As a physician practicing ER medicine in the south, I can tell you that myself and many of my colleagues, who are only in our mid to late 30’s, are considering changes in career if we go to universal care. The stress of the job will only continue to increase and since the quality of care and compensation will become more limited, then we will simply go do less stressful jobs where the compensation is lower anyway. Not to mention that universal healthcare does nothing to solve the malpractice crisis we face. And that is why the AMA does not speak for me and many of my colleagues and why only about 40% of doctors in this country are members.

My sister, who, just 3 years ago finished her specialty training in colo rectal, has told me she plans to quit if this goes through. It makes me angry because my mother and I witnessed how hard she worked her whole life to fulfill her deam! It is an amazing thing to watch, let me tell you, and we are so proud of her!!! But I can’t blame her! She refuses to to call the government her boss! It will just be like dealing with the IRS! You are on hold over the phone for 2 days! I hope they take over 911 too! It is such a shame as well, because she is a young woman, Only 40, and has another many years to operate and treat people! We can’t afford to lose Dr’s!!!!!

I am a Board Certified Emergency Medicine physician that practices in central Illinois. As an ER Doc, I get to talk to all doctors, both primary care and specialists and sub-specialists over the course of my work day. It would be a conservative educated estimate for me to say 2/3 of doctors disapprove of the plan for health care reform. Where I practice, a mid sized town with conservative values, I would bet the percentage is closer to 80%.

I also see first hand the move to shift work and hospital based work. Doctors to do not want the hassle of running their own practice because of the cumbersome and irrational regulations imposed by MediCare and MediCaid. They want to do their shift, get paid and go home. No on call time and no real investment in patient care on a personal level. We have Prompt Cares open from 9am to 6pm, we have hospitalists that work 12 hour shifts and sign out to next doctor at shift change. The intensivist , the radiologist, the anesthesiologist, the yes especially we the ER Docs all want to show up, do our job and get paid and go home. The increased bureaucracy that this reform proposes will make medicine less and less personal, erode the patient-doctor relationship, and make health care just another government run service like the impersonal DMV, DOT, or the water department.

The rhetoric suggests the progressives feel that physicians are in effect theri asset to utilized however they please, and I suspect physicians in general will not allow themselves to be forced into an untenable situation, but will work to find solutions that work for them. I choose to work in a hospital setting, because its more challenging and interesting, but if squozen to ohard will abandon this to set up a private facility – no doubt not everyone will want to get their care in progressively lower quality, less user friendly facilities. Certainly England has two health care systems, for the haves and have nots, and if providing care for the have nots becomes too cumbersome or too costly, i will switch and provide care for those who can afford to pay me what I am worth.
If people are so concerned about the high cost of medical care, why isn’t there a burgeoning ‘Discount’ medical business, using older equipment, less trained staff, outdated medications? Because everyone wants the highest quality care, they just don’t want to pay for it.

I’m not a doctor but have been in and out of many doctors offices for the last year because of injuries from a car accident last year. What I’ve heard from them is that they don’t support it and are planning for either early retirement, changing their practice to a “concierge serve” where they charge an annual fee for access, or they’ll stick it through to see how and goes and then consider.

My overall impression is that they and the nursing staffs are very concerned and looking for other options. So, it looks like if a public option is adopted we’ll not only have increased demand and not enough doctors as is but SHRINKING medical providers doubling the problem and increasing the problem of access and the assurance of rationing. Yikes!

I’m only a country doctor, but I hope will read my post on this subject today.

drtombibey.wordpress.com

ObamaCare with out Tort Reform………Is my ticket to Retirement. I know that as
our Incomes Decrease and our work week lenghtens – Risking everything to continue
my practice is like playing Russian Roulette. Who want to play this GAME??

I own a small business in which we work very closely with doctors. I see how hard doctors work. They are under tremendous stress trying to abide by the government regulations, perform within hospital systems, and run their own offices with tremendous overhead (because of the govt regulations) all while doing what is best for their patients. They deserve every penny they make. Being a small business owner, I have had to purchase my own health insurance. I pay $1500.00 per month for my families coverage. I have had a child be denied coverage and I have been denied coverage for preexisting conditions. So, I totally agree that we need reform, just not the reform the democrats want. We have the best healthcare system in the world. We should pay more for it. I won’t be for any plan that congress won’t also participate in. Congress must have to have the same healthcare that they want to force on us. They shouldn’t get to keep their “Mercedes” plan while they stick us with the “yugo” plan.

I disagree and have no intention of leaving medicine. It’s the best career in the world and if my salary drops a few thousand so more of my patients can get insured, so be it. The move to shift-based and hospital based work has nothing to do with government regulation (save maybe medicaid, which is really a state, not federal, program) and everything to do with a better lifestyle/more time with family, less hassles with reimbursement from insurance companies, and malpractice costs. I am an internist and would love for more of my patients to be able to afford decent heath insurance because I see too many tell me they cannot take their medicines because they can’t afford them, or never went to the doctor before their diabetes got out of control because they didn’t have insurance. It would also help with getting my patients out of the hospital and into quality rehab hospitals because too many of the good ones won’t go within 100 miles of uninsured patients. Given what we know about the new senate bill, a single-payer system is not on the horizon. You can argue what you want about so-called “socialized medicine” but that’s not what’s in the offing as of this writing. People forget that some of the industrialized countries who have universal healthcare don’t use a single-payer system; Switzerland, for example.

As a member of the health care industry, I oppose the current health care reform bill. I am a Registered Nurse and I feel there are better, more reasonable ways to make changes that will benefit all instead of a bill designed to help the minority. Most people are responsible enough to already have some type of healthcare insurance- whether it is private insurance, employer insurance or MediCare/Medicaid/CHiPs coverage. I realize that there are some middle- income families who are struggling, and I have been there myself. However, there are a few things we as a country can do to make a major impact on the healthcare industry without putting the burden of increased taxes on the very people we are attempting to help. Tort reform would lower malpractice premiums. Reigning in the pharmaceutical industry could make medications affordable. Illegal aliens drive up the cost of our healthcare because we have to treat them even when they cant pay, and those bills get passed on to the rest of us in the form of outrageous hospital bills. We all know the system needs help, but socializing medicine is just not the answer. If we focused some of this energy on stopping fraud,waste and abuse of the current system- and fired all the government ketchup tasters and cow fart researchers- we could fix alot more than just healthcare.

I’ve wondered – for some time – where the doctors are in this debate. The five doctors I’ve queried in the last month state that tort reform is a must. We have it in Texas. Also, if medicine becomes “state run”, who will the attorneys sue? You know there will be safeguards built in to prevent claims against the government, so why aren’t the trial lawyers sitting up and taking notice? In addition to trial attorneys, there are also defense attorneys. Where are they right now? Surely, they can’t think everything is going to remain status quo.

I’m a consumer, who pays for private health insurance to the tune of almost $600.00 per month. It is, however, my decision to be self-employed, and I don’t expect anyone to pay my bills for me.

I believe in the inventive spirit of the American people. I suspect that the more restrictive government grows, the more subterranean the rest of us will become.

As a 3rd year ER resident – I can report that people who aren’t insured are already recieving health care at the expense of the general public. The “one payer” system is already in place- it is the employed section of the population. As a physician, I am very concerned about the proposed health care plan and its effect on my profession as a whole.
My concern is that once there is no incentive to work hard and acheive the status of a physician, that the public will begin to see the secondary effects of this health care plan. There will no longer be competition to be the best informed and most competent physician. The quality of health care available will be drastically affected by decreased availability and decreased interest of the physician.
I am considering moving out of the United States if this plan passes- because the “best healthcare system in the world” will cease to exist. I will move to an area where I will be able to provide care to my patients using my medical knowledge and best scientific evidence–not the opinion of a faceless policy maker.

I have been in the medical billing field for a long time and work with doctors daily and I want to say, doctors need not to be thinking of quitting because of Healthcare Reform. America needs them all. The question is what can we do as Americans to help doctors from leaving the profession. The multitude of doctors I deal with are all doing very well and have no plans of leaving the profession they love. I heard there was a piece on “Happening Now” today where a doctor and her staff are having a hard time getting reimbursed because of all the governmental regulations and coding requirements and believe that it would get better under a Healthcare Reform plan. Nothing could be further from the truth. They just need help and should not go it alone. There are medical billing professionals that can wade through all the governmental regulations and relieve doctors of the burden Medicare and insurance companies place on them so doctors can get back to their patients.

I am a physician and was an AMA member for the last 25 years–until the week AMA announced support for the health care proposal, when I cancelled my membership. Government can provide health care, but the competition in the not for profit/private sector has and can continue to provide a stronger incentive for quality improvement and innovation. Medical decisions must remain between the patient and the physician.
I am very concerned about the future of the profession, as I do think more physicians will look to leave practice if the current health care proposal passes. Also, fewer will want to make the sacrifices necessary to enter practice, given that 79% of US medical students now graduate with over $100,000 in debt [Association of American Medical Colleges].

What if Atlas Shrugs — and not just in Medicine?

As a member of one of the less-traditional medical professions (optometry), I see my own physician patients, and talk to members of my own profession, and the move toward any government-run health care system is almost universally decried. I am too young to consider retirement, but would discourage my own children from pursuing medicine unless they have an overwhelming internal call to the profession.

Under any gov’t run plan, doctors become even more of a commodity. Given the years of training and the stresses of being a physician, being an easily-replaceable commodity flows contrary to the personality drivers found in most physicians. Once tax issues cause us to pay over 50% of our income in state and federal income taxes, we then have the added insult of being de facto government employees who merely have the honor of receiving an allowance from our dear Uncle Sam.

As a medical provider and small business owner, I could not more vehemently oppose increasing government control of health care. It will lower quality of care, reduce the number of excellent physicians, and increase costs to small business. Nothing worth having is free; and in this case, “free” health care is astronomically expensive!

I’m currently a pre-med student and starting to apply to medical schools… but if this bill passes I am much more likely to not even apply and just go on to get graduate and doctorates in the scientific fields. This bill would definitely deter me from going into the medical field.

I work in the medical field and find that it’s not the uninsured that are flocking to the Emergency Department–it’s the welfare people. It doesn’t cost them a dime, and they can take the kids to the doctor at a time convenient for them or a time that doesn’t interfere with their all-important activities of daily living….unlike those of us with insurance that get charged a copay for using the ER.

Why aren’t welfare recipients charged a copay when they bring their kids in or go themselves for something that could have easily been handled by a primary care physician?

I am a Family Nurse Practitioner and have already seen a 40% pay cut this year. I do work for a state entity, but I have never made more than private practitioners in my area. There seems to be an odd illusion that state jobs pay higher wages. Unfortunately former colleagues that work as ER/Surgical/ICU nurses make much more money than I do now! Yet, I am still on call with no reimbursement, and less money to look forward to in the future. If this continues, FNP’s will go to administrative nursing positions, for which most of us are well qualified, or we will go back to the ER/OR/ICU just to earn a fair living. I love being an FNP but I am wondering how long I can afford it! Maybe I could do it if Obama would pay my kids college tuition?

At our hospital we collect more money from people WITHOUT insurance than we do from medicaid and medicare patients. This legislation takes money ($500B) from medicare and also expands medicaid. It’s obvious that the facility will take a large cut in reimbursement. I hope our institution survives. I’m sure that as doctors we won’t be accepting patients with this proposed coverage for very long. This will leave our patients waiting in line at the ER or driving 60-100 miles to see a PCP who will accept the coverage.

A slightly different take:
I am a physics professor at a large private 4-yr school. I teach several hundred pre-med students every semester and often ask them their intended careers so I can tailor example problems and applications to their interests.
I have seen a dramatic shift this semester from bright kids saying they were planning on pre-med to the same kids saying they’re thinking of dentistry, pharmacy, physical therapy or chiropractic instead. Some specifically said they’d wait to see if the health care bill passes before deciding. It ought to be no surprise that if smart folks can choose what they want to do that they’ll choose a personally rewarding way to make money without opressive oversight.

I’ve been a practicing psychiatrist for 17 years. I left the hospitals 8 years ago when reimbursement dropped so low I was losing money seeing patients. I’ve left all the nursing homes I’ve worked for (one of my specialties is geriatric psychiatry) due to low reimbursement. I plan to drop government supported healthcare if the Obamacare plan goes through as it is currently constructed.

To fail to address tort reform as an integral part of medical care reform is hypocrisy at its height. To fail to address insurance competition by limiting across state line competition is simply ludicrous. To fail to address medical insurance company’s pay structure of it’s administration is folly. To not include physician input, or lie about it, is simple madness.

Obamacare is a farce, even Senators and Representatives complain that they can’t read it without legal advice.

Where are the functioning adults in this fray?

I am board certified in family practice and fellowship trained in obstetrics. After about 6 years of being on call every other day and every other weekend, barely breaking even with a minimal salary only, I switched to straight shift work in emergency rooms. Despite no lawsuits ever in my career, 100% of my obstetrics revenue went straight to paying malpractice insurance! There can be no meaningful reform in healthcare without meaningful TORT reform! Medicare and Medicaid have caused the problems we have with healthcare, more government involvement will make things worse, not better, and I will look for a new career.

Hey, docs – go into selfpay private practice doing psychotherapy. If you are rusty because it has been so long since your 3-month psych rotation, just ask a local counselor to let you know how to go to a “CME” type refresher. Or devote a few thousand and spend a week at the Beck Institute. Ask a psychiatrist about decent malpractice insurance covering solely the Rx of psych meds. Or, skip meds altogether, just do the talk therapy, and simply get malpractice coverage for talk therapy, and refer to some nurse-practitioner for meds.

Get into a suburban neighborhood, and charge self-pay $200 per hour, and work up to 30 hours a week. Enjoy your life. Take 4 weeks off a year. Meet your family. Play golf, hit the driving range, and watch 18 holes on cable, all in the same week!

Read the lit: the strongest, most essential ingredient for successful talk therapy is a good patient-provider relationship. On top of that, do some good ol’ basic supportive therapy and some cognitive/behavioral. Read the Lorig stuff on managing chronic illness, and do psychotherapy for ppl with chronic health conditions, to achieve lifestyle change and disease management.

Then, Kiss Ob-AMA goodbye.

Oh – this won’t work for surgeons because you have to have some empathy. Surgeons – jump the Ob-AMA ship and do boutique cosmetic surgery. I know, I know – you are already planning. I just didn’t want to leave you out.

I am getting my application together to apply to medical school right now. Being a doctor is the only thing I can imagine myself doing BUT this health care plan is making me really worry and second guess my choice for going into health care. I can’t even believe that people think that this health care plan will work…and am trying to keep hope. I pray that people will figure it out before it is too late.

Thank you all Doctors!!!! You are all very special people to do what you do!

The administration does not understand the costs associated with health care nor do they understand the consequences of pushing through a plan which benefits very few. There has been no data presented regarding where the top 20% of the costs come from (Pareto analysis of costs). Unless these real costs are corrected, the dollars being thrown at health care will climb. Do they realize the after effect of pushing through such a plan? Less doctors and medical professionals, no new innovations which make American care so appealing (there is no benefit for medical device companies, drug companies, bio-engineering companies to develop new products when there will be no return on their investment). Instead of good quality care which the majority of Americans enjoy now, everyone will have mediocre care at best.
Yes, the people who do not have health insurance now still need medical care. The answer is not insurance but medical care. The approach should be available free services (paid by the government once individuals have proven they are eligible for the program-no insurance, income level, etc.). Of course before instituting such a program, the governemnt needs to get a handle on medicare, the VA hospitals-reducing the costs here, and understand where the biggest costs occur, like tortes and correcting. The free services for the uninsured few would be far less expensive than this proposal.

Proposed changes to the health care system will shift me and a large number of my associates into retirement. As costs mount there will be a concerted effort to supress reimbursement as a solution and when reimbursement drops below cost, health care stops. Hospitals generally run on a 5 to 6% profit margin in good times and private practice clears about 11%. Reimbursement doesn’t have to drop far before delivery of care becomes impossible. Medicare reimbursement is already significantly below cost and delivery of care at Medicare rates is already essentially community service delivered at a loss. Without tort reform utilization cannot be reduced and if utilization is not backed up with reimbursement the system fails to function. Everyone cannot have everything they want at everyone elses expense. Reality is harsh.

I will be aplying for a visa. I am a primary care physician. I will not be involved in poor quality health care. I took an oath. I will not stay in a country where I will bare the liability for performaing such care. Why are we protecting the attorney’s when they are a large part of the problem. Oh ,thats right, they are large contributors to the powers that be ,and possibly because they represent a large magority of our ruling class. We once had the best care in the world. I guess its time for other nations to take that title. Sadly when the people are promised more for less they typicaly wind up with nothing.

I am not a doctor, I’m just a simple single mom. I don’t care what they do, I would just love to be able to go to a doctor again. I haven’t been in years. Literally. the last job I held that offered medical insurance took a huge chunk of my paycheck… then refused to pay almost every single time I went to the doctor – always a reason this or that “wasn’t covered” so I wasted all that money for nothing and STILL had hundreds of dollars of bills.

Doctors don’t want to see you without insurance cause they’re too darn greedy.. and as a single mother I can’t afford their rates for an office visit anyway so I treat myself and my daughter at home.

Now if I want to quit work I will qualify for Medicaid – the worker told me I have to earn less than three hundred a month but I don’t have a sugar daddy to support me and $300 doesn’t pay squat so I’m just stuck.

I work for a living. I don’t get welfare or food stamps. I’m going to have to beg for a medical card for my daughter to get her teeth fixed but such is life. It would be nice to be able to go to a doctor for a change if I need it. Just to have the option, you know? So if Obama can fix it where single moms like me can get insurance that WORKS – I don’t care who he pisses off.

I am an anesthesiologist in the southeast and, if the plan passes, I will be retiring much sooner than I had ever expected. Currently, I tolerate WAY too much red tape from the government via Medicare. A good, solid one-quarter of my time is spent administratively, trying to learn and comply with rapidly changing government guidelines. Every single day, I practice defensive medicine, ordering needless tests just to protect myself should I end up in court. Additionally, I literally lose money (not “sort of” lose money, not break even) every time I take care of a Medicare patient. If all patients become Medicare patients, you do the math!

If Medicare payment trends were applied across the board, specialists would take a huge pay cut, while primary care physicians would likely stay steady or get a slight increase. Howard Dean seems to think that all doctors need to be paid about the same as a plumber. If that were the case, I want to know who is going to become a neurosurgeon, sacrificing 16-18 years of their life to essentially unpaid training.

The long term effects on quality of care are already beginning. I mentored 2 pre-med students who were accepted to prestigious medical schools, scheduled to begin a few weeks ago. Both would have been awesome physicians but opted not to go to medical school because of the current crisis. In the end, I am sure their spots were filled..but by whom!!!? I am sure the schools had to go further down their list to fill these spots.

Eric, your comments trouble me… I think you have a heavy heart!!!! But please try to realize that this bill hurts many of us….

Trust me, two thirds of docs are not going to up and quit just because Obamacare passes. They will wait until they see how it affects their paycheck and quality of life, and that will take several years. Then they’ll make the final decision.

Young docs graduate from medical school with over $100,000 in educational debt. They won’t be able to pay that off without practicing medicine.

As a surgical onc fellow finishing this year, I describe the “right” to healthcare as the right to enslave doctors and nurses. I find the increasing encroachment of lawyers, administrators and the such more and more dismaying. Each day, we have another set of rules, papers, signatures to complete. Some 9-5 lackey then has the nerve to tell me how much time all that paperwork will save me.

I have been shopping for opportunities abroad. Thankfully, I have picked field that ensures demand in almost any nation. I will probably leave the country and join a vacation/surgery practice in the caribbean. Not sure how many cancers I will resect, but I didn’t go through these years to be an “employee”. Certainly, not a govt “employee”.

Doctors, the new middle class.

I am a US physician currently living in England, which certainly should not be looked at as an example of efficiency of government run health care. The government National Health Service is incredibly inefficient, facing huge budget shortfalls of over $60 BILLION, is looking at cutting over 10% (over 100,000 care provider jobs) of the workforce, and has more people employed as administrators than as care providers. Patients get care, but those with any means buy private insurance to use when they cannot stand the long wait for any elective procedures. And it is not FREE care, the employers and the individuals pay a large amount of their income for coverage, more than most Americans would feel it was worth. There are no savings due to the “non-profit” nature of the NHS (the government run plan has to pay for all the non-care providers they employ)! Patients live with long waits for procedures and varying care based on their post code and the health trust to which they are assigned. The “crisis” in the US is not as acute as the politicians want to make it, we need to look at the system and fix the broken parts, but it does not need to be done by a political deadline. The system should be reformed by the people who truly understand it, the health care providers. Why has tort reform not been a serious issue brought up in DC? Would the lawyers and politicians allow the doctors to reform the legal system? Speaking of which, why isn’t universal legal care a right?

As an orthopedic resident working in an inner-city trauma center, I feel I have a unique view on the topic. Most of the patients I see are uninsured. These patients receive the same care that insured patients do. They get the same tests, the same physicians, the same surgeries, and the same expensive prostheses that the insured patients do. The uninsured simply don’t get to have their office visits at a swanky office in the suburbs.
I think most of the talk of quitting if the health care reform bill passes is all hype by frustrated physicians who are not well enough organized to fight the reform as we should be doing. I’m very frustrated with President Obama’s lack of insight and tendancy only to mention the money that physicians make and how we should be willing to sacrifice. Show me another job in the country where it’s customary to be woken up by a phone call from work at 3am when you’re not “on-the-clock”. Show me another job where your patient can get a surgery without paying, then go home and inject heroin into their arm with dirty needles, get infected, and sue the surgeon. Show me another job where people get excited when they ONLY have to work 80 hours this week. Most physicians are not making an income until they are almost 30. Until this time they live on hundreds of thousands of dollars of school loans, and a salary most college graduates would laugh at. And our president chooses to make the focus of his health care reform the greedy surgeon. Impressive.

Doc

I am a nurse and as you know there is a shortage of us to. The shortage is getting worse and for most of us we are in the 45 and up group. The health care plan will make me leave the profession as I will not have more work put on me in the name of cutting cost.

As an Emergency Physician in the south, I am finding it more difficult to find the specialists I need to care for patients as it is. If there is a sudden glut of patients, Emergency Departments will become still more crowded because even if people have insurance, there aren’t enough physicians and nurses now to care for them. Also, healthcare reform without tort reform is meaningless- to make us indentured servants to the government without protecting us from lawsuits is asking for fewer doctors in practice. Absolutely reform needs to happen, but putting it in the government’s hands is a mistake of gargantuan proportions.

As an academic surgeon, I think the healthcare overhaul bill will be a significant setback for academic medicine, US medicine and for the American people. While universal health insurance is an admirable goal, government run healthcare plans have failed in the US and abroad. Look at VA and Indian Health Service healthcare. Why do many private practice physicians refuse to take Medicare and Medicaid? Government healthcare does not work. The reimbursements are so low that physicians lose money for patients seen and cannot pay expenses. The new public option will be as bad or worse. The result will be few physicians taking Medicare, Medicaid or the public opeion and acess to healthcare progressively more difficult. I think the overhaul of healthcare is being rushed through for political expediency with little input from healthcare providers who labor in the trenches daily to take care of the American people.

You really have to love the polling Fox’s News uses. Two questions,

1) Approximately how many medical doctors do we have practicing in this country???

2) Does polling only 1,376 doctors really represent how all MD’s fall into this claim?

I’ve been practicing for 7 years — after 13 years of post high school training/education.
I recently paid off my $200,000 medical school debt to the government.
I make a comfortable living now, but have seen it decline every year by 3-5%, despite increased “production”.
Right now I’m not compensated for after hours care or weekend ER coverage. Plumbers get paid an after hours/emergency rate or you don’t get serviced.
Why should my service be any less valuable?
I will serioulsy consider reducing my practice hours or finding another line of work if I continue to take pay cuts while working harder and seeing more patients.
When someone calls to the office unable to urinate after they’ve had a catheter placed in the ER, they’ll likely have to wait several weeks or months if Obamacare goes through to be seen.
Perhaps I’ll just start a fee for service practice and get them in earlier and actually get paid for what I do.
I’m part of the 45%. By the way, the average urologist is over age 55 right now, and only about 200 of us are trained each year in the US. Food for thought with an aging population.

I currently work in the healthcare field and receive government run healthcare due to being a soldier and I can say from experince that you do not want a government run program. Yes it is nice to not have to worry about the bill at the end of the day but what you do have to worry about is can I even get seen. You might have to wait for 30 days or more right now in the tricare system and even longer in the VA system to be seen. And these numbers would probably be a lot higher if you are talking about the entire country veruses the few who serve. So if you have a real issue, your health just gets worse until you can be seen or you go sit in a ER all day and hope to be seen within 24 hours. So yes myself and others would leave the healthcare field if this happens because I don’t believe it is in the best interest of the people. First fixed what is broken, for example: cost of meds, lawsuits, and overpricing of insurance. Then look into universal care when those are fixed.

i retired early because of low reimbursement and high malpractice rates to reform health care without tort reform is folly outcome based reimbursement is also folly as the population grows health costs go up its not rocket science

Thank you ERIC … I work in the medical field and have had major medical issues myself.
I see what expenses we at the Company pay for health insurance on our physicians, to drug companies, health equipment companies, etc. It is crazy! Yet the average employee at our Company has not had a pay increase and has benefits decrease in the past three years. Medicine does not change – but people cannot afford medical treatment. I have no problem with the government helping those that cannot truly afford treatment.

Doctors have already abandoned specifically ‘personal’ health care options for their patients. I was lucky enough to have a small practice doctor in the 80s. $5 office consults! Amazing. Doctors work for the big picture, and HAVE it. What about nutritional sciences, and well ordered preventive therapies through networked efforts? I don’t see much difference in hospital “shift” offerings verses private practice efforts. Well networked efforts are mostly not available. Insurance, and bureaucratic compliances are profoundly out of order, and doctors have not made the efforts to curtail, or diminish the destructive ‘business’ structures. In fact – Many have caused them through the ‘WE the workers just NEED paid’ efforts. In other words – Excessive using of what works to get paid verses factually based service billings. I had a doctor treat me for a bladder infection when I clearly had a kidney infection. My insurance was natorious for not paying for kidney infection testing and treatment IF a bladder infection wasn’t noted in the records. Never mind my kidneys were at stake. And what about fighting for targeting antibiotics, and other less invasive medications that work. Nah. Overdose women with birth control drugs, and forget specialty antibiotics for the sake of general ‘immunity scare’ consenus. Some are already working under ‘hospital only’ directions, and it will happen more with, or without, the legislative encouraging of those more simplistic directions.

I’m a 50 year old general dentist and I too will leave the profession should Congress succeed in passing this health care bill. I think that mandating health care professionals to contract with the “government” insurance is inevitable. I ran the numbers on my practice and should they mandate just ten percent of my practice be “government” reimbursement rates, my salary would be less than a hygienist. That assumes that production remains at the same level, not likely. Also assumes that reimbursement will be 50% of my current fees, again not likely as Medicaid fees are approximately 30 to 40%, not to mention a 70% no show rate. It is more likely that my salary would be closer to a high school educated front office position approximately $15.00/hr and I would still be personally liable for any legal fees and judgements for lawsuits frivolous or not. Why would anyone in their right mind risk it?

As a career gov’t employee, I can state with authority gov’t run institutions are rarely efficent or effective.
It will not work and will plunge us into a REAL health care crisis from which we will never recover.

It took 4 years of college, 4 years of medical school, 5 years of general surgery, and 4 years of fellowship training – a total of 17 years after the high school diploma – to become the subspecialist I am today. While I love the work I do and the patients I care for, I currently work a 60-80 hour work week, and I spend as much time doing the paperwork to document and bill as I do patient care! Once you add in the fact that medicaid pays about 30 cents on the dollar for what we bill (lower than the actual cost to provide care!), it is difficult to imagine working under a further government controlled health care system. I’ll leave clinical practice and go into research – better hours, less likely to be sued, and no more insurer headaches!

I’m a general surgeon. I currently work for a hospital. One of the lucky ones. I agree, many docs would and will quit if this bill passes. They could have avoided this fiasco if they had only considered speaking to the “soldiers” in the field.

IBD-TIPP is the same polling firm that said McCain would win the youth vote in 2008 by 74-24 percent.

A polling firm that publishes preliminary results based on a partial count without disclosing methodology isn’t a serious polling firm either.

Meanwhile no mention of the New England Journal of Medicines recent poll? In what twisted universe is the NEJM ignored when it comes to medical professionals while IBD-TIPP is seen as the “credible option”?

How much ad revenue is at stake for Fox to so blatantly distort this issue rather than report the facts?

The problem is that there is no such thing as a free lunch. As a physician who has actually practiced in an UK style NHS (New Zealand), I can tell you the waiting lists are massive and the MDs threaten strikes often (and occasionally go through with it). I much prefer Minnesota to Rotorua, let me tell you.

Most of the world’s medical research is done and paid for here. It would be nice if the parasite countries would pay for this. Incidentally, in response to the pollyanna above, if Eric thinks that paperwork would improve for him and insurance hassles will lessen in our lawyer driven system in a “reformed” system designed by lackeys of trial lawyers, he’s dreaming.

This is all about control, folks, and not about medicine.

Dear Sir, I am an anesthesiologist in a single speciality midwest group of 40 MDs.Government has been in total control of Medicare since its inception, yet it is bankrupt. To suggest that $60 Billion a year can be saved from Medicare to cover the uninsured is pipe dream. Medicare reimbursement is already at a non substainable level without the cost shifting to private insurance. If money can be saved in Medicare, then prove it fist. Allow people to buy tax dedutable competitive insurance options across state lines and introduce tort reform and caps. These alone would save enough to enroll the 20 million truly uninsured in Medicare…..problem solved. Our jobs are stressfull enough without hospital systems, and now government, threatening our autonomy and hard earned livelyhood.

My husband and I are both surgeons-what did that require? Highest grades from a good high school, graduation from a good University, acceptance to top medical schools and graduating in debt. So far investing 12 years toward our goal, but what many do not know is that no one practices medicine right out of med-school…you need to specialize and that includes Family Medicine which requires 3 more years of training, Neurosurgery is 7, General Surgery is 5, ENT 5-6, Orthopedics 5, Urology 5-6 years…and if you want to SUB SPECIALIZE…if you want to be a Spine Surgeon, Pediatric Surgeon, Colorectal Surgeon, etc. and hone your skills to be the very best and further MEDICAL KNOWLEDGE that can often require another 1-3 years. On average a surgical sub-specialist has trained for 16 years after high school in order to begin to operate on patients on their own. Many have large debts (even with scholarships) have postponed beginning families (studies forthcoming that shows women in medicine suffer terribly with pregnancy and complications), work long stressful hours and are involved in many of our long term patients lives and families. We attend the funerals of our patients, we torture ourselves over less than optimal outcomes (complications occur even when they seem to have been “textbook” cases) and we rejoice in cures, return of function and resolution of pain. You get what you pay for, “good enough for government work” are words you never want to hear from your surgeon…

Politicians, who are overwhelmingly lawyers, should not be designing healthcare when a MAJOR part of the current problem is defensive medicine due to lawyers. If Medicare cuts physician reimbursement further, with or without some new healthcare bill, I will strongly consider changing occupations. Why would anyone go through 12 plus years of education/training to have the same income as a high school graduate, or even dropout, and have to put up with government/insurance company “red tape” designed to delay/reject reimbursement? Insurance company reform is certainly needed since they function like organized crime, but the current legialative options are not addressing the abusive lawyers and adequate insurance reform! Also, demonstrate that Medicare/Medicaid can be “fixed” before considering any other public plans.

With this proposed healthcare plan the President says that coverage will be cheaper. What are the guidellines the President is assuming for this healthcare- will each supposed plan be with different coverage-will a person with pre-existing condition be charged extra because of it no matter if the condition causes any negativity to the person’s health-example: a person has arthritis-does that mean they will pay a higher premium just because they take prescription ibuprofin instead of just self medicating by buying it on their own without a script.

Th President’s plan is incomplete, it does not give reference to how the prices would be structured or how the bills for services would be coordinated. It is 1000 pages of unclear and unproven scheduling that any high schooler could have written and there are a lot of things in the bill that do not pertain to health care-but rather watchdog services, like visiting expectant parents to see if they are fit to raise a child.

The President’s plan is no more than a program to see who is worthy of living and who is in line to be taken out. Shameful just shameful

we need our doctors!I pray this isn’t true,we will just have to wait &see.

I already left private practice to return to the military, figured I can’t beat them, might as well have seniority. I am very much opposed to the plan but will stay military at this point until I can get my retirement. We already have coverage for people with Medicare, Medicaid and emergency care for anyone regardless of ability to pay. This would only result in another huge government program without improvement in care and great reduction in medical advances or new research, particularly in the pharmaceutical injury.

HJuly 30, 2009
Dear Senator:
Today 450,000 physicians and medical students stand together in strong support of health care
reform.
We want you — Congress — and the Administration, and the American people to know that we
believe, in the best interest of our patients and this nation, we must pass strong and effective
health care reform in 2009. Americans need affordable choices, and stable coverage. Not passing
health reform will result in continued rising costs, poorer quality of care, and more people
uninsured.
Everyday, we are on the frontlines of health care, and know that we must ensure everyone in our
communities, including working people, parents and children, all have a real choice of plans and
doctors, affordable care, and access to necessary medical services. Health care reform will help
physicians provide better care for their patients, throughout the nation.
Some people believe that patients are better off in today’s disorganized insurance market. We
believe that the health care our patients receive will be better within a reformed system. As
physicians and future physicians, we stand in firm support of the patient-centered changes being
outlined in Congress. We are confident that the reforms being proposed will allow us to provide
better quality care to our patients, while preserving patient choice of plan and doctor.
Continuation of the status quo is a steep pathway to growing cost of and decreased access to
quality health care for all Americans. Our patients can

We have raised several generations of citizens to believe that if something hurts there is a pill or a procedure to fix it. There is a total disconnect on behavior that causes disease and illness and treatment and prevention. Electronic medical records have other uses other than to improve medical care. It is impossible to ration medical care on a national level without centralized control. One third of all medical costs could be eliminated if defensive medicine were not necessary. One of my patients recently went to the ER for a bladder infection and ended up having $2000.00 worth of testing done. It would have been “no charge” in the office.
Doctors work hard and we enjoy what we do. There will be many that will stay no matter what happens. But already docs are telling their children to find other professions. The bills being proposed are not to make medical care more available or to improve its delivery. Just like the stimulus bills were merely payback to everyone that had ever supported the democratic party. The health care bills now proposed are a form of population control and manipulation. They have no implicit meanings and therefore once they are in place they can mean whatever the party in power wants them to mean.
Americans do not trust their elected representatives. They are passing bills they do not read. And if we tell them they are not trusted then we are racist, unpatriotic, or ignorant. Popularity will not produce good legislation.

I am overwhelmed by the number of comments from physicians that plan to leave medicine if the government continues with the current healthcare reform plan. I have been told it is illegal for physicians to strike…sounds like a complete walkout to me! The comment by Urology Doc is absolutely TRUE and worse it is outdated…those stats are from 5 years ago…which means over 50% of Urologists are now over 60 and will be sure to retire if this bill is passed. Please see the letter posted to President Obama on August 20,2009 from the American College of Surgeons regarding he absolutely false and ill informed information he passed during a speech. This letter was endorsed by the following: American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Ophthalmology
American Academy of Otolaryngology-Head and Neck Surgery
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American College of Surgeons
American Osteopathic Academy of Orthopedics
American Society of Cataract and Refractive Surgery
American Society of Colon and Rectal Surgeons
American Society for Metabolic & Bariatric Surgery
American Society of Plastic Surgeons
American Urological Association
Congress of Neurological Surgeons
Society for Vascular Surgery
Society of American Gastrointestinal and Endoscopic Surgeons

I am a neurologist in the south, though I spent time working in Canada as well. I feel that I have a good perspective having lived, trained, practiced, and been a patient in the 2 systems.

I highly doubt that even 1% of physicians would quit if the system changes; we’re not trained to to anything else and simply spent to much time training (16 yrs University for me).

I find it curious the extent of propaganda aimed at instilling fear of change. Also, the rhetoric is arguable that the US “has the best healthcare in the world”. Canadians aren’t as dissatisfied as one would be led to believe. (see: http://www.foxnews.com/story/0,2933,136990,00.html). Most certainly don’t want a system like we have here.

Finally, I find it striking how many DOCTORS oppose reform. Where’s the compassion? My old Canadian GP told me that his salary tripled when universal healthcare came to be (mid 1960’s). This is because he suddenly started to get paid for patients that had previously been unable to pay him. Here in the US, patients that can’t pay get sicker until medical bills bankrupt them, and THEN they get socialized medicine (Medicaid). In other words, EVERYONE here eventually gets healthcare (if they don’t die first), but they need to become bankrupt or disabled enough to leave the workforce (i.e. stop paying taxes), and THEN they get government-sponsored healthcare. In other words, we’re already paying for everyone to get healthcare, it just comes a little late for some.

I don not plan on quiting healthcare. I certainly enjoy the life that practicing medicine has afforded me. I also find it quite fulfilling to help people, and that is why we are here. I see this as a professional AND moral or religious obligation if you will. I feel that our system is quite broken compared to some in Europe and possibly Canada. Of course, I am worried about reimbursements going down and less autonomy, just like everyone else, but that does not mean I will not practice medicine. I find other thing far more infuriating than universal healthcare or (socializing medicine like we already do our fire/ police coverage). The main example is the amount of money a professional athlete or race car driver makes, as a product of how much money our society pours into those things, I feel that my job is FAR more important socially that these things, but it is yet another thing that I cannot control. I found this article on the moral issues interesting:

http://www.relevantmagazine.com/life/current-events/op-ed-blog/18175-why-care-about-health-care

The problem with reform is that we will never Have a true universal system, there is too much money being thrown around by the pharmaceutical companies and the HMO’s to get them out of this picture. It is a monster that we have created. It would take a MAJOR overhaul.

New Senate proposed bill will favor Health Insurance companies, require all people to buy insurance no matter what the cost, require insurance companies to increase their coverage of pre-existing which the insurance companies will pass on, the new competition will be ineffective not-for-profit cooperatives who have to negotiate with thousands of health care providers, an increase the money spent by the government by $856 Billion, of course the Republicans will sign on to the bill, So where is the savings, where is the change.
A not-for-profit government run health care option would increase competition, drive down costs in the private sector, increase quality of service for all. Any displaced or un-employed insurance company workers can be moved over to the manufacturing sectors, where costs have been lowered and we can start to eliminate ubiquitous foreign trade marks like “made in china” , “made in japan”, and made in korea” and replace it with “made in U.S.A”

Pollyanna? Amusing, but childish name-calling only lowers the level of discourse. The point about the quality of the polling agency is well taken, and you will be hard-pressed to find any physician who doesn’t support strong Tort reform. But to simply lump any effort (such as Sen Baucus’) to find a middle road compromise that will lower the amount of uninsured patients without going to a single-payer system (which, AGAIN, if you pay attention I am not supporting) into the nebulous and misleading category of “government takeover” is counter-productive. Why do you trust insurance companies so much? Are they not the ones who gouge us on malpractice premiums and settle claims out of court to save themselves the hassle but then pass the costs along to us? With the public option removed, the essence of the bill is insurance reform. If you force those people who currently take advantage of the system by getting free care in ER’s (which we then ALL pay for with our insurance premiums) to buy their own insurance to cover their costs, we all save money. Interesting also how all the surgeons who see their paychecks shrinking as reimbursement starts to favor counseling and preventative care instead of procedures are the ones raising the biggest ruckus (and please save your angry retorts, no I don’t think tonsils are getting yanked out needlessly, only that procedures are reimbursed too high compared to thinking, preventative care, and speaking to/counseling patients)

Iam from Canada and our Doctors said they would quite if we brought in public hearth care. they didn`t an neither will yours.

I am a college student pursuing a pre-medicine route and I can definitely say that if this healthcare bill passes I will seriously consider changing my major, or at least my career goals.

I am a nurse and yes, I opted to get out at 62 retiring. The regulations and paperwork rob us of time with the patient. It will only get far far worse under the Obamacare and Bauscus plan. They are forcing this down our throats, regardless of cost or choioces.

I would rather volunteer my time somewhere in the third world where there is no socialized medicine.

I can’t wait to see what (or who) the President will dream up to take care of the medical personnel deficit–witch doctors????

The bills being debated will have a negative impact on current physicians. Those just out of training will be shortchanged and have a hard time paying back their loans. A nice “thank you” from the Obama administration for years of sacrifice. Those closer to retirement will just quit, as we lose the most seasoned physicians in the workforce. Experience in healthcare matters. Equally troubling, and frankly insulting, is how out of touch President Obama is with regards to the current system, what drives decision making, and what reimbursement is really like. The President has demonized physicians, and notably surgeons, with his comments regarding tonsillectomy and amputation, as well as the theoretically enormous savings from waste, farud and abuse. The healthcare system is not corrupt — THAT WOULD BE THE POLITICAL SYSTEM. Ironically, cutting reimbursement will not allow enough revenue to follow all of the legislative requirements from the federal government regarding administering healthcare. Finally, there is a shortage of ALL physicians, not just primary care and general surgery. Next time a patient has a kidney, lung, or head and neck cancer, just call a primary care doctor?? All specialties have equal importance, and specialties other than primary care require longer training and more expertise, as well as incur more risk. I am dismayed at watching politicians pick and choose areas of health care to support. It makes sense – none of this is about patient care.

As a retired nurse of better than 40 years practicing in north Alabama, I can remember when the government became involved in trying to regulate insurance companies due to a few doctors who had defrauded the Medicare system and rather than punishing the doctors for their crime they decided to “fix” the system. At the time doctors didn’t have a problem with payment of claims and now the insurance companies pay people literally all over the world to handle claims and it sometimes takes an “act of congress” (although I think that is what got us into this mess), so to speak to get reimbursed. Doctors offices spend a great part of their time on the phone, when they should be devoting that time to patient care, trying to get approval for referrals, test and prescriptions and trying to make someone in another country understand what is needed and the reason. A nurse can spend 10 – 20 minutes on the phone trying to convince a technician that the doctor wrote a prescription for a generic drug because it is spelled out generic Zocor, for example, but because he signs on the line dispence as written instead of use of generic permitted, they don’t seem to get it. You ask how is it written and they say generic Zocor and you say, so dispense as written and they say, but he didn’t sign on the use of generic permitted line. And by the way most of the doctors in this area do not accept Medicare patients unless they can pay. The doctors do not file on Medicare.

I am writing as a small business owner of a chiropractic/physical therapy clinic who opposes HR3200 or any government socialization of healthcare.

See the doctor of your choice? Not true. HR3200 states that direct access providers will only be MD’s, DO’s, PA’s, & NP’s that are Medicare providers. This violates state’s antidiscrimination laws providing direct access to other providers such as chiropractors and will increase provider shortages. Consumer Reports state that for back pain chiropractors are patient’s #1 choice, physical therapists #2. Currently in my town only 22% of doctors will see new Medicare patients, and many opt out.

HR3200 proposes reimbursement rates of 80% of Medicare rates, well below the cost of doing business. Medicare does not cover the therapies that we do in our office so our reimbursement will virtually be 0. We need direct access to all providers and reimbursement needs to cover what is in each provider’s scope of practice as insurance currently pays.

If this bill passes our country will lose thousands of hospitals, clinics, and providers because they will not be financially viable. This will result in the loss of millions of healthcare jobs and more healthcare rationing. Raising taxes on small businessess who provide most of our countries jobs is not the answer either.

I don’t see any news coverage of the provider/financial aspect of government healthcare, but I suspect that is a major reason why doctors will close practices.

Ok I have government run healthcare. It is called tricare. My wife is pregnant. Her OB thinks she broke her foot. The OB can not send her to get it seen. My wife has to have our primary care doc refer her. The soonest my wife could be seen is 1 week (with primary doc and no phone consults). She called again asked “So you want me to walk around on a broken foot for a week?” They sent her to the on call nurse line. Nurse gives her referal number to go to ER. Wife is headed there to sit and wait. I just hope there are no sick people there since she is 8 months pregnant and does not need to be get the flu from someone in the ER waiting room. Anyone that thinks the government can run health care better needs to stop smoking illegal things.

I am writing as a small business owner of a chiropractic/physical therapy clinic who does not support government takeover of healthcare.

See doctor of your choice? Not true. HR3200 states that patients have direct access to MD/DO/PA/NP’s that are Medicare providers. This violates state antidiscrimination laws which guarantee direct access to other providers. Consumer Reports state that for back pain patient’s #1 choice are chiropractors, #2 are physical therapists. In my town only 22% of doctors see new Medicare patients and many opt out entirely. We need direct access to all providers as there will be a shortage of doctors.

HR3200 states that reimbursement will be 80% of Medicare rates which haven’t changed in 10 years are are well below the cost of doing business. Therapies that we do are not covered by Medicare so virtually our reimbursement will be 0. Reimbursement needs to cover the provider’s scope of practice as insurance companies do today.

If this bill passes our country will lose thousands of hospitals and clinics because they will not be financially viable. This will result in the loss of millions of healthcare jobs and more healthcare rationing. More taxes for small businessess is not the answer either as most private practices fall into this category.

Evidently our lawmakers have no concept how these bills will affect patients and providers. I see finances and paperwork as the main reasons that providers will opt out of government run healcare.

How come Fox news is not reporting the Harvard study that says 45000 people die a year from not having health insurance? Just curios. Its on CNN, Reuters, I think I’m done with Fox News.

I read the article you cited re: doctors who will quit or retire with interest (at investors.com). It seems outrageous that any high level and well paid professional would quit for such reasons. Nevertheless, there are some problems in the structure of the survey. For example, this result and survey question: “More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered “no” when asked if they believed ‘the government can cover 47 million more people and that it will cost less money and the quality of care will be better.” A student in an introductory survey course would identify that items as asking two (perhaps three) questions, not one, i. e.,(1) if the physician believed the government can cover 47 million more people, (2)if covering 47 million more people will cost less money … (hmm than what?), and (3) if the quality of care will be better when 47 million more people enter the healthcare system. It’s not a very well structured question and for that reason it’s difficult to interpret the results. Which part of the question was any particular physician answering?

First, Thank all of You Doctors for what you do! Having a personal friend who is a doctor, I am somewhat more aware of the “little things”, the “extra miles”, and the “sacrifices” you daily make toward the welfare of your patients. As part of the “civilian” population, I would like to acknowledge all of these “extras” you provide, many of them totally unnoticed or unknown by others.

Some of the provisions of the obama healthcare “power grab” are an outright userpation of a doctor’s right to “self-determination”! (Might I presume that something here is in conflict with the Constitution?) I’ve heard it said that his plan is in the “public interest”! Pray tell this simple person in just whose interest it is to completelty strip a much-needed segment of our population of their free-agency to pursue their chosen occupation in whichever manner they
desire?…………, this in addition to paying fealty to an already massive glut of governmental regulations?

Are any surprises in this story featuring a Fox News Poll??? There shouldn’t be……………..

Medicare and Medicaid rules and poor reimbursement ran me out of my office in 2003. I now work for a salary in a hospital. Physicians are already treated as a disposable commodity by many large entities and more Government regulation / control of medicine in this country is NOT what we need. We already have too many unfunded or underfunded mandates.
Taxing health care entities to pay for the uninsured makes little sense–hospitals already under threat of Federal Law MUST take care of all comers. Taxing them and spending most of it on the bureaucracy to run the “Programs” and then returning inadequate payment amounts to providers makes little sense. But that’s what “Big Government” does. Tax, waste / spend and return a poor value to those taxed.
I strongly agree with taxing tobacco and alcoholic beverages–some of the leading causes of health problems–but our own President can’t even quit smoking. Now that’s a great example for school children and his own children.
Regulate Health Insurers (if the government has enough guts). Prohibit Prescription drug advertising (which only increases the cost of drugs to patients). Fix the terrible Medical Tort system we have where 30 years of dedication to serving sick people can be destroyed by one incident because an “emotional” jury awards a “lottery” verdict or Plaintiffs Attorneys make lavish incomes by bringing nuisance lawsuits that insurers are afraid to defend even meritless claims due to medically illiterate juries

I strongly oppose the healthcare reform as it stands. As an anesthesiologist, I do work long hours and take care of very elderly critically ill patients ( I do mostly vascular anesthesia). I feel that government intervention and limits on the diagnotic tests we perform will adversely affect the outcome for my patients. Many patients are poor historians and cannot tell us their history, let alone their cardiac function. MRI, CT scan, Echo, and invasive vascular studies are essential to provide safe care for these patients.
Having a quick referral system can make the difference in limb salvage…and prevent amputations. I resent having the government determine best practice for me and for my patients. Years of experience and knowing our patients makes us better diagnosticians and helps us provide safe patient care.
Having government based guidelines interfering in our decisions will prevent us from working up our patients in a safe and complete fashion. Government guidlines might work for healthy preventive care patients, but not for critically ill patients.
Anesthesiologists will definitely leave their specialty if they are forced to cut corners to save costs for the government. Also, a government medicare based pay system would reduce our remuneration to less than 35% of most private insurance. (other specialties are paid at a much higher rate.) We cannot forget that the reason most procedures are safe these days is because of vigilant and safe anesthesia doctors.

I have discussed this matter with a number of MDs. My MD now gets between Medicare and Cigna 35.09 per visit ( Medicare 28.07 & Cigna 7.02). He tells me very openly that the first 15+ patients he sees during the day pay only for the staff, offices, taxes, electricity, insurance, car, etc. He starts making something ONLY after that. Under the new plan (Obamacare) if they cut Medicare by almost 500 billion, he estimates that his payment from Medicare may almost drop by 50% in which case he will no longer be able to keep his office open or accept Medicare patients. He just loves patients without insurance and charges 79.00/visit. That makes up for some of the Medicare losses. Right now, he gets to the hospital by 6:30AM visits his patients, etc. Office by 8:15 and starts at 8:30 to almost 6:00 PM. Gets home by 7:00 and starts again the next day. He said that he just cannot get to see more patients PERIOD. Remember at 15 min. per visit that is four an hour. If they are all Medicare that makes 140.36 per hour GROSS. This is not a great reward for some 11 years of school, and people that say that MDs are overpayed and make huge amounts of money are dreaming!!! That could of been true YEARS ago, but not now. He is very seriously considering working at a research facility or just going out of private practice!!! Welcome the “47 million” new people, when we will not find a good MD to see!!

If this bill gets passes, I will be just a short way behind in retiring early, as many others. NO DOCTOR went into primary care in Indiana last year. (AND THERE WON’T BE RATIONING….THAT’SS A JOKE!)It’s ridiculous.!

I CAN’T see anymore patients per day than I do now. I see more than 40 patients a day, and answer over 200 nurse-assisted phone messages a day, PLUS MY OWN PHONE MESSAGES. My partner does the same. I’ve been in the medical profession over 32 years, with over 20,000 patients (yes, 20,000 patients!) myself.

Less than 1/3 of doctors belong to the AMA, so Obama is VERY misleading with his comment….”he has the doctors on board”. The ones working in the trenches everyday sure aren’t!

I do not have health insurance. I am a private pay patient and I have never been turned away from a doctor because I did not have health insurance. In fact, I have been lucky and thankful to receive a discount because I do not have insurance. Discounts have ranged from 10% to 30%. I have received discounts from physicians and hospitals. All I had to do was remember to ask. All they can say is “no.”

Physicians should not be motivated by money, but by the desire to prevent illness and relieve suffering. If it is true that the majority of physicians in this country are only interested in how this reform will affect their own finances, then we have the wrong people practicing medicine and they should all be ashamed of themselves. We have more uninsured than the entire Canadian population and our mortality and morbidity statistics don’t even compare with other industrialized nations. We do not have the best health care system in the world – not even close – but we should be striving toward that goal.

Linda RN

“Popularity will not produce good legislation.”

Does that mean the lack of popularity means good legislation? For you, the only “good” legislation is something signed into law by a Republican president.

I’m glad to find this posting! Very useful for me, thanks for sharing. I recommend this post to my friends.

I don’t think a govt health insurance plan is “socialism,” and I don’t think the United States Postal Service is “socialism,” either. FedEx and UPS do just fine alongside the post office, offering higher-quality services for higher rates, so health insurance companies will do just as well in their own market, alongside a basic low-cost insurance plan administered by the US government, or some type of non-profit. It’s not rocket science. It’s just cheaper insurance for those that need it. I’d also recommend interstate competition for insurance companies. Haven’t decided about tort reform.

Dear doctors,

We appreciate you guys. We need you guys. It is just that we can’t afford to see you guys. We know the malpractice bit – a little anyway. But the main thing is that even people with insurance can rarely afford to see you if they have a combined $50K or less income. Co-pays, deductables, being refused by insurance companies and the whole in/out of network (with different charges for different clients) is just expensive and confusing.

When you all make $100K or more a year, don’t expect that we care if you take a pay cut. I wish we could cut out the frivolous lawsuits and the stupid/greedy insurance companies, but until then, we need you guys to help take care of our medical needs and to do this with more compassion as to our financial ability to pay what you charge.

A friend of mine’s son is a orthopedic surgeon. $500K a year. Most surgeons are in the $300-500K range. Can’t you take a pay cut of even 50% so the poor can get needed surgery. Doctors, when you are making $150-200K a year and in your neighborhood there are people who can’t afford to see you, doesn’t that make you feel bad.

Or, do you all need fancy new cars, huge McMansions, and first class everything else. Why can’t you live life without feeling that your Benz is worth keeping poor sick people out of your office.

Most of you doctors make us sick with your lifestyle “needs.” You take an oath to do no harm, but then your prices kill us.

Sleep well.

I read your article and wanted to comment about physicians leaving their profession due to government regulations. I whole-heartedly agree with the poll. My husband is a family physician and I negotiate his contracts. We already “regulate” how many government funded patients we see in our practice by not allowing Medicaid and Chips into our practice. I discovered early on that we have no negotiation options for higher reimbursements, timely reimbursements, and paperwork required for reimbursement. In addition, patients involved in government run planned are some of the most non-compliant patients we have in our practice. Why should we see those types of patients? We run a business and put a lot of customer service and result-oriented plans together for our patients. We do not just right a prescription for each health problem a patient presents. We actually spend time, listen, and offer alternatives to their health and life style to better our patients. This philosophy will be lost in a government run program due to the government dictating what their expectations are within an office visit and the customer (patient) will have no voice. Patients may think it is currently bad with private insurance company, but they can leave, they could call and complain, they are the customers. When the government is involved customer demand and customer service is gone. We will close our 5000+ patient based-practice if the government plan succeeds.

Amazing how Faux News manages to find things like this (from an investor’s news site that caters to those who buy stock in the very companies that stand to lose if health care reform is passed).

The survey taken by doctors at Mt. Sinai showed 70+ percent wanted to see a single payer system in order to simplify their business practices (instead of having to deal with dozens of insurance companies’ bizarre and arcane forms). In fact, the majority even wanted to see the “public option”.

Leave it to Faux News to invent their own version of stuff. “We decide, you concur.”

You people are a cancer.

I consider you physicians to be the closest thing to being divine we have on this earth, which is why i’m striving to join your ranks someday. I’m a 12th grader in high school, and i intend to be a interventional cardiologist – So that’s 4 years pre-med, 4 years med school, 3 years residency in internal medicine and then cardiology fellowship which is about 3 years also. I’m 16 years old right now, so that means i will be a full physician when i’m over 30 years old – 1/3rd of my life, gone, with a debt over 200k.

Kids like unimpressed that can not afford health care do not concern me ONE bit. I am not heartless, but physicians take the road less traveled by. They worked to be what they are now, and they deserve every single cent they get – even if it reaches millions. They did not drop out of high school – like you most likely did, unimpressed – nor did they decide to settle for a job at main street. The thing that hurts the most – and i’m not a physician yet – Is that physicians work SO hard to provide excellent care to their patients, while at the same time looking after their backs and they get treated like plastic cups and a wedding reception.

So anyway if Obama does pass this bill that will inarguably bring about chaos, i think i will be a pharmacist like my father. I originally intended to surpass him and become the first physician in the family, but so far…

My two sisters and I have made this decision so in nutshell, that will be 3 more physicians that will not

I took a hospital job almost 2 years ago due to increasing costs, especially malpractice insurance, and decreasing reimbursement. If I was still in private practice I would be very worried as the government’s increased involvement can only result in more cost, regulations, paperwork, and overall hassles. Any plan to cover everyone for everything would break the bank.

I closed a successful neurological practice in Va. and left the U.S. in April, 2009 to do medical work in third world countries. I practiced when Hilary first started destroying medicine, and felt I could expect worse from Obama. I leave behind many patients and employees that I loved in 20 years of practice, but I now have no thoughts regarding defensive medicine and goverment, the real expense of health care.

Many Doctors voted for B.O. elections have consoquences…enjoy your new president.

Medicaid is a FEDERAL program which is funded by the Feds and run by each state. OTHER insurance HAS to be purchased for the things Obamacare will not covered! If you really cared about your patients then join the 45% of doctors that threatened to retire or go into a different profession. If all of the doctors threaten to quit or change professions what would happen? NO Obamacare! It sounds like you must belong to the AMA that made a deal with the Obama admin. that if the AMA supported the healthcare garbage,the AMA could continue to be paid for the code system that pays them much more then they take in dues. Why not set the limit for Medicaid at a higher income level and start to pay the few doctors that accept Medicaid at a higher level or start to pay them at all. That is why doctors do not accept Medicaid..the government pays little or nothing. Instead of changing the whole system,change what is wrong with the current system. What they need to do is investigate the senators and reps as to why most of them came into office witha modest income and now are millionaires! Why should we the people have low standard health care and the congress,etc enjoy the better insurance? AMEN

unimpressed,Why pick on doctors? They get paid according to what the insurance company feel the proceedure is worth. I had 3 heart operation several years ago. One of them was billed to me for $24,000 and then the insurance paid them $48,000.When I called the insurace company I was told the insurance company had a contract with that doctor for the sum they paid him. Spoke to the doctor and it was explained that he had to pay for the operating room,the assistant,nursing & pre-op preperation,etc. Had I paid cash it would be $24,000. So the doctor got about $10,000 profit.Under Obamacare,you have to have insurance and SHALL NOT be able to pay CASH. All the government is interested in is to get the profits that the HMO’S are making as they denay medical proceedures at will.Blue Cross and a few others are on the up and up as they are non-profit. Blue Cross offered to do the medical for the government,BUT there was no PROFIT for the government!!CHEW ON THAT!!!

Can no doctors respond to my earlier points except a 16 year old child? Come on you guys – Linda the RN has got it totally right…if you are only in it for the money, you should go into something else. You guys have even influnced the 16 year old to go into medicine – not to help people but just to make money…doesn’t that tell you something? Obviously, his/her parent has good health insurance and can afford to see one of you, but how about some of his less fortunate classmates who can’t?

And, Terris: I’m no kid. I’m a 42 year old father of 3 who also is fortunate enough to have good health insurance for myself and my family. You should talk to your parents about your desire to go into medicine and the motives you have for it. It will affect the way you treat patients – prescribing things they don’t need just so you can make a buck. We need good doctors – not greedy ones who charge $200 for ten minutes of their time to over prescribe stuff and refer patients to those who will pay them for the referral. Hopefully you’ll change as you grow up. At 16, you have a lot more growing up to do. Trust us all.

I am stunned that despite facts, history, and basic decency there is a percentage of
the population that has no qualms about dictating to their fellow citizens what they
’should’ earn or what they ‘deserve’.

Why don’t YOU magically make yourself smarter, harder working, and more able?
Then you could go to a top med school too and become a doctor. You can’t. You
need to pay money to access the skills of people better than you. This is
fair. I’m not a doctor but I support our doctors %100.

I think insurance is
the number one killer of quality medical care in our country thus far (well after
tort). Don’t any of you remember when you could walk into your doctor’s office
and afford the fee? Before the thousands of dollars in unnecessary testing?
Want to guess why this has changed so profoundly in just a few years?
Insurance is the same as using credit cards. No direct purse hit for accessing
a product/service means you spend more and eventually get less.

Evidently we are failing to educate our children properly in many things but most
importantly in basic economics…could this be because the government runs education?

Terris,

One other thing. I’ve got a masters degree and I teach at the university level, so you should hope you don’t end up in one of my classes. I didn’t drop out of high school (don’t assume things like that), but, if I had, I would hope that some doctor would offer health care that I could afford. Health care isn’t just for the educated, which, I remind you, you aren’t yet. You are only in the 12th grade. Seriously, talk to your parents about having the right kind of motivation. Surely “passing up” your father isn’t. Sounds like you are a bit insecure and think that being a doctor will make you better than others – it won’t. You might be richer…but not better.

As the good book says: “The love of money is the root of all evil.” Don’t fall into that trap. Doing something you love – priceless…and if you can help others in the process and make a living for yourself and family, well…that is just wonderful.

B Levine -

I am fair and balanced, and it does make sense to clarify that the polls are in fact very different with the Mt Sinai poll “winning” on technical merit:
http://www.nationaljournal.com/njonline/mp_20090918_4062.php

However – the following is from the poll:
When asked to choose “which proposal you most strongly support,” 63 percent chose the combination of public and private plans, 27 percent chose the private options only and 10 percent chose the public option only.

The fact is that if you could guarantee that the public option would not crowd out the private options – it would be workable – and no one is denying that. Those of us who oppose (the 27% of realists above) are the ones who know that it actually guarantees that you WILL crowd out the private market. Doctors are smart, but not economists…Public/Private will either crowd out Private altogether, or make Private only available for fewer people (ie: Public vs. Private Schools)

Then we’ll have another class war over the rich having better healthcare – but now it will include the entire middle class as a huge voting block – vs the 15 million or so chronically uninsured now

the point is that “reform” means taking refined steps to change things. Using the Commerce clause as intended to spur cross-state competition would kill Big Insurance monopolies and corrupt special interest mandates in about 6 months…and then, if that didn’t work – we can try it your way….but if we do it your way, we can never go back…

There is not enough space to cover all the healthcare issues here. I would like to comment on Basic health insurance: it is becoming more affordable. $80.00 per month will buy a basic healthcare insurance package for an individual (Assurant). However, people don’t want to spend their money on health costs. Foregoing a cell phone and cable T.V. could certainly help pay for such a healthcare plan. But just like paying $200.00 to get your furnace fixed, these kinds of expenses are not the sort for which most people want to spend their money; a Coach purse feels better. I work in healthcare, and I am amazed at the things for which people come to the Emergency Department. It can only be described as outright irresponsible! I have insurance with a high deductable, and I cannot afford to run to the E.D. the way some people do. I must first WAIT and see my primary M.D, which is less expensive than an E.D visit. Also, the urgent care clinics are less expensive than the E.D if I cannot get in to see my doctor. I am tempted to reason that those who treat the E.D. as their doctor’s office are not paying the bills, unless they have more spare cash than I do!
My point is that there has to be some financial responsibility on the part of the patient in order not to overwhelm an already taxed system. Some people will have to make the choice between insurance coverage and a cell phone, a choice I had to make. But that’s life. We all must make choices.

The survey TRULY reflects the hidden emotions boiling within the entire medical profession. The point that a few of the angry, highly misinformed, an obviously pro-Obamacare are missing is that being a physician in the United States is arguably the hardest job in the world, not to mention that Doctors ARE NOT SLAVES! We begin our training at least by Junior High School. The amount of knowledge required to master by even a competent family physician is mind blowing. Each year it increases exponentially due to research uncovering new drugs, new findings, etc.

For the “single mother” & “Erik” – We live in a society (hopefully still) in which people have a choice of profession. Is it any wonder that more intellectually gifted students are turning away from medicine in order to pursue carreers in business, law, Hollywood & real-estate? Why go to school for 11-20 years after high school (studying/training over 100 hours a week), while amassing a “mortgage” that essentially pays MBAs for the privilege of receiving a medical education, when your only reward as a physician is to work at least 80 hours a week, stress constantly about malpractice, never see your family (if you even have the time to procreate), and hear shocking comments from people like you that we are “overpaid”??

Are you truly brainwashed or just plain deceitful? (BTW – I am a registered Democrat & a minority w/ a high IQ who is developing a serious case of “Buyer’s Remorse”!)

Also, I do not understand the following…

1. Why is TORT Reform not being addressed? (Obama paying lip service to this in his speech in no way equates to definitive action considering the campaign contributions.)

2. Why do some people complain that physicians are “overpaid” when the average B-list actor or actress in Hollywood makes so much more than the top-rated Cardiothoracic ER Surgeon (the Dr. who saves your life even at 3AM in the morning) or Neurosurgeon?

We sacrifice more than most will ever know. There is only so much a human being can take. Doctors are human beings with the right to have healthy, normal lives as well.

I’m truly afraid that we are about to experience a medical crisis. Not just in the number of early retirees, but in the number & quality of students signing-up for medical school. 1-2 poor years of enrollment can be DEVASTATING as it takes years to train even a basic family physician.

Medicine does not exist without 2 entities – Doctor & Patient. Because there is no relenting of the seemingly endless diseases waiting to strike, the only entity that is at risk of disappearing is the trusted, highly-competent physician.

We are MISERABLE & EXHAUSTED!! We can’t take any more interference, whether from private sector or big government. We do NOT need to pay more taxes to pay the salaries of more government employees trying to tell physicians how to do their jobs!
The dam is about to break…I’m not a magnificant speaker but I am telling the truth!

If any of the doctors are paying attention to this, here is a plan that I’d like to put forward in Congress –

http://64.203.97.61/SolutionsLab/Solution.aspx?Guid=2d50363e-00be-44e8-9251-9a6589ba820d

It turns the whole system into basically a cash “payment at the moment of service” system with a combination of self-insurance and catastrophic backup in a unique fashion. I just haven’t been able to get anyone in Congress to look at it

Having been in the active private practice of medicine for the past 40 years and still actively engaged, my limited survey of my colleagues tells me that the 45% estimate may well be too low. To a physician, every one I polled indicated that they would not be willing to continue under a government plan. More importantly, all found the VA model that the government uses as the “plan” to be laughable. ANYONE, not just physicians, who has ever worked in a VA system will most likely concur that it is neither efficient nor effective in the care it offers, though the cost is low to the veteran. One colleague, an orthopedist, is party to his group’s efforts to recruit from Canada and advises that his Canadian counterpart has over a three year waiting list for elective appointments.

When someone can make a plausible case for government efficiency and cost-effectiveness for running Medicare, Social Security, the Postal Service, NASA, the Bureau of Indian Affairs, building a building, exercising oversight responsibilities of grant monies (as with ACORN), internal monitoring and policing of the spending of its own members in Congress and/or the Administration, running the Pentagon and the branches of our military, letting and oversight of contracts in Iraq, Afganistan or anyplace else and/or getting the best “bang for the buck” out of monies spent for educational purposes, etc. then the idea of their taking over the health care of the American people should be considered.

I quit clinical practice 20 years ago for research.

Why?

1.) The ever-increasing price of malpractice insurance
2.) Increased costs (primarily office staff) for “paperwork” and regulation compliance
3.) Interference by government and insurance companies re: treatments for patients
4.) Quality-of-life: used to work 70+ hours/week in clinical practice; now work 40 hours/week with plenty of time for family and hobbies; 4 weeks/year paid vacation; numerous employee benefits, including heath care insurance for entire family

Best career decision I ever made!

There has been a ongoing trend toward government run health care since the 1980’s. With the advent of Medicare and Medicaid, the rules for entry – diagnosis and treatment have been slowly ratcheted back by both Republican and Democratic administrations (Faster by the Democrats)
Add OSHA rules and the cost for practicing medicine continuously increase with decreasing reimbursements. The biggest hits have been taken by the primary care doctors (General Practitioners, Internists and Pediatricians). Without adequate numbers of these physicians, everyone will have difficulty accessing medical care.

The private medical insurers only mimic the Medicare rules and regulations as they make entry for patients and reimbursements for physicians harder to achieve good doctor/ patient interaction.

The proposed Democratic “health care bill” will not reform the present system. They are only adding thousands of pages of regulationsls that no-one will (or)can read on top of an already broken system.
True reform would require a simplified new bill written in English and read by everyone prior to passage. All US CITIZENS need access to affordable health without exception – no pre-existing conditions can be used to deny care! Additionally, without TORT reform, no health care reform is possible.

Dear doctors,

I am not implying that you need to be “societies slaves” and society really appreciates that you guys do work so hard. I’m also not implying that you aren’t worth it – you are worth much more than society can pay. Just one of you is worth more than every two bit actor who, yes, is way overpaid. About the MBA’s and those in medical research who make more, vacation more, and even may “procreate more,” you are also right about their lives, but your contribution is so much more and I seriously hope that that helps you sleep at night. You are over-worked; you are under appreciated; and the whole malpractice thing makes most of us sick – we are reasonable people. We aren’t all trying to sue you guys…remember that. Thus said, how about a high school teacher who makes $50K a year and when he/she goes home, that teacher has to spend hours correcting papers, homework, lesson plans, supervise clubs/teams…they work 80 plus hours too…and many of them can’t afford insurance for their own families!

People without insurance do go to the ER, but the reason is that no one else will see them. It ISN”T irresponsible to take your sick or injured child to see the only doctor who is legally required to see you. It is good parenting. It is just wrong in our country to refuse people healthcare based on their education or wealth – this is just Nazish to be honest. We don’t need a NHS. We need reform.

If a doc makes $10K for an operation, it is sick and it is robbery.

(I just wrote a response and sent it, but my computer froze, so I don’t know if it sent – please forgive any repetitiveness).

Doctors,

We know you work hard. We know you are smart. We know you endure years of education and tens of thousands in debt. We don’t want to imply that you should be society’s slaves, but you do need to offer health care to those who can’t pay – which is why people go to the ER for a fever. Actors, those with MBAs and medical researchers make more and have easier lives, but all of them aren’t worth what oyou do for people. You save lives and save the quality of lives for people.

Problem is that many can’t afford to see you. Lack of education or wealth is not reason to refuse someone. The idea that one is “better” than others and those “undesireables” can then be thrown aside is Nazish. It is “casteish.” In America we have no untouchables, but many of you doctors won’t even look at our poor and sick cause you won’t get paid what you think you are worth. Firstly, you are worth more than we could ever pay; secondly, if you refuse to see and look down on those who can’t afford you, you are just educated scum.

Many high school teachers make $50K a year. They work 80 plus hours a week grading papers, making tests, supervising teams/clubs. Many pay $500 plus a month to insure their families…then get stuck with huge deductables and copays. Are they untouchables too.

Who is it you feel you are too good to serve?!

to unimpressed: (who requested a physician response) –

you have no idea what kind of sacrifice, both personal and financial, it takes to become a physician. before you start judging people on how they live their lives or spend their money, you should appreciate what they have gone through to get where they are.

if you take away the financial incentive to practice medicine, how will you convince your best and brightest students to pursue a career in medicine? in fact, how will you convince ANYONE that it’s worth a decade of your youth, $150,000+ in debt, 80-100 hour workweeks, frivolous lawsuits, a chance to be infected with any number of communicable and very deadly diseases, hassles of paperwork (if you think you have a problem figuring out HMO’s, try dealing with them EVERY DAY for EVERY PATIENT), less respect, more taxes, more governmental regulation, and now less pay?

i agree with you that there is a place for altruism in medicine… unfortunately, altruism doesn’t pay the bills. nor does it even begin to make up for lost years, and the time spent away from your family. (and by the way, i eat peanut butter and jelly sandwiches, i drive a honda civic, and i live in a $140,000 house. dont go judging physicians because you are frustrated with your insurance company. they set the prices, not us.)

To Comment by a physician,

I wish that medical school wasn’t so expensive. Maybe we need to as a society reduce the costs of medical school, but with that there would be a cost – i.e. not being charged so much. One of my kids wants to be a doctor…I hope he does. He’s smart. He’s a hard worker. But he is no more special than my other kids…one of whom is special needs (CP). Teachers get mountains of paperwork too and have to deal with kids problems in a way doctors never have to. Does that mean teachers should get paid $200K a year and only teach the kids whose parents have the ability to pay. Of course not.

Compensation – you guys should be well paid, but not at the expense of not seeing sick people and that is what is happening now. You guys do deserve a lot – no question. But how much is what is in question. My friend’s son-in-law is an orthopedic surgeon. $500K a year! In most places doctors don’t drive Honda Civics or live in $140K homes. At hospitals the doctors’ spaces are mostly filled with luxury cars. In my town, the most expensive homes are owned by surgeons. I know some very fine doctors who give generously and live modestly. But, many don’t. Hence “the bills.”

I guess what we need is reform that unleases you guys to practice medicine without more debt than someone with an MBA, a balance between real malpractice compensation and frivolous lawsuits, not being overworked, and less paperwork. Reform is needed now. Can we agree at least on this?

You know what, my parents are psychologists and have a sliding scale for people (insured/uninsured/underinsured) so that people with a huge host of problems from abuse, addicitions…you name it…can get quality help. They pay their bills. They also have comfortable lives and they can sleep well at night. We need doctors who can see patients who just can’t afford the full price. Show some mercy. I’m not saying you guys should go under or should see most for free, but when people refuse patients because they are medicaid or have no insurance, you are treating them worse than you would your dog. Doctors, have you forgotten the parable of the good samaritan or are you willing to step over the baby with a 102 fever who can’t pay so that you can get to the guy with a little backpain just because he has insurance and can? Do you really want to be that kind of doctor? We don’t need a NHS like Canada/UK…granted (I’m no Obama supporter), but we do need to support our country’s people who can’t help themselves. Remember those who don’t arrange appointments to see you because of their insurance/financail means are just bouncers in medical clothes. We need some kind of reform you guys…for the uninsured and also for you.

This will be my last post on this article. I’ve enjoyed reading your thoughts. I just beg to differ…a right all of us have in our country. My wife goes in to hospital tomorrow for a lump and I pray to God you guys can help her.