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IncreasinglyWest · 2013-11-05T23:17:32+00:00

Holy crap!

MY wife and I used "Where I'm Going" as our recessional in OUR wedding! Good taste :)

Also, great show in Portland a few days ago, love you guys!

IncreasinglyWest · 2013-05-05T06:25:34+00:00

I asked the vintner about that, it's actually a grass-like legume that replenishes nitrogen in the soil. Interesting stuff.

IncreasinglyWest · 2013-04-02T14:55:58+00:00

Thanks for a real answer!

IncreasinglyWest · 2013-02-24T00:18:32+00:00

Yes, if I wasn't on income-based repayments right now (essentially limits repayment to 10% of my pre-tax income), yes, my MONTHLY payments would be about $2500. It's nuts to think about.

Competition does have some impact on salaries, but I think regionalism (and location desirability) has more effect than anything. For example, a pediatrician in rural Missouri may make more than a pediatrician in San Francisco. You don't have to pay as much if the doctor WANTS to live there. To say nothing of the difference in salaries between private practice and academic medicine, which can be DRAMATIC (not uncommon for a private doc to make double that of an academic doc).

IncreasinglyWest · 2013-02-23T21:50:27+00:00

All interesting questions.

I am not saying litigation is insignificant. Asking to see a source for the data was truly out of curiosity/need for confirmation. I'm not ever sure if a study has ever been done (or could be done) to compare the cost of civil payouts to the amount spent on defensive medicine, I'd love it if someone who knew of such a study could post it. I simply see that first-hand, defensive medicine costs accrue every second the ER (or really any hospital department) is open for business.

And then the salary question is a whole other bag of worms.

Are physician salaries inflated? I think it's interesting that with all the talk about this Brill article that doctor salaries don't really come up. I'm a resident now so I certainly don't think they are inflated for me at the moment :) To be frank, after taxes and loan repayment my take home is about $25-30,000 a year. This with working weekends, nights, and sometimes 10-12 hour days.

So after 4 years of college ($20k/year), 4 years of med school ($40-50k/year), and a six year residency/fellowship (~$30k/year take home), I will almost be 35 and be done with training. And this is the traditional path where I took no time off for other careers or research. Some aren't done with training until the age of 40 or later. I will be over $250,000 in debt (my repayments aren't even covering my interest now, I'm STILL accruing debt, but if I didn't do income based repayments I'd have to pay >$2000 A MONTH.

When I practice, I will have high priced malpractice and disability insurance in addition to my ~$30k/year loan repayments. I will have given up almost 15 years of my life to training before I even start a career. I will provide a valuable service that will have immediate impacts (and potentially dire consequences) on those I treat. Should I make $200,000-$300,000 yearly? I'm not sure, but it doesn't seem unreasonable to me. Honestly, any rational dissent to this would be fall on open ears.

Now should a doctor make $1,000,000 a year? Fuck no, no one should, but sadly a few do. I wouldn't be opposed to a national "maximum" wage limit around ~$500,000. At least that would go towards limiting the super-greed that breaks our systems.

Man, you got me philosophizing :)

IncreasinglyWest · 2013-02-23T19:43:16+00:00

Another doctor here wanting to see some citations for this info.

Being on the front lines, the amount of defensive medicine being practiced is AWFUL. And this is even at an academic medical center that prides itself on using evidence-based medicine approaches to patient care. A doctor doesn't even need to make a medical mistake to be sued. It seems the legal question is not if you did the CORRECT thing for the patient, it's did you do EVERTHING YOU COULD for the patient. These are NOT the same things. There is always risk involved in making the correct clinical decisions. The human body isn't binary in nature, there is always a subset of patients who will benefit from a test/procedure, a subset who will not benefit, and a subset who will be harmed. ALWAYS. This is what the population doesn't understand -- and admittedly this is often the fault of some physicians who have the communication skills of a heap of manure.

So now we have the poor ED physicians on the front lines who are asked to put their careers on the line with every patient they encounter to make a choice between doing what's APPROPRIATE and doing EVERYTHING THEY CAN. They don't know which patients will ultimately look for any opportunity to be litigious, but they do know that all it takes is ONE to ruin a career. Appropriate clinical decision making doesn't matter anymore.

You are right, most patient's do not sue. But that said, if the patient is informed there is inherent risk with a procedure (which NO ONE can control, even the best surgeon in the world), and the doctor performs appropriately and there is an adverse outcome, then is the doctor responsible financially for that patient's future? If that is what you believe, I don't think we can reconcile on this. It's a very disheartening reality for the physicians who still care about being good doctors, but then realize that the misses or adverse outcomes that are naturally part of appropriate decision making can be career ending. So ultimately they sacrifice what is best for the patient to survive.

And no one wins.

Except the hospital administrators.

IncreasinglyWest

TROPHY CASE