on its feet. Or just pay me $10/month even if it takes years and years to pay off your bill - no interest. </p>
<p>I’m embarrassed for you, honestly, sorghum. And now I see you don’t even live in the US??</p>
<p>"You can at any time take a salaried job and let someone else worry about office costs and overhead. You get paid 50K+ during residency, not that out of line with other young people. "</p>
<p>When my H was in residency, he got paid far less than minimum wage when you looked at the number of hours. His father, also a doctor, was on food stamps when he was in <em>his</em> residency. Decent wages during residency (and reduced hours) are relatively new. </p>
<p>PG an ultrasound doesn’t identify Downs.
You know that.
I do realized that being female is a risk factor for osteoporosis.
But is that enough not o look further?
My 24 yr old athlete daughter also has it btw.</p>
<p>Re post #314: Actually, ultrasound now provides early noninvasive screening for Down Syndrome. <a href=“Nuchal Translucency Test — What to Know About Screening & Ultrasound”>Nuchal Translucency Test — What to Know About Screening & Ultrasound; Every young woman I know who has been pregnant in the past few years has had a nuchal translucency screening at 12-14 weeks, and a followup ultrasound at 18-20 weeks. The ultrasound provides early screening for various trisomies and congenital heart defects. When the ultrasound results are outside certain normal limits, the parents can consider CVS or amniocentesis. But many women will elect not to have the more invasive testing if their results are reassuring via ultrasound and blood tests. </p>
<p>People don’t have routine ultrasounds because the expecting parents think it’s “fun.”</p>