Arnold Schwartzenegger has a new opponent, and this time he’s battling a desi [Thanks Chick Pea!]. The governator’s latest adversary is the head of the the California Medical Association, Dr. Anmol Mahal. 
The Fremont, Calif., gastroenterologist admired Schwarzenegger’s goals–coverage for all of the state’s 36 million residents and improving health care for kids. “It’s in some ways very visionary,” Mahal said later. But Mahal’s admiration soured when Schwarzenegger revealed that his plan would force doctors to give up 2 percent of their gross incomes to help fund coverage. “We are very discouraged and disappointed,” Mahal complained. “We had no warning.” [Link]
It is strange enough for me to see two of the highest profile Republican governors in the country pick up Hillary Clinton’s banner of universal healthcare, but stranger still for me to see a turbanned face (wearing a turban almost the same shade of blue that Manmohan Singh wears) staring back at me from the pages of the MSNBC article on the subject.
The racial aspect of this is striking because this is a plan designed, in part, to cover the health expenses of illegal aliens. This is a complete about face from former Republican Governor Pete Wilson’s strategy of demonizing illegal aliens. Having a desi doctor as the face of the opposition adds another twist, framing this as a debate between wealthy legal immigrants and poor illegal ones. That makes the politics more interesting, but also more complex.
The crux of the doctors’ disagreement with the plan is the way in which it will be funded:
… nearly 30 percent of the plan’s costs [will be covered] by levying a $3.5 billion “coverage dividend” on doctors’ (and hospitals’) gross revenues. “Why not tax teachers to provide money for better schools?” complains Dr. Samuel Fink, a Los Angeles internist. [Link]Some medical practices would suffer more than others, doctors complain. Assessed on gross revenues rather than net income, the 2 percent fee hits doctors with high overheads harder, including oncologists, pediatricians and general practitioners–whose overhead costs may amount to 50 to 60 percent of their revenues. [Link]
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p>Here is how the costs break down across various economics groups:
… companies with 10 or more employees who do not provide health coverage be required to pay an “in-lieu fee” of 4 percent of their payroll. Hospitals would contribute a “coverage dividend” of 4 percent of gross revenues, while doctors would pay 2 percent of gross revenues. [Link]
The language of fees is important for two reasons. Firstly, the Governor doesn’t want to be seen as raising taxes:
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Schwarzenegger has steadfastly refused to call them taxes, but some of his own allies in the business and fiscal conservative communities say that’s exactly what they are…. some accuse the governor of being hypocritical, noting that Schwarzenegger criticized his Democratic opponent during the 2006 campaign for supporting a plan that would put billions of dollars in new costs on businesses to pay for health care [Link]
Secondly, there is a constitutional issue involved here:
The tax-vs.-fee debate is more than a question of semantics: It could decide the fate of the proposal. Tax increases require a two-thirds vote in the Legislature, while fees need only a majority. The larger threshold would give Republicans virtual veto power over critical pieces of the governor’s health plan. [Link]
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p>The CMA is girding their loins for a hard fight on these issues, hopeful that the administration will yield ground:
Negotiations have only just started. Dr. Mahal promises that the CMA will lobby hard to cut the provision that docs help pay for the plan. Schwarzenegger has signaled that almost everything is open for discussion–“I look forward to everyone having those debates,” he said on the day he unveiled his plan. [Link]
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One thing I’m sure of – Sacramento lobbyists will be as happy as pigs in $h1t for a while …
Individual lawyers arent required to contribute a percent of their gross income to fund universal legal aid.
A part of the legal aid funding comes from lawyers in private practice as all the interest accrued on client accounts goes towards legal aid funding.
errr..no. most professions have relatively open entry by people w/ “alternate” training… For ex., the # of software programmers who have actual software degree’s is a shockingly small % of the total number of engineers. And many of them end up being some of the best software folks….
By contrast, the # of med school / specialty slots is pretty directly managed from up high by the AMA.
most doctors who make money…make money–but not in medicine… it’s other things that they do.. whether it be real estate, or stock market… most of the ‘richy rich’ physicians think outside their degree..
The AMA is most definitely a monopoly (#77)
Hmm, Was just wondering. Doctors will have to pay more money, so doctors increases fees, so then insurance has to pay more money, so insurance increases the premium. So in the end, will it not be us, who ends up paying more money ?
And trust me..plastic surgeons will never leave california 😉
sad.. i was esp apalled at one of those nitwits who told a 17 yr old or so, what else she needed to have done rather than what she was originally going in for (on one of those true life bits on MTV years ago), i was so apalled that i wrote to the medical board… blech…granted the gal wasn’t that ‘confident’ in herself to begin with, but come on now.. there is a thing called ethics, esp in elective surgical procedures.. that 90210 show is also another BLECH…
I’m not a doctor and am 90% with the pea on this one. Schwarzeneggar’s proposal is fundamentally flawed on a number of levels:
1. Taxing Docs For those who think California doctors make a ridiculous amount of money, you are sorely mistaken. While there are a minority (a very small minority!) of “fat cats,” most doctors in this area are gutted by high malpractice insurance rates, overhead costs (always expensive in CA where real estate and the minimum wage are much higher than the rest of the country), cost of living (again, relatively super high), and med school debt. Doctors aren’t even reimbursed according to AMA standards; they’re paid a fraction of the true cost of medical procedures because California passed restrictive legislation that allows insurance companies to pay as little as $20 for a $3,000 procedure.
For those who argue that malpractice rates would go down if there were stronger internal disincentives, I disagree. No one holds insurance companies accountable for shit; they will continue to raise rates so long as public dialogue centers on those “rich doctors.” This is what we hear everytime there’s an effort to make life more difficult for docs – “they’re rich, they can afford it.” This is a total misrepresentation, especially given the current climate in California.
2. [The Lack Of] Coverage for Low-Income Families Arnold’s plan is also misleading – it is not universal health care by any means. It allows any medical hack (read: not a doctor) to be considered adequate coverage. This means that in low income areas people will be considered “covered” by their local chiropractor, nurse practitioner, or alternative med. specialist. I’m not ragging on these professions, but effectively this will ensure that only rich people are able to see doctors while poor people are required to see whoever is nearby.
3. California’s Fiscal Health & Debt Burden Arnold doesn’t propose financing this entire plan with a 2% tax (let’s call it what it is) on doctors – he also wants to borrow another couple of billion dollars. California’s structural deficit and debt burden is totally going to default over time – especially with the current crop failures, etc., that are going to cost the state millions in revenue. Arnold likes to pretend that he’s anti-tax, but in fact he’s raised “specialized taxes” or “fees” on the people who can least afford them. He’s frozen cost of living increases for many direct service providers (social workers, nurses, police officers, fire fighters, teachers), and his plan does not make sense. I’m still in favor of the California income tax adjustment that failed to pass last November and levied an additional 1% income tax on those who earned over $500,000 annually (and 2% on those who earned over $1million). Honestly, this just pays forward our debt, and I can’t see how this will cost less. I agree that our health care system is a total mess, but this is definitely not a solution.
Here’s where I disagree… 4. Health coverage for undocumented immigrants To be honest, I don’t think this will be a big draw for increased undocumented migration. Undocumented labor in our state subsidizes our cost of living. While many are scraping to get by, it would be a lot harder if we actually paid the fair labor rate for migrant farmworkers, house cleaners, gardeners, and sweatshop workers. Undocumented families have an estimated burden on the state that is more than offset by their contribution to the economy. Also, I think it’s just hateful and unfair to deny people health coverage. So what if they didn’t come through the “legalized” channels? Given the amount of poverty our trade policies create on our borders, it is no wonder that people have to migrate to find what they see as a “better life.”
No other profession limits their numbers like doctors. In law, the ABA sets criteria for accrediting a law school but any law school that meets the criteria can be accredited. Not so, with medicine where the AMA has much tighter reins on the number of med school seats. There are further restrictions on specialties by restricting residency programs.
Of course, a profession needs to be ensure the viability of their trade but the AMA goes way beyond that. They’re ensuring that doctors get paid far more than a free market wage. The AMA hides behind the argument that it’s not possible to increase the number of med school seats and residencies w/o decreasing quality but as you’ve pointed out, anyone can go get their degree in the Carribean and come to the US (even with this arrangement, the number of doctors is too low because many people who would be willing to go to med school in the US, even if medicine paid less, aren’t willing to go abroad to become a doctor). Surely, the folks coming in from abroad could be equally educated in the US!
Another distinction between medicine and other professions…people aren’t lining up around the corner to go into law, social works, or economics like they are for medicine. There are typically over 40,000 people applying each year for 17,000 medical school slots (a number which hasn’t changed since the late 80s even though the population has increased). Doesn’t this indicate a large imbalance between supply/demand for doctors?
To contrast with what I stated above: 40K med school applicants for 17K med school slots, number of slots hasn’t increased since the late 80s, below is the data on the law profession, 2000-2005:
people aren’t lining up around the corner to go into law, social works, or economics like they are for medicine
I disagree with the lumping of law in with the other professions. Just the sheer number of law school graduates being churned out every year speaks volumes about whether people are lining up to be lawyers or not.
Much maligned though we lawyers are, it remains a fairly lucrative and sought-after profession.
Honestly, this isn’t 100% true. No one’s “automatically accredited” just for meeting ABA standards, and there are limitations on the number of lawyers produced. Same with economists, etc. Not only is it expensive to educate people in these professions, but many “professional” grad programs specifically limit admissions so that they don’t flood the market. The AMA does not artificially drive up the cost of doctors through this process.
I think law is actually a good analogy. Take a public interest lawyer vs. a corporate lawyer. Both could be working 70-90 hours/week and kicking their butts, but the pub. interest kid is going to make less than half of what a corporate person makes, on top of paying off loans on their $150K+ education. I can’t speak for other states, but in California this is definitely what’s happening with doctors. They work more unregulated hours and are paid less hourly than other professions. I’m not saying this is atypical, but at the same time, I think it’s misleading to think that the AMA limiting the number of people entering the medical job market means that doctors countrywide are have some secret money horde that they don’t want to give up for universal health care.
There are two seperate issues here; one is the health insurance system, and doctors have little control of that. And then, the issue of medical school spots. Until the health care system began to break down, no one thought it was onerous that it was so difficult to get into medical school. If society wants to change the definition of what it means to be a doctor, so be it. However, to simply say, this system is messed up and its all the doing of the AMA, is farcical. Once again, as a society we’re told, its not our job, its not our responsibility. Even if you wanted to ramp uo the number of medical school slots, how are you going to pay for more trainees to become trained? Make the AMA pay for that?
Umm, my point was that doctors make much more than teachers.
Basically to solve a systemic problem, let’s canabalize another segment of society that has basically functioned well in the past, and run it into the ground, in the hopes that somehow all this will stop and everything will get better
Just on that point – it means that they make more and have more job security than if the system was more open, or constrained purely by considerations of quality.
I don’t think the standards (the exams and such) should be dumbed down but if we allow people who don’t get into med school in the US go to the Carribbean, why not just increase the number of med school seats? It seems like the requirements for becoming a doctor, not the requirements for getting into US med schools are what keep quality high.
Then they should raise tuition and provide loans for those who don’t have the money upfront. Why should society bear 75% of the cost of educating doctors? Seems like yet another perk doctors get over above their salaries…they only pay for 25% of the cost of their education!
I should clarify my previous statement. People line up around the block to get into law school, but there’s sufficient capacity to let most of them in. People lining up for med school aren’t able to get in because of the very limited number of med school seats.
I’ll admit that every profession does something to limit the number of grads so they don’t flood the market but medicine hasn’t increased the number of seats substantially since the late 80s. Surely, this goes beyond “flood prevention” and enters the realm of creating a scarcity to drive up prices.
I’m probably not addressing the point you’re making here but let’s not forget that the public interest lawyer works fewer hours and doesn’t have to hand in his soul at the door each morning when he goes to work. Surely, your soul has some value.
Agreed, there are many problems beyond the AMA’s over-restriction of med school slots and residency programs. The trainees should pay for themselves to become trained and if they can’t afford it, they should take loans. Of course, with the greatly increased cost of med school, today’s doctor wages would probably be justified.
First off I’m not a doctor. I just empathize on the medicos side with the whole situation. It just plain sucks that in a country where people are free to pursue their own avenues of happiness, someone who did it legally and is reaping the rewards for it, is being taxed in the name of populist policies. Again I’m not against universal or subsidised healthcare for the economically underpriviledged but if you are taxing someone, do it equally across the board.
Yes, but honestly, do you think “higher quality” doctors would result in better health care for everyone? Again, medical access would be limited by wealth. My mamaji (a PM&R doc) always jokes that no one knows the difference between a guy who was an ace in med school vs. the guy who had a C- average by the time they finish residency. Let’s say more C-‘s are getting through – where will they work? Probably in poor communities where they (individually) are paid less while others are paid more. I don’t see how this helps things.
Simply and totally unreasonable. To ask trainees to pay for medical education is actually to limit the field to those people already wealthy. Medical education in the US was a way for medical class kids to train in a basic meritocracy, and now in order to fix a systemic problem, we want to turn what was once a cornerstone of the middle class into a putrid cesspool of recrimination and antipathy. Nice going, way to think about the overall health of our society. 🙂 (hyperbole there)
Camille, that’s wasn’t my point. My point is that the reason for the number of doctors we have isn’t because we have set a quality standard and nobody else is good enough to be a doctor, it’s because the AMA limits the number of medical school spots. As somebody mentioned earlier, the number of spots has remained the same as the number of doctors has grown and the demand for them has grown. An artificial restriction in supply like that does lead to more income for doctors and more stability for them. The economics of what’s going on are pretty clear.
True, the quality arguement is a wait-and-see-arguement. There’s already de facto opening of spots as Nurse practioners start to do primary care. The definition of a doctor for years was, its super hard to get into because they are super smart. And now, society is saying they aren’t so smart, I can look up the same info on the web. So, which is it? Society as a whole lets us know who our doctors are, and they can go ahead and change the definition of what it means to be a doctor, and the AMA will have to implement the change, along with coming up with a funding source. However, on the economics, most primary care doctors are more than too busy, and would likely welcome more trainees
Actually, you don’t need to be wealthy to qualify for med school loans. Lenders like to lend to med school students because doctors are historically very good at paying back their loans. They make good money and have a lot of job security.
Exactly my point. Why not just increase the number of slots but hold them to the same stringent standards (exams, boards, etc.)? Seems like there’s not much worry of a decrease in quality in that case.
Seems like your first point contradicts your second one. The second point implies that as a potential patient, you would not want to go to a doctor educated like your parents.
Ok, well if more endowments can’t be raised to train more doctors then med students will have to pay more of their tuition. You could do this in two ways w/o hurting poor students too much: 1) the students who got in only because of the increased number of seats have to pay much higher tuition or 2) increase tuition for all students who can afford it.
Chickpea, sorry I couldn’t come to your aid earlier. I was at work. Even though I would GLADLY give up 2% of my income to fund indigent healthcare, I completely fail to see why I should do it when other professionals with equal or greater incomes are not. Why not make all the Hollywood stars give up 2% of their income? That would pay for a lot of immunizations!
Also, many hospitals already eat the bill for a lot of indigent patients. Every patient that’s unable to pay their ER bill is a decrease in the bottom line for that hospital and it’s illegal to turn a patient away from an emergency room for any reason, including ability to pay. Which is why I end up providing primary care for the indigent of southwest virginia when that’s not what I am training to do.
Why not tax everyone who makes over $100,000 an extra 2 percent, and use that money to fund healthcare AND education? Why not…because Arnold doesn’t want to lose his Republican vote base by raising taxes, and apparently he doesn’t see doctors in California as a sufficiently powerful group to block this initiative.
Poor access to healthcare is a societal problem, not just a doctor’s problem.
You were referring to increasing the number of spots, which would take an instutional commitment to providing loans, and individual lending institutions working on a basis of individual loans might actually make the number of medical students go down and not up
Doctors traditionally came from middle class households and spend a good deal of their 20’s and 30’s making 0 to $30,000 dollars. this is not the super-wealthy base that one assumes would lead them to be a demographic to be courted by those who see their base as the wealthiest group
You probably didn’t realize it, but you just stated the logic behind the consumption tax (value added tax). Basically, all income taxes get passed on the consumers, so you might as well just tax consumption in the first place. There are many other problems with the consumption tax, but that’s the basic logic.
But like I said before, doctors will probably raise their fees anyway under universal health coverage because the demand for their services will increase substantially and the supply of doctors is fixed in the near term.
Umang, your prescription is basically supply-side and leaves no safety net in case things do not work out according to best-case scenarios
Ennis, I understand, and I’m not saying the AMA’s system isn’t without fault. I’m just saying that when proposing a “free market” solution you have to think of the unintended consequences and impacts there, also.
Awesome, so then we can tax those who had their rich parents pay for them at the same rate as those who shoulder over $150K in debt. A regressive flat tax — that sounds like a perfect solution! Especially given how many low income students struggle to take out loans just to pay for the med school application process.
Unfairness aside, the Governator’s plan is actually the most politically viable one to be put forth in front of the California legislature in a long time. The biggest problem is that gerrymandered districts has led to a legislature that has very few moderates left. In the last cycle, Sheila Keuhl (D) pushed for a universal health care plan that was more socialistic than Canada’s. It essentially called for an end to all private health insurance coverage and mandatory health insurance covered by a small payroll tax. It had its advantages in that it was expected to cost the state a lot less in long term health care costs by eliminating the administrative costs involved with multiple insurance companies (estimated at 30-40% of health insurance costs). In California, you need a super majority to pass any tax increases. Ultra conservative republicans in the state legislature have an effective veto as they control approximately 40% of the seats. Thus the bill passed but only because it didn’t call for any immediate tax increases and thus did not need the super majority vote. The Governor subsequently vetoed it but even if he hadn’t the end result would have been a heavily watered down version of what she proposed if it had any chance of passing the legislature.
Arnold’s going to have a tough time to getting this bill through even with the current provisions, a 2% hike for doctors, plus coverage for illegal immigrants is a huge obstacle. All of the funding has to come from new taxes essentially because 90% of general fund revenues are locked up in constitutional requirements (ex. at least 50% has to go to education spending). The only other option to get a tax hike through is by the initiative process and evidence has shown that the opposition only has to instill a small level of doubt in the voter in order to get them to vote Nay. The whole system is pretty inflexible but it is the unfortunate reality. While I don’t necessarily believe that the Governor’s plan is ideal, it is probably the only one that even has a decent chance of passing and 6 million uninsured Californians would very much prefer a mediocre plan to none at all.
I should clarify my previous statement. People line up around the block to get into law school, but there’s sufficient capacity to let most of them in. People lining up for med school aren’t able to get in because of the very limited number of med school seats.
Point taken. I think the issue is more one of medical school administrative economics than of the AMA artificially enhancing demand by keeping supply low.
The cost of running a medical school is very high, and most of that cost is not deferred by the high tuition paid by medical students, especially when you factor in scholarships, waivers, etc. sometimes given to med students as recruitment incentives.
As an ancillary point, nobody complains that the ADA artificially enhances demand for dentists, but there are even fewer spots in dental school, and dental programs are even more expensive to administer than med school programs. Never wonder why your root canal cost $385, even though the dentist saw you for all of 10 minutes?
Contrast this to the cost of running a law school. All you really need is a building with big classrooms that can seat 100+ students, 12-15 faculty, and you’re all set. That’s why there are 4 law schools for every medical school, on the average.
Well, speaking as someone with a lot of debt, I don’t actually expect to be taxed less than someone whose income is the same as mine, but who doesn’t have the same debt because their parents paid their med school tuition. My student loan interest is tax deductible and I’m fine with that. I don’t think most doctors struggle to pay back their debt–I just won’t be driving a Bentley in the near future.
It’s not going to come from general new taxes, though; in the State of the State Arnold proposed floating the costs through increased bond measures. EVERYONE pays that off in the long term, and it’s incredibly harmful given the huge bond package CA voters passed in October. This is yet another method of shirking the responsibility for overwriting California’s totally ridiculous p.o.s. tax/budget system.
Also, Wilma Chan proposed several health care bills – notably the universal health care for children bill – in 2005 that Arnold vetoed. All were more affordable and generally leveraged the state’s collective bargaining power as a method of paying for children’s health. This proposal won’t pass, and neither will the other 2 alternate proposals put forth by Democratic & Republican leadership. In the end Californians will end up with more of the same – a lot of empty promises, more fiscal insecurity, and another crappy system.
I had no idea!
Damn dude, I am feeling all intelligent and what not right now!! Better try resolving this issue at work while I am still in form 🙂
I agree wholeheartedly.
Taxes on doctors is a stupid idea.
Maybe HMOs should pay Law Schools to convert to Medical Schools.
More Doctors, less lawyers, better for HMOs.
Schwarzenegger mandates that everyone get insurance–a big giveaway to the insurance companies, and then taxes doctors and hospitals to fund programs, while quietly not-taxing the insurance companies. the ironic thing is that most experts would argue the insurance companies are the root of our health system ills…and here we are, handing them more business.
I would have commented earlier, but I’m working 12-14 hour days. Our hospital is chronically short-staffed, I make 1/3rd of what I would in private practice, I see very high-risk cases for which I can easily be sued despite my diligance and hard-work. They are high-risk, after all, and I can be the best and still be wrong. It’s not about the money. Trust me on this. And it’s not so simple as just cutting 2% of disposable physician income; the numbers rarely work like that. Teaching hospitals like mine eat the cost on a huge number of cases, we offer free care, it comes out of my hard work and my career advancement and my life.I’m dedicated as hell, I’m single, I don’t have kids, and even I’m reaching my limit. I see a ton of this in medicine. You’re crushed by patient expectation, bureaucrats, the government, lawyers, bad colleagues and bad doctors. Skip med school. <
PS: What are the government regulations on insurance plans in California? Can health insurance companies even offer simpler, single payer plans or are there a whole lot of mandated coverage bullsh*t laws so that essentially, this kind of stuff is priced out of the market.
The government mucks around, creates problems, then says, hey! Let me add another rule to solve the problem created by the first rule we laid out. Beautiful.
Hey, these are Republican governors (Romney, Scwartzenegger) responding to the interests of business constituents … in short, these are right wing plans 😉
While I sympathize with your frustrations, MD, I would like to offer a different perspective (and I don’t in any way mean to invalidate yours). I would never tell anyone not to go to med school. I’m still a resident so presumably this is the worst of it. Yes, it is frustrating and depressing and often just plain hell. But it’s also rewarding and overall I enjoy being at work. I also have no complaints about my standard of living or how much money I will make. I see a lot of indigent patients, and a lot of patients who have been failed by the system, but I’d rather be here taking care of them than doing something else.
Yeah, that was born of frustration. I’m six years out of fellowship.
That’s four years med school, five years residency and one year fellowship, plus the six years as an attending. And, I don’t know your particular situation, but things are easier for residents and med students then when I trained (at least in my particular case and institution) because of work-limit rules. So, I do their work, too. So, yeah, I shouldn’t have said that, but it is rough out there, outside of residency
Sigh. I take it all back. But, I’m hurt. I given my life to this. And, I’m really worried about what I see happening.
md: don’t take your words back, you say things that most, if not all of us in the medico profession have felt at one time or another..it’s a different kind of sacrifice… dealing with life, that a lot of people who are not in it, will never understand…
i was dissuaded by almost 98% of my family members who told me not to go into it..
and at times i still hit my head against the wall in frustration..
i’m sick of the ‘government’ thinking they are coming up with these magical plans to cure the healthcare problem when in fact it’s a small bandage aid for a larger problem…
i think we all love what we do in the end… no matter what paycheck we get..but for those who are clueless about the field and it’s own frustrations (yeah you arnold.. my dear gov for (gasp) another 4 yrs) to tell us what they have figured out, peeves me out to no avail..
i’m sure the CMA will fight (well at least i hope so)
” You’re crushed by patient expectation, bureaucrats, the government, lawyers, bad colleagues and bad doctors. Skip med school.”
My cousins say the exact same thing MD. To all the MDs in training and in practice, Chick Pea, etc….as professionals what would be your approach to widen coverage? Can health care be re-structured to serve a rapidly aging population and a lower income class that is rapidly fading from the middle class?…
I respect and admire all the doctors who have put their views out here, and who serve us. But here are some very basic questions that strike me. In L.A., for example, why are all the specialists clustered in Beverly Hills and Century City? Those are ritzy environs. And I pay $10 for valet parking! There is no other kind of parking.
i did medical school in those areas, and to be honest, i don’t know why.. most docs think they will cash in a bigger buck due to less medical/medicare and more insurance paid clientele.. a lot of surgical subspecialties are there, yes, those plastic surgeons who are cash based, since most insurances won’t cover cosmetic surgery..
10 bucks for parking to see a doc is ludicrous… hence i stay far away from that ‘scene’… that is not a place in cali where the ‘real’ medicine is practiced, but in fact ‘fashion’ medicine is..one of the plastic surgeons i rotated with during my surgical rotation we were assigned was more prissy than a dancing pansy…
it’s not pity it’s principle.
i would have more sympathy for doctors if they didn’t limit labor supply through licensing regimes backed by government force (this goes for lawyers too!). there needs to be a happy medium between debasing the profession with an influx of quacks and credentializing racket we have today.
(in software you don’t have a credential, you have code sample 🙂
CP, I am regularly dispatched there by my Primary Care doc. I think I am real 🙂
well, for the doctors out there in academic medicine–can you tell your med students to get involved or at least informed about how our health care system works? a big reason why our healthcare system is in the sorry state it’s in is because physicians have in the past taken this laissez-faire attitude towards the way our health care system is run. we’re scientists, we’re doctors–we don’t want to get our hands into all this money-economics-administrative business. but we should be involved–it’s our industry! the reason why we’ve gotten so screwed is because businessmen want to apply business principles to the business of medicine. but principles that apply to produce and goods cannot be applied to people’s lives. applying “bulk rates” to procedures or time with a doctor just does not make sense. which is why physicans need to reclaim their place at the table in making these decisions about how our system works.
you’re real, no doubt :O)…there is a lot of designer medicine that goes around in those areas..
sparky: agree with you on learning about the business of medicine.. nothing like that was taught in medical school, and it’s hard to learn it in residency… i learn via other family friends who know both the business side of the practice as well as the medical side…i definitely think a few classes on health care policy would benefit a lot of us (myself included)