Tuesday, February 22, 2011

Response by Ali Haider

There is a huge misconception of physician salaries these days.  The days of old when doctors made the big bucks, lived the good life, and earned a certain level of respect in society have long since past.  Though people out there don’t’ seem to realize how much has changed in medicine in the past 15  to 20 years.  Now becoming a doctor means sacrificing half your adult life, in school and training making just enough to get by, then finally get released into the real world with an earful of debt, working bad hours, and yet still just making enough to survive.  This article said it best.  It is written by a physician and is a very interesting albeit depressing assessment of the financial situation of doctors through their career (half of which is spent on training) http://benbrownmd.wordpress.com/2010/06/20/informedconsent/
Money is important for any job and for life.  As doctors, we commit so much time, effort, and money, not to mention sacrificing things like family and friends, and real life experience, all to attain a high level skill to help others.  Should not one’s salary reflect this time, dedication, and noble trade?  Apparently not.

The recent cuts to doctors have had quite an impact.    It affects private practice the most.  Some private groups cannot even stay afloat these days--one cardiology group I know goes through a month and just breaks even.  I.e. after all expenses and staff salaries, they take home zero.  Other groups had to get bought out by the hospital, because it was not feasible to survive.  So they work like dogs, and can't even put all their kids through college now (that is a real case).  What happens next is that doctors have to try and compensate and see much more patients, which means less time with them, which by nature provides a lesser quality of care.  More hours, more patients, less time, less money.  Not very happy is it?  Then less people become doctors because they see that years of sacrifice and long hours and training, when you are finally in your mid 30's and earn a real salary, you don't take home that much and make an hourly wage of a schoolteacher.  So why go through another 11 years of training after college to be a cardiologist??  So less doctors means even harder to get an appointment, and when you do, you will spend 5 minutes with them. 

Then is the lack of tort reform.  If you are going to cut reimbursements (all one-sided changes courtesy of lobbyists who again are not physicians), you have to do something in favor of docs no?  The bottom line is that Americans love to sue.  Certain fields like cardiology, OB/GYN, surgery, deal with a lot of risk, but are among the most rewarding as you truly help people's lives and livelihood.  But sometimes one cannot be saved or helped or there are complications- that’s the nature of the business.  But the frivolous lawsuits are endless (you cant understand how baseless some are unless you know medicine, but trust me...)  And what happens is that doctors practice medical-legal medicine out of fear.  Someone has some bullshit chest pain, they send them to a cardiologist, and they get an echo, a stress, bloodwork etc... An internist could have evaluated all that with a stethoscope and a few minutes to elicit a good history. But why risk getting sued? As it is you are trying to pay off these loans and start a college fund for the kids, how can you go through a lawsuit in case the guy drops dead the next day and blames you for negligence? The result is millions of dollars wasted in the health care system.  Not to mention more unhappy docs after policy changes force them to work harder, see more patients, and make less money.  So once you filter it down, the quality of care delivered is just suboptimal.

But part of the problem is our involvement, like Dr. Pilip said.  One of the reasons we had huge reimbursement cuts in non-invasive cardiology is that when the CME people surveyed physicians across the nation, nobody did a good job of accurately and thoroughly reporting what costs and time go into certain things.  Too much time and paperwork.  But again, docs not getting involved.  Not to mention in part by the few bad apples out there who order unnecessary testing to put money in their pockets, which is reflected in the cost-analysis assessment, and leads to insurance companies regulating what we can do.

With reimbursement cuts come stricter regulations in ordering tests.  Now we have pencil-pushing suits behind desks that work for insurance companies who can tell us what we can and cannot order depending on the situation.  Can you imagine? Years of med school and training, when we see a patient, and our clinical judgment tell us they need a test, we cannot order it until somebody goes through some checklist and algorithm to decide if its ok.  And it is so frustrating I tell you.  Same thing with certain medications.  It is to the point where you will sometimes not even order a certain test or medication because getting the approval is a headache and a half.  Which is exactly what the insurance companies want, a cheaper avenue, less money for them to pay (as if the reimbursement cuts for the tests themselves wasn't enough) even though the doc may think otherwise.  So who needs docs? Just punch info into a computer and let them treat you...

But how do we get involved to make a difference? I really don’t know the answer.  The AMA is the biggest organization of docs that is involve din policy change and the voice of doctors in government.  But is that enough? Are enough of us involved? Are there other avenues and organizations?  Obviously they are, but again, what is the next step to try and make a difference?  I am not sure.  But this generation, we need to have our voices heard.

Sunday, February 6, 2011


Cardiology is a medical specialty which is of great importance to those individuals and families which suffer from heart disease.  Prevention and early detection can save untold millions of dollars and needless pain and suffering, but the opportunities to do this and to serve people who need us, are becoming more and more difficult in the current climate.

Why are we as cardiologists or any physician for that matter, so passive when it comes down to the fate of our livelihood?  I mean when it comes to the intellectual stimulation and further advancement of our knowledge base, we take active roles in being smarter and better so that we can help our patients.  On the flip side, when policies are passed which are highly influenced by non physician lobbyists who range from lawyers, pharmaceutical companies, insurance companies, and which have a deep and powerful impact on our livelihood, we as physicians simply watch on the sidelines in disbelief but without one unified voice. 

I propose that we as cardiologists as well as other physicians unite to make a unified front that will allow our voice to be heard. 

We all have complained to each other:

How could it be that as decades pass the reimbursement rates continue to decline in real terms?
How could it be that malpractice insurance has gone sky high with the result that some doctors in certain areas refuse to practice medicine?

How could it be that after staying in school for over 10-15 years and accruing loans in excess of 200k, we as physicians have no unified entity that would fight for our rights?
How could it be that when the recent cuts in Cardiology have set a devastating ripple effect though an infrastructure that is over 100 years old, we as doctors did nothing more than complained to one another with no impact on the system?

How could it be that as many cardiology private practices across the nation are closing their doors, we still do nothing but watch it unfold in disbelief, horror, anger but once again without a unified voice?  Private practice is an example of an American dream: the more you work the more you expect to see in return.

Is it because we are cynical, thinking it will not matter?
Is it simply a diffusion of responsibility where we think somebody else will or should take up the cause?
Is it that we think that it will get better only if we just wait and see?
Or is it that we think well it doesn't really affect me that much, since I am a part of a bigger institution?

Well, if political power comes from the people that demand certain change, and as a result laws are made to be in accordance with such wishes, we as physicians have the same power.  The power of our voice.

If lobbying influences politics in such a great manner, ie, we all know that a stricter gun control should be in effect but will not be, than we as physicians have the same power to make such an outstanding impact.  The power of our money and status.

If we simply wait for tomorrow and wait for others to make an impact, we may end up in a country where private practice will be nothing more than a distant memory.  Where a doctor will make the same salary as a social worker or a high school teacher while the Wall Street day trader can make far more. 

How many of us are working twice as hard just to make the same amount of money as the year before?  If we spent a fraction of our time being involved and organized, maybe we would not have to settle for less.

Some may think, well what if I am employed by a hospital and while it is unfortunate what is happening to my colleagues in the private practice community, it certainly does not affect me.  That may be true today or even next month, but what happens if the hospital is no longer profitable and closes its doors as is common these days.  What happens if there is a difference in opinion with the administration?  How difficult will it be to find a job in the world where private practice does not exist and we only have to depend on the hospitals to provide us with a job?  It will create an environment of take it or leave it.

Let's not forget about the unspoken victims, the patients, of unchecked and unbalanced policies that are imposed by the non-physicians.  How will the aging population gain access to the appropriate specialists when we are approaching a time in our society where private practice is heavily punished to the point when there may be little or none available.  What happens when the earliest appointment to see a cardiologist will be in months and not days, and most care will be received in our Hospital Emergency Rooms where cardiologists will be on staff?  What happens when appropriate tests will not be ordered because the costs will be prohibitive or they will be heavily delayed because the Hospitals will be overburdened?  There are so many ways that our patients will suffer because we physicians are not strong enough to stand up for our rights. 

We physicians have to unite behind one unified voice and make it abundantly clear that we will not passively accept what is offered to us by the insurance carriers and biased public policy.

We can make a change but it will require an active involvement from all of us.  Let us help ourselves.  Whether you are a fellow or a practicing physician, give your feedback and be heard, and most importantly pass this along for others to get involved, join the movement!

It starts here with this blog ........

Let's start the dialogue.....