WhiteCoat

What Is Your Life Worth?

By BirdStrike M.D.

“Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.”- Johnathan Blaze August 27, 2012 at 4:54 pm

It is generally agreed upon that the more one values a good or service, the more he or she is willing to pay for it.  Most will agree that shoes are important.  They keep your feet from bleeding and hurting when you walk on the street.  People seem happy to pay anywhere between $20-$150 for them.   Some will clamor to pay without complaint as much as $315 for sneakers that mimic those of their favorite basketball hero, or $865 for designer Manolo Blahnik “BB” Snakeskin Pumps.  Many place great value on a youthful physical appearance and sex appeal and will gladly pay up to $15,000 cash for a new pair of breasts with little if any sense of resentment for the doctor providing the service and metering the charge.  Having a car, most of us will agree is very important, and therefore paying around $30,000 is pretty average.  Though it seems that many are outraged at a Plastic Surgeon charging $12,000 to repair a fingertip, most people consider their limbs and appendages important, and being able to use them of significant value.  Therefore, it follows that a total cost of approximately $40,000 for a hip replacement tends be generally well accepted and frequently paid by insurance companies along with the physician portion of $1,505 (CMS CPT 27130.)

So how much is your life worth to you?  Clearly it is worth more than a pair of shoes.  Are we still in agreement?  Certainly you would be more than happy to pay $20-$150 to have it saved, if you or your insurance company had the finances.  Is a human being’s life in total worth more than the $15,000 pair of augmented breasts on the human being?  I’m sure most would agree it is.  I’m sure as a society we must pay more than this for a human life saved, correct?  I’m sure we all similarly agree that the entire value of a human life saved is greater than the value of a “spare replacement part” such as a $40,000 hip.  We must certainly and gladly pay those who save our lives at least as much as we pay for sneakers, designer shoes, our cars or a spare hip, correct?

No.  We don’t.  It’s not even close.

In the field of Emergency Medicine, there are only a few situations where the physician can truly walk in a room and walk out a few minutes later absolutely certain he saved a life.  One is an emergency intubation (making a non-breathing person breath again) and another is cardioversion/defibrillation (restart a non-beating heart.)  It doesn’t always happen every day, but it is what Emergency Physicians and other critical care providers are paid to do.  To be an Emergency Physician is a paid position.  It is not a volunteer position.  It stands to reason that Emergency Physicians would be paid at least as much as for a life saved as for the aforementioned goods and services, correct?  Let’s break down what a true life-saver gets paid to save an entire life, not just the hip, the breasts, the fingertip or the shoes.

What an Emergency Physician actually gets paid to save a life-

1)      Emergency intubation: $112  (CMS payment for CPT 31500) or,

2)      Cardioversion/Defibrillation: $131  (CMS payment for CPT 92960)

Even if one combines cardioversion with a $226 charge for critical care services provided (CMS CPT 99291) the total charge is still only $357. Therefore, according to the United States Center for Medicare and Medicaid Services, your life is worth $357, or at least that’s what they’re willing to pay Emergency and Critical Care Physicians to save it.  This doesn’t factor in the number of people who are still uninsured and unable to pay anything.  In other countries the payments are even less, or are lumped into a salary that if broken down service by service doesn’t come close to even this amount.  Any outrageous bill from such an Emergency Department visit is and only can be from the hospital itself.  Zero of the portion of the hospital charges go to the Emergency Physician.  Zero.  This is a fact.  So, to paraphrase the above commenter, is $357 a “ridiculous amount of money for a simple routine procedure?”

I am not an economist, nor a philosopher, but this all seems to follow a theory of sorts, that I have observed.  There may be an official theory of economics of which I am unaware that explains this.  This may or may not be an original thought or observation (economists: if not, please place source in comments section and I will cite it.)

The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free.  Any charge for this infinitely valuable service will not be considered a very fortunate undercharge.  Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it.

It is for this reason that an Emergency Physician that asks to be paid $40,000 for giving someone a new chance at life is considered greedy and contemptible, yet the hospital and orthopedic surgeon that ask for the same payment for a spare hip are not.

It is for this reason that the Emergency Physician that expects to be paid $15,000 for a life saved is wrong, yet the Plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.

It is the same reason, Manolo Blahnik is a “life-saver” for trading beautiful shoes for the fee of $865, but an Emergency Physician is expected to feel fortunate to be paid hundreds of dollars less than this for a life saved.

I am not suggesting that Emergency Physicians (in the United States) aren’t paid well, because they are.  I am also not suggesting that orthopedic surgeons, plastic surgeons, shoe designers or anyone deserves less than that which they rightly earn.  Also, I am by no means implying that Emergency Physicians are, or should be, motivated by primarily by money, nor that those with life threatening emergencies should have their lives held hostage and be price gouged.  I am not even suggesting that for life saving services Emergency Physicians should be paid a fee equivalent to performing a hip replacement, breast implant operation or a pair of luxury shoes.  I am suggesting, however, that if they were, they would certainly deserve every penny.  My main assertion is that if people and society are not going to pay life-savers that which a life saved is worth, or even what they gladly pay for a new hip, pair of breasts or luxury shoes, that at a minimum they hold Emergency Physicians, nurses, EMTs and other emergency service workers in the highest regard.

Some patients give great thanks when treated for true emergencies in the Emergency Department.  However, many others, for some reason, rather than showing great appreciation or at a minimum rewarding the providers of such infinitely valuable and life-saving services with compensation comparable to that of products and services of definitively much less valuable ones, often times the payment is instead the toxic and misguided negativity of those such as the commenter above.  It is very unfortunate.

Clearly, the economics of our healthcare system are warped and distorted in countless ways, and far and away those who profit the most are the insurance companies and hospital mega-corporations, not the Emergency Physicians, nurses and other providers.  However, to point the finger of blame at those who are on the front lines of the trauma and chaos, with the highest burden of burnout, who also get paid a small fraction of the payment of other medical services for the service of saving a life, seems to me at best misguided, and at its worst sick and twisted.  How much longer they will choose to do so I am not sure, but thank God, the unappreciated heroes of the Emergency Departments of the world can make their way through the negativity, sleep deprivation, and stress to be there to save the lives of all of us, including even those who resent and condemn them the most.  To them, I say, thank you.

(Financial disclosure: In my current practice I do not bill the above mentioned procedure codes and would not benefit financially from any increase in reimbursements for these, or any other emergency procedures or services.)

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This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that it should be considered fictional.  Any opinions expressed here are of the author alone and not those of EP Monthly or WhiteCoat.

78 Responses to “What Is Your Life Worth?”

  1. Anony says:

    I agree with the point that you are trying to make, however, please don’t assume that everyone who has a hard time making medical payments are the same people who are getting $15K breast implants or paying $150 for shoes.

    I am a young adult who is trying to pay back student loans, rent, food, water, electricity, health insurance, etc and it’s hard when you are living single and almost all of my money is going into that. I am also not someone who frequents vacations or shopping sprees although it would be nice too.

  2. it's just me says:

    BRAVO.

    DH and I are both medical professionals, and often hear about how we as a profession are greedy and over paid. To that, we wonder why it’s OK for entertainers (actors and athletes in particular) to get paid exorbitant amounts of money to entertain…but we get a few dollars to maintain life and the quality thereof?

    • Birdstrike says:

      You get it. Thank you.

    • Matt says:

      Actors and athletes are paid for their skill sets depending on what the market will bear.

      The problem with physicians is that you have chosen, both in the past and frankly still, to not be compensated based on your skills, but as a group, and by a third party.

      Now, it has resulted in you as a group receiving the highest salary of any profession in the world, but at the same time, but at the same time individually you are compensated essentially the same whether you’re the best or worst. It makes no sense to most of the rest of us businesspeople, but of course most of us don’t make what you do so maybe we don’t understand the “good for one, good for all” mentality among physicians.

      At least actors and athletes’ pay is responsive to a market for their skills, and a rather direct market at that. For example, LeBron gets a max salary (although even he is subject to the CBA) because his skills are worth that, while Shane Battier gets a lesser deal because that’s all his skills are worth. The best or worst ED physician at a given hospital are pretty much compensated at the same rate. And the public has no say or ability to judge the difference.

      Whose fault is that if you’ve agreed to this compensation scheme?

      • it's just me says:

        Really? You think LeBron James’ *skill* is worth roughly $22K per shot?

      • Gregory Mullen says:

        it’s just me:

        How much longer is his career expected to last? What income does he get after that? What happens if/when he blows out his knee?

        How about his privacy?
        How many people care about his breakfast?

      • Matt says:

        I think his skill is worth whatever the market will bear. In fact, Miami actually gets a bargain on him due to the CBA which restricts his value as compared to a true open market. Just because I might not pay that much for him doesn’t mean much since I’m not the sole arbiter of value.

        Any one of us, compensation-wise, is worth what the market says we are worth. Physicians have chosen to negotiate as a group so individually it’s hard for them to Really maximize their individual value. But collectively it works for them they’ve decided. Not so different from a union in some ways.

      • Matt says:

        And while yes, I do think LeBron is worth that, it doesn’t really matter what I think. What matters is what his employer, Mr. Arison, thinks. My opinion matters to the extent I might buy tickets and a jersey, but Arison and 30 other very rich guys are his market.

    • defendUSA says:

      I have several family members who are docs. It used to drive me crazy to hear how “they” were over charging. If they could have seen how much my Father-in-law wrote off, they would be astounded. Back then I could work in the lab there were so many tests he did for free, I used to wonder how he got paid!
      Yes, I wonder the same thing about the entertainment or sports industries. The problem is that what is tangible makes the difference. Stars and athletes are intangibles and people cannot relate on a personal level. It is the same with the political arena. One side lambasts the “evil” rich people, while justifying their own side and the wealth that is abundant without seeing the double standard.

    • it's just me says:

      “Skills” of an entertainer>Skills of a medical professional. Or police officer. Or firefighter. Or________.

      And that’s ok?

      SMH.

      • Matt says:

        You want to be the arbiter of salaries based on your personal value judgments. That’s not how it works. And never has.

        I may not always have the same values for services and goods as the market as a whole but I prefer the market to some individual making all the calls on such things.

      • it's just me says:

        Matt, assume I have the very most basic medical skills available to a person that would still allow me to be called a professional and keep my license. LeBron James and I are having dinner with you, and you suddenly lose consciousness. Or your significant other. Or your child.

        NOW who is more valuable to you? Do you want LeBron to ring the ice bucket with his napkin or do you want me to use my considerable years of training and education and experience to start assessing the situation and spring into action?

        My own personal biases to my profession aside, I would gladly shut down Hollywood and forego all professional sports to pay the fee of the person who saved my child’s life.

      • Matt says:

        You misunderstand. I didn’t say I disagreed with your assessment on this issue, merely that the market does. The public does.

        The other thing to remember is that lots of people can do what you do. What LeBron can do is unique.

        And frankly your Illustration is silly. One could equally say “imagine I’m in a liquor store and a guy holds a gun to my head. Do I want a doctor who can clean up the mess after or a cop who can kill him before he shoots? Therefore we should pay cops more than docs.”

    • it's just me says:

      I agree LeBron is a talented athlete…overpaid nonetheless. But there are countless actors who are also grossly overpaid as well.

      I am not paid to clean up messes. I am paid to save lives. Your rebuttal falls a little flat.

      • Matt says:

        You’ve latched on to a position that only makes sense if YOU are the one who solely decides the value of everyone’s contribution to society. And you want to decide that value only in the most dire circumstance, or according to your own personal values.

        That’s not how the world works. Never has, never will. LeBron will always be compensated more than you until you develop a skill set equally unique as his.

        The actor who is overpaid is not overpaid because he/she is a bad person – they may not be overpaid at all. Because YOU think so does not make it an objective truth. Most people struggle with that concept, I realize, but it’s true. Your beliefs do not equate to objective facts.

        My illustration was not a “rebuttal”, it’s just pointing out the absurdity of your position, which seems to be “I might, in a very limited situation, really be able to help someone, therefore I should get paid more than LeBron.”

      • it's just me says:

        I never once stated that I think I should be paid more than LeBron or any other celebrity for that matter. I am pointing out that there is a gross inequitability between his salary as an entertainer…who can be replaced, and my salary for preserving a life, which cannot.

        I’m no better than the janitor. I’m just regular folks. I am, however, more educated than the average bear, and if I screw up, the stakes are higher than if LeBron misses a shot.

        My thoughts echo Birdstrike’s…a life is more valuable than a pair of shoes…or it should be. I think that is understood among mentally healthy individuals. That’s not just my set of values.

        Lighten up, bro.

      • Matt says:

        I am lightened up. You’re just throwing out sophomoric thinking on the issue and expecting it to be self evident because you buy it.

        “I am pointing out that there is a gross inequitability between his salary as an entertainer…who can be replaced, and my salary for preserving a life, which cannot.”

        So you don’t think you should be paid more? You’re getting kind of mealy mouthed on this. You may be able to preserve a life, but guess what – millions of other people can provide that same service. But only a few can do what LeBron can.

        Still though, using your logic, I should value the cop more than you, or the fireman.

        “I am, however, more educated than the average bear, and if I screw up, the stakes are higher than if LeBron misses a shot.”

        To you they are. Maybe not to others.

        “a life is more valuable than a pair of shoes…or it should be. I think that is understood among mentally healthy individuals. That’s not just my set of values.”

        What a silly thing to say. People value lots of things greater than their lives, and they do it by making cost/benefit analysis, conscious and unconscious, every day. I do admire your conceit that whatever you believe is what is “mentally healthy”. It’s a nice contrast to your “just folks” schtick.

      • it's just me says:

        LOL WOW! I have a schtick? Our discussion escalated to a personal level pretty quickly!

        No, Matt, for the record,I don’t think I should be paid more than LeBron James’ current salary. Not mealy mouthed…I never made such a claim. Once again, I think there is an outrageous contrast between the salary for what I do and what he does. I recognize that you call this “my” set of values, and maybe so. But there was a cat named Abraham Maslow who years ago wrote a psychological theory about a human’s needs. And while sustaining life is the very foundation on which it’s built, I don’t remember seeing basketball on there anywhere. And I even googled it. Maslow’s theory is widely accepted, and I hate to put words in the guy’s mouth, but based on what he wrote, I think he just might agree that life>entertainment. So that makes 2 of us. I asked DH, and he agrees as well. There may be more; I’ll ask around today and get back to you on that.

      • Matt says:

        I didn’t realize the term “schtick” was a personal attack. A thousand pardons.

        There is an outrageous contrast. Mainly because lots of people can do what you can. But then, there’s an outrageous contrast between what you get paid and what someone gets paid doing the same job in other countries. Welcome to the market.

        Again, people make value decisions about their life, and their quality of life, every day. There’s a reason not everyone buys the safest car out there. They value other things more than their safety. This is not a new concept.

        If you truly believe your survey will bear fruit, perhaps your salary will be raised. Or maybe, just maybe, your compensation is more complex than that. But who knows – I hope you get your raise!

    • Ed says:

      interestingly, if Lebron holds out for more cash, or goes on strike, he is a businessman trying to get the most for his “product”

      If a doctor goes on strike he is a heartless bastard who puts money over the value of a life.

      • it's just me says:

        Excellent point, Ed.

      • Matt says:

        Nonsense. Every time players in any sport go on strike you hear plenty of stories about “why are they complaining – they get to pay a kids game for millions”.

        And if physicians are cowering in fear of publicity from a few people who don’t want to pay for their services, then they don’t value themselves enough, and that’s the real problem.

  3. it's just me says:

    Anyone care to comment on what attorneys make???

    • Birdstrike says:

      The attorneys that love to come to this site and blast away in the comments when there’s an article about legal issues suddenly don’t care to comment. That is interesting, isn’t it?

    • Matt says:

      We make on average about 2/3 of what physicians make and 40% of surgeons. You can go to the Dept of Labor and see all the stats broken down a myriad of ways and by profession, region, etc.

      The main difference is that the ways we are compensated are much more diverse and a much smaller subset of our profession have signed on to the third party payment model. Although those that do, insurance defense lawyers, have many of the same compensation gripes as physicians.

      Why does what other professions make have anything to do with this. Everyone knows physicians make far more than any other profession. And are for the most part compensated in a different manner.

      • defendUSA says:

        In my office, a client calls his lawyer and must pay 250/hour. No physician charges that where I am from. I pay 55/per visit, unless it’s a physical.

      • Matt says:

        Anecdotes are interesting but not terribly useful. The DOL stats speak for themselves. The fact that physician compensation and payment scheme is significantly different and more compkex is part of our healthcare problem that separates consumers from providers.

  4. pinbor1 says:

    I whole heartedly agree, as an EM physician at a teaching institution, I think about how much I get paid to take care of patients. The math comes out anywhere from 15-30 dollars per patient I see, depending on a given shift. Damn, the taxi driver gets paid more than I do to bring a patient to the hospital… how much is your life worth indeed!

  5. another doc says:

    I don’t know if you were doing the pure doctor’s fee or the global fee. What people fail to think about is that RIDICULOUS fee includes paying my front desk staff, the business office staff (who have to resubmit claims 3 and 4 times to get them paid just because…..), my nursing staff, rent for the office, and….oh, yeah, the medical malpractice premium. Is it a scam? Sometimes with all these levels of bureaucracy it feels like a scam, but I don’t think it’s the professional fees where the scam truly originates. Just suggesting….

    • Birdstrike says:

      Overhead is huge, I agree. It can be overwhelming, especially for primary care physicians. I don’t know which fee you’re referring to, but if you click on the blue link, it will take you to the source.

    • Dan says:

      Not to mention a quarter million dollars in student loans! What are the monthly payments on those?

      The real reason you guys get screwed is that emergency care is necessary for the patient. The thought immediately goes from “I need this treatment” to “you need to provide this treatment for me” — a logical leap that makes no sense to me. How do my needs give me a claim on your labor?

  6. Gregory Mullen says:

    You just got your brand new (overpriced) red $X0,000 sports car you’ve been waiting your whole life for… How do you feel?

    You have to pay $X00 in a new SURPRISE tax on said car… How do you feel?

    It’s not about the money, or the services. It’s about what they mean. What’s the Px look like for a cardioversion, or intubation, is the quality of life for that person better then before the primary event?

    I agree with everyone of your points, I’m a EM student so I’m walking in to this myself, but a cigar is not always a cigar.

  7. Amy says:

    My health insurance premium just jumped by over $100/month. It did the same thing last year. How much higher can it go before I simply can’t pay it anymore?

  8. justadoc says:

    Amy, the payment to your doctor did not go up anywhere even close to $100. In most cases it went up $0. And in some cases(many heart tests as well as radiolology studies) it actually went down 30%. The reason doctor incomes are relatively stable is because they are doing more and doing it faster. There comes a time where that is not safe and then there comes a time it is not even physically possible.

  9. E says:

    After seeing the horrible way the medical profession encourages hazing and carelessness I am not surprised there is a medical crisis. Medical education needs a major reform or else it will continue to perpetuate problems.

    • E says:

      In other words, I am arguing the valuation problem is largely due in part to poor practices internal to the medical profession. This leads to the medical profession devaluing future docs and consequently devaluing themselves.

    • Birdstrike says:

      Having gone through medical school and residency before the current ACGME limits on that “hazing” you refer to, I can’t disagree.

  10. Amy says:

    I don’t know what my insurance premiums are paying for, but it’s not better coverage, because in the months leading up to that premium increase, my insurer stopped paying for my Elidel, a hand cream I use to control eczema, the price of which has recently doubled to over $200/mon, and denied my neurologist’s request for them to cover 12 generic sumatriptan per month instead of just 9.

    I wasn’t sure why the Elidel had gotten so much more expensive until I read an article in Consumer Reports that said this is a new tactic used by the drug companies. As a drug reaches its final years of patent protection, they start jacking up the price, sometimes to 4-5 times the original price, in anticipation of losing the revenue stream when the patent expires.

    Because of this, when my eye doctor recommended I try a drug called Restasis, I asked him to check when the patent was due to expire. We found it was in a year and a half. I told him I probably couldn’t afford it since they were likely to be jacking up the price right now, and I’d start taking it 2 years from now.

    Medicine is a mess, and paying customers like me are footing the entire bill, not just for ourselves but for the deadbeats who pay nothing, and our bills are going up at an astronomical rate. More of us are being priced out of the market every day. Medical professionals’ reaction to ridiculous bills like $12,000 to repair a fingertip should be outrage, not, “Hey, I want a piece of that.”

    • ThorMD says:

      As I medical professional, I am also a CONSUMER of health care. My insurance premiums go up every year too. My wallet is not immune to the sleazy stuff that insurance companies and pharmaceutical companies do either. EVERY SINGLE medical bill I have EVER received was paid for incorrectly by the insurance company. I also spend a lot of time on the phone arguing with the insurance company about having them actually pay for what they have contractually committed to pay. I am now a much smarter consumer of health care because of my tenacity and willingness to spend the time to fight and to save a few bucks.

      • Birdstrike says:

        ThorMD,

        My wife took my own child to one of the EDs I was working at for a respiratory condition for which she was eventually discharged, and the hospital portion which by policy they do not waive even for staff physicians, was $1000. Not one penny of that goes to any doctor, including my own partner who treated her. My own insurance paid less than half. It was an ED I worked at, as a doctor. Amazing.

      • ThorMD says:

        Agree. I’ve never had a doctor, hospital or pharmacy “waive” my portion either.

      • Dan says:

        So Birdstrike, had you been the only physician on duty, and thus were forced to take care of your daughter, then you’d have the joy of paying $1000 for your own damned services?

    • suki says:

      I also have heard that about the pharmaceuticals. Now that is a scam! It is called greed by the pharm. industry.

    • Birdstrike says:

      Amy, you are a victim of the same games insurance companies play with doctors. They don’t want us to have a penny more than they can get away with letting us keep, either. I’m sorry you have to deal with this. It is very unfortunate.

      • Matt says:

        Makes one wonder why physicians keep getting in bed with the insurance industry.

      • Ed says:

        Matt, you beat this horse quite a bit. Tell me, what is their option? Have you attempted to receive medical care without insurance? I have. Let me tell you, it is practically impossible to do. Unless you are quite wealthy, you cannot pay out of pocket for services.

        If doctors did not accept insurance, they would have no income whatsoever.

      • Dan says:

        Matt, doctors are “in bed” with insurance companies the same way a victim is “in bed” with her rapist. And each practice is forced to negotiate with insurance companies on its own, lest it be charged with forming a cartel.

        And I’m a computer programmer for a company only distantly related to healthcare — I’ve no dog in this fight.

      • Matt says:

        Ed, for hundreds of years physicians worked without insurance and Medicare/Medicaid. Many, many other professions do it as well.

        I’m not saying it would be easy. I’m not even saying they would still make as much.

        Some physicians are already doing it. It can be done, and unless physicians want to be in a single payer system, they better start doing it now.

        And yes, they are in bed with the insurance industry. They play front man for the liability insurers all the time. They talk about greedy lawyers hurting the poor helpless carriers, but at the same time they sue health insurers for billions.

  11. JN says:

    Dr.WC, you should also take into consideration of the quality of care. I’m not happy paying a $20 co-pay to my dr because it took 3 months just to schedule a wellness visit with her and I only get less than 15 mins of her time.

    • Birdstrike says:

      Please ask your doctor about this. Ask her why she had less than 15 min for you. Please do so, and please post the answer here. I’m very curious as to the answer. Likely she’s billing a level of service that only pays her for 10 or 15 minutes. Likely over 50% of that time she had to spend charting on her Obamacare required Electronic Health Record meeting government required “meaningful use”, checking boxes to document government required “core measures”, and documenting extensive details to protect herself in case of any frivolous lawsuit as required by her medical malpractice carrier. Ask her about these requirements and whether or not they make it easier or more difficult for her to take care of you. Ask her if any of this time spent makes you healthier. You might be surprised at her answers.

  12. E says:

    No research and no medicine is worth risking your financial independence. Everything is canceled and was years ago because I was paid less per month than my rent and could not afford anything. I should have been paid at least as a phd student this entire time. The reason everything is canceled is because no one cared about my safety and well being, they tried to push me down and hurt me instead of appreciating my contributions. The consequence is wasted time, energy, and delay in research.

  13. Matt says:

    I agree with the point. However, I wish physicians would see this and work on valuing themselves more equally. Surely not all ED physicians are equal, yet you are all valued the same.

    Also, given how justifiably sensitive you are about this sort of criticism, perhaps you’ll be more circumspect about lobbying criticism at others with buzzwords like “greedy” and “money hungry” when you really don’t know what is involved in their job either.

  14. Nurse K says:

    Now to get an ER doc in my ER that is actually trained in intubation, not just trained in saying “page anesthesia!” I’m still perplexed why ER doctors are allowed to work without ever having been trained to intubate or place central lines or whatever. It’s not like these are rarely-used skills in the ER. I can see not being God’s gift to art lines, but intubation? Really?

    A 250K-275K salary plus benefits is still the top 2-3% of income earners in the US. The guy paging anesthesia is still making about the same as the guy not paging anesthesia, which I think you should be more grumpy about than reimbursement overall.

    • Birdstrike says:

      Apparently you work with Emergency Physicians who aren’t trained to save the lives of patients with minutes-to-seconds emergencies such as airway and respiratory failure. That is a major problem, but it doesn’t diminish the value of of those who are able to fulfill their job description.

      • Nurse K says:

        Nothing like a little levophed through a #22 hanging out of a thumb to prevent a central line infection, says the nurse as she stares at the line waiting for it to infiltrate and cause tissue necrosis.

    • ThorMD says:

      Most ER docs have part or all of their pay based on productivity. So those who do more procedures (intubations/central lines etc) get paid more. If they call anesthesia then anesthesia gets to bill for it, not the ER doc. My pay is almost entirely based on productivity, so I don’t willingly give up procedures. However, if I anticipate a difficult tube in a 500 lb patient with no neck, no chin, and facial hair, then I do the best thing for the patient and ask the expert to come do it. In addition, all of the literature states that central lines put in the ER are more dirty and prone to infection. My hospital actively discourages central line placement in the ED in preference for the controlled environment of the ICU. So, in a major emergency in a patient with no access, they get a central line – but otherwise I don’t do it. So, for me and my group, putting in a central line IS a rarely used skill. I can only think of one I’ve put in in the last 4 years. Now that the government is penalizing hospitals for things such as line infections, I anticipate that we will be discouraged even more from putting them in the ER.

      If your hospital does not incorporate productivity into the pay of your docs, then maybe they should. Those who do their own procedures will be rewarded and paid more.

      When docs are credentialed by the hospital, they must exhibit a core set of skills, including intubation etc. So if your docs passed the credentialing committee (which they have if they are on staff), then they CAN intubate and CAN put in lines. If they choose not to do it and call their back up then that’s a different story.

    • Dr. N says:

      Where do you work that ED docs can’t tube or put in lines? Where I work attending start at 204k but every single one is excellent at both of those skills. Hell, the EM interns can tube and put in lines halfway through first year.

  15. Ardosa says:

    I do find it amazing how many times we get “well you have it easy… you are a… ” fill in the blank for doctor’s daughter or pharmacist.
    Do i get a decent salary? Yes. Do I get any perks? nope. I can’t even take ibuprofen from the pharmacy without risking being told i’m stealing and fired. And, how many hours a week do i work for this decent salary? More than I care to think about.
    But, the indigent patients who have medicaid or no social security number? they get free drug. We spend money to work with the drug companies ‘programs’ to fund the indigent programs.

    So, it goes back to this – like you said – what’s more important. I have no issue paying my portions of covered services (and like you, becoming VERY well informed and talking to the insurance company of why something wasn’t covered and what my policy says). And I do find it funny how many times we see medicaid patients coming in driving a car that surely is better and more expensive than mine, with gold dripping off them more than I have, et cetera.

    Even as a surgeon’s daughter. we grew up barely middle class. Why? My father was one of the few who taught me ‘just because they can’t pay doesn’t mean they don’t deserve treatment’. However, he didn’t accept medicaid. He was fine writing off taking care of patients who truely couldn’t pay, but refused to help those playing with the system… which screws us all up.

    SO, I agree, what is more important. And more importantly, why is it the person who just had $20,000+ of plastic surgery complaining and yelling and screaming at the physician or pharmacist how much things cost when they are not the ones that just charged them all that money for whatever surgery they had. We just did something silly – like suture on their finger, or give the abx for that infection that could have spread… (and i hope not for a cold!)

  16. FPMD says:

    The reason why your primary care doc only spent 15 minutes with you is because with the amount she gets reimbursed that is all the time she has as she needs to see 25+ patients a day to make an adequate income. When I was self-employed I had to see 13 patients a day to cover my overhead before I earned any income (this paid my rent, front desk, nursing staff, supplies, malpractice, etc). Medicine has become a very tough business for use in primary care. We are not necessarily paid poorly but we have to work very hard to earn a decent income. We have given years of our lives to train and we work long hours- we work many hours after clinic is done to finish up administrative work that must be done in addition to clinic notes. People who do not work in medicine really have no idea how complicated the whole thing has become and the government regulation and insurance (for profit) has made it difficult for us to function without a huge support system in place. All I want to do is practice medicine but that is impossible- no one gets away with out significant administrative work that really goes unpaid.

    • it's just me says:

      …and depending on your call group/hospital bylaws, you also have to be tethered to your home for unattached call, covering patients during off hours, inane questions from ancillary staff and patients at 3 am…

    • Matt says:

      You mean you have to comply with a contract you signed? Shocking!

  17. DataGirl says:

    I happily pay the $250 ED co-pay along with hospital fees, imaging fees, surgery fees, etc etc etc when the ED Doc diagnosed me within 30 minutes of walking in the door and I was in the OR within 1 hour later…yeah they saved my life for sure…and I happily completed my surveys and walked out 2 days later on my own two feet…I believe the total cost of my life ended up around $14K (according to insurance statements) but who knows for sure…but I dunno…those shoes sure are gorgeous…

  18. JJ says:

    Writing off care is up to the doc, and if one feels that is the way to go great. However, the cost of my surgery is tiny compared to the hospital bill. As an example, I had a guy get a nail into his eye. Self employed, hard working guy, with no insurance. I dropped my fee down to medicare allowable, $1043.81 (in retrospect strange that a finger tip is 20X more than an eye, but I digress). That is my fee for repair of his ruptured globe. For the next 3 months every office visit was included in that fee. Also keep in mind trauma patients have much higher complication rates due to the nature of the injury. This guy’s hospital bill was $24,000+, and I din’t even admit him. That is the total from the ED doc, radiologist, CT scan, ED fee, OR fee, anesthesia fee, supplies etc… While I believe everyone needs a “skin in the game”, it drives me crazy that hospitals drive the cost up on the uninsured.

    • WhiteCoat says:

      I’m curious about a few things.
      1. What would have been your fee if it wasn’t discounted?
      2. If, during the next 3 months, it is determined that the patient requires other surgeries due to this injury, are those surgeries included in the global fee?
      3. Does the hospital impose any limits on what you charge patients for surgeries or office visits?
      4. When was the last time that you raised your fees?
      5. Did this patient end up losing his eyesight? Was the severity of his injury such that it may have been more cost effective just to do nothing or to do something minimal to treat his pain and prophylax infection? Not asking you this to question your judgment, but more curious about whether this is a discussion that patients would welcome/accept. “Chances are very likely that you’re going to lose your eye. Do you want comfort care for $X or do you want everything possible done with a small chance to gain partial sight in your eye for $X plus $20,000?”

      No underlying motive in asking these questions and you obviously don’t have to answer – just curious about them because I have little experience with these types of billing issues.

      Thanks

      • JJ says:

        WC,

        All very good questions. I have an answer for some.
        1) If my fee was not discounted, my office has set a policy that the charge is 1.75 X medicare allowable. I have no idea where they came up with that number. If they are a hardship, we universally drop down to medicare allowable. Of course I have not discounted due to my own judgement based on the case.
        2) If I take the patient back to the OR there is a modifier and I get paid less than usual for same CPT code. If another surgeon in a different specialty takes them back the global has no relevance.
        3) I have no idea, but I don’t think so.
        4) 5+ years, just like you, reimbursement from insurance is tied to Medicare rates which are dropping
        5) It American medicine, go all out, deal with finances later. A few points, this was not an 89 year old in the ICU, CRF, s/p MI on a vent and we are thinking about adding another presser. He was/is a productive member of society with years (in theory) of life ahead of him. As far as eyes go, we universally never give up on an eye. Even ones that look doomed, primary enucleation is extremely rare. Also, unfortunately, it does not take much to turn a good eye into a bad eye, CRVO, CRAO, complicated cataract surgery, etc… This guy had an anterior rupture, I knew the nail also went through his lens. With a ruptured globe the first thing to do is close the eye, let it quiet down then proceed from there. We knew he was going back to the OR in 2-3 weeks with the retina doc. Did it at our ASC alot cheaper than the hospital. He is now 20/20 with a contact lens in that eye. Hence the reason we never talk comfort care. Anecdotally, I have many patient 20/20 after anterior ruptures/corneal lacerations. It is the posterior ruptures that usually do not do as well.

  19. Ian Random says:

    I think part of the problem is that people don’t like paying to restore functionality. The items you quote are for new things that in theory make you better. I really don’t fault doctors for what they charge. They spend 7+ years on top of college before they can make money. My problem is with the people that abuse the system.

  20. Matt says:

    By the way, there are multiple studies on how much we value life. Here is a starting point:

    http://www.economistsdoitwithmodels.com/2010/07/01/how-do-you-value-a-life-economists-are-happy-to-show-you/

    “Personally, I find it interesting that the objections to this type of estimation persist despite the fact that economists use people’s revealed preferences to determine how much THEY value their lives rather than trying to tell them how much their lives should be worth.”

    . . .

    “Palatable or not, such a valuation is necessary and very important in a policy context. If policymakers went with what our mommies told us when we were little, they would argue that we’re all priceless. The logical extension of this is that if people are priceless little flowers, then any amount of expenditure is justified if it brings about any reduction in risk of death. However, I’m guessing even those that hold tightly to the belief that we are all special snowflakes would agree that a society shouldn’t spend $10 trillion to enact a change that will on average result in 2 fewer deaths per year. Those snowflake-defenders then need to realize that as soon as they make that judgment they’ve put an upper bound on the value of human life.”

    • Birdstrike says:

      Matt,

      The economists in your article value a human life at $1,540,000 per life. (edited for succinctness)

      • Matt says:

        I never left. I really don’t understand the obsession with LeBron’s salary though. You act as if the only way we establish salaries is utility to a single person’s continued existence. Obviously, that’s not the case.

        I don’t do physician contract negotiation, but would be happy to look at it. Tell me, do you think cutesy replies like that help your profession or just distract while you continue down the road to single payer and joining the federal employees’ union?

      • Matt says:

        Why did you edit your post Birdstrike?

  21. A.N. Onymous says:

    I think it is worth noting that emergency care constitutes less than 2% of US healthcare expenditure (per CDC statistics). (And that is the entirety of emergency care, not just the physician compensation.) Given the regulations of EMTALA, we evaluate any patient that presents to the ER, regardless of their ability to pay. We are available all day, every day, to anyone who makes their way to our door or the phone to dial 9-1-1. I work in an area with an enormous uninsured population, and provide more free care than I can keep track of (which I don’t because I don’t make a point of looking at a patient’s ability to pay), and I don’t lose any sleep over any lost income…I am happy to help make a difference in those lives.
    Healthcare is an imperfect system, as are most large systems/organizations, but I think much of the malice toward emergency care is misdirected.

  22. Dr. N says:

    All of you people talking about markets or market prices have a fundamental misunderstanding of what a market is. Once the CMS is involved in price-fixing the general functioning of the market ceases to exist. Government intervention is the opposite of what a free market is and any rational market-based compensation does not apply exist once the government is involved.

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