What do you think... is med school worth it for the kids?

Parents Forum
81

<p>"Unfortunately, that's one of the things that's wrong w/ our healthcare system. There's no emphasis on preventative medicine (which is what family med and internists would excel at) and compensation is procedure-based. I talked about that w/ my WashU Med interviewer, an internist, and we talked about the battle b/w surgeons, cardiologists, and interventional radiologists over who gets to do angioplasties"</p>

<p>Not trying to highjack this post but..... if you LOOK at most health plans (probably your own, not the el cheapo crapos) you WILL find most plans allow 100% coverage for preventative care, mamograms and the like. It's usually capped between $300-500 depending on the plan. Which means in most cases IF a person goes in for a preventative check up once a year, it should be covered in full or at a minimal cost.</p>

<p>Here's the real rub (of which I too was guilty of) most folks don't get off their arses to schedule an appointment to go see the doc. </p>

<p>There is incentives (try 100%) to go in and get checked, but alot of folks don't. I'm talking just about every plan in my state. The el cheapo stinkos I'd like to name but I don't think I'm allowed. </p>

<p>Now back to our daily thread. </p>

<p>I know one quick reaction to my post is well what if they find something "how's $300 supposed to cover that?" ( that was a true question more often than I can count) well... it's no longer preventative at that point is it? ;)</p>

82

<p>I think preventive care is doable from the patients perspective, but for the purposes of this thread, it doesn't reimburse very well, so there is little financual incentive from the doctors perspective. A very loose example is how much longer it takes to talk to someone about caring for themselves when they have the flu, vs. givimg in to the pressure to prescribe an antibiotic. It takes longer to talk about child development and behavioral interventions then it does to prescribe ritalin. Or to listen to someone or sit with them when they cry instead of prescribing an antidepressant. Of course the last two are near and dear to my heart, but there are examples for diabetes, high blood pressure, weight management, back pain, etc.</p>

83

<p>Sorry, what I meant was that there is little incentive for the physician to practice preventative medicine since his reimbursement comes from the tests/procedures he does. Logic would dictate that he loses money if he helps a patient get better (or prevents an illness) w/o doing procedures.</p>

<p>edit: Shrinkrap beat me to it.</p>

84

<p>
[quote]
Speaking of Medicare, I've heard that it's in the middle of the road in terms of reimbursement. I guess not?

[/quote]
</p>

<p>That would be "not."</p>

<p>Medicare reimbursement is lousy and pays much less than typical "private" insurance. Global Medicare reimbursement is constrained by the Sustainable Growth Rate formula which has the effect of mandating annual medicare global reimbursement cuts despite increasing health care delivery by providers.</p>

<p>
[quote]
Medicare payments to physicians are modified annually using the sustainable growth rate (SGR) formula. Because of flaws in its methodology, the SGR mandated physician fee cuts in recent years; only quick congressional fixes averted these cuts. Absent long-term congressional action, the SGR will mandate more fee cuts for the foreseeable future. In July, the U.S. Centers for Medicare and Medicaid Services issued a proposed rule to cut payments by nearly 10 percent effective in 2008, and payments are expected to drop by more than 40 percent by 2015.

[/quote]
See Medicare</a> Sustainable Growth Rate and the AMA's summary article: <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_ppfacts.pdf%5B/url%5D"&gt;http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_ppfacts.pdf&lt;/a&gt;&lt;/p>

85

<p>
[quote]
You should see the doctor's McMansions within a quarter mile of my house. There's a whole cluster of them. And those guys are probably early fifties at the oldest.

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<p>Well, just as a side note I'd point out don't ever try to judge a persons actual wealth by the size of their house. Given that up until recently many lenders would let someone with a McJob buy a McMansion I don't think you can accurately assume much of anything about their financial situation other than that they likely have a lot of debt. </p>

<p>
[quote]
dbreeze, these are people whom I know very well. I DO know where their money came from. No family wealth. No fabulous investments. Just two doctors making well in excess of $500,000 per year at their highest level of income a few years ago. (I know that one of them--yes, a radiologist--was making $300,000 working three days a week, and I'm being very conservative in assuming that the other was making the same or less working a full schedule.)

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<p>I don't think anyone doubts that somewhere out there one can find a physician that is very wealthy and makes "300k working three days a week"; however I also think it's very clear that such an anecdote is the extreme exception and not the norm. The many other opinions and reports of current physicians expressed on this and other forums only strongly support that fact.</p>

86

<p>I don't want to hijack the thread, but I am curious about fee structures. I am uninsured. When I go to the doctor, I am seen for about 10 to 15 minutes by a nurse practitioner and am charged $125 for this. When I am seen by a specialist for about 10 to 20 minutes, I am charged between $300 and $500. When my mother was alive, we saw countless physicians. None of them accepted just Medicare. Medicare would reimburse around $100 to $150 and my mother would have to make up the difference. Most offices would demand some kind of payment from her at the time of services. Then she would receive a second bill after the Medicare payment came through. So it would seem that doctors are on par with plumbers at least!!!</p>

87

<p>rocketman, you can google physician salary and get a wealth of information. The $300k amount is about average for salaried physicians in a mix of specialties. As with nursing, it is very common for physcians to work extended hours and 3-4 days/week.</p>

<p>yorkyfan, the fees you mentioned are on the low side where I live. Even so it does not take advanced math to realize that there is a lot of money in private practice. Even a single doc office can easily turn over 75-100 patients/day.</p>

88

<p>I didn't read all through, but will respond to this (and many of you have heard my views before):</p>

<p>
[quote]
You're a Doc, you don't live in a card board box house, you can afford vacations, you can pay for private school for your kids if you choose, You can live above the "average" american, your respected my the vast majority of people in this country and you have a job where you can use your brain everyday.</p>

<p>Is it really that bad? Is it? Or are you the person who bemoans my caviar is not buluga? </p>

<p>Sure your job has bad days, want to trade?

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</p>

<p>My H was not the kind of person who "Bemoans my caviar is not buluga" He instead was the kind of person who worked ungodly long hours taking care of the country's poorest children, which, though hardly ill-paid, did not even begin to support the lifestyle described in this post.</p>

<p>Additionally, he, to do his job well, missed a lot of his kids' childhoods, despite his best efforts (Little League coach, lots of camping and baseball games, etc). He worries, though I wish he woudln't, that his long hours then contributed to our S's college woes now.</p>

<p>All job stresses are not alike--waking up all night to deal with possibly life and death situations is not the norm for most people I know. Dealing with extremely sick children coping in horrible social circumstances is not the norm. HMO's aren't like having one bad boss, more like twenty or thirty, each with its own esoteric and constantly changing rules.</p>

<p>Opie, I hope your kid has a wonderful career. As for my H, he did trade--he's a very hardworking and happy HS teacher now.</p>

89

<p>Very interesting posts. </p>

<p>
[quote]
Medicare would reimburse around $100 to $150 and my mother would have to make up the difference. Most offices would demand some kind of payment from her at the time of services. Then she would receive a second bill after the Medicare payment came through. So it would seem that doctors are on par with plumbers at least!!!

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</p>

<p>There's a huge difference between what gets billed and what the physician gets as take-home pay. Overheads can be massive. During our discussions thus far we talked with one physician who's practice overheads are about $17,000 per month and this is a small practice, so he needs to take in at least that much in fees each month before he gets a dime. On an 'amount of money per hours spent performing services basis' the plumber probably makes more, although the physician likely has a higher annual pay since they work longer hours and perform more service cycles per day. Because the margins are quite slim, many practices must focus on volume to stay afloat. </p>

<p>
[quote]
The $300k amount is about average for salaried physicians in a mix of specialties. As with nursing, it is very common for physcians to work extended hours and 3-4 days/week.

[/quote]
</p>

<p>According to the US Department of Labor the only speciality with an average salary in that range is Anesthesiology (which has always been the highest paid specialty in part since they're usually the first to get blamed, and sued, if something goes wrong during surgery). The reported average for surgeons was in the mid 200s, and average for other internists and primary care physicians was in the mid 100s. These are all post residency numbers so one generally wouldn't see these figures until their early 30s. Again, when you see larger numbers remember that (as the physicians on here have often commented) there is often a big difference between up front salary and final take home pay. The reported government numbers seem in line with what we've heard in our own discussions with physicians. I'm sure one can earn a lot mores, especially if you set up a plastic surgery practice in Hollywood, but in terms of in general looking at the field as a whole the figures are much more modest. </p>

<p>Finally, we came across a 2007 study surveying 1,175 current physicians from all across the country (published by Merritt Hawkins) which showed some quite sobering results that only confirm what has already been said on this forum:</p>

<ul>
<li><p>Only 1 in 10 said they found the practice of medicine "very satisfying" and 25% said they found practicing medicine "unsatisfying." </p></li>
<li><p>More than half said that they are now less satisfied with their career than they were 5 years ago. </p></li>
<li><p>Almost half (46%) said that if they could start over again they would NOT choose medicine as a career. (This is again, wholly consistent with what we found by talking to local physicians)</p></li>
<li><p>More than half (57%) said they would NOT encourage their own children or other young people to choose medicine as a career. </p></li>
<li><p>One bit of good news was that half felt that the quality of health care in the US has improved over time.</p></li>
</ul>

90

<p>@edad, your interpretation of the physician salary survey is incorrect. The website called themselves physician salary survey, however, I can assure you, those who participated in the survey are mostly not salaried. Most of them were in private practice and mostly those who were not doing well, were not willing to participate in such a survey, because they were depressed. That data from physician salary survey is skewed. Significant numbers of physicians are in academic practice and are paid less than $150k (some of them less than $100k). One of my acquaintance in late 90s, had 5-year residency and two-year fellowship (total 7 years after medical school, fellowship done at Hopkins and he was a specialist), was asked to stay as a junior faculty at Hopkins with a starting salary $78k. He did not take that offer though. You really have to keep that in your mind that majority of physicians are GPs (general practices: family practice, internal medicine, pediatrics, GYN/OB, the later is no longer considered specialist by insurance company’s definition). </p>

<p>People mentioned here about dermatology. Yes, this group is still doing well. However, it is extremely difficult to get into dermatology residency. You almost have to be top 5% in your medical school class to have a chance to be accepted into a dermatology residency. The last thing I heard about Moh’s surgery (mostly done by dermatologists, a procedure taking cancer out of a patient’s face/ other critical locations, then repair the area), Medicare just cut the reimbursement by 50% either for the part of cutting out the cancer or the part of the repair (depends on which part causes more). Somehow, any doing well specialties, easily become the targets for reimbursement cutting. That happened to orthopedic surgery and ophthalmology among other specialties. People like to think that cosmetic / plastic surgeons and dermatologists (dermatologists do lots of cosmetics) are quite rich. First of all, cosmetic /plastic surgeons and dermatologists are very small portions of doctors. Second of all, cosmetic patients are very difficult to be satisfied. A few of my acquaintances in dermatology, started with some cosmetic practice in addition to treating skin cancers and rashes and now totally abolished the cosmetic portion of practice because cosmetic patients have high and unrealistic expectations and frequently are very difficult and demanding patients.</p>

<p>Yesterday a friend just told me that the other friend’s 22 year old son is graduating from Harvard this year, has been recruited by a hedge fund company with a starting 6-figure salary, totally eliminated four-year of medical school, 3-7 years residency/fellowship. However, I would still consider medicine as one of the top choices as a career.</p>

91

<p>Someone mentioned that for dermatology you need to be in the top 5% of your class. Does that mean grade-wise or performance on the boards? If it is both, what is the breakdown. It seems like a generous portion of people get A's in each medical school class, so it seems like there would be a significant minority of people getting straight A's.</p>

<p>Do recs impact this? I mean, would it matter if you got the top grade in every class instead of just being in the top 10%?</p>

92

<p>OPie- in a different state our BC/BS high deductible plan covers annual check ups at 80% but does not pay the lab work. For a general lab test covering the usual stuff, my DH was billed $750, the BC/BS contract rate brought it down to $500- being in the insurance business I know the people getting insurance physicals for a life insurance application are having more tests done, but the price paid is not nearly that high. Frustrating</p>

93

<p>Folks again it's a perspective thing... "My overhead's high, my malpractice ins is 6 figures".... yet you're able to pay these bills....meanwhile people are losing their homes because they can't afford the house payment. </p>

<p>Can anyone cite information on the number of mds that file for bankruptcy compared to the general population? Is it higher or lower or the same?</p>

<p>Again no offense is intended, but from where we sit, life ain't all that bad where you're sitting. Your expenses rise, you have difficulty with customers, the boss is a horse's a, your dissatisfied.... again how is that different than alot of folks? In many of these situations you're just adding a zero or two behind the numbers... </p>

<p>I know my remarks make some angry here, but honestly, have you had to miss a meal? There are problems and then there are problems... </p>

<p>As my child goes through medical school, the only kids (not all) that seem to complain about the profession's compensation already have family it in...the rest still don't see it as a problem because it's a huge step up for them. </p>

<p>As someone else asked me, "well what do you think your kids will tell your grandkids?" I guess my response would be the same I told them.. "find a career where you will be challenged, you'll earn a decent living, you'll have the respect of your community and you can pay your bills." </p>

<p>pretty basic... </p>

<p>again my apologies to those who take offense to my posts on this subject. I would not have allowed my kids to enter the profession if I did not have deep respect for it. I know it's hard, but for most people hard, at the end of the day, is why we take on some tasks.</p>

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<p>@collegealum314. top 5% is generally the grade. Clinical performance for 3rd and 4th year med-school also counts (pass, high pass, pass with honors). Boards score does not count for the ranking but does count for whether you can get an interview (generally, people by the time to apply for residency interviews, they would at least have their basic medical boards USMLE1, many have USMLE2). If your grade is among top 5%, but your board score is not top, the chance is not very good. Among the top 5% graduates (gednerally they do perform well on their boards, too), 50% (on the ball part) succeed in getting a dermatology residence. There are always exceptions. May be some schools give generous grades. But many others only give As to students with scores 1SD above the average scores (for class size 100 students, about 15 people gets A, above average but less than 1SD would get B). When I was a graduate student sometime ago, there were some required classes for us to sit with med students. In one specific class, the teacher hold a specific score (90 points and above) to get an A, only two students got As (among 120 student class 110 med/10grad students). I got 89 and got my only B in my graduate school. Every school is different, that is where the Boards score become important.
I hope I partially answered your questions.</p>

95

<p>YUIOP: Check your source. The physician compensation information on the bls webpage is not from government sources. The data cited is from a private survey from the Medical Group Management Association. There is information from other sources which is more recent, more detailed and probably more reliable.</p>

96

<p>
[quote]
Someone mentioned that for dermatology you need to be in the top 5% of your class. Does that mean grade-wise or performance on the boards? If it is both, what is the breakdown. It seems like a generous portion of people get A's in each medical school class, so it seems like there would be a significant minority of people getting straight A's.</p>

<p>Do recs impact this? I mean, would it matter if you got the top grade in every class instead of just being in the top 10%?

[/quote]
</p>

<p>What's important is induction into AOA (the med student honor society). Most med schools participate in AOA and induct roughly the top 15% of their medical class into AOA. AOA is generally based on your test scores/grades. Also, med schools don't give grades. They go by honors/pass/fail. AOA is sometimes determined by how many courses you are able to get "honors" in versus just a "pass."</p>

<p>Next is the USMLE. To be competitive for derm residencies, you need a high USMLE score (230-240 range). This is roughly 1 std. dev above the mean. </p>

<p>All other factors need to be top notch, including research in derm and publications. </p>

<p>Derm is probably the second toughest residency to match into, next to plastics, if you go by the % of applicants that go unmatched.</p>

97

<p>"Even a single doc office can easily turn over 75-100 patients/day"</p>

<p>That sounds crazy! Assuming you just stood in the exam room with someone having patients ready at the door, you didn't have to write any notes or take any calls, 100 patients would be a patient every four minutes and eight seconds! I think there is some risk management data that says seeing more than 60 patients a day dramatically increases you risk of liability. And then of course there would be zero job satisfaction. I imagine a practice like that would revolve around "churning" patients and providing unnecessary visits. Here's a listing for locums I browsed; they probably underestimate but they mention 25 patients a day.</p>

<p>Here's something about Doc's and bankruptcy.</p>

<p>Medical</a> Economics - Bankruptcy reform: What it means to you</p>

<p>Active</a> Jobs - Doccafe.com</p>

<p>This might shed some light on a "day in the life"
From Family</a> Medicine Notes
"The Annals of Family Medicine is becoming one of my favorite journals. I been very impressed with the quality of the papers published their and as soon as they get RSS feeds (I lobbied Kurt las month about this) we will be all set.</p>

<p>The article about time that physicians spend with their patients is interesting to me because it seems that most physicians spend rather little time with their patients even though the paper suggests that the results revealed that physicians actually spend more time with patients than was previously thought.</p>

<p>I'm certain that I spend much more than 50% of my day in the exam room .. and my day is certainly longer than 8.6 hours</p>

<p>Another very interesting article in this issue looks at the time that physicians spend outside of the examining room.</p>

<p>The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records"</p>

98

<p>
[quote]
YUIOP: Check your source. The physician compensation information on the bls webpage is not from government sources. The data cited is from a private survey from the Medical Group Management Association. There is information from other sources which is more recent, more detailed and probably more reliable.

[/quote]
</p>

<p>The source is solid and the data is from 2005 so it's hardly out of date (perhaps add a few percent to adjust for inflation). The data reflects information from 50,000 physicians across 2,200 medical organizations in all 50 states. They didn't exactly just make the numbers up. There are many different surveys out there so I'm going to trust the one used by the Federal Government's Department of Labor. As I mentioned this is also wholly in line with what we found on our own (mid 100s for primary care and general internists and mid 200s for OBGYN and most surgeons, higher salaries in exceptional cases for very specific practices but that's the exception not the norm).</p>

99

<p>shrinkwrap, perhaps office management is different in different parts of the country. Every office I have visited in many years has numerous exam rooms in operation at the same time. PA's or nurses perform the basics: height/weight, history, vitals. An initial office visit might involve as much as 10-15 minutes of physician time. Followups are usually much shorter. Blink twice and they are gone.</p>

100

<p>edad, the sort of figures you're talking about (300k average salary) are way higher than most physicians see. There are some physicians that do make those sorts of numbers, in the same way that there are people in any field that make way more than average, but the general picture of the field is much lower... half that much in many cases. Your friend may very well make that sort of money, but most don't.</p>