A few more symptoms of a broken system

[disneysteve]

Re: A few more symptoms of a broken system

cicy33 - I totally agree. The cost of medical care is definitely a problem and there are plenty of people who have to choose between food and medicine, especially younger adults and senior citizens. I help out as much as possible by distributing free samples of meds, so that paying for an office visit often gets you your prescriptions too. Recently, I've also started doing a lot of prescribing based on the Wal-Mart list of $4 generic prescriptions as there is a Wal-Mart not too far from my office.

Do doctors give a discount to their cash patients? Many do. We certainly do. I have patients who have no insurance and very little money and we charge them as little as $25 for a visit, plus give them free medicine samples. And I know we aren't the only doctors around who do that.

[LuckyRobin]

Re: A few more symptoms of a broken system

Steve--I was more or less with you until you threw in the student loans. I get all the other things you listed, they are the costs of doing business, but I'm not sure why the patient should have to pay for your student loans. You chose to go into the medical field and you chose to go into debt to do so...why is this the fault of your patient and passed on to them? Especially if they are paying everything else you listed. Just curious, trying to understand the mindset, not trying to be a stinker. Yes, the patient pays for the doctor's knowledge, but I'm lucky if I get 5 to 10 minutes of his time in a visit after sitting in the waiting room anywhere from 20 minutes to an hour wasting my time, and I just don't equate that with my fee going to pay off his loans (which he no longer has being in his 70's).

I would never dream of passing on my personal debt decisions to a client. And by the by, I am the person who mows my lawn, I work for free, so umm...if I paid my doctor less than that it really wouldn't work for him.

[disneysteve]

Re: A few more symptoms of a broken system

Steve--I was more or less with you until you threw in the student loans. I get all the other things you listed, they are the costs of doing business, but I'm not sure why the patient should have to pay for your student loans. You chose to go into the medical field and you chose to go into debt to do so...why is this the fault of your patient and passed on to them?

If it wasn't for that expensive education, your doctor wouldn't be a doctor. None of us go into medicine for the money (unless we are totally delusional) but the reality is that nobody would ever go to med school if there wasn't some expectation of earning enough when we got out to make the cost worthwhile.

I guess my point was if an office visit was only $35, by the time the doctor paid all of his business expenses and made his loan payments, he'd have very little left. His true take-home pay would be minimal and I don't think you'll find too many people eager to take on the responsibility, hours and stress of becoming a doctor just for the fun of it.

Believe me, I'm not crying poor. I do just fine and feel very fortunate. But doctors don't make nearly as much as many people think they do. Thanks to increasing costs and decreasing reimbursement, doctor income has been on a steady decline for the past decade. All the billions being spent on healthcare end up primarily with the insurance companies and the pharmaceutical companies, not with the folks actually providing the care.

[Joan.of.the.Arch]

Re: A few more symptoms of a broken system

LuckyRobin, we all pay our students loans out of our earnings. Why shouldn't a doctor do the same? When I had my own business I set my own rates and they were definitely influenced by my needs, including my needs to pay back loans. (I mow my lawn, too, except occasionally as an act of charity I will pay someone who needs the work.)

[Scanner]

Re: A few more symptoms of a broken system

Joan of Arc and LuckyRobin,

I'll be notifying your employers to reduce your paychecks.

Why should they pay for your student loans?

Truth is, every employer, and that includes the patient, pays for education, expertise, and talent.

[LuckyRobin]

Re: A few more symptoms of a broken system

Scanner--Actually, I don't have any student loans. I never did. I worked my way through college carrying a full load, while flipping burgers, cleaning houses, paying a small rent to my folks to continue to live at home, and earning scholarships with grades and volunteer work and going to local to my state and city public colleges and not distant or private colleges. Oh, and my parents paid for one year's worth of tuition and books at the community college where I started. Hence my not wanting to or I guess needing to pass on that debt to other people. Now, of course, my education didn't come anywhere near to what I am sure a doctor or a chiropractic doctor (which I think requires more education than a standard doctor) would cost.

And you can notify my employer if you want to, but I don't have one anymore. I'm a SAHM now. LOL

Steve--Honestly, I am just curious, not coming from the student loan background myself. In my mind I was separating the cost of doing business from the money generated as a salary draw with which to pay personal bills, but it sounds like you just lump it all together and pay everything out from one kitty. I don't have a problem with the fact that my doctor charges me $80 per visit or that the pediatrics charge $72, it was someone else who said $35.

My doctor is plenty rich, now. But hasn't always been and it showed. My chiro on the other hand is loaded! And is about 25 years younger. Their house is gorgeous, their cars are gorgeous, they have a second home in Arizona and travel a lot. Don't have kids, probably why they are richer than doctor. Chiro only works 3.5 days a week. Does he charge a ridiculous amount? Nope. Nice family plan, $130 for six visits for everyone in the family. That's not per person, that means between the four of us we each get 6 visits for $130. Okay, he's a bit of a drive-thru doctor, crunch, crack and back out the door you go, but he's good at it. And if you need more time he takes it. Now that money amount IS spoiled health care. LOL He does make up a lot of money through L&I and accident claims though.

[tinapbeana]

Re: A few more symptoms of a broken system

Steve--Honestly, I am just curious, not coming from the student loan background myself. In my mind I was separating the cost of doing business from the money generated as a salary draw with which to pay personal bills, but it sounds like you just lump it all together and pay everything out from one kitty.

this method of figuring what to charge is actually pretty common in any sole-propritorship, whether medical or otherwise. same for contractors, actually.

for instance, i might need 1k per month for business expenses and taxes, and another 2k per month for my 'personal' expenses (i.e. what i want my salary to be to be able to pay my bills, students loans, etc.). so i need to generate 3k per month. if i average 30 dogsitting clients a month, i need to charge each of them $100. in this instance, i've chosen the wrong industry

now, say i build websites and charge $30 per hour. i'd know i need to bill at least 100 hours per month (25 hours per week) to met my minimum requirements. in this case, i have chosen wisely, because i can meet my goal (bring in 3k per month) when charging a reasonable rate and working a reasonable number of hours.

[disneysteve]

Re: A few more symptoms of a broken system

tinapbeana - Thanks for the more articulate explanation of billing practices.

The one HUGE difference between the dog-sitter or the website builder and the physician is that the physician has little control over his rates. For the most part, my rates are set for me by the government (Medicare, Medicaid) and through contracts with private insurers, who also base their rates on the government fee schedule. I can't just raise my rates whenever I feel the need. If my expenses increase, I just get to keep less of what comes in.

LuckyRobin - You are assuming your chiro is loaded based on outward appearances. While that may be true, he may also be up to his eyeballs in debt, so don't be too quick to judge. You also assume that his wealth, if it exists, all came from his chiropractic practice, which also may or may not be true. I learned long ago that you can't tell a whole lot about someone's financial situation from the car they drive, the house they live in or the clothes they wear. Too many times, I thought someone was pretty well off only to find out later that they weren't, even though they were living a pretty flashy lifestyle.

[Scanner]

Re: A few more symptoms of a broken system

Steve is correct on the loaded chiropractor.

He may be rich or he may not be - just leveraged to the hilt.

And no, a chiropractic doctor has less education/training than a "RD" (regular doctor, lol) - the best way to think of it is it's like dental school - about 4 years after college, but no residency like DO's and MD's.

To validate what Steve is saying, the average DC in the US is making around 68K/year, and that's being self-employed - some states, they do phenomenal, others. . .not so well. As Steve noted, a lot depends on what the rates are set at. And that figure is probably not taking into account some DC's close their doors after a go of it.

Of course, some DC's make millions, much on car accidents like you noted.

It's easy to think your doctor is making a lot but a little investigation reveals salaries on the decline.

Ask Steve or I if we would send our kids into medicine - I told my son(s) they are smart and because of that, to not go into medicine or chiropractic.

I am very clear on this - if they come home and tell me they are going into health care, I'm having a Fred Sanford heart attack.

They will deserve to be paid for their talent and education. The family MD next door has said the same thing to his kids.

[Joan.of.the.Arch]

Re: A few more symptoms of a broken system

Scanner, you and I are not in disagreement.

[kv968]

Re: A few more symptoms of a broken system

I am very clear on this - if they come home and tell me they are going into health care, I'm having a Fred Sanford heart attack.

That's a Fred "G." Sanford heartattack. The "G" stands for "Go into another field."

[cicy33]

Re: A few more symptoms of a broken system

I am the one who suggested $35 for a doctor visit. I did because I was asked what I thought was reasonable. I think that is reasonable. I am aware that doctors have a huge overhead, so do contractors like my husband. If I didn't work we couldn't manage, me having insurance is the best part of it! being in business for yourself is not a get rich quick idea! If the doctor office sees 3 people an hour in his office and charges $35 per hour he is grossing $640.00 per day. or $3200 per week. If he is charging $80 for the same 3 people per hour (24 per day) then he is grossing $ 1920.00 per day or $9600 per week. That is almost $40,000 per MONTH. Please do not tell me that they need to pull in $10,000 per week in order to meet expenses. Now if there are less people per day then the number changes, but I would say 3 per hour per office would be about right. Now, as I am not a doctor I have no real idea what goes on in an office. am I figuring wrong? Too many people? That is just for the office visit cost, no other tests, or diagnosis cost. Can we not find a happy medium? Maybe $50 or $45 per visit.

[PrincessPerky]

Re: A few more symptoms of a broken system

Not ever having needed to pay doc 'stuff' (all the stuff steve listed), I will keep out of what you should charge.

because it is pointless to decide...right now the govt chooses the rates for us, and if we don't like it we can't go complaining to the dr, we need to complain to the government.

either tell them to back off or tell them to rate lower.

Personally I pick back off, if I want my dr who has a private practice (not group) and I am willing to pay more for her extra time, why shouldn't she get to charge more? (though my actual Ped wouldn't, she does most of her buisness for poorer spanish speaking clients)

[LuckyRobin]

Re: A few more symptoms of a broken system

I did like reading about the billing practices and why things seem so "expensive" to us, when they seem reasonable or underpaid to doctors. A lot more goes into it than what you think at first glance. This is one of the things I like so much about this site. When I'm curious I end up getting real answers from people with real experience. I'd never ask my own doctor how come he charges what he charges, but I can ask here and get a relevant answer.

My chiropractor has no debt. He's very proud of that fact and the fact that he has earned everything he has himself. He does have a booming, thriving practice. He has actually helped us a lot in getting a handle on finances with his sound advice.

The reason that he is able to offer nice little family plans is because of what he gets off L&I claims and accidents.

[disneysteve]

Re: A few more symptoms of a broken system

He has actually helped us a lot in getting a handle on finances with his sound advice..

Maybe he should write a sequel to The Wealthy Barber called The Wealthy Chiropractor. That's great that he's done all that on his own and is debt-free. Sounds like a good person to take lessons from.