Thoughts on Changing the Healthcare System

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The cost of medical training is an investment that may not provide you with a good return.

As Congress and the Nation turn to a consideration of what to do about Obamacare, I am writing to offer several things for consideration. We must examine the entire medical services delivery system, not just Obamacare,  in terms of educational cost and training, in terms of payment systems for medical care and the regulatory intrusion of the federal and state governments as well as the choke hold on the practice of medicine established by the insurance companies and drug companies.

My view from 35 years down the road, medical school paid off, but not until lately, and I am 62!

In 2016 the bill for medical school tuition after college is about $45,000/year  ($180,000 for 4 years) if this amount is added to living expenses (of about $20,000/year) one would have a total $360,000 invested!. After the first 4 years, residents begin getting a paycheck of about $47,500/year, for a 90 hour work week (for OBGYN), this ends up being less than minimum wage! At the same time many young men and women with perfect grades are making much more per hour in other fields such as pipe-fitting and law. These professions make conservatively $55000 and $114,970/per year respectively, with overtime for nights and holidays, doctors do not receive these benefits. If pipe fitters and lawyers  worked  90 hours per week like most residents,  they’d make over   $123,739 (pipe fitters) and $269,100 (lawyers) The estimated loss of income for residents working  90 hours/week  compared to these other professions, is $76,239 compared to pipe fitters and $221,600 a year times 4 years and equals $886,400 less than a lawyer and $$304,956 for a pipe fitter. The total investment by a physician for training  at the end of a 4 year residency includes tuition paid, living expenses for the first 4 years and lost income if they were in another field working the same number of hours the 8 years is one and a quarter million. This is before they are free to begin their own medical practice.

What I have not mentioned is the interest on the loans that medical students must borrow to live,  but I  don’t want to belabor the point. The point is that physicians make a tremendous investment in getting prepared for their career and they have a right to obtain remuneration that would compensate them for that investment.  Few, if any, other professions make comparable investments in preparing for a career and they have a longer earning life than physicians do. So as we consider reforming the American Medical System we have to consider the appropriate wage determination for physicians that is a reflection of their investment and their skill acquisition, and secondly we need to consider the appropriate number of hours for a physician to work per week into these calculations.

These are all considerations as long as doctors are responsible for paying for their education and  training. If the “system” takes on that responsibility then much of this will go away as a concern for future doctors.

The bottom line is that in the U.S., the monetary and emotional investment as well as the time commitment that physicians are required to make in training and practicing to achieve the privilege of caring for the sick, is  onerous, some would even say outrageous, and I believe requires appropriate income to repay them for their investment of time, money, lost income, and delayed gratification!. The US Health and Human Services  and Centers For Medicare and Medicaid do not figure the monetary investment doctors make into the dollar amount they determine a service is worth.  Doctors incomes are regulated in part, by the government and by the insurance companies, who have sole power to determine reimbursement rates they will pay for procedures patients receive and medicines they (the insurors) will cover. I believe that as a result these two interlopers, government and insurance, essentially skim 50% or more off what doctors should be taking home as a reasonable return for their investment of time, effort, and acquired expertise.  You might want to ask yourself, “Would I like my brain operated on by the Neurosurgeon who was ranked at the bottom of every class he took and barely scraped through?” “Would I be willing to pay for the skill or success rate of the physician I am seeing?”

Doctors  must  agree to be paid whatever the insurance organizations determine is “fair” and the insurance industry takes the rest for just “money changing”  There is no negotiating. Doctors are now paid what they are given,-a very small percentage of what they are worth, and they can never recoup their monetary investment in their education with these types of controls.  Is it any wonder that your doctor just spends 7 minutes with you? Do you blame the doctor for only taking care on one problem at a time?  Then redirect your anger and send it to your insurance company and the government!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.  

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