dumb doctors

[Meadbh]

mdPassport

The Medical Post hit a nerve when we asked physicians about retirement planning. We contacted Dr. Raj and other doctors to find out how they are saving for retirement, and whether they think their government should help by setting up a pension plan. Our interviews supplement findings from our exclusive online survey of physicians recently conducted with our Web partner, mdPassport. ​

The pension survey was completed by 642 physicians earlier this summer. Respondents were in private practice (58%), academic medicine (19%) or working at a community-based hospital (19%). Respondents were divided evenly between solo practitioners, those who worked in small groups and those who worked in larger group practices. Half (54%) of our respondents were family physicians or GPs, while the other half were specialists. ​

This is a profession struggling with the issue of retirement. Only 61% of doctors plan to retire at or before age 65. A huge majority (91%) would be willing to contribute financially to a pension plan if their province offered one. In fact, 76% believe a pension plan for doctors is the most critical financial strategy in future negotiations with government.​

 

[kumquat]

I couldn't read the whole article but curious:

1) Are you Canadian?
2) A physician?

I am Canadian and have a few doctor friends. I think they expect to be 'self-employed' until they 'retire'. Trouble is, they don't save.
A story supplied by an 'enlightened doctor', conversation between doctor and accountant:
Doc: I want a new Beemer.
Acc: You can't afford it.
Doc: Of cource I can, your job is to show me how.

Canada doesn't have to worry about it's doctors retiring, just nurses (they have pension plans).
Annocdotal evidence: I have a doctor friend: 3 ex-wives to support, low-paid speciality (if one exists), 70+YO. Still practicing. Canada is gratefull that he is w*rking, our area can't attract someone with his training, he can't afford to quit. What physician shortage?

 

[packrat44]

My experience with doctors here in the US is that a large portion of them are "large hat, no cattle".

 

[Rich_by_the_Bay]

My experience with doctors here in the US is that a large portion of them are "large hat, no cattle".

Alas, I've got to agree.

Part of it is bad planning and ignorance. Part of it is crushing debt still being paid off at age 40 or beyond. Entering your profession at age 30 with $200K of debt is not easy and compensation is not what it once was, especially in the all-important primary care areas.

In my case, there were elements of both. Fortunately a) I have had the honor of loving my work, and b) I woke up at age 40 and started scrambling in the nick of time. Now its time for some balance.

Combine all that with a cultural selection bias for grandiosity and it is no surprise that lots of docs are forced to work til age 65-70 despite the big house and fancy car. Alot of them say, "I love my work so much I don't even want to stop." Smoke, IMHO.

 

[barbarus]

Here is a guide to riches for the family practitioner. The solution?
Burn through even more patients per week.
Probably a quickly burned-out doc thereafter!


Rich, do these income figures look accurate to you? FP income hasn't risen in 10+ years?


Getting Paid - July/August 2005 - Family Practice Management

 

[packrat44]

Combine all that with a cultural selection bias for grandiosity and it is no surprise that lots of docs are forced to work til age 65-70 despite the big house and fancy car. Alot of them say, "I love my work so much I don't even want to stop." Smoke, IMHO.

About 5 years ago the broker I was using at the time brought some papers by my house for me to sign. During the conversation the subject of financial independence and retirement came up. He had recently spoken with a surgeon who wanted to retire in 3 years at 65 YO. The broker told the surgeon he needing to greatly increase his investments if he wanted to retire. Surgeon's reply was he needed a new engine in his yacht and his DW needed a new Mercedes; therefore, there was no money for investments. The surgeon had an annual income of over $200K but only had $300K in total investments, excluding the equity in his McMansion.

All his options looked bleak: 1) live on a radically small income with SS; 2) continue working for rest of his life; 3) after a couple years of retirement at 65 and living the good life, they could call Dr K and see if he would come out of retirement. I would hate to choose any of those options.

 

[Rich_by_the_Bay]

Rich, do these income figures look accurate to you? FP income hasn't risen in 10+ years?

Don't know. I'm an academic internist/hospitalist/section chief. That's a totally different category. I do well for a nonsurgeon and probably far better than family medicine.

The latter has gotten clobbered both financially and in "popularity" or prestige. Residency programs have failed to fill all their openings for years.

 

[ndfmnlf]

Originally Posted by barbarus
Rich, do these income figures look accurate to you? FP income hasn't risen in 10+ years?

Based on conversations I've had with FP colleagues, they look accurate. However, FPs tend to make more money in rural areas where they can do OB care....some may net $200-250K.

 

[Meadbh]

I couldn't read the whole article but curious:

1) Are you Canadian?
2) A physician?

I am Canadian and have a few doctor friends. I think they expect to be 'self-employed' until they 'retire'. Trouble is, they don't save.
A story supplied by an 'enlightened doctor', conversation between doctor and accountant:
Doc: I want a new Beemer.
Acc: You can't afford it.
Doc: Of cource I can, your job is to show me how.

Canada doesn't have to worry about it's doctors retiring, just nurses (they have pension plans).
Annocdotal evidence: I have a doctor friend: 3 ex-wives to support, low-paid speciality (if one exists), 70+YO. Still practicing. Canada is gratefull that he is w*rking, our area can't attract someone with his training, he can't afford to quit. What physician shortage?

Sorry you couldn't access the site. I guess it's member only. Anyhoo.....yes, I 'm a Canadian physician. And I responded to the survey. But obviously my FIRE philosophy leaves me out in left field!

Retiring nurses are already leaving big gaps in their wake. And despite the obvious lack of financial savvy among physicians, leading to forced non-retirement, we are running short. Canada currently has one of the lowest physician to population ratios in the Western world. Part of this has to do with the Barer Stoddart report in the early 90s. Physician workforce planning was done on the mistaken assumptions that women (who form an increasing percentage of the workforce) would never jobshare or take maternity leave, and that physicians would go on slaving 70-80 hours per week with ridiculous call schedules, and would never retire.

But some of the inability to retire is guilt. Physicians in underserved communities who CAN afford to retire come under pressure from the public and from community leaders to hang on "for just one more year" until they can be replaced.

 

[Martha]

Here is a guide to riches for the family practitioner. The solution?
Burn through even more patients per week.
Probably a quickly burned-out doc thereafter!


Rich, do these income figures look accurate to you? FP income hasn't risen in 10+ years?


Getting Paid - July/August 2005 - Family Practice Management

I used to represent some clinics employing family practice docs and the numbers are consistent with what I have heard. Also true for pediatricians. As I posted on another thread, in my city of 80,000, the pay range for docs is extreme, varying from about $75,000 to about a million five.

 

[deserat]

Did you read the rest of the report? They were advised to see more patients - 8 more a day than the average - either the MD's day gets longer or the patient's interaction gets shorter - I'm sure it's a combination of both. Doesn't make for a pleasant experience on either side and if bad news is involved could snowball into problems. Very sad. Add to that the obsession with technology at times and that 'human' touch is lost. Also, making $140K per year is not too shabby - still puts one in the very high earner percentage - notwithstanding crippling college loans, one could amass savings fairly quickly to retire early or reduce hours if they decided that was a priority - probably not with the McMansion, boat, Mercedes, plane and exotic vacations, but better than most on this board (including me and I think I get paid fairly well).

 

[Rich_by_the_Bay]

Many family docs see 35-40 patients a day. Granted, these patients are not nearly as complicated as seen by internists, but I can't imagine practicing under such circumstances.

My hat's off to them for meeting the need, but it wouldn't work for me. As a patient or a doctor.

 

[windsurf]

Many family docs see 35-40 patients a day. Granted, these patients are not nearly as complicated as seen by internists, but I can't imagine practicing under such circumstances.

My hat's off to them for meeting the need, but it wouldn't work for me. As a patient or a doctor.

My hat is not off. I respect your integrity in asserting that it wouldn't work for you. Is it better medicine if the present system "forces" docs to see more patients in ever tinier "modules" of time conceived of by some bean counter who is seeking per his/her MBA to maximize the profits of the medical corp? Combine that dimunition in optimal care with our insurance system (if you are lucky enough to have it) that discourages seeing the doc in the first place for health concerns that are subject to a huge decuctible or co-pay.

 

[Martha]

At least in some large clinic practices, there is tremendous pressure to meet "goals" and a pressure to change your status (to part time with reduced bennies) or leave if you do not see a certain number of patients. The carrot is a lot more money if you roll through more patients.

All driven by the ways insurance companies reimburse for medical care.

 

[Rich_by_the_Bay]

At least in some large clinic practices, there is tremendous pressure to meet "goals" and a pressure to change your status (to part time with reduced bennies) or leave if you do not see a certain number of patients. The carrot is a lot more money if you roll through more patients.

All driven by the ways insurance companies reimburse for medical care.

True enough, as well as constant downward pressure on reimbursement; the doctor can't raise fees much (those are largely pegged to medicare and bullying insurance companies), can't improve efficiency (large clerical staff just to do insurance work), and expenses rise every year. "Gimmicks" such as in-house lab machines are impractical due to CLIA laws and other legal constraints, other than in large clinics and even there, special laws require measures to prevent the ordering physician from benefitting directly from tests on medicare patients.

About all he or she can do is work harder and we all know that's a loser's game beyond a certain point. Big bucks specialties can absorb all this and still do very well, but primary care (internal medicine, pediatrics, family medicine) is no longer a viable entity unless it is subsidized through other income sources. In my case, part of my compensation includes stipends for teaching, senior admin duties, and the like. In groups, highly paid surgical specialists share receipts to some extent in order to harvest their referring doctors.

It's a mess. If I were younger, I might consider starting a concierge practice which required an annual retainer to be my patient, fee for service, in return for which I have fewer patients and super availability. Then I'd take 1 day a week and work in a free clinic for the indigent for free.

Maybe I'd call it the Robin Hood Clinic.

 

[DblDoc]

And we haven't even touched on the time consuming rules, policies and procedures we have to work under to meet JCAHO requirements. While I applaud their goals of quality and safety the cost is significantly less time available to spend with patients.

DD

 

[Rich_by_the_Bay]

And we haven't even touched on the time consuming rules, policies and procedures we have to work under to meet JCAHO requirements. While I applaud their goals of quality and safety the cost is significantly less time available to spend with patients.

DD

DD, what's your field if you don't mind my asking?

 

[windsurf]

I used to represent some clinics employing family practice docs and the numbers are consistent with what I have heard. Also true for pediatricians. As I posted on another thread, in my city of 80,000, the pay range for docs is extreme, varying from about $75,000 to about a million five.

I think the pressures that commodify the patient are very much across the board cutting through those income ranges. The orthopod who is addicted to making a half million to a million or more a year makes it in the OR, not seeing patients for careful screening or follow up.
The family doc or internist who needs to spend time doing a thorough work up is more likely to utilize pigeon hole lab panels and remibursible radiography than to "waste" time getting a thorough history from patients who are often inarticulate or hesitant to the point of bordreline dishonesty about their symptoms and relevant past. I think it is going to get much worse before it gets better.

 

[DblDoc]

Rich - Emergency Medicine

DD

 

[teejayevans]

Many family docs see 35-40 patients a day. Granted, these patients are not nearly as complicated as seen by internists, but I can't imagine practicing under such circumstances.

My hat's off to them for meeting the need, but it wouldn't work for me. As a patient or a doctor.

I went to a urgent care facility because I had an infection from bug bite,
we spent 2 minutes on the bite, 28 minutes on golf. I'm guessing I paid
for 1/2 hour consultation. If antibiotics were over the counter, I could
have saved $125.
TJ

 

[Martha]

Man, I would rather have pain killers than antibiotics over the counter. Can you imagine how much faster antibiotic resistance would grow?

 

[bosco]

I went to a urgent care facility because I had an infection from bug bite,
we spent 2 minutes on the bite, 28 minutes on golf. I'm guessing I paid
for 1/2 hour consultation. If antibiotics were over the counter, I could
have saved $125.
TJ

sounds familiar. I had some nasty bites that I couldn't identify. Was on a bike trip to Sturgis, so I went to the clinic. The doc was sure they were scabies, but a test showed they were not. He finally diagnosed "topical skin irritation." Gee--that sounds a lot like "I don't know." Prescribed cortisal creme--which helped the itching. The fee for the visit wasn't bad--$80. Except that all it really represented was a finders fee for the creme since I got no diagnosis.

My wife finally made the diagnosis--chiggers. She's a doctor, but a PhD in education. But thanks to the internet and some online photos, the symptoms and pattern were a dead match.

The confusing thing is that I had been to central Oregon and Southern Idaho at the time the bites occurred. This was fairly far north for chiggers, and probably a South Dakota doc wasn't familiar with them. Guess the little buggers are moving north.

 

[DblDoc]

Man, I would rather have pain killers than antibiotics over the counter. Can you imagine how much faster antibiotic resistance would grow?

With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD

 

[barbarus]

With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD

Your reference, doctor?

 

[Rich_by_the_Bay]

Some people seem to think that antibiotics are basically all one drug with a few variations on the theme. Not so. Some are very focused in their action (only affect one category of bacteria) while others are very "broad spectrum." Some have potentially fatal side effects while others are extremely safe in nonallergic patients. The wrong antibiotic creates risks of resistant infections without benefit.

Already we are fighting drug resistant germs I would no have dreamed of decades ago. I see lots of patients with no white cells and blood stream infections; it can be very challenging as the race for new drugs loses ground to the emergence of multiple drug resistance.

And some people feel that "colds" need antibiotics (they don't and are viral not bacterial) but even antiviral drugs, spawned by AIDS, are beginning to create drug resistent viruses.

I shudder when I see them available in other countries like Mexico, and am glad they are controlled here. More generics would be nice.