Overheard on CNN.com: Broke doctors, rich doctors? Behind the stethoscope
Some medical practices are struggling to fund payrolls in this difficult economic climate. Readers shared their explanations.
January 5th, 2012
07:51 PM ET

Overheard on CNN.com: Broke doctors, rich doctors? Behind the stethoscope

Editor's note: This post is part of the Overheard on CNN.com series, a regular feature that examines interesting comments and thought-provoking conversations posted by the community.

We've seen quite a bit of reaction to a CNNMoney story on doctors going broke due to reasons including insurance changes, the economy and business acumen. Commenters claiming to be doctors and medical staffers (and their family, too) wrote in to share why people should appreciate their circumstances. Many consumers also responded with their own thoughts.

Doctors going broke

The following comments were selected to show perspectives from beyond the sea-foam-green curtain.

Higher costs, sicker patients

One commenter cited many external factors that are creating financial stress for doctors.

JarheadTribe: "Two big problems: There are huge advancements in medicine every year, with understandably huge costs associated with them. The companies that make these advancements only do so because they hope to profit from them. No profit = no research = no advancement in medicines or technology. But, unlike any other industry in the U.S. (or even the world), everyone expects to get everything in medicine regardless of their ability to afford it. Can't walk into a BMW dealership and ask for the 2012 750Li if you don't have the money. But you can certainly come into the hospital with a massive lung cancer wrapped around your aorta and expect to be admitted to the ICU, see the hospitalist, the intensivist, the cardiologist, the oncologist, the social worker, the cardiothoracic surgeon, the vascular surgeon, receive large amounts of pain medicines, food, breathing treatments, BP meds, cardiac meds, numerous CT scans, angiograms, echocardiograms, duplex, push for surgery, radiation and long courses of the latest four-drug combination of chemotherapy, months of post-operative care, rehab, meds, food, follow-up doctor visits, wound care, etc. etc. etc. All of this, even if you have never worked a day in your life or paid a penny into the system. And guess what? We can't deny you any of this simply because you don't have the means to pay for it. You can't even get a cup of coffee at a restaurant if you don't have the means to pay for it!

"Second problem: People are living much longer than they ever have before. I see 90-year-old skeletons brought into the hospital for the 10th time in two months, with the family asking for everything to be done to keep 'grandpa' alive, even though he hasn't been able to talk, eat, drink, pee, poop, see by himself for months. He lies in bed and moans all day long, doesn't recognize anyone because of advanced dementia, has a tube for feeding, wears a diaper, has massive skin breakdown etc. etc. etc. Again, nowhere else are you expected to continue providing very, very expensive care even in absolutely futile cases when people cannot afford to pay for it. In the U.S., it is expected. None of this care is free, nor will it ever be. Someone is going to have to pay for it. We don't have endless resources or money."

A well-deserved life

One commenter said they were proud to be a doctor and defended their compensation.

emergentmd: "Doctors still make a lot of money. We worked hard for it. We deserve to drive nice cars, live in nice homes, take big vacations. I live in a million-dollar home I built, have a BMW, put my kids in private school. I worked hard for this, I spent countless time training, sacrificing my best years of my life. I now work 30 hours a week, have a salary in the top 1/2%. I get to spend time with my kids, take them out to eat, spoil my nieces/nephews. Thats right. I do not apologize for my life because I worked hard to get here. There's a lot of jealousy in this thread. I am sorry that most on here did not choose to spend time alone studying and working 120 hours a week in residency. You chose to drop out of high school or major in English.

"I graduated with an engineering degree, and was offered $70,000 out of college. I chose to go back to school/residency for another eight years, making very little. By my calculations, eight years x 70,000 is $560,000. So I gave up over half a million dollars, and eight years of my 20s. So yes. I deserve to live the easy, happy, upper-class life. I deserve my million-dollar home, my kids deserve their $15,000 private day care, I deserve two new BMWs in my garage, my wife deserves to stay home and raise our kids. I am not shy about this. I traded the best years of my life so my family would not have to struggle. No apologies here."

Long hours and reimbursement woes

Many doctors noted the long hours and years spent in training, as well as difficulties getting reimbursed by insurance companies. Several people complained that Medicare was undercompensating doctors for treatment.

kcool: "Where to even begin to address the idiotic statements made by people who don’t know what a doctor endures and the stereotypes that persist. My wife is a primary care physician. She has only been practicing for 2.5 years post-residency. She does not bring home six figures like some of you think. Some people are posting comments indicating we have club memberships, drive expensive cars, etc. How about a 6-year-old Accord? Expensive? I am currently unemployed and we’ve had to refinance our house to make the mortgage payments. Million+ dollar home? Not hardly. About a quarter of that. I’ve been on the unemployment line since April. I get interviews but no offers. We lost a significant portion of our income when I lost my job. We’ve burned through savings just paying the bills – now we are dipping into our 401k. We are definitely in the 99%!

"Some people are comparing a vet to a doctor. Not even close. Yes, they both have years of education under their belt, have to do continuing education to stay licensed, and have insurance and business overhead to pay for. Vets don’t have the market regulation imposed by insurance companies and Medicare/Medicaid. I was talking to a chiropractor friend who gets reimbursed by the state of Minnesota for Medicare/Medicaid patient visits. His reimbursement – $1.56. Time in the room – 10 minutes. That’s $9.36 per hour to cover rent, utilities, insurance, equipment, student loans, staff paychecks, and somewhere in there he’d like to take some pay home as well. I know private physicians who don’t take insurance. They are cash-only and are much happier. Their patients are much happier, too. Nobody has to deal with insurance. His per-visit price is lower than my wife can charge because of the insurance billing overhead. Her practice has at least three people who do nothing but file insurance claims – three more salaries to come out of the low reimbursement rates from insurance. Oh, and eight-hour days/five days a week. What a joke! She works minimum 10-hour days (five days a week) and if she’s on call that’s a 24-hour shift (once per week plus a day every third weekend). She doesn’t get overtime pay for putting in extra hours. Why so many hours? That many sick people? In some cases, yes. In other cases, she has to sit around waiting on patients who arrive late, expect to be seen immediately when they do arrive and bring every ailment they can think of crammed into one visit. A 15-minute slot, pushed back because they were late, then extended to 30-45 minutes because they cram too much into one visit pushes everyone else back. That’s why you get to wait in the waiting room for long periods past your appointment time. Not because the doctor is screwing around – because patients don’t come on time and cram too much into one visit. Oh, and stacking two or three deep on a schedule? People make an appointment and don’t show! So, they are supposed to just sit around and do nothing? Fifty percent of her appointments are no-shows.

"My wife is on salary, so those weeks where she is working 70 hours a week isn’t worth it. She has more medical school loans than most houses cost in the U.S. – and it’s on a 10-year note, not 30. She has insurance that costs more than someone on minimum wage earns per month. She isn’t bringing home six figures, but she is the gatekeeper to the system. As primary care physician – and those are becoming a rare breed – under Obamacare, she is the entry point for patients to see a specialist. Without her, you get nowhere. Medical school graduates aren’t going into primary care because they can’t afford to. So, when all you who are whining about not having access to health care, remember this – there is a difference between access to health care and availability of health care."

No sympathy

We heard from a few readers who said they had worked with doctors and felt that at least some of the "rich doctor" stereotypes are true. The following poster said in another comment that they are a CEO.

ospreyisland: "Having worked in the medical profession for over 40 years, I can say I have absolutely no sympathy for physicians. The vast majority of those that are in a precarious financial situation is due to financial ineptitude. For years they have taken kick-backs from drug reps, medical equipment companies, and corporate conglomerates. They have become acclimated to six- and seven-figure incomes, preferential political treatment because of the financial contributions of the AMA to our ethical members of Congress, and the general perception that they are in an elitist strata relative to the rest of society. Frankly, the majority are egomaniacal, marginally competent, money grubbing dregs that have financially raped patients for years. Can you tell I have considerable sympathy for physicians?"

Medical student's perspective

We heard from many commenters talking about the grueling medical school regimen that all doctors must go through, and one comment from a student touched a nerve (no pun intended) with many others reading the forum.

Jason Feldman: "I'm a third year medical student in Arizona. Let me give you some figures:

"When I graduate my debt load will be close to $400,000. After interest and residency it will be closer to $500k+. The New Health Care Law requires us to get our student loans from the government now that charge higher than market interest rates. E.g. 10% of my loans are interest free, then about half of what is left is around 6.8% and the next half is around 7.5%. So when I am out and all is said and done, if I wanted to pay my loans off in 10 years that would amount to a $5,300 a month payment. Now take the average family doctor and say he makes $160k a year/$13k a month. Take out our 40% in tax (federal + state + Social Security + Medicaid) or more and we get $8,000 a month. Now take out the loans and we have $3,700 take-home essentially, equivalent to maybe a $60,000 a year job, which is not bad by all means ... Also factor in that we're trying to catch up on retirement since for the 10-12 years we're in school we put nothing in. In short, the cost of attending medical school now between lost income, benefits, and tuition is just under a million dollars. Oh, and all the interest we pay is not tax deductible. Am I complaining? No. I chose my career and I love what I do. But for everyone who thinks we're greedy and charge too much and live these lavish lifestyles, I think they're forgetting the eight years we spent in school, the five years we worked as residents for 80-120 hours a week and got paid $40,000 or $50,000 (roughly like 7 bucks an hour)."

Stitching it all together

We heard from a lot of folks saying that doctors have to take on a huge amount of risk, and who were frustrated with the insurance companies.

DTM03: "I am a surgeon. For those of you who think I make too much money, I would gladly give back my 20s for my modestly increased income. I have $170,000 in debt from medical school, I spent my 20s and early 30s in surgical residency working 100+ hours per week, I've missed every major holiday in my family to take care of the sickest patients in the greatest need. I love it. What I have never appreciated is how many people think that my sacrifices or skills do not deserve some level of compensation. I sometimes wonder if the general public realizes what it takes to become a physician. It is competitive and cutthroat. While we work through the training aspect of it, we have bankers, lawyers, and insurers lining up to see what they can take from us. I do wonder whether a nationalized health plan would be better than this current state. Your insurance company hates you. They want you to live a nice long, healthy life and die of a massive heart attack in your sleep. They certainly don't want you to get cancer, diabetes, or use any of the resources you've paid for."

That's my 12-year-old Chevy

Lots of the medically oriented commenters said they love what they do, but there are a lot of problems and hassles to deal with, and not everyone is superwealthy.

RationalDoc: "I am a board-certified internal medicine doctor in solo practice. I drive a 12-year-old Chevy. My next door neighbors are a fireman and a high school teacher. I struggle to pay my staff. But what I want people to know is that the governmnet is not the devil in this deal. I fight every day with Humana, Anthem, United Healthcare, etc. These Wall-Street-investor-driven for-profit companies have made practicing medicine miserable. Medicare is easy to work with by comparison. For whatever faults Medicare has, at least its heart is in the right place, and I can't say that about these for-profit companies who turn down coverage and make me fight on behalf of my patient to get a CT scan approved, all because they are trying to meet the high expectations of their shareholders. Look at your own 401(k). If you have shares in any for-profit health insurance companies, then YOU, not President Obama, are the problem."

Destination: Doctor

We did hear from a few commenters who said they were skeptical of the stories from the medical side of things. Some said doctors come to the United States to get more money.

Terry Chris: "This is a propaganda piece to elicit sympathy for doctors. American doctors are never unemployed and the highest-paid in the world. This is why America has so many foreign docs. The money is large and full-employment. I have four doctors in my family: two on my side and two on my wife's side. They are all rich."

But in Canada ...

One might even look to the health care in Canada and other countries to see how they're faring. We heard a lot of commenters talking about nationalized systems. Some love them, some hate them. Here's one comment. We'd love to hear your perspective on this, too.

ellaskin: "I am a specialist working in Ontario, Canada. My waiting list is three weeks. Urgent referrals are seen on the same day or next day. A single payer system is certainly not perfect, and taxes in Canada are high, however there are no physicians in Canada that I know of on the verge of bankruptcy, and it beats dealing with insurance companies or patients that won't pay up. The misconceptions about the health care system in Canada are unbelievable. Yes there are longer wait times than in certain areas of the U.S., and you may not be able to get an MRI just because you want one, but this is not medicine. If you need an MRI, you will get one even on the same day, if you need to be seen urgently you will be seen. If you have metastatic cancer, you will be treated with expensive chemotherapeutic agents at no cost to you or your family outside of your tax rate. Yes if you have a cold or thinning nails or knee pain, it will take longer for you to be seen and or treated, but no system is perfect. I agree with some of the previous comments. If for-profit insurance companies were taken out of the mix in the U.S., I truly believe physicians, their patients and everyone would be better off."

Lack of incentive

There is little incentive to take on the risk of the medical business or accept the payments from insurance companies, this father of a doctor says.

borealbob: "My son is an MD/Ph.D. and this story is true. Most docs will no longer go into private practice and/or accept Medicare/Medicaid. This issue goes far beyond graduating with $300K of debt. To run a medical office and give optimal care takes time and money. When you cannot even pay your bills, there is no incentive to killing yourself and punishing your family. You can drive a cab and make more money than primary care physicians. Something needs to be fixed and fast."

Uncertain futures

Many commenters said they think the current system is unsustainable.

voyager68: "For those of you on this blog who blithely comment that we (doctors) will have to make due by not buying a new Mercedes every year, I have some incredible news for you! Most of us don't drive a Mercedes or have two or three vacation homes. Yes, in general, we have incomes that are considered high but it was no easy task to achieve that. Four years of college, four years of medical school and then anywhere from three to eight years of post-medical school training and several more years in private practice before we make the 'big bucks.' On top of that, we have to make life-and-death decisions every day, take call every fourth or fifth night (usually for 24 hours straight) and carry enormous liability on top of all that. Most of us are not kicking back and placing the burden on underlings. As for the future of medicine, do the math. Our expenses (employee salaries, health care premiums, cost of meds, devices, malpractice insurance, etc.) keep going up and our remimbursements are stagnant or going down. Unlike a traditional small business, we can't raise the price of our services, because they are fixed by the government or insurance compaines. The future of medicine in this country is in greater jeopardy than it has ever been and I fear the quality of care will diminish significantly."

What do you think about these opinions? How would you fix the health care system? Share your opinion in the comments area below and in the latest stories on CNN.com. Or sound off on video via CNN iReport.

Compiled by the CNN.com moderation staff. Some comments edited for length or clarity.

soundoff (107 Responses)
  1. M. Smith

    I worked hard too. I couldn't finish high school because I was basically bed ridden most of my teen years and I lived in the middle of nowhere with drug addict parents and no transportation. When I was 20 I was finally well enough to go to college, and my mother was clean enough to take me. I too studied engineering, not English. I spent thousands of hours studying and got very good grades but having been diagnosed with a neuromuscular disorder, and being transportation limited, it took me 10 years to get my degree. By the time I finally did, my body was not holding up very well anymore and I was having a hard time explaining to potential employers why it took me so long to graduate.

    I am currently seeing multiple doctors. My health insurance costs $300 per month, and my medical bills totaled more then $12,000 for this year. I paid what I could out of pocket and the rest was subsidized by the government. I always pay co-pays out of pocket and would not have any reservations about paying my doctors the full price of the visit if it were reasonable, but I was charged over $700 for an office visit for one doctor, and I don't think that's right as no tests were done and no drugs were administered.

    So news flash to some of you doctors: You DO NOT always work harder than everyone else, there are others who work just as hard and just haven't been as fortunate to be able to afford houses and nice cars.

    Sick people have a hard time earning money, and those who need you the most probably earn the least.

    I pay you. Or at least theoretically. Every month I pay $300 to a company that is supposed to give you that money if I use your services. That is almost half of my meager income and I live with that hardship because I can't afford not to put my health first and I believe doctors actually should be paid and should be paid well. However if my health insurance company is ripping you off, that's something you need to take up with them, not grow resentful of your patients who are doing their best to afford your services.

    January 6, 2012 at 7:14 am | Report abuse | Reply
    • Terry

      Amen, my friend. Wish you al the best.

      January 7, 2012 at 11:04 am | Report abuse |
  2. M. Smith

    And another thing. My engineering school was right next to the medical school and though both fields are equally important and require roughly the same effort and aptitude, the medical students generally dripped with arrogance and pretentiousness while the engineering students were rather humble. Some of the best doctors I've had were the older ones because they weren't so full of themselves.

    January 6, 2012 at 7:42 am | Report abuse | Reply
  3. banasy©

    Dan M and M Smith:
    Great posts...

    January 6, 2012 at 7:53 am | Report abuse | Reply
  4. Allison

    I have worked in healthcare as a RN for over 15 years. I am currently in the middle of obtaining my MSN as a Family Nurse Practitioner. We are required at my university to have a business course in healthcare (and write a business plan) as part of our curriculum. Many of what the physicians are saying here is true in regards to reimbursement, patient demands and expectations of what is realistic for an office visit versus what is not.
    We are paid on salary by how many patients we see in a day. That may not be something the public likes to hear, but that is how we make a living. It isn't to rush people through, it is to be able to buy groceries, gas, pay a mortgage and allow for a vacation here and there.
    I know MD's that leverage themselves to the hilt with debt, and I know physicians who live a modest lifestyle and sock away money for retirement. Yes, some of it is personal income responsibility, but I can assure you that when a third party payor is telling me that I cannot get back the cost of my time for seeing a patient, I will have to compensate by seeing more patients in less time.
    That is not how Physicians and NP's or PA's have set it up, that is how Medicare, Medicaid and other private insurers have set it up. If it were up to me, I would see the patients that needed to be seen, order the tests that needed to be ordered and get fair compensation. I don't see that happening any time soon with the current system or with the new healthcare laws being put into place.
    It is sad really. The most experienced and talented ones will be the ones to move on from the field, leaving behind patients that need their expertise.

    January 6, 2012 at 8:54 am | Report abuse | Reply
  5. The Brilliant Idiot

    I am
    Currently writing a book on this very topic, "The Brilliant Idiot: The American SICK Care System". It is important to understand that doctors are simply pawns in the health care game. They are limited as to what they are "allowed" to do to and for patients, and that is regulated by government (FDA, CDC, NIH), insurance companies (Medicare, Medicaid, and private pay insurances), Pharmacietical companies (lobbiests infiltrate every level of our governement...congress, executive branch, and literally fund/own the FDA).

    95% of the 2 trillion dollars we spend on "health" care are literally spent on the sick, not the healthy. There is no money in healthy people, only sick and fat ones.

    Doctors now treat symptoms with medication instead of targeting the cause of disease because that is what they are trained to do in medical school.

    Medical school doesn't teach nutrition (only 6% of doctors are trained on nutrition) or business classes...but when doctors leave medical school, their loans are so incredible that the new physicians (now entrepreneurs without business sense) will take pennies on the dollar agreements from insurance companies because they are desperately in debt! This forces doctors to "settle" for
    Less than they deserve or literally need to survive. This causes the final domino to fall...forcing doctors out of work...literally closing their doors because of falling reimbursement and continued increases in cost.

    The fat keep getting fatter...companies and patients. Billions of dollars over expected earnings for insurance and pharmacy companies while decreasing the dollars spent on patients. The all mighty dollar makes the world go round while Americans continue to get worse, not healthier.

    Take a look at the CDC.gov website, search for "obesity" and find the graphic showing the year by year spread of obesity across the US since 1985. As doctors continue to focus on symptoms of obesity (cancer, heart disease, diabetes, stroke, arthritis, autoimmune disorders) instead of treating the 70% of overweight patients (11 states now over 35% obesity rate when in 2000, no states were over 30%), we will continue to treat symptoms and not the cause. Doctors do not know enough about environmental medicine to provide proper guidance to help patients lose weight and do the proper exercise. This leads to my second book, "The Fattening of America". Something must be done, and I am William g to help make this problem become mainstream knowledge.

    There is no mercy for the ignorant. Become informed. Do the research. Find the
    Problem, then provide a solution. This country depends on an informed public! While American citizens go "biz as usual" and keep their heads in the sand, Big business and big government will continue to run the poker table and gamble with our health in the process.

    January 6, 2012 at 10:06 am | Report abuse | Reply
    • InformedMD

      Brilliant Idiot – You say, "become informed. Do the research", yet you state that doctors aren't trained on nutrition and don't know enough to help patients lose weight and do the proper exercise. From what orifice are you pulling that information? I know for a fact that the vast majority of doctors know what a healthy diet is and also know enough to tell their patients how to lose weight. There isn't a magic will power/self control pill just yet, so patients are still going to be held accountable for their choices when it comes to not exercising and eating too much. Preventative medicine is great, only is requires self control. Do you think the average person likes exercising and eating healthy more than being sedentary and eating unhealthy foods?

      Bottom line to this whole mess – Lack of accountability and Entitlement. Until you fix those problems, nothing will improve.

      Make it mandatory for people to read Atlas Shrugged. The more socialistic our society becomes, the worse off America will be.

      January 6, 2012 at 11:58 am | Report abuse |
  6. bigwilliestyles

    @ Dan M: agreed.

    January 6, 2012 at 10:41 am | Report abuse | Reply
  7. Philip @ Idiot

    Hogwash. Even an seriously obese doctor has a brain and knows he should be more concerned with what his patients are eating than just selling them a bunch of pills. He knows the big screen TV in his lobby should be offering dietary advice rather than a looped Big-Pharma ad spouting the goodness of pharmaceuticals, lap bands, and fat sucking devices. Doctors know the truth about health. These aren't ignorant people we are dealing with. They know ALL about what goes into pharmaceuticals. And now you can too. Visit http://www.truthinlabeling.org and donate a dollar to the cause: Lobbying Congress to force Big-Pharma to tell US the TRUTH. Nearly 20,000,000 dollars have been raised by the 3 million members of this movement.

    January 6, 2012 at 12:14 pm | Report abuse | Reply
  8. Mar

    I don't know about physicians being broke or not. I do work in the ER as a nurse, and therefore I am exposed to the awful waste of money spent on useless medical procedures/visits. I think that we can save billions by cutting to the chase. Starting with drug OD's. Guess what, illegal substance or on purpose=no care.
    You choose to continue to smoke after all the evidence points to the ill effects on health? No care.
    You choose not to wear a seatbelt or a motorcycle helmet? No care.
    How many 90 yr old nursing home pts. with no quality of life are needlessly put through the rigors of CPR with its associated intubation, medications, xrays, and possibly ICU stay if they get the faintest of heartbeats back? I can only count the ones that happen in one ER, now multiply that by hundreds.
    How about dialysis? It cost's at least $700 three times a week for a dialysis patient to live. Many of those pts. don't have a quality of life either. If they do, then give it to them, if not....stop.
    The other thing is the needless ER visits because people are either too lazy to visit their own PCP's(Primary Care Physician) or too stupid to know that their condition is non-emergent. People actually fess up to the former more than the latter. How much money is wasted there?
    Now the real stickler. Do you know how many people are actually listed as disabled? Do you know how many people are walking around fully able to function in their day to day lives yet do not have to hold a job because they are disabled or on government assistance? I think the solution to that problem is to have a systematic review of everyone on welfare/disability, and make those people do something for their money. I have no problem helping people out if they do something in return. My solution may sound extreme, but i'm sure it would work, and taxpayers would actually be happy with the return. Take 1 square mile areas and get a list on who is on government assistance. Take a look at their capabilities and make them take care of that square mile. Everything from trash pick-up, maintenance, to beautifying projects. Instill a sense of pride in themselves and their communities.
    Seriously, take a long look at these suggestions and think about how much money could be saved.

    January 6, 2012 at 12:21 pm | Report abuse | Reply
    • cigarman

      All of thes items that you have mentioned and then your ideas make to much sense. Your ideas will happen WHEN PIGS FLY.

      January 6, 2012 at 4:14 pm | Report abuse |
    • debrah

      Its people like that nurse working in ER that is the downfall of our medical society. Heartless and think your better than the poor souls out there who don't understand human anatomy. So they smoke drink don't wear seat belts so let them die. Great way to show what kind of people are working in our ER's. Shame on you. Everyone matters !!!!!

      January 6, 2012 at 9:29 pm | Report abuse |
    • Anastasia

      MAR * VERY CREATIVE. You should not be a nurse if you don't care about people. You don't pay for these people's hospital bills. Every "WASTE of money" that walks through the door means that you get a paycheck! so you should be glad about that. You sound like a rude butt hole, who I would hate to have as my nurse. Also, its not up to you to decide what is an emergency either and alot of these people that come in do not have health insurance and know they will get care at the hospital from butt hole nurses like YOU. I am an RN too and people like you RUIN our reputation.

      January 7, 2012 at 12:49 pm | Report abuse |
    • JB

      Scholastica8,
      The idea that medical treatment should only be reserved for those "who have quality of life" is profoundly, profoundly disturbing to me, and is also, in my mind, quite immoral. Reducing the meaning and value of life to only those who can enjoy it, ignores the existential, philsophic, and moral value of life. A person is intrinsically important, a person is valuable, and a person must be treated and healed regardless of how much they can enjoy life. This, I believe, is a fundamental principal of morality. Moreover, why do you view "quality of life" as the most important part of life to the extent that you believe that life is worthless without this? How about, the inner drive that we all have just to live, is this not valuable? How about the relationships which a 90 year old grandparent may have with their family that is very meaningful to them? Who are you to effectively murder a person because you think that life is only valuable inasmuch as it provides one with pleasure?? How about the idea that everyone values the mere fact that they are alive? Are all of these parts of life, not meaningful?
      I would also like to ad the following point: what if this person were you? Would you not want to live, or at the very least to be given the option of choosing whether to get treated or not? Remember, we are not necessarily talking about a person who is in deep pain, but rather an older person who simply will not live much longer. What if this person was your son or your father, what would you say? Would you want to lose them?
      Please, please, please think about this position of your before voice it in such a public forum.

      January 7, 2012 at 5:25 pm | Report abuse |
    • Another RN

      So your money-saving idea is to deny healthcare to anyone who contributes in any way to his/her illness or injury; or anyone who doesn't have a quality of life that is up to your standards? Since when do nurses judge who 'deserves' healthcare? Maybe you're in the wrong field.

      January 10, 2012 at 2:23 am | Report abuse |
  9. Happinest

    My doctor is taking cash only now. He actually has a paper in his waiting room talking about Obama Care, BUT he is taking insurance on procedures. He drives a Corvette and I don't. I cannot feel sorry for people who are about money and not the care of the sick which is a part of their Oath??? I took an Oath while working for the Government and took long and ardeous legnths to make sure I kept that oath. All the ifs and all the butts, the only thing that matters today is the money and who has the most and I just wanna know "Do You win if you die with the most toys?"

    January 6, 2012 at 12:51 pm | Report abuse | Reply
    • YRS

      I am 58.The last two years I used up over half my retirement trying to keep my practice afloat. I have been selected as "best doctor" nationally every year for the last 15 years. I give my all to take care of the complicated and sick. Per my letters from patients and family they appreciate the caring and expertise. Yet, barring a miracle I may have to close my practice soon.

      The problem is society. Americans will pay cash, credit card or credit union for cosmetic procedures (hence why dermatologist and plastic surgeons do okay) but will balk at paying a 50 dollar co-pay.

      The current climate is driving out the doctors who care and spend time- and rewarding those who see patients as only a number. A colleague in the same complicated specialty schedules 10 pts an hour, I schedule 2. We get the same reimbursement per pt, something is wrong woith the system.

      January 6, 2012 at 7:40 pm | Report abuse |
  10. medstudent24

    I realize that a few doctors are only obsessed with trying to make money. These docs will only take cash and private insurers, and will leave the rest of the population to try to find care. However, the vast (and I mean vast) majority of docs try to accept patients from all walks of life, and these docs do not make a salary undeserving of their specialty and the sacrifices they made to become physicians. I hope the people commenting here know that as health care reimbursements go down, more and more docs will have to deny patients with sub-optimal insurance plans. What then happens to these patients? They go to government funded clinics and to the ER where you, the general population, must pay for them. This isn't just an attack on docs. SOMEBODY WILL HAVE TO PAY for the sick, and its going to be you!

    January 6, 2012 at 2:10 pm | Report abuse | Reply
  11. snagglez19

    I am a doctor (humanities PhD instead of medical MD). I spent just as much time in school as a medical doctor and have large student loans due to graduate school. I am currently making under 50,000 a year before taxes and am not likely to make any more than this for the next ten years or so. Yes doctors work hard in school, they have debt, and they deserve to be fairly compensated for their work, but that does not give them the right to make 300% more than a college educated nurse or 500% more than a teacher with a masters?

    January 6, 2012 at 2:23 pm | Report abuse | Reply
    • YRS

      Your statement is incorrect. First of all, many PhD'S can be obtained part time- not so in medicine because the "hands on" time is far greater and the work rigorous.

      Further, you are done once you receive your PhD. Not so in medicine- after the MD a further three years minimal residency education is required just to be a generalist and a further 5-7 years (or more) required to be a specialist.

      January 6, 2012 at 7:54 pm | Report abuse |
    • YRS

      Your comment is misleading at best and deceitful at worse. First of all many, if not most, PhD programs can be done part time. Not so in medicine because the "hands on" requirements are so much more and the rigor much more intense.

      More importantly, when you finish the PhD, you're done, you can work. However, after the MD a doctor has a minimum of three more years of residency training just to be a generalist and 5-7 years (or more) after the MD to be a specialist.

      So, the average doctor has 4 more additional years of training above the PhD level-quite a bit wouldn't you say (if you are honest)

      January 6, 2012 at 8:04 pm | Report abuse |
    • MikeM

      Compensation also depends heavily on the value that a society assigns a skill or service. Professional sports players for example are very handsomely compensated in the United States. Whether or not they should be is not my point. My point is 1) they have a skill that very few possess and 2) society (for the most part) has no problem supporting their high pay. Both of those requirements (but not necessarily only those requirements) are needed for a profession to command high compensation.

      The same applies to physicians as well as humanities PhD's.

      January 6, 2012 at 8:49 pm | Report abuse |
  12. CaliMD

    There is a significant amount of misunderstanding on both sides. I understand that there are some "bad" doctors out there, but that should not represent all of the medical profession. As a physician, I agree with all the posts about the sacrifices, long hours, lost years, and financial risk that doctors take on when they decide to join the profession, but the point is that ALL of us CHOSE it. That's where I think we lose the sympathy from the general public. We all chose to mortage our 20s and 30s for our careers. Sure, you can say that we "desreve" the compensation, etc., but I would give it all back for a little respect from the public. I don't need to make a ton of money. I just want patients to understand that your doctor actually knows something and is trying to do the right thing. We are not all greedy, rich scumbags living off the teet of the drug company; I think you have us confused with the people who manage your 401K.

    The US system definitely needs an overhaul, but the doctors aren't the problem, and neither is the government. Insurance companies deny everything. We as your physicians, try to fight for what is right. I have faced this on both sides. I have spent countless hours on the phone haggling with some un-educated, non-physician insurance claim reviewer about denying medical coverage for a necessary treatment for an ill patient. I spent the same amount of time trying to do the exact same thing as a parent of a special needs child. IT IS INFURIATING!!! I nsurance companies should NOT decide the cost of medicine because they are NOT DOCTORS. The current system overcharges those who can pay to compensate for losses for those who can't. This makes no sense! I can't even begin to include all the complexities involved in insurance coverage for end of life care/futile treatments, but denial of preventative medicine/vaccines/exams.

    The health consumer today has a significant amount of access to medical information–much more than years ago. You can look something up on WebMD and decide which tests you want, etc. Of course, when your doctor refuses because it's not medicall indicated, or you have to pay out of pocket for an unnecessary test, you will scream about your arrogant, inconsiderate, "only cares about money" doctor doesn't want to give you what you want. THIS is why insurance companies win. They pit us against each other when we are supposed to be partners in your health. Unfortunately, it is not a level playing field all of the time. As doctors we are highly trained and we KNOW MORE about medicine than you do; this is a fact. Unless you are a doctor yourself, there is no disputing this. If we could learn to trust each other and push out the money-grubbing, for-profit insurance companies, maybe we could all improve our health as a society.

    January 6, 2012 at 3:30 pm | Report abuse | Reply
  13. cigarman

    I am very sorry to report that I cannot feel sorry for any doctors. I associate and go to several doctors. In our area there are many, many doctors. I see them in there offices and at the country club and sometimes at each others houses for different occasions. My little three hundred fifty five thousand dollar house looks likes these guys GARAGE. These guys have total Mansions.No I cannot feel sorry for them.

    January 6, 2012 at 4:02 pm | Report abuse | Reply
    • YRS

      Only a minority of doctors live as you describe and most of those in cosmetic type specialties.

      January 6, 2012 at 7:44 pm | Report abuse |
  14. SM-MD

    There is a significant amount of misunderstanding on both sides. I understand that there are some "bad" doctors out there, but that should not represent all of the medical profession. As a physician, I agree with all the posts about the sacrifices, long hours, lost years, and financial risk that doctors take on when they decide to join the profession, but the point is that ALL of us CHOSE it. That's where I think we lose the sympathy from the general public. We all chose to mortage our 20s and 30s for our careers. Sure, you can say that we "desreve" the compensation, etc., but I would give it all back for a little respect from the public. I don't need to make a ton of money. I just want patients to understand that your doctor actually knows something and is trying to do the right thing. We are not all greedy, rich scumbags living off the teet of the drug company; I think you have us confused with the people who manage your 401K.

    The US system definitely needs an overhaul, but the doctors aren't the problem, and neither is the government. Insurance companies deny everything. We as your physicians, try to fight for what is right. I have faced this on both sides. I have spent countless hours on the phone haggling with some un-educated, non-physician insurance claim reviewer about denying medical coverage for a necessary treatment for an ill patient. I spent the same amount of time trying to do the exact same thing as a parent of a special needs child. IT IS INFURIATING!!! I nsurance companies should NOT decide the cost of medicine because they are NOT DOCTORS. The current system overcharges those who can pay to compensate for losses for those who can't. This makes no sense! I can't even begin to include all the complexities involved in insurance coverage for end of life care/futile treatments, but denial of preventative medicine/vaccines/exams.

    The health consumer today has a significant amount of access to medical information–much more than years ago. You can look something up on WebMD and decide which tests you want, etc. Of course, when your doctor refuses because it's not medicall indicated, or you have to pay out of pocket for an unnecessary test, you will scream about your arrogant, inconsiderate, "only cares about money" doctor doesn't want to give you what you want. THIS is why insurance companies win. They pit us against each other when we are supposed to be partners in your health. Unfortunately, it is not a level playing field all of the time. As doctors we are highly trained and we KNOW MORE about medicine than you do; this is a fact. Unless you are a doctor yourself, there is no disputing this. If we could learn to trust each other and push out the money-grubbing, for-profit insurance companies, maybe we could all improve our health as a society.

    January 6, 2012 at 5:10 pm | Report abuse | Reply
  15. Brandon isaacson

    For those of you who think that doctors make to much money I have this to say: Have you ever had to tell a patient they are going to die? Have you ever had to tell a mother or father that their child is going to be disablled or has 6 months to live? Have you ever saved someones life? Have you ever in the process of trying to help someone caused a significant disability? These are the issues that most physicians face routinely.
    In addition to the long training period most physicians routinely have to put their patients (YOU) ahead of their own lives and families. In addition to these issues most physicians are not shift workers. You cannot go home until the patient is safe.

    January 6, 2012 at 7:32 pm | Report abuse | Reply
    • Terry

      Well, tell this to the soldier, the police officer, the fireman, etc. How many physicians have had their legs, arms, hands, blown off, shot in the chest, etc ? How many physicians have lost their lives in their job dutes? Does anyone really think it is approriate to argue that physicians have to go through sooo much education and are paid too little. Cry me a river !

      January 7, 2012 at 10:33 am | Report abuse |
    • anon

      I agree that the hardships doctors go through (schooling, income deferral, ridiculous hours) don't necessarily merit high compensation. A few other careers also involve hardship, though probably not as much as a surgeon's.

      Doctors are paid well because of the value they provide. If your doctor is providing very poor guidance, then maybe you should replace him/her with WebMD, medical tourism, or a number of emerging concierge services. But if you believe that your doctor is highly competent, and you're trusting them with your health, what happens when they go out of business? When doctors can no longer provide cancer treatments, or administer anesthesia for surgeries, or staff the only Level I trauma center in the state 24-7?

      January 7, 2012 at 10:18 pm | Report abuse |
    • peds doc

      Terry and Anon. You are completely right, many other professions require hardship and sacrifice. However, the way our society work is that if you have a special skill, talent etc that not everybody can do, it is worth more. Do you find it ridiculous that our society pays athletes $250 million over 10 years for having a batting average of .300? Nobody seems to complain about movie stars, athletes etc...

      January 25, 2012 at 10:49 pm | Report abuse |
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