Home Forums Discussions General Discussion NPR Diane Rehm

As much as Diane Rehm usually irritates the ba-jeebus out of me, it was really refreshing today to hear her interviewee/commentators emphasize the great disparity in physician incomes, with "some nurse might do really well while the pediatrician may be just trying to scrap by," and "should equalize physician incomes...elevate some so that some aren't starving and [decrease others] so they don't have ten vacation homes." They also mentioned that although docs on average make more money than their colleagues in other countries, in America we do not have the medical education subsidies, and doctors leave school "100 to 200 thousand dollars in debt." FINALLY, some decent press.

But, wouldn't it be great if there was a prominent website (say Google could take you directly to a well designed and organized site that listed:

Physician incomes for certain specialities
Average debt for physicians in state schools
Average debt for physicians in out of state or private schools
Average hours worked

Average reimbursement for a 99213 for:

BC/BS, Aetna, Cigna, Blue Card, Medicare, Medicaid, etc.

But, again, that should be something we could do. Of course, the AMA, AAFP, AAP, Maine Medical Association, Maine Medical Society and other state organizations should be able to do this.

But, the Maine Medical Society is too busy planning our annual summer picnic. Let's see, I have gone, ummm, never. One, I really don't want to spend my Saturday afternoon with more doctors, and I usually need to work on Saturdays.

Still don't understand why hockeyref left. Maybe burnout. He would be a great one to lead a good website.

According to Glenn Beck, the average income in India is about $1000.00/year. The average income in the US is about $27,000. The average physician in India makes about $15,000/year. The average in the US is $150,00 (not 27 times that in India).

I just emailed Paul. Talking to him a lot over the next few days. Do you want me to give him your email address?

Bert, you already have an aweseome website. Why don't you just add this information and we'll spread the word when you do?

@Bert: yes. Yes, please give it.

@Adam, Bert: what the website?

One point of frustration, now that India is mentioned: in many countries medical school is paid for or tuition is really low, so docs graduate without debt.

Then they can come to the U.S. with no inhibitions to pursuing residencies and fellowships, whereas many of us here are already so debt-heavy we have to start earning right away. Now see in many cities how many foreign (non-citizen) doctors we have and how difficult it can be to find a job. This is just another form of "outsourcing."

Thanks. I do have a great website. Unfortunately, GoDaddy has it down for the moment.

what's the website?

Peter,

Adam, owes you an apology, because I don't have one. He brags because he has one of the cookie cutter sites. I am not putting down anyone for one, only his since he teases me for mine.

Running a cookie cutter site is fun!

SoloMio,

The parents of the people in the other countries carry the entire load of the education. They live on a lot less than we do here. They don't have 4 DVD players, 3 large-screen LCD TVs, a couple of XBoxes, etc...

They don't have running water all day, nor a stable electric supply. They don't have 3 cars in the garage. Most make do with a scooter.

They live in those conditions and save, save, save to educate their children.

You can make similar sacrifices to make sure your kids get out of Med. School with as small a debt as possible.

Just a small bit of perspective.

it's a warped perspective. I have no cable TV, a rusted car, no TV, no XBox, and no DVD player, just a computer. i dont go to movies. my kids dont have video games and they go to public school.

I went to school with the foreign residents I spoke of--and i studied overseas as well, so nothing is made up by me. My parents saved and saved just to get me through my bachelor's degree. Bottom line is, a lot easier to save for med school when med school is cheap. In many countries this "entire load" for medical school is around $1000 per year--some more ,some less.

the idea that all Americans are misappropriating their funds to material ends is as incorrect as saying that all the foreign residents have no running water. That villager is not going to medical school-- his wealthy compatriot is.

I guess comments above about "3 cars" is the same sort of thinking that gets us those wonderful animadverts about how doctors are all living the decadent good life at everyone's expense.--end rant (for now)

Yeah, that's it guys. We American docs are saddled with debt because we splurge our money away!--end rant (maybe)

We also have a huge supply and demand problem in the US when it comes to medical schools. If we opened more for profit schools and allowed the test/boards to weed out students instead of interviews, not only would tuition go down, but schools would be trying to make themselves better to attact the best students instead of settling for being mediocre because there are far more applicants than spots.

Yeah, I've got an awesome site too. www.hotsexyosteopath.com Makes me more $$ than medicine.... lol

[lol] Scott, your site seems to be down... how does it make you money if it is always down? [/lol]

Because he can't get it up?

(so sorry...just could NOT resist!)

>>> Re: Glen Beck

It's interesting that in Panama, which actually is considered an up-and-coming 3rd world country, a full 92% of the population make less than $2000.00. Doctors make between $25000 to $50000 a year.

>>> Then they can come to the U.S. with no inhibitions to pursuing residencies and fellowships, whereas many of us here are already so debt-heavy we have to start earning right away.

No XBox??? Should we pitch in and buy you one? <G> Actually, that's not true about the "no inhibitions."

I just finished helping a Cuban doc last year get into an internship up in Illinois. He had to take his ECFMG 3 times, not because he didn't pass it in the first 2 times, but because he needed to score in the top 5% in order to secure an interview for admission! In my state of Virginia, there are now laws that severely restrict that chances of an FMG in obtaining a license to work after doing 3 years of residency and passing all licensure examinations. On the other hand, they now have opened up a 5th medical school in my state, making it easier than ever to get in. Most Virginia medical schools are really cheap- I remember paying $12000 almost 30 years ago which included both tuition and room & board at VCU. At the newest medical school (actually an osteopathic school), in Virginia Tech, most likely the tuition will cost about $7000 a year.

Some countries like Cuba have accelerated programs lasting only 6 years for both college and medical school, and it's all FREE for EVERYBODY. The only problem is that politically, you probably won't be able to work in the USA with a Fidel Castro approved degree. In Panama, where my in-laws live, it's very difficult getting into medical school since there are so few spots available. On top of that, you then have to work 1 residency year in the jungle!

To sum it all up: I keep telling my son to go to VETERINARY school at VA TECH. It's all cash up front, no Medicare, no United Healthcare, and no abuse!

Scot- your site is still down... I just finished upgrading my site with HIT political stuff, BTW (http://www.msofficeemrproject.com/Page3.htm ) Check out the HIMSS whistleblowers column that I will be putting out this month!

Al

Scott, you lost me on that. No, seriously, can you explain it better? The main part I don't understand is it would seem to be that if you have more students than spots, the school can be more selective, correct?

Yes Bert, the less spots and the more students does mean the school can be more selective. Another way of saying that is that the demand for the school is high, but the supply is low. Therefore the power is in the hands of the school. They can select who they want and charge what they want. The students are just trying to get in a school at any cost.

Now flip it. If there are more slots than students, then the supply of slots is higher (or equal to) the demand for them. This would allow students to be more selective in where they applied if they wished and schools would have to compete against each other to attract those students. That would show up as either price savings or better facilities/faculty/etc.

more clear?

BTW, the website above does not really exist as far as I know. I just made it up. lol

I think he is saying that it will be better to change the dynamics so that medical school applicants can be more selective rather than the other way around.

@Al: good news, and good information there in your post

Cute response, SoloMio. I guess everyone needs to rant once in a while.

I was born in India. I remember when I was a kid one of the big joys we had was the day my dad brought a tabletop radio home. We never more transportation than a bicycle.

My father was asked to come here by his professor while doing research in India. He came on borrowed money. We came two years later. He completed his Ph.D. and got a job teaching. I'm sure you know that professors (especially sociologists) don't make a whole lot of money. We bought used cars and lived in apartments (I remember painting one to save some rent) until I entered high school.

Finally, in 1975, we bought a house. Yeah, my dad earned a whopping 18,000 a year, I think.

To make a long story short, he's got 1 child a Ph.D., and two children MDs.

He finally retired this year. I think his ending salary after 35 years of teaching just hit 80K.

Yes, we walked out of schools with debt. Of course the MDs have a much higher debt load. So what? They earn a lot more. After a few years of saving and repaying, the debt is cleared. Big Whoop.

Oh yes, even if (that's a big IF) med school in those countries costs $1000 a year, you're talking more than a year's salary for most people. Kinda like it costing $30,000 a year in this country.

Then, you have to remember, that all the infrastructure that the other country spent to train that doctor gave benefit to the US, not the original country. The US is getting a bargain in the deal.

Maybe we can start to discuss version 5, and how to find better ways to run our offices.

ahem, "general discussion". you are welcome to open a thread of your choosing if this one doesn't suit you.

I know where that discussion goes. I was just trying to dissipate your heat just a bit.

I don't see where that dissipates any heat. And, I don't really see your point.

My parents barely made that together. $18,000 in 2008 dollars is roughly $80,000. (ironically what your father made when he retired).

I owed over $180,000 after medical school and, as a pediatrician, I cannot pay off my loans after a few years of saving.

The average Tufts medical student owes approximately $160,000, a figure that seems rather low when one figures it is the most expensive medical school in the country, and only NYC costs more to live in than Boston.

http://www.tuftsdaily.com/editorial-medical-school-costs-affect-more-than-just-students-1.2111234

FP doctors average $198,000? I make less than half that.

And talking about Version 5 is boring. It isn't even out yet, and who knows when it will be.

I think this thread can only continue to get worse - discusssions about foreign grads tend to get heated. Average pay is also very skewed as each of us may do more or less than the average - don't worry if you are lower as each of us practice differently. Hopefully each of us are comfortable with our pay or need to re-evaluate our path. I for one have not paid off my loans as fast as I could as I have my share of toys.

And, therein lies the paradox. I would love to re-evaluate my path, but my studient loans won't let me.

You could become military doctor - I am sure you would love the rules and hierarchy(LOL)

Bert,

You also need to give it up. The example I gave is of my own family. We grew up here, in the US, in case you missed he story.

Yeah, my parents had maybe $18,000 a year in income. Probably less. I just threw out a number I thought was low. Maybe I should check with my parents. The point is that they saved and sent us to school. Yes, we came out with debt. Yes, the debt is high. And yes, it will be paid off. We're not whining about it.

What point don't you see? This guy is running his mouth off about foreign doctors, and how they don't have any debt, etc..

I tried to give him perspective about life in one of those countries. He just argues.

I then tell of my own life here. Again, what don't you get? You're an educated person. Read.

The way you were yapping a few posts earlier about weeding out people, you'd turn the US into a 3rd world country where only the richest would have anything.

Try looking over history a bit. You don't want the US to become old world Europe. That's what people ran away from.

The real enemies happen to be the Insurance companies. Try to find ways to weaken them. No CEO deserves $15 million a year.

I hope I didn't put too many advanced thoughts out. I can explain a bit slower if need be.
You're just in a mood to shoot down anyone who doesn't agree with you all the way.

Mr. ANSharda,

It would be easier for Peter and I to conduct a flame ware with you if you would not use so much slang. "Give it up." I don't have to give up anything.

Please show me where I missed your story and said you didn't grow up here. But, please. Trust me. I do not wish to read your story.

Don't just throw out numbers if you don't want people to respond to them. By the way, my parents didn't send me to college or medical school. I did.

I saw what Peter wrote. I just didn't see the point in your post. Your first post was adequate enough.

Thanks for telling me to read. I actually got through college and medical school with books on tape.

AND PLEASE TELL ME WHERE I WEEDED ANYONE OUT. USE QUOTES. I HAVE KNOW IDEA WHAT YOU ARE TALKING ABOUT. And, once again, use words like talking, communicating, etc. and not yapping and then people won't argue with you. Yapping is an inflammatory word.

Since you do not want to use quotes, I will. And, I will also quote you. Please read. I could be wrong, but since I have only had a few posts, I will assume it is this one. The only thing this post tries to do is suggest it would be nice if all Americans knew what all doctors made. Most Americans including Congress things we are all rich. And, it would be nice if they knew we charged X amount of dollars for a routine visit but were only paid x amount of dollars by certain insurance companies. When the people are either supporting or not supporting a one-pay healthcare bill, they should know that the government's idea of a one-payer system is to pay 1/3 of the charges. There is no weeding out there.

I think we all know the insurance companies are the enemy. I happen to think no CEO is worth that either, but it's capitalism, and that CEO made Anthem or Cigna successful so the board pays him or her. If Aetna ran in the red, I doubt its CEO would make millions. Now, please don't say I am defending the CEOs and insurance companies.

Yes, please slow down. Peter and I can't keep up. Sorry, I shouldn't speak for Peter. Don't be so defensive. Your quote above was unnecessary.

But, here's something interesting. There is no debate from me. I never said you didn't work hard to get through medical school. So, what is the debate over?

Ansharda clearly has personal issues. My post was not about HIM. This thread is not about HIM or his family. Happy to hear his family struggled and eliminated his debt. I guess his situation is not typical. He certainly does seem very self-involved.

And how was I "running my mouth off?" Because I made one statement that touched a desi nerve in this guy because he personalized it? Further, if he is so good at reading, he would have noticed that I stipulated "foreign" docs specifically to refer to "non-citizen" docs. Or is that term not politically correct enough? So far, then, I don't see that his personal story is relevant here.

If we are such idiots and you are so much our intellectual superior, what are you doing here? It boggles the mind. Go engage yourself with persons of your lofty stature!

Don't make me play the Bollywood card! (Mwah-hahahhahaha!)

Yes, and to be fair, what makes the world go 'round are the different personalities. Peter will be the first to tell you that he and I don't always see eye to eye. The difference. He speaks his mind, albeit, not always what you want to here. And, trust me, our flame war was hot and completely sizzled my video card. But, now I read everything Peter posts. Just need a lot of salt nearby or at least a grain. LOL.

I agree, the first post wasn't meant to be this incidiary.

This is one of those "Manny being Manny" things. Gotta love Peter.

ANShare I agree this isn't about you. And, if I offended you, that wasn't my intent.

So, let's all have a happy holiday. We have our differences, but one thing I do know is that Peter, you and I all practice to help patients.

OK, was that sappy enough.

OK, ANSharda, you get the last word, then I will freeze the thread unless there are any objections.

But, no happy police out there to try to put water on the flame war. You gotta have one every now and then to burn out the underbrush.

Happy Holidays.

OK Bert,

You don't want to turn this into a flame war? Good!

So you and your friend know, here's the quote that got me going. It's from SoloMio. Peter, is it?

"One point of frustration, now that India is mentioned: in many countries medical school is paid for or tuition is really low, so docs graduate without debt.

Then they can come to the U.S. with no inhibitions to pursuing residencies and fellowships, whereas many of us here are already so debt-heavy we have to start earning right away. Now see in many cities how many foreign (non-citizen) doctors we have and how difficult it can be to find a job. This is just another form of "outsourcing.""

Please note that he's "frustrated" by the fact that tuition in these countries is so "low", and that "American" graduates have to get jobs right after med-school while the "foreign" graduates can go on to fellowships.

This is a form of prejudice that I, and many other "foreigners" don't appreciate. It's rather insulting to us.

My father was also one of those "foreigners" who came here to raise his family. He was a pennyless student.

There may be a lot of rich families in other countries that fully finance the education without a wink. There are plenty of those in this country also.

I attempted to show that the tuition is NOT "low" for the people living in those countries. I believe alborg also tried to show that by giving an example. It's insulting when someone (a physician, no less), insinuates and prejudges that "foreign" docs come from wealthy families and are doing him harm for being so.

My siblings and I are "foreign" US citizens who also came out of school with debt right here in the USA, and we have/will repay it. I certainly won't go around whining about other "foreigners."

Two posts up, your buddy states that his post was not about me. I know. But my wife is one of those "foreign" docs. She was a "non-citizen" doc that he speaks of who is now a US citizen. She struggled to pass her exams, went through residency, and is practicing medicine.

She doesn't come from some "rich" family. Yes, they were well-to-do, but not the way Dr. SoloMio paints the picture. Her parents toiled to pay the bills, and worried about their kids' future, just like anyone else. Their personal savings amount to very little.

So how do I NOT personalize his statements? They hit home.

The remark about Bollywood? That's just childish and stupid.

If your buddy doesn't want to continue fighting, I suggest he stop his adversarial attitute, and not make prejudicial and insulting statements. I'd love to stop this right here.

We're trying out AC and I came to this forum to find info on how to better run a practice, and to discuss the ways to make AC work better for us. I didn't come to find this sort of talk.

In your case, thought, Bert, I appreciate your stating that "if I offended you, that wasn't my intent." Likewise from me. If I offended you, then please know that it was also not my intent.

first of all, if what i said does not apply to you then it does not apply to you and your need to personalize my statement js evidence of your personal hangups.
my wife is also from INDIA yet she apparently is emotionally stable enough not to get upset about it.

furthermore, as you have sunk your conversation to a further and further juvenile level, ever pushing the envelope in attempt to get me heated, i decided not to let your raving bother me.

so it is fine with me if you want to keep posting comments loaded with sputtering maniacal rage and personal insults. my responses will be frank but absent of emotion.

i have not changed my position. over here we are free with our opinions. sorry, no rioting or burning things in US.

OK, I promised ANSharda another comment. I think we should freeze this thread now.