Sunday, August 14, 2016

Are Doctors Paid Too Much?

Years ago on Cape Cod, my kids and I stumbled across a man who had spent the day creating a sand sculpture of a mermaid.  It was an impressive piece of art.  “How long did it take you to make it? ” we asked.   While I can’t recall his precise words, the response was something like “25 years and 7 hours”.  I’m sure my astute readers will get his point.

We are transfixed now watching Olympic athletes performing in Rio.  So much depends upon their brief routines which can last seconds to a few minutes.  While a diver’s acrobatic plunge may take 2 seconds, it would not be fair to leave aside the years of work and training that prepared the athlete for this moment.

The same point can be made for anyone who has worked and trained hard to reach a point where the action performed seems easy to a spectator or a customer.   If an attorney prepares estate documents, we can assume that the fee for this reflects the prior training and research that the lawyer has done on this issue, as it should.  If an appliance repairman, by virtue of his expertise, fixed our ailing washing machine in 5 minutes and charged us $100, should we balk at this price gouging?  If a less skilled competitor spent 2 hours before finding and correcting the glitch, would we feel better about handing over $100?  Is this fair?  A musician doesn’t just wake up one morning and hop onto a stage to give a concert.  When we pay to listen to an artist perform for 2 hours, we are likely listening to the product of years of grinding work, disappointment, innovation and discovery.

What's a fair price for an hour of Aretha?

I believe that this same principle applies to my own profession.  Over the years I have heard patients complain about various medical charges and fees. While we all know that there have been excesses, many of their gripes are misplaced, in my view.   It’s not fair to equate the medical fee with the time that the physician expended on providing your care.  A cardiac bypass operation takes just a few hours.  A colonoscopy takes 10 minutes.   Treating a patient in an emergency room with a drug overdose may take just a few hours.  A psychiatrist might guide a suicidal patient to choose another path in half an hour.  A spine injection to relieve chronic pain takes only a few minutes.  A dermatologist recognizes a suspicious lesion in a few seconds.  A seasoned surgeon tells an anxious patient after a 20 minute consultation that surgery is not necessary.

Often, folks who make is all look easy are fooling us.  If we think it’s as easy as it looks, then we’re the fools. 


2 comments:

Anonymous said...

You honestly come off as a real dimwit.

What you are talking about is the price of labor, and the thing that affects that the most is supply and demand, and the relevant thing re: supply in medical situations is, How competitive is the labor market? Flood the country with programmers from elsewhere, and their salaries will go down. Flood the country with doctors from elsewhere, and the price will go down. Protect the labor market...and prices stay up...which is what has been happening for a long time. And that is indeed not fair to patients who are effectively undergoing extortion.

It is very difficult to get a man to understand something when his salary depends upon him not understanding it.

MauiGabe said...

Fair enough to voice your opinion. The big difference you fail to see however is that if you flood the market with practitioners of whatever skill/job, quality declines as well. There are more people offering service X, but if 5/100 plumbers are bad plumbers and we allow 1000 additional plumbers to get a license and work then that's 50 additional bad plumbers. You may get your drain snakes for 25% less than in the period before allowing the new 1000 plumbers to work but there are more bad options you may choose as well resulting in, at a minimum re-doing the work previously done poorly (drain re logs in a couple days) or in a worse case, they create new problems (crack pipe under house requiring thousands of dollars in excavations, etc.). This is probably an acceptable risk for most people when it comes to plumbing issues (or whatever service you want to discuss) because the risk of a bad outcome (drain reclogs) is relatively minor compared to potential benefits of allowing more total but also more inept plumbers into the workforce (reductions in costs for plumbing services). I think you or anyone else could be referred to as a dimwit (as you so elegantly described the author in your first sentence, which quickly shows everyone how smart you are when reverting to name-calling within a few sentences of providing a countering opinion to the initial discussion point) if they decided this was an acceptable risk when relating to your health (be it a nurse practitioner mistaking a colon mass for a hemorrhoid, a bad surgeon clipping a ureter instead of a muscle tendon, or a psychiatrist treating your bipolar disorder (I) with an ADHD medication. Doctors, which I obviously am, are the most talented people in our population and most everyone would collapse under the incredible amount of balls we juggle on a daily basis, not to mention the incredible importance of each of those balls (missing a melanoma on a patient is a little more serious than incompletely snaking a drain). You however are like every other ungrateful troglodyte in society. "If my doctor screws up, I'll sue his ass!". We doctors are at a breaking point and I'm quite certain the attitude of patients and society in general will be much more apologetic and appreciative of physicians when your moms, dads, daughters, and sons are in poor health and the good old supply and demand nurse practitioner just can't figure out what is wrong, unfortunately for you the mean, greedy doctors are now acting like every other profession and working on a cash basis, maybe $1000.00 for an initial consultation, $2,500 extra for diagnosis and treatment plan. I may sound love me an ass for that approach but people like you and your attitude towards the amazing service and dedication of physicians has forced us to that point. Good luck with your third rate nurse practitioner and your google searches, because unlike me, you will probably find it difficult to concentrate when your son, wife, daughter, mother is screaming in pain and google or nurse Susan just can't figure out how he. Good luck, ingrate!

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