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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:49 AM   #81
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Re: More Details On My Savings and Salary.

I have been a nurse for 30 years. After two - four years you can work as a registered nurse once you pass the boards and start in the 40's. My friends all make somewhere mid fifties to high seventies and we are not in a high cost of living area. However there is a severe nursing shortage, ever wonder why? Work as a nurse for a few years and you will know.

Now the Doc's spent years in high cost school while the nurses were working. They can have loans of hundreds of thousands of dollars. I know very few who do not earn the money they make.

Obviously the original poster has made lifestyle choices like we all have. I will never amass near the fortune he will, but I am happy. That is the bottom line. If you want to live in a shack an outhouse and grow all your own food, fine. If your idea of happiness is to live in a 6000 sf house with high end new cars in the garage, that is a choice as well. Most of us are in the middle.

I do think that everyone benefits by reading "The millionaire next door" and books like "Your money or your life". It doesn't mean they are right, just that they make you think. Barreling through life thoughtlessly can leave you at 60 looking at a pile of cash thinking "What happened to my life?" I think that would be a greater tragedy than having less money to get you through your golden years.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 06:12 AM   #82
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by MedicalDoc

Pay docs $50,000/yr and you'll attract the type of people responsible for making sure that your luggage doesn't get lost at the airport. Can you imagine? "I'm sorry Mrs. Jones, we lost your husband during surgery......No, he isn't dead, we just can find him. We're hoping he just wondered over to the blood bank to find something to drink".

Isn't $50,000 what you said you pay the person who takes care of your kids? I guess by your standards they can't be very good at what they do since they don't make as much money as you do.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 07:29 AM   #83
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Re: More Details On My Savings and Salary.

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Originally Posted by Lazarus
Isn't $50,000 what you said you pay the person who takes care of your kids? I guess by your standards they can't be very good at what they do since they don't make as much money as you do.
I think your logic is totally wrong. He never suggested that if you don't make more than 50K you aren't good at what you do.

what kind of people do you think would be drawn to med schools is being a Doc paid $50K/year. I'm sure there would still be some hardcore humanitarians there, but most of the qualified applicants would go into business, law, or other sciences like they already have started doing. Places where you can still make a good living without the constant fear of being sued for the lack of being 100% perfect.

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 02:22 PM   #84
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Re: More Details On My Savings and Salary.

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Originally Posted by saluki9
I think your logic is totally wrong.* He never suggested that if you don't make more than 50K you aren't good at what you do.*

what kind of people do you think would be drawn to med schools is being a Doc paid $50K/year.* I'm sure there would still be some hardcore humanitarians there, but most of the qualified applicants would go into business, law, or other sciences like they already have started doing.* Places where you can still make a good living without the constant fear of being sued for the lack of being 100% perfect.

The question of protection form lawsuits and the Docs rational or irrational fear of same is a separate question. Physicians in many advanced countries make much less than they do in America- yet their patients live longer! Physicians in Canada make much less than in America, yet their patients live longer.

Sorry folks, but the " You won’t get quality people unless you pay them $250,000 p.a. just has no evidence to back it up.

A reasonably intelligent person who is good at delaying gratification can slog through medical training and if he chooses his specialty well, be essentially assured of earning $200,000-$250,000, with plenty more room on the upside. Medical school is not a place full of geniuses; it is full of very hard working practical grade-getters with good memories.

True, a major league ballplayer makes more- but that career choice entails a large risk of becoming a AA guy living on a bus somewhere in Podunk. Likewise, a successful software designer can make more for a short while, if she is in the right place at the right time. But how many do you know who thought this would be them, but instead they are slaving away at Amazon?

Obviously, the financing of medical training would have to change. Lots of government support, in exchange for year for year givebacks in underserved areas. Malpractice would have to be tamed. But IMO, if our medical caregivers are motivated by riches, we have designed the wrong system to attract the wrong people.

I apologize in advance to anyone who is hurt by my ideas.

Ha
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 02:37 PM   #85
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Re: More Details On My Savings and Salary.

I am in general agreement.* IMHO medical school should be free and docs should be paid a decent salary (and have humane schedules) during internship and residency. After that they also should receive a salary commensurate with their expertise and hours worked, and sorry gang - risk adjusted results.* Just as is done with immuzations, bad outcomes should be funded by a national insurance pool.* If a Doc gives bad care their practice limited and if it is repeated licence pulled.

I also think that there should be an outcomes based basic national health insurance and if some people want a higher level of coverage they should be able to purchase it (just like long term care coverage).*

Docs may receive less but they aren't in debt and receiving stipends for a good part of their adult life.

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 02:54 PM   #86
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by Brat
IMHO medical school should be free and docs should be paid a decent salary (and have humane schedules) during internship and residency. After that they also should receive a salary commensurate with their expertise and hours worked, and sorry gang - risk adjusted results.* Just as is done with immuzations, bad outcomes should be funded by a national insurance pool.* If a Doc gives bad care their practice limited and if it is repeated licence pulled.

I also think that there should be an outcomes based basic national health insurance and if some people want a higher level of coverage they should be able to purchase it (just like long term care coverage).*

Docs may receive less but they aren't in debt and receiving stipends for a good part of their adult life.
I'm OK with that. Just 35 years too late .

HaHa, I really like your underlying sentiments (your facts are open to question -- e.g. general health outcomes are far more closely related to diet, exercise, access to care, immunizations, reduced poverty, etc. NOT to the doctor's quality of care).* But I agree with the gist of what you are saying: if you allow reasonable hours, freedom from bureaucratic paralysis and frivilous law suits, and avoidance of hundred-thousand-dollar debts before you even start practicing, lower salaries would be palatable.

As for those who "need" to make > $500K per year, I would rather they do so in other lines of work. Nothing against those who achieve that now -- they played the game well. It's just the wrong place for such games. I have always been in primary care and let me assure you, the numbers are quite different from those you mentioned, yet I am happy with my choices.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 04:35 PM   #87
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Re: More Details On My Savings and Salary.

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Originally Posted by HaHa
yet their patients live longer! Physicians in Canada make much less than in America, yet their patients live longer.
Not that I doubt anything you're saying, but is there actually any data that shows that canadians live longer than americans or anything correlative about cheap doctors resulting in longer lives? Maybe they eat/drink/exercise differently in other countries? Maybe the broader availability of health care? Less obesity?

Your conclusions may be spot on, but if theres data to support this claim then I havent seen it yet.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:09 PM   #88
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Re: More Details On My Savings and Salary.

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Originally Posted by Cute 'n' Fuzzy Bunny
Not that I doubt anything you're saying, but is there actually any data that shows that canadians live longer than americans or anything correlative about cheap doctors resulting in longer lives? Maybe they eat/drink/exercise differently in other countries? Maybe the broader availability of health care? Less obesity?

Your conclusions may be spot on, but if theres data to support this claim then I havent seen it yet.
CIA world factbook lists 47 countries/entities with life expectancies longer than the US life expectancy. We did manage to edge out Cuba by a few months. Castro musta killed a bunch of political dissidents. Canada's life expectancy is a few years more than ours.

http://www.cia.gov/cia/publications/.../2102rank.html

Not sure how the CIA arrived at these figures.

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:15 PM   #89
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Re: More Details On My Savings and Salary.

I was a lot more interested in the correlation between cheap doctors and longer life spans.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:24 PM   #90
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by Cute 'n' Fuzzy Bunny
Not that I doubt anything you're saying, but is there actually any data that shows that canadians live longer than americans or anything correlative about cheap doctors resulting in longer lives?* Maybe they eat/drink/exercise differently in other countries?* Maybe the broader availability of health care?* Less obesity?

Your conclusions may be spot on, but if theres data to support this claim then I havent seen it yet.
I am not attempting to show that cheap doctors produce longer lifespan in their patients. You and Rich are right, there must be many factors. Still, as Justin cites in his post above, it is clear that expensive doctors are certainly not a particularly powerful force in prolonging lifespan.* ** And it is hard to deny that when health is the topic, average lifespan is a salient metric.

Just for a thought experiment- since our very expensive MDs and system of medical technology are at best no better in terms of length of life than many cheaper systems, often in much poorer nations, we could always redirect some expenditures toward whatever might be shown to be more decisive in producing better outcomes.

Ha

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:34 PM   #91
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by HaHa
Just for a thought experiment- since our very expensive MDs and system of medical technology are at best no better in terms of length of life than many cheaper systems, often in much poorer nations, we could always redirect some expenditures toward whatever might be shown to be more decisive in producing better outcomes.
I'd hate to be subject to a system that confuses quality of life with lifespan.

I also notice that the countries that do the best job of collecting all the data are frequently the countries that can't make the top 10 ranking. Not that Cuba would have any motivation to mess with their numbers...
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:47 PM   #92
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Re: More Details On My Savings and Salary.

I think that in some measure, education and training are investments in one's future. Physicians invest a decade (and sometimes longer) and hundreds of thousands of dollars in postgraduate training and lost wages while their contemporaries head out into the job market. One return on that investment is financial security in latter years. Other returns include engaging in work that is personally rewarding and intellectually stimulating. As I read some of the posts, I am bemused by those who pride themselves on their ability to achieve high returns on investments in the stock market, but then seem too willing to condemn those who achieve high returns on investments in education and training.

Reducing the cost and expense of becoming a physician would make lower salaries more palatable. Of course, reducing investment always reduces the expected return whether we are talking about investments in stocks or investments in education and training.

Finally, I don''t know at what salary you cease to attract high quality people into medicine. Interestingly, about 6-8 years ago it was widely reported and believed that with the growth of HMOs, job opportunities and salaries for physicians in hospital specialties (i.e anesthesiology, radiology, and pathology) would be substantially reduced. As a result, the number of American medical school students applying to these specialties dropped dramatically. In my field (anesthesiology), this number dropped in a single year from an average of 1500 to approximately 150. As someone at an academic hospital who trains residents, it was pretty obvious that the foreign med grads who stepped in to take their place were nowhere near as bright or capable. Fortunately, the outlook has improved dramatically and these specialties are recovering. But the supply of specialists remains low (because most people are not willing to make the investment) and the demand is high and growing (aging population).

And physicians in Canada do make less. In fact, medical costs, in general, are substantially less there. That's why it can take years to get non-urgent surgery like a hip replacement (unless you cross the border to get it done in the US) and you can die from a brain tumor before you ever get an MRI of your head.

Kinda funny, we cross the border to get cheap perscription drugs in Canada and they cross the border to get timely medical/surgical care in the US.

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 05:50 PM   #93
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Re: More Details On My Savings and Salary.

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I'd hate to be subject to a system that confuses quality of life with lifespan.
Well, not sure where this problem is coming from. In medical research, when one treatment is compared to another, DEATH RATES in the contrasted treatments are generally accepted to be "hard data". Pretty hard to fudge death; you are alive, or you are dead.

Now you seem to be positing some situation where you are doing really well with a great quality of life, but then you die. Whereas the other guy, with a lower quality of life (and in some other country from you) struggles along with his miserable but longer life?.

Well, whatever.* *

Ha
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 06:07 PM   #94
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by Cute 'n' Fuzzy Bunny
I was a lot more interested in the correlation between cheap doctors and longer life spans.
Alas, doctors (cheap or expensive) have very little effect on lifespan in "developed" countries, as you have seen. It's not that we don't add value, etc. but rather that the societal issues vastly overwhelm the statistics. Humbling to me, though i would like to think that compassionate docs add a lot to the quality of life for ill patients, and yes, we occasionally save a life here and there.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 06:27 PM   #95
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Re: More Details On My Savings and Salary.

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Originally Posted by MedicalDoc
I think that in some measure, education and training are investments in one's future. Physicians invest a decade (and sometimes longer) and hundreds of thousands of dollars in postgraduate training and lost wages while their contemporaries head out into the job market. One return on that investment is financial security in latter years. Other returns include engaging in work that is personally rewarding and intellectually stimulating.
That would explain the popularity of the TV shows "Scrubs" & "Grey's Anatomy".

Quote:
Originally Posted by HaHa
Now you seem to be positing some situation where you are doing really well with a great quality of life, but then you die. Whereas the other guy, with a lower quality of life (and in some other country from you) struggles along with his miserable but longer life?.
No, I'm referring to healthcare systems that won't take the surgical risk on bad hips or prostate glands because they're afraid they'll kill the patient. A bunch of money is spent on U.S. research, funded by 78 million Boomers with abused hips & prostates, to find safer operating procedures & non-surgical alternatives. I doubt that research was pursued with the same funding or enthusiasm by all countries, but I'm sure they'll reap the benefits of the U.S. research. Yet who's paying for that?


Quote:
Originally Posted by HaHa
Well, not sure where this problem is coming from. In medical research, when one treatment is compared to another, DEATH RATES in the contrasted treatments are generally accepted to be "hard data". Pretty hard to fudge death; you are alive, or you are dead.
Quote:
Originally Posted by Rich_in_Tampa
Alas, doctors (cheap or expensive) have very little effect on lifespan in "developed" countries, as you have seen. It's not that we don't add value, etc. but rather that the societal issues vastly overwhelm the statistics. Humbling to me, though i would like to think that compassionate docs add a lot to the quality of life for ill patients, and yes, we occasionally save a life here and there.
Gosh, there's no messing with statistics!

Have you noticed that baseball's veteran shortstops have lower error rates than their rookie counterparts? It's because the older shortstops won't dive headlong after a ball that they "know" they can't catch.

Have you noticed that basketball's "hot hand" theory has been proven statistically invalid? It works, however, because the rest of the team believes in the theory and makes sure that the "hot hand" player gets more scoring opportunities, even as their scoring average reverts to their mean.

It's the same way with death statistics. A doctor with high-tech equipment & advanced training is supposed to dive after that line drive, and in fact his competence is questioned if he doesn't. American EMTs & ERs spend horrendous amounts of money & effort reviving patients who were "DOA", and American neonatal ICUs tackle premature births that many other countries would just sadly log as "died during childbirth". But every success story is greeted with a disporportionally higher number of-- for lack of a better word let's call them "failures"-- that are used as proof that the system's not worth the effort.

Except for that shortstop who makes an impossible catch. And the families of the survivors.

When it's applied personally, I suspect most cost-conscious taxpayers would decide: "Screw the system's cost effectiveness. When my vital organs are being hosed off the freeway, I want the first team on duty in the ER."
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 06:53 PM   #96
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Re: More Details On My Savings and Salary.

MedicalDoc:

You talk about being accustomed to your current lifestyle, and so need the funds to allow that same lifestyle in retirement.....

There are other things you and your wife receive from your careers today - prestige, recognition from colleagues, a history of accomplishments, etc.

When you retire those things tend to fade too. it can be a major issue.

Some people continue to work part time or consult to keep a tap into that powerful career source of ego strokes and validation. Not to be taken lightly!!

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Re: More Details On My Savings and Salary.
Old 03-22-2006, 07:20 PM   #97
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Re: More Details On My Savings and Salary.

MedicalDoc
I appreciate the time and investment that you made for you career. I have a bs and ms engineering degree and cannot even imagine going through medical school and residency. You certainly deserve to make a good income after that envestment of time and $.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 07:31 PM   #98
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Re: More Details On My Savings and Salary.

Quote:
Originally Posted by HaHa
Well, not sure where this problem is coming from. In medical research, when one treatment is compared to another, DEATH RATES in the contrasted treatments are generally accepted to be "hard data". Pretty hard to fudge death; you are alive, or you are dead.
Wish it were that simple, but it rarely is. More often, the result is that treatment A gives a 78% survival, and treatment B gives an 88% chance, and treatment B is 4 times as expensive and has additional side-effects.

How about this one: average middle aged man, standard risk might have a 0.8% chance of a heart attack or sudden death each year. High cholesterol? The risk might be 1.3% per year. Add GorillaStatin? Reduce that 1.3 down to 1%. These approximate real world numbers.

So, DrugsRUs says that GorillaStatin reduces your risk of a heart attack by 23%. True enough, for relative risk of 1.3% versus 1%. Absolute risk is more like 0.3% per year, each daily tablet going for about $2. You have to treat about 330 people to prevent one heart attack a year (330*$2*365 = about $241,000 a year).

Anyhow, not trying to dazzle with numbers, just to show that these health care issues can be complicated, and parties do have a tendency to spin it to their advantage.
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 07:42 PM   #99
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Re: More Details On My Savings and Salary.

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GorillaStatin
Hey, Doc, earlier this year we learned that some hormone-therapy medications are made from equine urine.

Gotta be careful with those generic drug companies. I don't wanna know where GorillaStatin comes from or how they extract it in the first place...

Just one more incentive for an ounce of prevention!
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Re: More Details On My Savings and Salary.
Old 03-22-2006, 07:43 PM   #100
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Re: More Details On My Savings and Salary.

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Hey, Doc, earlier this year we learned that some hormone-therapy medications are made from equine urine.

Gotta be careful with those generic drug companies. I don't wanna know where GorillaStatin comes from or how they extract it in the first place...
While we're on the subject, anyone know exactly how much whiz is in cheese whiz?
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