More Details On My Savings and Salary.

[Rich_by_the_Bay]

I don't wanna know where GorillaStatin comes from or how they extract it in the first place...

No, you don't.

Just use your imagination, and you will never, ever be pissed off again at how much your doctor earns 8).

I use that one with my students and residents all the time. Never fails.

 

[MedicalDoc]

  Good points about death rates, Nords.  Even in this country, one of the potential unintended consequences of attempts to compare hospitals or physicians using outcome statistics (like death rates) is a reluctance by some to offer surgery to high-risk patients who may negatively affect the statistics (and cost more to care for, to boot).  To use your sports analogy,we don't want to get the point where nobody is willing to dive for that tough grounder or kick the 50 yard field goal.

 

[Nords]

...or kick the 50 yard field goal. 

And then we'll just move the goalposts back another 10 yards.

 

[justin]

While we're on the subject, anyone know exactly how much whiz is in cheese whiz?

The internet knows:

http://www.cockeyed.com/inside/cheese/cheese.html

(one of my favorite sites )

 

[haha]

One last post on the topic of death rates. While the caveats various people have mentioned might be meaningful in comparing one hospital or one doctor to another, they are not when comparing one country to another.

If the heroic surgeon/shortstop kills enough people on the operating table to increase the overall death rate from all causes in the entire country- well if you guys can't parse that, then I hope you will be around to take the opposite side of my trades.

Frankly, to me it mostly sounds like spin. And fairly transparent spin at that.

Ha

 

[Ed_The_Gypsy]

Don't you think we've beat ol' MedicalDoc to death? Let him work for another 10 years. His widow will be happier.

(And I will be on the beach in Mazatlan on IMSS, dying of cirrosis.)

 

[ladelfina]

MedicalDoc, this is all fascinating.. I see where you are coming from, and yet... I don't.

My dad was a general surgeon. Made nothing like the numbers thrown out here, I don't think. This was back in the days before HMOs. It was either fee-for-service or Blue Cross, basically. I remember he was usually around but never did have time to play with us because he spent all evening filling out forms or using the Dictaphone! He charged less to patients of lesser means, and some patients literally paid him in tomatoes. I never knew exactly what he made. He did have his turns at being on call for emergencies, and there were those occasional midnight phone calls where he had to run out.

I know he was completely devoted to his career and to providing for his family, but being the typical teenager, we didn't "communicate" all that well, and I myself missed out on opportunities to learn from him. We were both stubborn and kind of arrogant so we were usually at odds more often than not. It's hard looking back for me to say whether if he had been less occupied and more available whether that would have made a big difference.

On the other hand, yes, I had a super-expensive education paid for. He established investment accounts for me and my sister and gradually turned these over to us when we were in our 20s. If we had had different temperaments, we might have just gone off to Katmandu or Ibiza and blown the lot, but we didn't; we knew it was our nest egg. I chalk this up to our parents' super-conservative live-below-your-means lifestyle. The only thing that said "doctor" was the Caddy in the driveway (historically an Oldsmobile.. man, that Olds 98 was one loooong car, as the pole in the local supermarket parking lot can testify..hey, I was 17!).

Vacations for us were a week in NH at one of those cheesy "family" camp/resorts with little cabins that were actually really great for kids, though we would now probably turn our noses up at it. Also a 'cabana' (actually a changing booth) at a local beach club for the summer.

Going "out to eat" was special and consisted of the "Mr. Twist" or fried clam strips (yum!) at HoJo's.  We got clothes at Sears (the "Lemon Frog Shop"!). I remember a huge fight with my mom when I wanted a pair of real Earth shoes, and she said I could only get the Sears version... . (But at Christmas we almost couldn't move in the living room for the piles of toys, which took us numerous hours to unwrap.)

My dad was forced to retire in his early sixties due to heart attack (complications also from TB, which he contracted working in a Navy hospital.. he had had one lung removed and part of the other.. we as kids were never aware of this). He got one of the first defibrillator implants but had a couple of ICU episodes that were very painful just to observe; I can't imagine what it was like to go through personally. The first time the defib. went off was when I was home from college and it couldn't be turned off.. it kept shocking him all the way to the hospital. Very scary, and after that my mom always carried around a big-ass magnet that kept obliterating all her credit cards. Anyway, he got another 10 years of life out of the defib./retirement/having quit smoking (yep.. min. 2 packs a day on half a lung), and he was OK but really DID NOT WANT to be retired. He often commented on his colleagues still working at his age; he really missed interacting with the patients and staff. Fortunately for him he did not die in the hospital but went into arrest as he and my mom were driving somewhere for lunch.

MedicalDoc, are you sure you & your wife will really want to be retired at 60? Maybe a better idea is to work less now and have more time to enjoy life while it is happening, rather than saving it up for a retirement where your health and energy are not going to be at the levels they are now. As you get older you can still keep your hand in, and probably make more per hour given your extra years of experience.

You may say now that you "need" to spend $250k/year, but I bet you can trim that to $200k or $175k without feeling too much pain. Reducing your spending $50k means not having to make $80k pre-tax to cover it. That "buys" you x amount of your life back..NOW. There's been a lot of talk about your income, but not about your spending, which is equally important. I'll second the other posters who've recommended "Your Money or Your Life". While you may not see yourself in the book, the principles are sound.. (just multiply every number you see by 10..  ) !

When I think back on life with my dad, I just remember that at home he was quick to get angry and was very impatient.. something of a tyrant.. Yet when we met people who were patients or co-workers, they all spontanously beamed and went on&on about what a great guy he was! We thought they were nuts.. they couldn't be talking about the same person, right?

Something to think about.

P.S. Have you read the book "Complications"? V. interesting and (I think) honest first-person essays about doctors, health care, and the human element. Maybe a doctor doesn't need to read it, but I think the general public should.

P.P.S. I would rather have my money go to the doctors/nurses/hospital than to some insurance company executive. I don't see what the latter add to society to justify their 6-figure incomes...

 

[Spanky]

P.P.S. I would rather have my money go to the doctors/nurses/hospital than to some insurance company executive. I don't see what the latter add to society to justify their 6-figure incomes...

I agree - it's outrageous to see compensation of executives from the health insurance industry commanding a compensation of of millions. For example, the lastest total compensation of Bill McGuire from United Health Group is $124.8 million. I saw an ad that they are also looking for a CFO. The base salary is $350K. The total compensation is unknown but probably in the millions.

 

[Nords]

P.S. Have you read the book "Complications"? V. interesting and (I think) honest first-person essays about doctors, health care, and the human element. Maybe a doctor doesn't need to read it, but I think the general public should.

Wonderful book. The guy is probably a pariah among his colleagues now...

 

[cute fuzzy bunny]

fried clam strips

Clams without bellies are also known as "rubber bands"

 

[Martha]

Ladelfina, fascinating story about your dad. My dad too lost a lung to TB, and spent years in a TB sanitarium before I was born. Most of his good friends were doctors who worked at the san and ended up with TB. He ended up marrying a nurse who worked there.

My father was the most patient person I have ever known.

 

[Meadbh]

Oh yeah, it's cheap here.  When I said "small town", I'm talking a population of 5,200 people. 

HOUSING
We've lived in the same house since 1990, and we bought it for about 50K.  Added a pool and have remodeled a couple of times, but still very cheap digs. 

Cardude, you are in good company. Warren Buffett bought his house in Omaha for $31,000 and still lives there. See

http://www.forbes.com/billionaires/2005/03/10/cx_sc_bill05_0310home.html

 

[Meadbh]

Cardude, you are in good company. Warren Buffett bought his house in Omaha for $31,000 and still lives there. See

http://www.forbes.com/billionaires/2005/03/10/cx_sc_bill05_0310home.html

omigod....maybe Cardude IS Warren Buffett!

 

[Meadbh]

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.

On the subject of effectiveness of medical care, one of the most challenging features of healthcare management is to ensure that people get the care they need and don't get care they don't need (which can be harmful as well as costly). Dr. John Wennberg, who developed the Dartmouth Atlas, has led some fascinating research on this and has come up with the notion of three types of healthcare:

Effective care includes care for which there is good evidence and general agreement on the need. e.g. fixing a broken leg.

Preference sensitive care is care for which two or more options are available and there are two or more reasonable choices the patient could make. e.g. different types of surgical management for breast cancer.

Supply sensitive care is the most interesting; it's care that seems to be delivered in a pattern that reflects the supply of hospitals and professionals rather than the population's burden of illness. e.g. back pain surgery. If you take a look at the Dartmouth atlas (URL below) you will see tremendous variation in this type of care across the US, with corresponding variation in healthcare costs, but no corresponding variation in outcomes. In healthcare, more is not necessarily better.

http://www.dartmouthatlas.org/agenda.shtm

For more on population health, check out this site (sorry, I don't know a US equivalent offhand)

http://www.phac-aspc.gc.ca/ph-sp/phdd/determinants/#res_and_ev

 

[Brat]

Echoing Meadbh: Oregon healthcare plan tried the outcomes approach several years ago, got beaten up by those who said they were denying medically approved care. For some it is all or nothing. To me it is similar to sayng we should live in tents because McMansions can't be provided for all.