Is it time for doctors in America to go on a mass strike like it happens in countries like India, Nepal, and more recently South Africa? MDs in US have been under 3rd-party rule-n-money-control for years by people who don't know squat about medicine. Should it really take a psychologist to drive home the point that hello docs, healthcare sector is yours and you need to take it back ? Gregory L. Garamoni, PhD makes a call to all US docs to go on strikes to wield their powers on DoctorsonStrike.com
"In the mid-20th century, patients paid doctors directly for 80 percent of their services. By 1980, that proportion had dropped to 40 percent. Today, a patient controls only 10 cents of every dollar a doctor earns."
An option to going on strike and being jobless is to take control of the healthcare business and work at a for-profit clinic that takes insurance companies out of the equation by charging low monthly flat fees to patients, like the Qliance group in Seattle, WA, which even gives stock options to its physicians ! What's in it for patients ? No wait times, anytime access to docs and no binding to contracts - they can drop off any time with no penalties
Yet another Seattle, WA story: Million dollar salaries for Hospital CEOs - Read here
Despicable living conditions for medical residents at some hospitals in Mumbai (Bombay), India - like this story mentions: "Barracks double up as residence and are infested with rodents, gnats, and other insects. Five to six people stay in one room. The roof leaks during monsoon and the toilets are not good either" - Now why should residents need to stay in hospital provided housing? Because its free and cannot afford anything else on their tiny stipends - I remember the late 90s when I was a medical student in Bombay, the janitors made almost twice as much as residents. Stipends improved after multiple strikes, but are still low at about Rs. 15,000 a month (US$ 307)
Various professional organizations & recruiting agencies publish results of doctor incomes each year, like you might have seen on this blog, and their figures differ a lot at times - why ? Coz' they all have a different pool of physician-mix that they get their data from, like academic, practice owners, group practices, etc.
Modern Healthcare published a compilation of such 2008 surveys - which can certainly qualify for "Mother of all surveys" ..Lol, somewhat like a meta=analysis of various research studies looking at the same research question.
Specialty Salary Ranges (Annual, Pre-Tax)
Anesthesiology :$311,000 to $446,000 Cardiology(Invasive) :$389,000 to $561,000 Cardiology(Non-Inv) :$332,000 to $439,000 Dermatology :$287,000 to $385,000 Emergency Medicine :$216,000 to $300,000 Family Medicine :$150,000 to $204,000 Gastroenterology :$330,000 to $498,000 General Surgery :$271,000 to $356,000 Hospitalist :$174,000 to $217,000 Internal Medicine :$175,000 to $209,000 Neurology :$203,000 to $298,000 Ob-Gyn :$231,000 to $304,000 Oncology / Hematology :$296,000 to $410,000 Orthopedics :$372,000 to $512,000 Pediatrics :$140,000 to $202,000 Plastic Surgery :$300,000 to $791,510 Radiation Oncology :$357,000 to $453,000 Radiology :$386,000 to $600,000 Pathology :$239,000 to $331,000 Psychiatry :$171,000 to $248,000 Urology :$352,000 to $426,000
"Residency Stipend Programs" become more prevalent
Besides moonlighting, another good way for residents looking to add extra dollars to their average $45,000 a year stipends is signing up early for jobs and getting paid additional monthy bonuses from their future employers in advance. This is something that I had already mentioned on my post about "Bonus Job Payments Long before Residency Ends"
Recently we Internal medicine residents received a flyer from a recruiter in Twin Cities, MN that went like this (click to enlarge):
Of course, IMGs doing residencies on J1 / H1b visas cannot be paid in advance by another employer, but if they signed up for employment in the same institution network as their residency program, they possibly can.
IM / primary care / hospitalist job market is certainly pretty hot at the moment, I routinely get about 5-10 legitimate job offer email a day !
2010: Specialist Salary Cuts & Primary Care Pay Raise?
This had to happen some day...Medicare recently proposed readjustments in their payment amounts and here are numbers that reflect an approximate effect on payment to different physician specialties. Biggest losers seem to be Cardiology and Radiology. While Primary care (Internal medicine, Family Medicine, Geriatrics) would see higher payments...
SPECIALTYOVERALL PAYMENT CHANGES 1 ALLERGY/IMMUNOLOGY -3% 3 ANESTHESIOLOGY 6% 4 CARDIAC SURGERY -2% 5 CARDIOLOGY -11% 6 COLON AND RECTAL SURGERY 5% 7 CRITICAL CARE 3% 8 DERMATOLOGY 3% 9 EMERGENCY MEDICINE 2% 10 ENDOCRINOLOGY 3% 11 FAMILY PRACTICE 8% 12 GASTROENTEROLOGY 0% 13 GENERAL PRACTICE 6% 14 GENERAL SURGERY 4% 15 GERIATRICS 8% 16 HAND SURGERY 3% 17 HEMATOLOGY/ONCOLOGY -6% 18 INFECTIOUS DISEASE 3% 19 INTERNAL MEDICINE 6% 20 INTERVENTIONAL PAIN MGT. 6% 21 INTERVENTiONAL RADIOLOGY -10% 22 NEPHROLOGY 2% 23 NEUROLOGY 3% 24 NEUROSURGERY 2% 25 NUCLEAR MEDICINE -13% 26 OBSTETRICS/GYNECOLOGY 1% 27 OPHTHALMOLOGY 11% 28 ORTHOPEDIC SURGERY 3% 29 OTOLARNGOLOGY 1% 30 PATHOLOGY 0% 31 PEDIATRICS 4% 32 PHYSICAL MEDICINE 7% 33 PLASTIC SURGERY 5% 34 PSYCHIATRY 3% 35 PULMONARY DISEASE 3% 36 RADIATION ONCOLOGY -19% 37 RADIOLOGY -11% 38 RHEUMATOLOGY -1% 39 THORACIC SURGERY 2% 40 UROLOGY -7% 41 VASCULAR SURGERY -1% 42 AUDIOLOGIST -10% 43 CHIROPRACTOR 5% 44 CLINICAL PSYCHOLOGIST -7% 45 CLINICAL SOCIAL WORKER -6% 46 NURSE ANESTHETIST 2% 47 NURSE PRACTITIONER 7%
Source: Medicare Program: Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010.
The big cuts for Cardiology and Radiology comes due to cuts to the money paid per procedure - for example, Medicare plans to pay 38% less per stress test, 31% Less per cardiac Stent and 32% less per Left Heart Catherterization.
Cardiologists are obviously not happy about this. "Robbing subspecialist Peter to pay general practitioner Paul is a dangerous proposal for our patients. Instead of devaluing subspecialist services in order to find the revenue, why not implement some simple new practices for our country that will yield huge payoffs immediately?", Says Cardiologist Dr Melissa Walton-Shirley, also the owner of TheHeart.org
I am not sure if this might bring down the number of procedures, in fact the there might be a temptation to perform more of them to make up for the lost income ! What the American Health System needs is an uncoupling of payments from procedure volume.
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