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.

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    I am very concerned about the future of America's medical system, and becoming a doctor for young people is becoming less popular because of the costs for education and lack of support from the government. With all this, many people are complaining about doctors salaries, well docs deserve what they make due to the enormous stress and hours they put into patients. They also have to take their work home, like paperwork, and insurance issues. But also, they have to take home the stress and bad news that occurs in hospitals all the time. But most are diligent and have adapted everyday with ordeals, and america should put more support for docs as they are the ones who make america so great.

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