An op-ed piece, No Country for Old Men, filed today on The Health Care Blog by health industry consultant and futurist, Jeff Goldsmith, provides a brilliant review and excellent analysis of our past sins and possible future under health reform. Perhaps most telling is the frightening scenario he paints of doctors, especially primary care physicians, leaving the profession.
In a recent HealthBlog post that was also picked up by ABC News I provided some of my own thoughts on why "affordable" and "health insurance" shouldn't be used in the same sentence. It's really all about cost. Unless we figure out a way to substantially reduce the cost of just about everything related to healthcare (which like food is something that every one of us must consume) we are doomed to failure. But where to cut?
A lot of folks immediately point to greedy doctors. Yes, there are some of those, but if medical practice was so lucrative why a predicted shortage of physicians? A new MGMA survey of physician incomes ranged from a low of around $150,000 for primary care to $650,000 for neurosurgery. I don't know about you, but I want the doctor drilling into my head to be well paid. $650K doesn't seem like all that much for someone who trained for more than a dozen years and sacrificed all of his or her 20's and early 30's learning a trade. Likewise, $150K seems inadequate for people making life and death decisions after a minimum of 8 years of very expensive, post graduate education. Heck, they don’t even come close to qualifying as “needlessly wealthy” which has been defined by some people as those earning more than $250K per year.
I do know one thing. These days even the "needlessly wealthy" are having trouble saving for retirement, paying for college, and funding their future healthcare needs. To the idea of a public healthcare plan that would let me retire before I become eligible for Medicare and also be affordable, I’d say “sign me up”! The problem is, the math just doesn't figure without passing along much of the burden to someone else. And I just don't know who that someone else is going to be.
Our present health system doesn’t “scale” for lots of reasons; access and cost among them. Technology can help. If a unit of health service can be delivered by telephone, e-mail, web visit, home test, home monitoring, retail medical clinic, or visiting nurse as a less costly or more efficient alternative to traditional office or hospital services, we should encourage it. Organizations like Group Health, Kaiser, UPMC, Geisinger, and Mayo are already paving the way. The health industry is ripe for disruptive innovation. What’s needed are the appropriately aligned incentives that will move us in that direction.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Great article. You can also include how much malpractice insurance is for doctors as a percentage of a physician's income especially being a neurosurgeon. Yikes! I can't imagine.
Thanks for your comment, Eugene. Malpractice rates vary widely depending on specialty and region of the country. Ob-Gyns likely have the highest rates due to the high liability associated with childbirth. According to Medical Liability Monitor, in 2008:
"Dade County, Fla., reported the highest rates in the country with OB/Gyns and general surgeons paying as much as $238,728 for coverage, a decrease of 4 percent from last year. Internists in Dade County also pay the most, as much as $54,710, the same dollar amount as last year. Some internists in Minnesota have the lowest rates in the country, paying $3,375, a rate that did not increase from last year. Minnesota general surgeons also pay the least of their specialty, $11,306, the same as last year; obstetrician/gynecologists in the state pay as low as $17,166"
You can assume that neurosurgeons, espeically in places like Florida, pay through the nose for malpractice coverage. In fact, I recall a period of time not long ago when neurosurgeons in the Seattle-Tacoma area bascially stopped seeing patients because their malpractice premiums had gone up so much.
Bill Crounse, MD
Bill - can't agree more! I've come to the defense of many PCPs when I hear the argument - well the docs are making all the money! A day in the life of a PCP - well, I don't have to explain. Unfortunately, the public perception is out of alignment. Even more unfortunate for the PCP - my experience has consistently been that people choose this path out of a geniune interest to help people. Technology does have the potential to restore this profession to the role and recognition, (and reward) that it should have in our society. At least it is starting to feel like there is light at the end of the tunnel.
Let technology connect the Patient to Doctor without HMOs who only server the stockholder interests and that would be a real win! Direct P2D relationships worked before the 1970s, before Employer's started bearing a majority of Health costs. We can do it, but some big HMOs will need to trim heavily first...
Are those spiralling costs not of our own making? How many more 'Super-Size Me' movies do we need to watch before we realise just how much our current diet has to do with the massive drain on medical resources. Those of us who watch our diet should be substantially rewarded in some way to make it attractive to those who don't. I mean something beyond the fact we'll live longer and happier lives. That benefit unfortunately just doesn't seem to make an impression on the 'bad diet' guys. Sorry about the rant but had to be said!
Great article finally someone who defends doctors rather than attacks them. Im a medical student everywhere i look doctors are getting persecuted by the media for one thing or another. It makes me wonder why do i bother, but then when im in the hospital with patients i understand the reason why i chose this proffesion
Thanks for your comment NAS. Hang in there. Medicine will remain a nobel profession. And whatever the level of economic reward, at least you will have a profession that will always be in demand. That alone is worth the price of admission.
Bill Crounse, MD
Several years ago, about 2005, at Johns Hopkins I spoke with a young neurosurgeon who was planning to set up practice in Maryland. He told me that he expected to pay $300,000+ for malpractice his first year. That's 300K up front before he earns dollar one. If congress wants to do something to lower medical costs they might consider reigning in the lawyers.