First of all, stated goals are not the same as goals in practice - see the NRA for a simple example of that. Second, the stated goal of the AMA is not entirely about the patient care - it is about promoting the practice of medicine ("To promote the art and science of medicine and the betterment of public health.") The AMA routinely engages in the political arena on topics that have little to do with the best interests of patients - it's one of the largest political lobbying organizations in the country. Medicare is arguably the single best thing that has happened to seniors as far as the health care goes - and it was a program strongly opposed by the AMA. It routinely fights for higher reimbursement rates for doctors, etc - this may tangentially be related to patient care, but its far more about being in the interest of its members - doctors. They involve themselves in debates on all sorts of topics that have nothing to do with "ensuring that the board-certified physician is qualified to take care of patients to the highest held standards." That is very clearly not their sole job. That's not to say they are a bad organization - but you make it sound like they are this angelic organization that just cares about patients. That's not remotely true - they are an organization of doctors, and their job is to represent their members' interests.
Reading his posts on the first page, he is basically stating that they don't let enough people become doctors and because of that they make giant salaries and because of that healthcare costs are out of control and costing taxpayer money. He then equated the process of becoming a md as being no harder than the process of becoming an I-banker or lawyer. You chose to focus and argue on whether or not we have enough openings and med schools, which was the first part of his point. I chose to focus and argue on the incorrect conclusions he draws from that point. So, I agree to disagree with you telling me I missed his point just because I chose to debate a different portion of it than you did.
Sorry. Was't referring to the AMA. The American Specialty Board organizations are independent and have different goals. They represent patients. Every practicing physician who completes residency has the opportunity to become board certified in their specialty... this includes internal medicine, surgery, family practice, pediatrics, etc. If you go to any of their sites (american board of -specialty-) you'll see that every one of them has their stated goal to serve the public. There are several doctors who aren't board certified, or didn't even finish a residency. They mostly work in urgent cares, rural hospitals, or ER settings. There are a handful of them practicing for so long they were grandfathered into the current industry. I'd think twice about going to any physician who isn't board certified or board eligible, in any specialty.
As long as a body does not start to confuse Board Certified with the ability to practice medicine and make it a requirement, thereby limiting supply even more. We need practices that increase the supply of physicians and have their studies be more focused on healthcare than weeding out people as rejection ratio continues to fall in most US medical schools as the doctors coming out is not even keeping up with population inflation! Whether a doctor is board certified, US trained or if they worked in Australia for 20 years, they all bill virtually the same. Which is a bit unfair to the best physicians, as the guy trained in the Caribbean shouldn't command the same compensation as the Mayo Clinic trained specialist. When there is such a lack of supply of a needed function and bottlenecks by their own trade Union's (American Medical Association) that artificially enriches their members, there is not even question about qualifications where trained or board certified as people are lucky to see a doctor in urban areas!
I don't think you understand how the residency system works. In order to practice in the USA you have to be trained in a US residency system. Thus the guy from the American medical school, Australia, Nigeria, Caribbean, India or Pakistan are all US trained if you see them practicing in the USA today. They may have done their basic sciences and clinical years abroad but their residency training is all done in the USA. That is why they all command they same pay ultimately.
Who cares what they "bill"? Its about the quality of care they're trained to give. You claim there's an "artificially created shortage", and you want to open the floodgates to more medical students... but you also want to get rid of the quality control standards (which is what the American Board of Specialities maintains) that ensure appropriate patient care by those practicing medicine. That's a recipe for disaster in patient care (which as many of said already "struggles" in this country as is, which is somewhat mitigated by this countries other issues)... more less qualified practitioners, with no board oversight. Again, healthcare is not your standard "business" where you can simply hire tons of people, throw them against the wall, and if they somewhat stick... they're good. Also,doctors actually bill more in rural areas because there are so few willing to work out there... whereas they're a dime/dozen in the medical center, all likely to be fellowship/board certified trained, all making a fraction of what they'd be making if they practiced in the middle of nowhere. What they bill is not reflective of their abilities, or the standard of care one receives.
LMFAO Doctors charge more in rural areas? I cannot speak for the rest of the country but I can tell you that is not the case in Chicago versus rural areas such as Ottawa. The bills in Chicago and places such as Wheaton Illinois are literally twice those in rural areas.
I am an engineer and my sister is a 3rd year resident. I started working right out of college and have no graduate degree. My sister's starting salary will be easily $300k+ after her residency but with the debt and the lack of meaningful salary for almost ten years after college, she will only really start being better off than me financially probably around the time she's 40. She easily puts in 100 hour weeks and has had to constantly had to study for board exams all throughout her 20's, not to mention the extra 4 years of school while I have been yucking it up with my yuppy lifestyle working only 40 hour weeks and going out every weekend, enjoying life in my 20's. Anyone who decides to become a doctor because of the money is an idiot and they deserve every dollar they make for sacrificing their good years on studying and training.
I should have said Doctors typically "make" more in rural areas... As hospitals far out have to compete and typically pay more to get internists/specialists to come there to work. From a billing standpoint, yeah... you'll probably get billed much more in a med center hospital vs. a rural hospital... and again, that's not the doctors fault. The original posters point that it doesn't matter what sort of "training" your doctor has had since they all make the "same" money anyways is ridiculous... and further goes to show you that arguing about doctor's "salaries" as being the problem in healthcare is flat out false. The problem should, and always has been, whether or not people are getting access to the best possible standard of care.
I didn't mention the other countries like Canada because it only proves my point. OP is complaining about the lack of medical students in the U.S. and how it is artificially made to be competitive...well its about twice as hard to get into med. school in Canada. They also put the base salary for primary care physicians at 250K which is more than most in this country.
They bill what the insurance allows them to bill with respect to their specialty. Different specialties in turn command different amounts, and the specific codes for each visit vary as well. I know this because I did medical billing for a while in college. Also, to your point about the australian, carribean , etc doctors commanding the same amount, its because they received training in a specific residency and were able to obtain a spot. Its no secret that a foreign graduate will have MUCH MUCH tougher shot at getting a residency, the competitive ones...they can forget about it. To qualify for those residencies they actually have to be more qualified than the U.S grads, so that is why that acts to normalize those differences. Pretty soon however, residency spots are going to be curbed to the point only U.S grads will get them.
So Mr. Brightside takes the time to respond to your thread, and in response you call him "an arrogant infant?" I think it is clear who is acting the "infant" here, OP.
I just saw this, and at this point, I don't think you're here to have a reasonable discussion. There are some deep seated irrational hatred you carry. The thing most people don't understand is that only some doctors are employed by the hospitals. The rest have privileges and bill the patients independently. Those costs, even at the highest code used to bill for that visit, pale in comparison to the profits that hospitals make. It costs next to nothing for a tablet of aspirin, a formulation so simple you could make it at home, but because they control the availability of care in their facility they feel that they can mark up the prices up hundreds of times. The insurance companies are at the other end. The price you would pay to a physician for a self pay visit is drastically more than the amount the insurance actually pays to the physician for a patient visit. This is because of the agreement between the doctor and the insurance company. They are given the liberty to "allow" certain amounts for visits because it allows for a greater number of patients to be seen. Not only do they shaft the physicians with the claim denials (for reasons that would make you lol...) that they hope will pass the timely filing deadline so they won't have to pay out, but they shaft the patients themselves with the outrageous premiums and pre-existing conditions used to exclude them from coverage. Regarding your final point about an I-banker or law associate, you tell me what kind of stress you would be under if the decisions you make could cause someone's life to hang in the balance. To be accurate, more like 80 people a day. The rules of the game change and it turns into a burden more than the romanticized privilege you once thought it to be. To Rocketman, you may mean well, but you are basically attacking the people that are responsible for the presence of healthcare in this country, while ignoring the people that set procedural guidelines and generate outrageous profits out of them. You can have hospitals and insurances, but without doctors they are completely useless. The ones you ignore are also responsible for 90% of the charges.
Where are you getting this from? During undergrad, I was 2/3s of the way done with a PhD in cardiovascular physiology, focusing on the improper closure of fetal shunts. If I chose to go that route, my PI said that he would defend me for my dissertation after one last publication, as I had already published one paper as a 1st author in a high impact journal, and another as a 2nd author. Granted I really got lucky on that 1st author publication, a little over a year after graduating and I would have had my PhD. You do have to complete a post doc if you want a decent job though , but those don't normally last more than 3 years. Compare that to one of, if not the most intense schooling experiences for 4 years, following by grueling residency training that can take anywhere between 4-7 years. So, I have no idea why you repeatedly bring up the fact that PhDs have more schooling. Goto a PhD that performs medical research in the area of interest you would see a doctor for, and ask him for help. Since he has more schooling, I'm sure that he'd be able to fix you up.. and at a much lower cost ...right?
I wouldn't want a doctor treating me to have been anything less than the best and brightest of med students. You want the less competent med students to also be allowed to become doctors?
I don't think it is that hard to understand for most people here. We are a growing and aging population that has a tremendous demand for healthcare services. Yet in light of this huge demand, the American Medical Association, a trade union that protects its own has stymied at every corner for 50 years the creation of new medical schools, has disallowed other professions to cover facets of healthcare instead having everything go through physicians, and this has created shortages of physicians in the US thus artificially raising the prices to all consumers in the marketplace. Thereby their incomes are also artificially increased by around 30%-50% because of the shortage of doctors in this country. This has led to today the top 9 highest paid professions in the country are doctors! You had to go to number 10 to find CEO. Whereas in a CEO there is a wide range so a few significant outliers will skew that number higher so the typical one makes even less. We are paying much, much more to physicians than their counterparts in countries with not better results because of the maneuverings of a lobbying group designed to benefit its class of members. I think that is deplorable. I also don't see why more people aren't up in arms about this. I can understand why LosPollosHermanos and other doctors or those with wives, sisters etc. that are ok with it as they're benefitting from this. The rest of us however shouldn't have to stand for this crony capitalism on an enormous scale in the USA.
My point was you have a doctor trained in Nigeria or Pakistan and then squeaks into a residency spot and then after a few years will bill medicare or most insurance companies based on a CPT code. The Harvard trained physician that was the head of Mayo Clinic for 20 years does the same procedure and bills based on the same CPT code and gets paid the same. A McDonalds Cheeseburger of a Doctor shouldn't be paid the same as a Ruth's Chris steak. The system is so screwed up that really great doctors are billing the same as very poor doctors despite experience and other normal market tendencies. http://online.wsj.com/news/articles/SB10001424052702303873604579492012568434456 Medicare billing is a perfect example. The AMA didn't want it published what doctors billed the government and for 30+ years it was not public till recently.
