"Frank Boettcher" wrote in message
...
On Fri, 05 May 2006 04:46:02 GMT, "Maxprop"
wrote:


"Frank Boettcher" wrote in message
. ..

Today the average doctor makes
approximately five times and much and many specialists make 15-20
times.

Where have you been, Frank? 15-20x? Hardly. Nearly all medical
reimbursement to physicians is now third party, and the rates of
reimbursement have been cut dramatically. Whereas a cardiologist could
reasonably presume to earn in excess of $500K per year in the mid-90s,
today
they are lucky to clear $200K before taxes on average. Top-notch surgeons
used to earn well over a million per year, but work harder now, do more
surgeries and make half that or less. There are a few physicians in
private-pay only settings who still make the megabucks, but they are few
and
far between.

In an industry that controls supply side by the number of
available seats in Medical schools which is way out of proportion to
the talent available.

Really? Have you chatted with emerging med school grads these days? My
recommendation to you is that you'd be well-advised to stay very healthy
in
your later years. Entrusting your life to some of these new physicians
would seem riskier than skydiving. Medicine doesn't pay nearly as well as
it used to, ergo the top-notch students don't apply to the schools in the
percentage they used to. They now go into computer-related and finance
fields, where the money is. I was one of 69 optometry students chosen
from
a field of nearly 1000 qualified applicants in 1980. Today the entering
class at my school is 60 students drawn from roughly 450 qualified
applicants. Med schools take about 250 students annually from a field of
roughly 1500 applicants, but of the 1250 who don't get into one school,
about 70% of them get into another school. You've implied that the supply
side of medical doctors is controlled ostensibly to keep earning high for
those in the profession. What would you propose? Would you take all of
the
qualified applicants in order to spread the money around? And what would
the result of that move be? My best guess is that fewer and fewer
qualified
applicants would show up each year. Money and prestige are and always
have
been the primary driving force behind the interest in medicine, but are
becoming mitigated more and more each year. Stay healthy.

You're contradicting yourself Max. On the one hand you talk about
emerging class being substandard as an indication of the pool and
since I know a number of them (but not necessarily a relevant sample)
I can't concur; on the other you talk about 450 qualified applicants
with 60 selected.

Not contradictory at all. The point I didn't make is that the applicant
pools are dwindling somewhat, but they are also comprised of less-qualified
students than, say, 25 years ago. For example, anyone with a GPA of less
than 3.8 needn't have applied to med school in the Seventies. Today the
average "qualified" applicant has a GPA of roughly 3.4. And of course
programs that still utilize affirmative action use a dual standard for
qualifications, allowing GPAs as low as 2.8, plus or minus, for minorities.

And I don't believe a high percentage of those not
selected get in at another school.

Believe what you will--it's true. Of the 1900+ qualified applicants who
applied to Indiana University School of Medicine in 2001, only 250 were
accepted at IU. Of the remaining applicants fully 70% or more were accepted
elsewhere. Most applicants use the "buckshot" approach in applying to
medical school, sending out anywhere from 3 to 15 applications--a busy and
expensive process, but with generally good results.


Are you concluding that doctors if paid $200K per year will become
discouraged, quit the field and become something else, or will as a
result of that "low" pay give substandard service.

A few will when they consider the work, the responsibility, the hours, the
call, the legal ramifications, the hassles, the busywork, the politics, and
other factors, not the least of which is that many doctors entered the
profession believing they'd earn far more. More importantly, the top-notch
students won't apply to med school at all, knowing better money is available
elsewhere with less gruesome responsibilities and hours.

My position is
that fees will come down with more competition but the pay will remain
attractive to entry.

It IS attractive to some, but generally those people aren't the same quality
of individual that used to be attracted to medicine. I say "generally"
because some very good people do enter medicine, but the overall quality has
slipped, and organized medicine will be the first to admit it.


And that has been going on most of my life. As
a pre-65 forced retiree I spend five times as much for health care as
gasoline. And I'm healthy. And I don't hear very much about that.

Do you really believe physicians' fees are responsible for the high cost
of
medical care?

Yes, to the extent of their poroportional impact on the total cost of
health care. Their fees also include their overhead which includes
their liability insurance among other things.

If you are hospitalized for an MI (myocardial infarction = heart attack)
your total bill will typically break down this way: 75% hospital bill, 15%
physician's fees, 10% associated costs, such as outsourced MRIs, etc.
That's quite oversimplified, but relatively representative. Thanks to
managed care, physician reimbursements have been cut dramatically. The
single biggest increase in the cost of health care is hospitalization, with
the profit to third-party carriers a close second. In a way, it can be
honestly said that doctors have done their part in attempting to limit the
cost of health care.


If so, you'd better do some research. Dr. fees are only a
small part of the equation. Hospital costs are a far larger percentage,
and
profits to health care insurers is an equally-large percentage.

And I never indicated they were not.

And the
cost of absorbing the expense of hosptial and medical care for the
uninsured, impoverished masses may just be the largest percentage.

Come on Max. Since that slug Dickey Scruggs is suing most of the
hospitals in the country in a class action to make himself another
billion or so dollars, what they spend on the indigent is public
knowledge. Not anywhere near the largest percentage.

Notice I said "may just be". I really don't have the numbers, but I know
they are significant, especially at municipal hospitals such as the one
employing my wife. Such facilities cannot reject indigent patients.
Private facilities can and do.

In any
discussion of illegal immigration, this factor must be considered, because
it's significant. My wife had an undocumented Mexican patient on her
floor
at the hospital who required extensive care and treatment for a period of
6
weeks. After incurring an unpaid and unreimbursed (by the gov't.) bill in
excess of $1million, the hospital wanted to dismiss the patient to
long-term
care, but no one would take her. So the hospital covered the cost of
putting the woman on a private jet and flying her to Mexico City, where
she
was turned over to Mexican authorities for extended care. My guess is
that
they let her die.

But let gasoline go up and the cry begins. Mostly from people driving
urban assault vehicles and throwing their plastic (oil) disposable
junk out the window. And lining up at WalMart to get that cheap
chinese stuff, which is the primary reason for the world market in
energy going through the roof.

Yup. Do you advocate paying more for inferior, more costly domestic
goods?
Do you think you'll find anyone standing in line behind you in that
philosophy?

Hitting a sore spot here, Max, since I was one of those domestic
manufacturers making an "inferior" product that was "alledgedly" more
costly.

The product I used to make actually cost a little more now with a
strategy to high chinese content. The Corporate genius were shooting
for a 25% reduction in cost (with a strategy of no reduction in price
BTW). The basic cost is a push, some models higher some models lower,
The warranty element of the cost of quality is four times higher.
With warranty four times higher, relative quality comparison fairly
easy to make. Overall, everybody lost. The end user gets a crappy
product with no choice in the matter, other than the competitors
crappy product. The company is making less money,(so much less that
they sold off the division as a defensive move) and many good people
(with average seniority of 25 years) in this country lost their jobs.
And were talking about $25-35K highly productive people.

Market share for the product is down since it is now "just another
chinese import" garnering no end user loyalty.

And you might ask, why not just reverse it. Once you dismatle U. S.
manufacturing and destroy tooling, the cost of reentry is prohibitive.
If you try to go back you would have "more costly domestic goods"

Don't get me started on this one. Oh, you already have

Sorry to hear about your situation, Frank. My implication was not that US
goods should have been replaced with less costly foreign ones, but that is
what has happened, and it's impossible to reverse the situation now. What
has been lost is gone and, short of a major global catastrophe, won't be
returning ever. But my point is valid--e.g.--the Toyota Camry is the number
one selling model in the country now. There must be a reason for that.

Max