Sunday, February 26, 2006

Money

It’s not news to anyone that physicians in the U.S. make good money. Even the lowest paid specialties are at the upper end of the pay spectrum. But should doctors make a lot of money? Most of my colleagues would say yes, but I’m sure there is a fair amount of resentment of our salaries, especially if one is not well off financially and must pay some hefty doctors’ bills. That person wouldn’t look kindly on the physician speeding by in their Lexus or Cadillac.

On the one hand, doctors can make a good case for their high salaries. It takes a lot of education and training to become a physician, and our jobs carry a pretty big responsibility. If anyone is going to make a big salary, shouldn’t it be the people who deal with health and, sometimes, true life and death issues? Besides, certain attorneys, business people, and entertainers make a lot of money, and it’s hard to say they deserve it more than we. And don’t even get me started about professional athletes.

But still….in almost all instances where a patient has to pay a bill, it is a relatively poorer person giving money to a relatively richer person. Usually I’m insulated from the money collecting aspect, letting the hospital do that while I receive a salary, but not always. I got a letter once from the mother of a baby we took care of in the NICU. Her baby was doing fine, but she asked if we would forgo the last $600 of her bill. Her blue collar family had struggled to pay most of the bill but now were stuck. My heart almost bled when I read that. Here I was, able to buy almost any clothes I want, or able to dine out at a nice restaurant whenever I want without having to hardly think about the cost, taking money from this family.

Sometimes at work we have quiet days, where I have time to sit in my office and read or relax, and it seems almost criminal to be getting money for this. But other times are different. When you’re standing at the bedside of a baby with dangerously low oxygen saturations (low levels of oxygen in their blood), and you’ve done everything you can think of to raise them, and the parents are sitting there looking at you waiting for you to make their baby better – then we’re deserving every penny we get.

21 Comments:

Blogger Dream Mom said...

I don't think I have ever thought that a physician did not deserve the income that they had. If anything, I often thought that they didn't get enough. I think of my son's pediatric neurologist who sees some of the most complex cases, and sees them all day. He told me one time that he sees 40 patients in 4 hours; unbelievable. And he has clinic five days a week. That's a lot of patients, a lot of write ups, prescriptions, letters, insurance issues and everything else. Healthcare is so complex today.

When I worked full time a few years back, I earned a very good living, drove a luxury car and was very comfortable. Now I work just a few hours a week so I can take care of my severely disabled son and make less in a year than I did in one paycheck, yet I still don't think the physicians are overpaid.

Some things that strike me as expensive over the years were: $6,000 to be airlifted 10 miles, $10,000 for a custom manual wheelchair and now prescription drugs. My son has one of those new high deductible plans and prescription drugs for one month are running at $1800 retail or $1400 for mail order.

6:28 PM  
Blogger La Lubu said...

Wow. This is a fascinating blog; a real window-on-a-world to me. I'm a mother to a 6-year-old girl who was born at 25 weeks, one pound, ten ounces. My daughter had scores of complications (IVH, PVL, NEC, DIC, BPD, RDS---hey, after she was on the road to survival, I tried to make light of this to well-meaning acquaintances who'd ask me about her well-being by calling her the "alphabet soup baby") and ended up spending time at two different NICUs. This blog really humanizes the doctor's perspective for me. My daughter's neonatologist wouldn't use her name for the first three months---and at the same time it made me incredibly angry, I knew why he wouldn't---he didn't expect her to survive.

Anyway, my girl beat the odds---she's indistinguishable from any other 6-year-old, provided she doesn't lift her shirt and show off her battle scars. I feel....incredibly blessed. And thankful that the NICU existed. At the risk of "outing" myself (yeah Doc, I'm also in the midwest), I'll say that I was one of the electricians who worked on the project. My hands were all over the inside of that NICU long before it opened. I couldn't believe the size of it---I thought "no way are they ever gonna fill this thing up" Was I ever out of touch!

My insurance was known as a "Cadillac plan"; even so, the bills I was left with were staggering. Especially on top of the ongoing medical bills I had. To top it all off, my employer terminated me when I asked for Family and Medical Leave. But I felt obligated to keep trying to pay the neonatologist's bill. I couldn't afford much, but I plugged away at it, drop-by-drop. At the rate I was paying, I'd be a grandmother or great-grandmother by the time it was paid, but what-the-hell else could I do? The economy had hit the bricks, and construction jobs were scarce. No steady work to count on meant not having the confidence to increase my payments---I needed to keep money back to tide me over during the between-work periods when I had to make monthly COBRA payments (in addition to my daughter's ongoing medical care).

And I felt guilty about it. Ashamed. The accountant was so nasty to me over the phone, like I was some sort of deadbeat. I was too ashamed to speak of it to the doctor. He did his job, after all. I never begrudged the charges (although I was angry that my "cadillac plan" insurance wouldn't pay half of them). After years of my half-assed attempts to pay, the charges were "forgiven". And I'm still ashamed. The doc's son-in-law is an electrician, a member of my Local. I'm sure he's heard second-hand from his SIL about my traveling to find work, my mother's terminal cancer, etc. He was being a nice guy---and God bless him for it, because if he had taken me to court instead, I'd be offically bankrupt now, instead of slowly rebuilding my nest egg that evaporated after my daughter's premature birth. But when I think about it, I still feel that shame for not being able to pay the full freight.

Anyway, I hope you keep the blog up. If you have no objections, I'll be adding you to my blogroll under the "Preemies" section (not like there's a whole lot of traffic there, but still!).

Ciao.

10:06 PM  
Blogger That Girl said...

As the mother of two preemies I have never resented paying a doctor. I dont think most people ever resent the salaries that a doctor gets.
What they DO resent is $30 for a tylenol, etc. They also resent (although it's sometimes an easy fix) getting substandard or poor care and having to pay for it.
Recently, I took my son to the ER and they said he was fine and sent him home. Six hours later he wasnt breathing, which only complicated his treament later (Disregarding the whole not-breathing thing).
I dont even know how youd go about fighting with your insurance for this but I get a bill from the hospital - for $300.
$150 for each "admission" (six hours late it was 1230 am the next day).
The second time we came in he was still breathing (he coded on the ER table). THIS time they called the neo-doc down. He put his stethescope up to my son's chest and diagnosed the problem right there.
So it obviously was a screw-up on the first doctor's part.
And I have to pay for this?
That's the kind of thing that sticks in someone's craw.
Certainly not paying a good doc for good service (not outcome which is different).

12:47 PM  
Blogger La Lubu said...

That girl, do you still have access to case management? If so, maybe they could help you negotiate around that "double admission" ER penalty.

What always got my goat? Never the doctor's charges; those looked reasonable. What pissed me off was my insurance refusing to pay for a damn good chunk of it by claiming "above usual and expected cost". Now, how that is figured in the insurance "blue book", is by your geographic area. And I just happened to be using the only NICU in my geographic area. But they still wouldn't pay the full freight, because it was "above and beyond the usual and expected cost", even though it was the ONLY standard for comparison in the geographic area.

GRRRRR. Still smokes my ass.

6:47 PM  
Blogger neonataldoc said...

Thanks, everyone, for the comments! I've had some medical care myself and am astounded at how quickly the bill makes it up to $10,000!

la lubu, don't be ashamed, enjoy your daughter, and thanks for the link.

7:32 PM  
Blogger Flea said...

I remember seeing interviewed Donna Shalala on the News Hour back when she was Clinton's Secretary of Health and Human Services.

On three separate occasions she uttered the words "doctors make too much money".

The first time I wasn't sure I heard her right. The second time I thought she was being intemperate or misspoke. The third time I knew she meant it.

Quite apart from the issue of NICU care which is expensive and should be paid for by insurers, if parents shouldered more of the load to make a visit to see me they would do so less often.

They'd come to see me only when it was really worth it to them to come.

I might make less money as a result but I'd be delivering better medicine.

best,

Flea

4:14 PM  
Anonymous Anonymous said...

Your second paragraph said it all. I am under the impression that not all doctors are "rich," sometimes because of having to pay back college loans. But in any case, I do not resent the incomes that doctors make, because they do jobs I would never be able to do (I am smart enough but I have chosen not to go through a lot of schooling, and I would tear myself up over every possible mistake and cry over poor outcomes to the point that I'd be mentally disabled - there's a reason why some very intelligent people otherwise interested in science and medicine do not go into medicine) and my attitude has always been that doctors WORK for their money (and work under the pressure of tremendous responsibility, too) and thus deserve it far more than some other people do, considering the nature of the jobs that some of those other people do.

11:19 AM  
Anonymous Anonymous said...

Oh, by the way, that was me again ("anonymous 2"). ;o) Refer to "futility" comments if confused.

11:21 AM  
Anonymous Karen in KC said...

la lubu, I work in a NICU and I find it horrific that the doc did not use your daughter's first name from the very beginning. I don't care how sick the child is or if they believe he/she will survive or not, they deserve the respect and dignity of being called by their name. And even if it was just that docs way of keeping his/her emotional distance, I still think it was rude and disrespectful to your daughter and your family. I apologize for him/her.

4:08 PM  
Anonymous Anonymous said...

I don't know if you read your old comments or not, so if you DO read this, please respond so I will know for the future that it's okay to comment on previous entries. I'm completely addicted to your blog already, and will likely be responding to more of your old posts, which is why it will help to know. :o)

I don't resent doctors making high salaries, as long as the doctor is competent. But I do resent when they think everyone lives like they do, has the same choices they do, and the same control over their life. Here's what happened to us, and how a doctor made us feel so terrible about our financial situation.

My husband lost his job 6 weeks before the birth of our preemie triplets. We still had COBRA from my job, so we had insurance for another year but we had to make the COBRA payments because one of the triplets was extremely sick and would require follow-up care with several specialists for a few years. .

It took my husband almost two years to find another job. In that time we quickly exhausted all our savings and began to live primarily on credit card debt plus help from our families. (At least we had that.) But while my husband may have been technically unemployed, but he worked like a dog - he did the night shift and I did the day shift.

When our period of COBRA coverage was about to expire, I tried to apply for Medicaid. It turned out, I couldn't apply as long as I had active insurance, and my inurance company couldn't prove we were losing coverage until the coverage expired - so my son's insurance had to truly lapse in order to be eligible. And it could take a few weeks at least until he got on Medicaid, so my son would be briefly uninsured. What choice did I have?

Anyway, I was speaking with the Chief of Pediatrics at the Children's Hospital where my son went for his neurology appointments, and I started to explain the situation that we would be without insurance temporarily until we could pick up Medicaid, and he started *yelling* at me, "What do you MEAN your son will not have insurance?!? He MUST have insurance, you cannot allow him to be uninsured! It is YOUR RESPONSIBILITY to get him insurance, you better get him insurance immediately!"

The worst part of enduring his tirade was that I was truly helpless in the situation. I had no money to pay for insurance and couldn't go out to work because you can't put sick preemies in daycare, plus I had to take my son to three specialists a week, plus MRI's EEgs, constant blood tests - blood from his scalp, his foot,m his wrist artery, etc. - his illness was my life, plus I had his two sisters to care for!

(Not that I would trust anyone else to their care either - a kind friend hired us a night nurse for a few nights to give us a break, and she was given strict orders to wake us up if anything happened that was strange. Well, my son had a seizure right in front of her but she didn't tell us until the next day! So even if the help was free, it was useless.)

Anyway, this doctor just had no clue what it's like to have a sick child and not be ABLE to provide insurance for him. I was barely able to provide formula, even with WIC - they only paid about half of what we used at one point.

I remember biting my tongue not to answer the doctor back, "Fine, I'll get a color copier and start printing dollars at home." Instead I politely told him that he would only be uninsured long enough for us to prove to Medicaid we have no coverage, and we would borrow money to pay out-of-pocket if we needed to see a doctor in that time. Which is precisely what we did. An danyway I knew answering him back would only backfire against me, so I kept my mouth shut.

So while I didn't resent the fact that this doctor made so much money, I DID resent the fact that he was so judgemental of me that I didn't.

In the end we had to file bankruptcy because of the credit card debt and the medical bills. The medical bills really only amounted to $2100, but we just didn't have it.

The story has a happy ending in the sense that my triplets are all healthy and in school now, and my husband found a steady job which provides excellent insurance for the whole family. I also work part time while the kids are in school. We still struggle financially, but at least we're stable now and have such good insurance.

Here's a positive story from that period of time. The main specialist who cared for my son was a saint of a man. He could have made so much more money if he wanted to, but chose to accept every insurance including Medicaid. We found out at one point that there was another doctor who was considered more of an expert in this disease, but he wouldn't take any insurance at all, and it would have been $600 just for an initial consultation! (Not counting any of the tests.) So we admired the other doctor all the more for making himself available to all families.

He later told me how much he wished America would have socialized medicine even though he would make less money - he would rather that health care be accessible to everyone. Even if you disagree, you have to admire a man who is willing to sacrifice what he has so others can live better.

Keep up the great blog, it's really very interesting to read.

9:03 PM  
Anonymous Anonymous said...

P.S. I also resented when the hospital would make a mistake and then leave me with the bill - like when they precertified every procedure but "forgot" to precertify one, and then I got stuck with the bill. That was the bill I declared bankruptcy on.

9:06 PM  
Anonymous Mandy said...

I have to say, I'm genuinely enjoying reading your blog...when my daughter lets me. I just found it this evening and have lots of catching up to do. You seem like a very genuine, sincere person. I haven't met many doctors like that.

8:13 PM  
Anonymous Anonymous said...

Hi. I think i'm probably the youngest one here to post. I'm 15 years old. haha. I would really like to be a doctor and Neonatology sounds really interesting to me. I've looked up all the different kinds of doctors, but i'm still kinda confused what they specifically do. So do neonatologists do surgery also? Like they diagnose the disease and if the medicine doesn't help can they do surgery also?

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