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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Would you trade places with your physician?

Would you trade places with your physician?

  • Comments 8

imageI suspect many people would answer that question with, “Yes, in a heartbeat”! They might consider the perceived status, the opportunity to help others, and what is arguably a very good income. These and other reasons might make a person want to trade places. But what is it really like to be a physician these days? And if you were able to walk a mile in their shoes, would you really be so willing to trade places.

I’ll be perfectly honest. I haven’t practiced medicine for more than a dozen years. But I did practice in a variety of settings for nearly 20 years, and many of my current friends and colleagues are still practicing physicians. Whenever I’m having a bad day in the corporate world of technology, I often think of my colleagues who remain in the trenches of patient care and all of the challenges they must meet in caring for their patients.

First of all, let’s be cognizant of how many years of training are needed to become a physician. After four years of undergraduate college, becoming a doctor requires 4 years of medical school followed by at least 3 or 4 more years of residency. Some residency programs for medical specialties are twice that long. Consider for a moment the investment that represents. Many docs fresh out of medical school are carrying educational debt that exceeds the cost of the average house.

Once one becomes a physician, keeping up with the exponential growth of medical knowledge is a huge challenge. In addition, physicians are now dealing with a patient population that has 24 x 7 access to health information on the web. It seems everyone is now an “expert” on their own disease. Physicians must also meet hundreds of hours of continuing medical education requirements every few years in order to maintain a medical license to practice. Many docs also have to take expensive examinations every few years to remain certified in their specialty. 

imageIf that weren’t enough, physicians are also being asked to digitize their work using costly, and often confounding, electronic medical record solutions. In the US, approximately 80 percent of doctors are now using an electronic medical record (EMR) of one kind or another. The growth in EMR use in the US has been stimulated by the American Recovery and Reinvestment Act of 2009. Physicians (and hospitals) can receive federal funding assistance to purchase and implement EMR solutions provided they are able to demonstrate “meaningful use” of an EMR according to guidelines provided by federal agencies. “Attesting” to meaningful use has become an exercise much akin to filing a federal tax return. It takes a lot of time and effort in an industry that is already stressed with too many things to do.

Then there is the matter of Health Reform and all the changes, current and forthcoming, to the way physicians will be paid in this country. It is anticipated that the healthcare industry will transition from a volume-based (fee for service) system to a value-based (payment for quality and outcomes) system. All that is well and good. I want my physician to keep me healthy, not just treat me when I get sick. I also want to know that he or she is practicing with the highest quality top of mind. None-the-less, I sympathize with my physician colleagues during this time of payment transformation just as I feel their pain over the EMR and how it can be so disruptive to clinical workflow, at least initially.

imageSpeaking of payment transformation, have you ever considered how long it takes your physician to get paid? While physicians face spiraling increases in their costs of doing business (employees, equipment, supplies, office rents, and more) it seems it is taking longer and longer for them to get reimbursed for the services they provide.

For instance, I get health insurance through my employer. As part of that insurance plan, I must contribute to and manage a Health Savings Account. When I see my doctor, a bill gets generated and goes to my insurer. They determine what, if any part of my bill they are going to pay. Within 30 days or so, I get an “explanation of benefits” form showing what has been paid (usually far less than the actual charge due to negotiated rates) and what I owe. I am then instructed to wait until I receive a bill from my doctor before paying that bill through my Health Saving Account. Even when everything works smoothly, it takes about 90 days for all this to happen and sometimes longer. Meanwhile my physician waits and waits, and although I try to pay my bills on time, you can bet there are plenty of people who drag their feet for as long as possible before paying their physician. With more and more healthcare costs shifting to patients, even for those who have insurance, the physician will be waiting even longer to be reimbursed for services rendered. Doctors who see Medicare patients sometimes wait 6 to 12 months to get paid. Who would put up with that?

So the next time you see your doctor, show him or her a little sympathy. These are challenging and uncertain times for many healthcare professionals. And if your doctor happens to be using an electronic medical record during your care, compliment him for taking the plunge and perhaps say “thank you for all that you do”. It’s not easy being a doctor these days.

Bill Crounse, MD                    Senior Director, Worldwide Health                  Microsoft 

 

  • sounds like you must have an usual insurance plan. mine pays within 2 weeks and I get the bill as long as they are linked into the electronic payment system at Regence.

    Hard to have much sympathy when most specialists make between 400k and 980K so if they can't figure out cash flow (once you are past the first 90 days in your example they would be paid for the ones they saw 90 days ago,,

    The sympathy should go to people who on average make 40k a year and now have deductibles of up to 2500 (as much as their disposable income for the year..

    So who would put up with making on average 10x as much as they people they care for? Everyone I know.

  • You re so far removed from the rest of us..

    Dctors are PAID during their residency and internship and the only "debt" they might have equal to the cost of a house (where do you live? houses cost 800k in Seattle suburbs) if they chose to go to a private medical school.. Everyone who goes to graduate school (law school or business or even social work) would have a similar debt load (perhaps 1 or 2 years less.

    While they are still in training (residency and internship) they are being paid from 60k to 100K which is more than the average income in the US.. Who pays them? Medicare and Medicaid picks up their salary AND pays the hospital higher rates.. The total cost to us taxpers to train a doctor is 100k a year for four to 11 years (that is why they are expected to treat for Medicare and Medicaid patients for less - they are paying back a grant/loan of about 1million).

    So please don't tell us to have "sympathy" for people that we paid to train who are no living lifestyles of wealth.. Take a look at the wealthy neighborhoods in any large city and they are dominated by doctors

  • WhoPays etc is clearly unfamiliar with current prices of medical school, not to mention the fact that while MOST college graduates (assuming they can find a job in this Obama economy) are out making money following graduation, medical students are SPENDING between $50,000-$100,000 a year to get educated.  (And this isn't counting the cost of undergraduade or graduate work done prior to medical school.) So - spending hundreds of thousands and making no income for four years.  With no taxpayer assistance (unless they qualify for food stamps, which some do.)  

    Then, taxpayer funds DO help to subsidize the cost of residency training, yes - however, I know thousands of residents throughout the nation who'd LOVE to know where they can get paid up to 100K during residency.  Granted, this was a while ago, but when my husband trained, he was paid $12,000 a year - which, considering that he worked between 100 and 120 hours a week came out roughly to minimum wage.  Yes, today's residents are paid more - but they are providing health care for 80 hours a week for whatever amount they're paid.  

    And after graduating from residency, these days, they DON'T get "rich" just because they're doctors.  Reductions in reimbursement from all third party payers have seen to that.  Most wealthy neighborhoods are NOT dominated by doctors - and frankly, even if they were, I fail to see why people like the above commenter (who obviously couldn't get into medical school) WANT the doctors in whose hands their lives often rest to make as little money as everyone else.  Sounds like a lot of professional bitterness and jealousy - coupled with staggering ignorance - to me.

  • I am not sure where those statistics come from, but the pay for physicians who are hired by the big hospitals is less than $100,000 per year. Deferring pay for a very long time during training, they also wind up with $200,000 in medical school loans to repay at 8.5% per year.  That is really not too much different from people who make $60,000 per year but who have no debt.

    Doctors are retiring early as the climate to practice medicine is very different than it was 20 years ago. That is simply a fact, and since we will all need doctors as we get older, it might be good to face reality. Younger doctors are no longer those living in the wealthy neighborhoods. While the number of physicians has increased 150%, the number of administrators in the health care sector has increased 3000%. THAT is why your insurance premiums are too high.

  • Thanks for the comments. For Real World and Who Pays, my intent wasn't to suggest doctors deserve sympathy. Yes, most still earn a good income, but the average isn't anywhere near what you suggest, nor is residency pay. And let me tell you, the wealthy neighborhoods (let alone waterfront) in Seattle are no longer dominated by doctors. Thanks also to Donna and Alieta for weighing in.

    Medicine is going through some pretty big changes, and change is hard no matter where you are on the ladder. I don't expect anyone to feel "sorry" for doctors. But it wouldn't hurt to perhaps appreciate at bit more what they do, the hard work and sacrifices they make to get where they are, and the stress many are feeling right now during this period of intense and uncertain changes.

    Bill Crounse, MD

  • I've been an unpaid advocate for physicians and patients for 20 years, and I often say (and write) that there isn't a single good FINANCIAL reason to go into medicine.  Maybe, in the past, there was, but no longer.  

    In fact, since people who are smart enough to be doctors are also smart enough to be successful at any number of other things, those who may have been "in it" for the money are LONG gone, because the money isn't anywhere near what it was.  

    Those who have remained in medicine, and those who go into medicine now, KNOW that they're not going to live in those wealthy neighborhoods - which means that people should be even more respectful of their efforts and the sacrifices they've made in order to take care of other people.

  • From a recent CBS story on the "$1 Million Dollar Mistake of becoming a doctor": If you are brilliant, ambitious and gifted in science, you may consider becoming a doctor. If so, think twice. According to a new survey by personal finance site NerdWallet, most doctors are dissatisfied with the job, and less than half would choose a career in medicine if they were able to do it all over again.

    There are many reasons for the dissatisfaction, said Christina Lamontagne, vice president of health at NerdWallet. Most doctors enter the field thinking they'll be able to spend most of their time healing the sick. Yet the paperwork burden on doctors has become crushing, and could become even more complicated under the Affordable Care Act.

    "Administrative tasks account for nearly one-quarter of a doctor's day," Lamontagne said. "With additional liability concerns and more layers in health care, we can understand the drain this takes."

    Worse, the cost of becoming a doctor has soared, with higher education expenses leaving the average newly minted physician with $166,750 in medical school debt, while average salaries are declining. Nearly one-third of doctors -- 28 percent - saw a cut in pay last year, according to NerdWallet's research.

    It also takes between 11 and 14 years of higher education to become a physician. That means the typical doctor doesn't earn a full-time salary until 10 years after the typical college graduate starts making money.

    That lost decade of work costs a cool half-million dollars, if you assume this individual could have earned just $50,000 annually, and the typical medical school candidate is smart and successful enough to earn considerably more. Add in the time and cost it takes to pay off medical school debt and a dissatisfied physician may well consider pursuing medicine a $1 million mistake. (This assumes the average $166,750 medical school debt  takes 30 years to repay at 7.5 percent interest -- a total cost of $419,738.)

    Moreover, primary care physicians -- those who go into pediatrics, family and internal medicine -- earn barely more than the amount they accumulated in medical school debt, between $173,000 and $185,000, according to the study that looked at data from George Washington University's School of Public Health.

    "The frustrations that patients have about not getting enough time with their doctor is mirrored by the frustration their doctors have with not having enough time to spend with their patients.

  • Very timely post, Bill. Very educational comments above too. It should also be pointed out that life-expectancy for physicians is much lower than the average population. And, having an HSA plan myself, I go through the same process while paying my medical bills.

    It would also be useful to inquire why deductibles are bad. Don't we have deductibles for auto and home-owners insurance? Besides, most people making 40K are getting health insurance mostly paid by their employers. It is time we teach people that paying for medical care should be as painless as paying for those season tickets for football games (football players make more than $500,000/yr on average, so folks like RealWorld should be upset at them too!).

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