05 March 2010

doctors making money: the problem

I'm going to be a doctor. It is an incredibly difficult road. I became a doctor because I know it will be a rewarding and interesting career. However, I also became a doctor because I knew it would be a great way to support my future family. In fact I became a doctor because I expected it to support my family quite well actually. Sure, I wouldn't be making as much as the guy who works a successful pyramid scheme or the successful business owner, or the investment banker, or the dentist... in fact this list could go on. But I became a doctor because it's not about the money... but it is just a little bit.

Then I read THIS ARTICLE in the New York Times. It talks about how part of health reform ultimately must control... gulp... physician salaries.

But I can't help but agree with the author. The author is taking from an article written by Dr. Howard Brody, professor of family medicine and director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston wrote for the New England Journal of Medicine. He talks about the way physicians can quickly run up the cost for medical care by utilizing expensive technology like diagnostic imaging.

This reminded me of a conversation I had with a pediatrician yesterday. I asked her "So, how difficult is it to sub-specialize in pediatrics?"

She responded, "It is a little bit competitive for some specialties. But I would advise against it for you. The field of primary care is where the demand is, and specialties are getting too overcrowded."

This was really interesting. Could this be true? Could medicine in the United States turn its back on expensive frivolous treatments and diagnostics?

I don't know. Most people I meet in the United States seem to think it is appalling that people in Canada have a waiting list for elective surgeries and the fact that access to an MRI sometimes is not as simple as showing up to the primary physician with a complaint of dementia.

As much as people complain about medical costs in America... maybe they complain about them the same they complain about Baseball players: many think it is ridiculous that players make that much, but they continue to buy the merchandise and pay $100 for a mid-level seat.

So what's my opinion? I don't want people to pay for unnecessary treatment. It is dishonest. It is like a dentist I had who performed several unnecessary procedures on my family (ie. "I have good news and bad news. The good news is that you didn't need a root canal. The bad news is that I did a root canal."). I didn't go into medicine to be a businessman. But do I think ultimately greedy doctors are the reason medical costs are up?

No. A big no. I think it is what people expect. It is the lawyers who sue doctors who don't do the MRI of the brain. It is the way insurance pays for CT scans and refuses to pay for physiotherapy. It is the way people expect to be lazy and eat high fructose corn syrup while taking insulin. It is the way drug companies are able to advertise direct to consumer just like a breakfast cereal does to kids.

Ultimately, I think it is the desperation we all have to be healthy, pain free, and to extend life as long as possible that allows capitalist structures to ultimately take everything we have monetarily (and then some) to fulfill these lofty promises.

Holy smokes. We need health reform in America.


Stephen said...

I think if doctors also did dances or some form of entertainment, high salaries would be more accepted. People have a lot easier time paying for entertainment. That is just a really random thought though. Look at me, I am going to be a lawyer. A profession that sues doctors for really funny reasons sometimes. (And I am NOT going to one of those lawyers... unless someone is willing to pay me a lot of money.. Just kidding!). When will people realize money is just paper the government says is valuable? That is a stretch I know, but its funny to think about how modern society is built upon paper. "Give me that house and I will give you a lot of this green paper." "If I hire you, we are prepared to give you quite a bit of green paper."

Marge Bjork said...

Your dentist makes me think of Arrested Development. "Don't worry. He's going to be all right."

really interesting thoughts, Rich.

Azúcar said...

Although the UK model is far from perfect, they have perfected preventative care. Emphasis on seeing the general practitioner for smaller ailments before they turn into larger ones could truly help us control costs.

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