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.