Wellness

[Abrowneyegirl]

Average medical school loan debt is $197,000
24% of medical students have debt in excess of $300,000

[Abrowneyegirl]

Reading the responses here has shown that there is a lot of depth to this topic.
It is not just private concierge practices cropping up (which seem to be more white glove service based)
But
Self pay practices are also making a big entrance into the field of medicine. Doctors can offer traditional care and simply opt out of insurance, charge what they want and let the patients deal with fighting with insurance companies. Instead of the doctors eating the short-term the patients will pay.

A health care provider told me, only the better, highly competent doctors will move to these new models. The less than average will stay part of the insurance industry mill. They get paid regardless of quality of care in that model.

[Abrowneyegirl]

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@hckynut wrote:

@Abrowneyegirl 

Yes, it is happening all over the US. The more the "you know who's" take control, the harder it will be for every doctor. They have to follow "dictates" and who suffers beside the patient, the doctor.

Having insurance means very little if the quality of care suffers and the length of time to get in to see a doctor increases. I compare this to having new high tech motor vehicles for everyone, but only a few technicians that are able to service them. Same thing is, and will keep happening to physicians. The more they are controlled by time and $$$ the faster the level of care will head downward.

One of my good friends, who is also my Ortho doctor, moved here from Canada, and it wasn't because he didn't  like his primary Country. It was how he had to run his practice that kinda forced his move.

A lot of things theoretically sound great and Just,  but in reality, everyone pays a price. I have lost 3 of my long term doctors by what "is going on" and I  suspect it will get worse, not better.

hckynut

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@hckynut  Well said!

[granddi]

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@Abrowneyegirl wrote:
Average medical school loan debt is $197,000
24% of medical students have debt in excess of $300,000

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So my point about student debt is that it is proportional to the graduates expected salary.

Medical debt $200-300K with salary expected to be $200-400K

Teacher debt $35-50K with salary expected to be $45-65K

I have very very close connections to the medical field and I just do not have a lot of sympathy for the complaints of "poor working conditions" 

Doctors are not ever required to participate in ANY insurance plan. When they do, they know the reimbursements and the rules. When it is said that doctors are losing money by accepting certain insurance plans, that is to be questioned. 

When a physician says," I want to make more money and care for more affluent patients and chose which patients I want to see," then that is his/her choice. If your doctor makes this choice, then either go with it or move on. 

Health care in America is broken and politics will not fix it because politics are broken too.

[LilacTree]

Spoiler

“My son (or daughter), the plumber.”

Graduate high school, go to a tech school and learn to become expert at your chosen profession, whether in the tech world, electrician, plumber, or house painter ( my ex BF made a fortune painting houses because by word of mouth, he was never without a job and always had several more lined up).

Go into business for yourself, and be really good.

”My son, the doctor” doesn’t work anymore.  I know of several doctors who have quit their practices and gone into research or worked for insurance companies.

[ChillyTulip]

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@granddi wrote:

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@Abrowneyegirl wrote:
Average medical school loan debt is $197,000
24% of medical students have debt in excess of $300,000

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So my point about student debt is that it is proportional to the graduates expected salary.

Medical debt $200-300K with salary expected to be $200-400K

Teacher debt $35-50K with salary expected to be $45-65K

I have very very close connections to the medical field and I just do not have a lot of sympathy for the complaints of "poor working conditions" 

Doctors are not ever required to participate in ANY insurance plan. When they do, they know the reimbursements and the rules. When it is said that doctors are losing money by accepting certain insurance plans, that is to be questioned. 

When a physician says," I want to make more money and care for more affluent patients and chose which patients I want to see," then that is his/her choice. If your doctor makes this choice, then either go with it or move on. 

Health care in America is broken and politics will not fix it because politics are broken too.

Not quite.  Med school loans have egregiousy high interest rates.  Whatever the student borrows they can multiply that by 3 and that is what they will have to pay back.  Most take out 30 year re-payment plans now.  The majority of new residency grads going into primary care in my area are making 120-125k.  Even seasoned PCP's, esp. pediatrics,  aren't making anywhere near $200k.  Doctors are well into their 30's before they even begin to make money----residency salaries pay slave wages.  My current resident owes over $400k----and she wants to be a family doctor.  She will NEVER dig herself out of debt.  And the sad part is she has no clue what she is in for.  Unless you are independently wealthy you'd have to be nuts to go to medical school nowadays.  Being hospital employed and forced to see 8 patients an hour isn't medicine, it's a cattle chute. Bravo to those who are taking control and going back to a good old fashioned fee for service model (different from concierge level care).  Seeing 10-12 patients a day and being able to listen and take your time is HEAVEN.  And many of these practices are quite affordable, esp. if you have a high deductible plan.  

And I have very close connections to the medical field too.  I am a physician.  

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[esmerelda]

Insurance companies dictate how much time is spent with a patient?  Are you sure?  

It may be true that some doctors limit their time and that may be because they are part of a multi-physician practice and are required to see a certain number of patients each day/week/month/quarter to generate a certain amount of revenue for the practice.  Like a lawyer and "billable" hours for a law firm.

Doctors in private practice...I don't think they have that limitation.

These doctors going "concierge"...are they with other doctors or do they practice alone? 

eta...I think this concierge "trend" started after the passage of the ACA.  Coincidence?

[LilacTree]

Am I wrong in thinking that eventually these doctors may wind up losing money because people will not be able to afford Them?

[reiki604]

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@esmerelda wrote:

Insurance companies dictate how much time is spent with a patient?  Are you sure?  

It may be true that some doctors limit their time and that may be because they are part of a multi-physician practice and are required to see a certain number of patients each day/week/month/quarter to generate a certain amount of revenue for the practice.  Like a lawyer and "billable" hours for a law firm.

Doctors in private practice...I don't think they have that limitation.

These doctors going "concierge"...are they with other doctors or do they practice alone? 

eta...I think this concierge "trend" started after the passage of the ACA.  Coincidence?

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According to a quick google search and wikipedia, it seems that concierge medicine has been en vogue since before 2004. Way before the now gutted ACA.  Of course more physcians are going that way as insurance reimbursement decreases. The fear is that we are heading to a tiered health care system where those who can afford to privately pay will get better care than those with insurance. 

[pitdakota]

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@esmerelda wrote:

Insurance companies dictate how much time is spent with a patient?  Are you sure?  

It may be true that some doctors limit their time and that may be because they are part of a multi-physician practice and are required to see a certain number of patients each day/week/month/quarter to generate a certain amount of revenue for the practice.  Like a lawyer and "billable" hours for a law firm.

Doctors in private practice...I don't think they have that limitation.

These doctors going "concierge"...are they with other doctors or do they practice alone? 

eta...I think this concierge "trend" started after the passage of the ACA.  Coincidence?

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@esmerelda  No, the insurance companies don't dictate how much time a patient is scheduled with the doctor.  However, the trend has been for years that physician groups have turned their practices over to either hospital based groups or some other enterprise specializing in managing physician practices.  And those managing groups DO dictate how many patients an hour must be scheduled.

  So yes, docs in private practice all over this country are mandated to schedule a certain number of patients an hour.  Which directly impacts the amount of time they can spend with each patients.  This has been going on for years and years. 

The majority of docs these days don't have much say in their practice. They have to deal with both insurance companies and the group managing their practice that sets rules and guidelines for that practice.  That is why the trend to move toward concierge medicine has been steadily growing over the past several decades.

Which answers your other question  "I think this concierge "trend" started after the passage of the ACA. Coincidence?"  No, it is not coincidence because it actually started in the mid to late 1990s, long before AHA.  In fact, I knew a couple of doctors I worked with that went to concierge practice by 1998.   Both seemed to be very successful in their "boutique" practice & have since retired and passed their practice on to other physicians that moved into this type of practice.

In fact, more and more physicians in our area have moved to concierge practice.

And as @ChillyTulip who is a physician mentioned, some are now moving toward fee for service like in the "old" days.  

And the docs that I knew that moved to concierge practice did not make the move in order to make more money.  They did it to have more control over their own practice and to be able spend better quality time with their patients and ultimately deliver higher quality care.  That is why they changed to that type of practice.

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