WhiteCoat

Healthcare Update – 05-18-2010

Lather, rinse, repeat. Difficulty in accessing psychiatric care and lack of follow up blamed for a mentally ill Louisiana patient stabbing her grandmother to death. Sketchy episodic care doesn’t address underlying psychiatric problems. Patients go from emergency department to psych hospital to emergency department. Because only 145 psychiatric beds are available in the entire state of Louisiana, patients who are a risk to themselves or others are sedated and wait in emergency department beds for days to weeks until inpatient beds open up. Effective July, the state is dropping funding for 35 more inpatient psychiatric beds, which will make definitive care for seriously mentally ill patients that much harder. As the emergency nurses complete the every 15 minute checks on sedated patients as required by JCAHO (and complete the requisite paperwork each 15 minutes), there will be even less care available for other patients with emergencies.

What are we whining about? The best paying jobs belong to doctors. I saw a graph on a message board somewhere showing that upon graduation from college, it took doctors 19 years to catch up to the salaries made by a UPS driver. While attending physicians are paid well, don’t forget that doctors have to spend hundreds of thousands of dollars on college and medical school – while at the same time their peers are earning money working. Residency positions pay much less than attending positions while interest accrues on the educational loans.
When you think about the $105/hour that surgeons are quoted as earning, take away $25/hour in taxes, then deduct $25 to $50/hour each year for medical malpractice premiums, then deduct another $15/hour for student loan payments, then factor in that few surgeons work only 40 hours per week. I’d venture a guess that an average surgeon works more like 60 hours per week.
When you hear about how good all the greedy doctors have it, keep in mind that many times there’s more than meets the eye.

Eat your veggies, dear, they’re good for you. Woman sentenced to 4.5 years in prison after putting foxglove plants in her husband’s salad. Foxglove is what digoxin – a heart medicine – is derived from. Oh, and if that didn’t work, she also stockpiled the poison ricin.

Not sure why they needed a poll to figure this out … When you increase the number of patients with “insurance”, then decrease the number of emergency departments and decrease the number of family practitioners so that the “insured” patients can’t find routine medical care, what do you expect will happen? Emergency department visits will increase and the strain on the safety net will get worse.

Hey! Who keeps messing with the nitro drip and why do the monitors keep blinking on and off? Israeli officials dig up grave site and remove Pagan bones to make way for new “fortified” emergency department. The citizens are pissed off. The graves have been desecrated. Can you say Poltergeist 4?

Liar liar. Healthcare worker files complaint after waiting 8 hours with abdominal pain at LA County Hospital. She stated that her vital signs were never taken and that she was told the average wait time to be seen was 35 hours, so she left and went to another hospital.
After an investigation, it was discovered that the staff took her vital signs 4 minutes after she arrived and that her name was called after only 4 hours. With patient volumes up by 15%, expect wait times at LA County/USC to increase.

Do you want me to fill out the JCAHO forms before or after I write admission orders, transfer the patient in Room 2, intubate the trauma patient and sew up the laceration? Emergency physicians in this study from Australia were interrupted an average of 6.6 times per hour. Eleven percent of all tasks were interrupted and 3.3 percent of tasks were interrupted more than once. It took doctors less time to finish interrupted tasks, leading researchers to believe that doctors “cut corners” when finishing an interrupted task.

25 Responses to “Healthcare Update – 05-18-2010”

  1. Matt says:

    Well, if you saw a graph on a message board. . . .

    • Ed says:

      …it has to be wrong.

      Unless a lawyer posted it.

    • WhiteCoat says:

      I’ll do a post comparing the two, then.
      Why don’t you give me numbers that you think are fair for UPS wages from someone starting at high school graduation versus costs and wages for an average family practitioner, including average costs of attending college and medical school – just so I don’t get accused of being biased.

      • Matt says:

        Scroll down – someone did that below already. Took the best case scenario-worst case scenario and even then the FP was going to catch up and pass the UPS driver.

        Of course you’re biased – we’re all biased.

      • WhiteCoat says:

        Do you agree with the numbers posted?

        The initial post wasn’t that UPS drivers will forever earn more money than “rich doctors” but rather that the break even point when a “rich doctor” actually has a higher net worth than someone who isn’t a “rich doctor” can be nearly two decades.

        Nice try at distorting the issue with a Mattuendo, though.

      • Matt says:

        Your post says nothing about net worth. And it contains a bunch of figures that don’t make sense. Who is changing the subject?

        I can see where it might take a physician 9-10 years (not two decades) if literally everything broke wrong for them while everything broke right for a UPS driver.

        Of course as you well know for us professionals our peak earning capacity is in our later years and we leave the driver far behind. And the public knows that too so I don’t see your claims getting much traction even if they were true.

        I wish I had a catchy name for your distortions of the truth but they’re just so clearly wrong so often it’s not worth the trouble.

  2. Anonymous says:

    If we do the math on your hypothetical surgeon making $105 an hour, even after subtracting misc. “expenses” he/she still comes clean with $60k a year…not exactly standing in the soup line there. And 19 years to catch up with someone making $20k a year…ummm, no.

  3. Avenger says:

    Even truly incompetant ambulance chasers clear $60K per year – the good and/or unethical ones far exceed that take

  4. Matt says:

    Not sure where the Forbes article got its info if it’s claiming anesthesiologists pay well into 6 figures for malpractice insurance. According to the chart on page 27 of this article:

    http://aqihq.org/Anesthesia%20in%20the%20US%202_19_10.pdf

    Average malpractice premium for an anesthesiologist was about $21,000 per year in 2009, which represents about a 40% DECREASE over the last 25 years. Their ’09 average salary was $333,000 according to this site:

    http://www.locumtenens.com/anesthesiology-careers/2009-anesthesiology-salary-survey-report.pdf

    I realize neither of those links are as solid as a message board, though.

    Wonder how many anesthesiologists would trade income/costs with a UPS driver and vice versa?

  5. harry says:

    I would hope my surgeon makes at least 5X 60k. Someone qualified to cut on vital parts of your body should get pay commisurate to that responsibility.

  6. Matt says:

    $156,456 – According to the Association of American Medical Colleges (AAMC), the average educational debt of indebted graduates of the class of 2009. Also, all student loan interest is deductible, and the amount can be paid out over up to 30 years.

    I’m not sure which peers WC thinks are getting so far ahead and who don’t have student loan debt.

    Average law school debt is anywhere from $75K-100K, depending on the source.

    Of course, average physician starting salaries are pretty good:

    http://www.valuemd.com/physician-salary-first-year.html

    Can’t find an average salary for a first year attorney, except for big firm associates. That doesn’t factor in the small firm, government, nonprofit, etc. attorneys. Probably similar to a resident, maybe a little less. Attorneys top out at about 50% less than physicians. Again, on average.

  7. ThorMD says:

    @Matt: Your statement that ALL student loan interest is deductible is WRONG.

    The maximum amount of student loan interest you can claim as a tax deduction is limited to $2,500.
    The deduction is also limited by your total income. If your income is under $55,000 (or $115,000 for married couples filing a joint return), then you can deduct up to $2,500 in student loan interest.

    If your income is over $55,000 but under $70,000 ($115,000 to $145,000 MFJ), then your deduction for student loan interest will be prorated.

    If your income is over $70,000 ($145,000 MFJ), then your student loan interest is not deductible at all.

    The phaseouts for the deduction are described in more detail in IRS Publication 970.

    So the average doc making the average starting salary can’t deduct ANY student loan interest.

    • Matt says:

      My mistake. You are correct. I guess a resident would be the only ones with the possibility of claiming the deduction. Physicians make far too much, fortunately for them!

  8. Guiac says:

    According to blogs.payscale.com the average UPS driver makes $26 an hour with bennies. Nothing to scoff at for a high school diplomate or GED. The site isn’t super specific as the range for light truck drivers being $26k to $40k /year to start wiht UPS being on the high end. Experience ups the wage so at 20+ years exp it can push $60k.

    Assuming someone is lucky enough to get the job as at age 18 making 40 making lets say $40k x 5 years then $50k X 5 years that would be $450,000 salary over 10 years. Add in $55 k for the next ten years and your up to $1 million over 20 years.

    A doc who isn’t clever enough to go to state school might run up a cool say $400k in debt over 8 years. Follow this with 3 years of residency in FP at $50k/yr and now after 11 years then are net -250k. Now as an FP they make about 130k a year so it would take them 9-10 years to make up the gap.

    So it is possible – that said it requires that the comparison be made between the best paid driver and the worst paid physician.

    • DefendUSA says:

      We own a CPA practice and do some individual returns of people who work for UPS. It is absolutely staggering how much money these people make. 30 and making 75k, no college.

      It is entirely possible for physicians to take ten years to catch up, even in some state schools.

      My kid is headed out of state for her dream of marching in the Michigan Band as a biomedical engineering student…she will be in debt a good 80k when she is done. It will take her 8 years to pay it off at 1000/mo. Good thing she doesn’t want to be a doctor.

      I must say, Matt. I do get tired of your constant need to be right.

      • Matt says:

        The post you replied to isn’t mine. And the figures I quoted weren’t mine.

        And congrats to your kid for chasing her dream.

  9. Classof65 says:

    Thanks for the somewhat humorous tone of this update — still informative, but not scary… the sky is not falling!

  10. JustADoc, says:

    Since the UPS driver is working for the 8 years that the ‘rich doctor’ is in college and medical school than the best-case scenario for the isdoctor equalizing even yearly salary is 9 years. Forget lifetime salary, let alone net worth. At 8 years the UPS driver has lifetime salary of $424,000 and the doctor has $0. Don’t know many interns making the necessary $473,000/yr it would take to catch up within 9 years.
    And that is just counting salary and ignoring loans and loss of time for benefit of compounding interest on savings.
    Don’t need best-case UPS and worst-case doc for these numbers. This is just school and residency which has the same income(within a very narrowly defined range) for all doctors in the US.
    And that

  11. Matt says:

    Aren’t you assuming the ups driver is making max salary from day one?

    • JustADoc, says:

      Um, no I went with average salary for the whole time period. DefendUSA above noted that some UPS drivers make $75,000 a year which is nearly 150% of what I based my calculations on. Using that and it gets out to almost 25 years to catch up for a typical FP making $150,000 year starting 11 years after the UPS guy.

      • Matt says:

        According to this article, the average UPS driver’s salary is $55,000. BTW, they are unionized. http://www.boston.com/news/nation/articles/2006/02/22/ups_drivers_avoid_blue_collar_union_blues/

        Of course, since we’re talking about the first 10 years it’s probably a little less.

        I’m not sure how you figure 25 years. Let’s say you could get the average from day one at UPS, so we add 8 years of school right off the bat. So $440,000. Then what? 3 years of residency, where you’re making probably around $40,000? So they gain another $45,000 on you there. So they’re ahead of you by about $500K.

        Now, all of the above assumes that during undergrad you never earn a dime or do a thing, and of course that they immediately make the average (neither of which are likely to be true).

        But since we’re using the average, let’s use the average family practitioner salary you used of $150K. You’re gaining $95,000 a year on them. And that’s just if you’re a FP. Since we’re on an Emergency Physicians blog, their average salary is probably $250,000. So they catch up pretty quick. I got that info from the ACEP here:

        http://m.acep.org/MobileArticle.aspx?id=45806&coll_id=574&parentid=740

        In short, by 40, even the lowest paid physician is hundreds of thousands ahead of the average UPS driver.

        Again, you guys are not going to get any traction with this. I’m not arguing you’re overpaid, I don’t think you are. I just think you’re foolish to try and push this angle. The public isn’t going to buy it. But who knows, I’ve been wrong before.

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