Between job security, an increasing need for properly trained workers, and a raise in expected salaries, healthcare careers are becoming a more popular and profitable choice that many are showing interest in. With a national nursing shortage, those who do chose this path will rarely struggle to find employment.
Healthcare careers in nursing break down into more than one type of position, each requiring different training and provide differing responsibilities and salaries. Although all fall, to the general public, under the category of nursing, CNAs, LPNs, and RNs are not the same.
A healthcare career as a certified nursing assistant requires more face to face time with patients that other options may provide. Because of this, CNAs need to have fairly good people skills. These individuals are responsible for everything monitoring patients' blood pressure to bathing those who cannot do so for themselves.
Although this healthcare career requires one to handle some of the less pleasant aspects of nursing, CNAs often find their interactions patients very fulfilling. Those who chose this option have to obtain a diploma through an accredited course that takes six months to a year. The average salary for a nursing assistant is $22,000 a year. According to a simplyhired.com survey, there has been a 79 percent increase in the hiring of CNAs since 2006
Licensed practical nurses maybe responsible for some of the same things that CNAs are, but they may also collect patient samples, perform routine lab tests, set up exam or treatment rooms, and in, some states, prescribe certain medications. LPNs may also supervise the work of CNAs.
To become an LPN, one usually has to get an associates in nursing which can take anywhere from one to two years. Although the education may take longer, LPNs are rewarded with larger salaries. The average licensed practical nurse makes approximately $36,550 a year. Simply Hired's survey showed that 18 percent more LPNs have been hired this year than previously.
Requiring more education than either of the other two healthcare career's mentioned, registered nurses almost always have to have a bachelors degree in nursing. RNs also work more closely with doctors to ensure that patients continue their recovery. These individuals often perform more complicated tests and can be responsible for writing health care plans, which they supervise CNAs and LPNs to carry out.
Many RNs assist in surgery, handling sterilization of instruments and a variety of other things that the doctor in charge may require. These individuals make, on average, $57,280 a year, but many enjoy much larger salaries. In the last year, simplyhired.com says there has been a 52 percent increase in the hiring of RNs
Salaries in thse careers are usually effected by the degree of education and experience that one has. As in most cases, extra training and certifications can increase the size of one's paycheck.
Monday, October 22, 2007
Friday, October 19, 2007
A tool for consumers and physicians alike.
I came across a website that I saw a while back, but forgot about. Check out HealthNewsReview.org. It’s a well done watch-dog website for medical news, which is an incredibly valuable tool, considering the the “In-bed” status of so much of the mass media and the “big business” of health care. Here’s a little about the site in their own words:
What is Health News Review?
HealthNewsReview.org is a website dedicated to:
improving the accuracy of news stories about medical treatments, tests and procedures
helping consumers evaluate the evidence for and against new ideas in health care
We support and encourage the ABCs of health journalism:
Accuracy Balance Completeness
What news stories are reviewed?
HealthNewsReview.org reviews news stories that make a therapeutic claim about:
specific treatments
procedures
investigational drugs or devices
vitamins or nutritional supplements
diagnostic and screening tests
Who conducts the reviews?
A multi-disciplinary team of reviewers from journalism, medicine, health services research and public health assesses the quality of the stories using a standardized rating system. Stories are graded and critiques are published on this website.
HealthNewsRevier.org also has a fine blog, written by Gary Schwitzer of University of Minnesota School of Journalism & Mass Communication. It’s a great read. Here is sample of a recent entry:
Influence of industry on academic medicine
A new study published in the Journal of the American Medical Association gives perhaps the best picture yet of how extensive are industry-academic relationships are in medicine. The authors surveyed department chairs in the 125 accredited allopathic medical schools and the 15 largest independent teaching hospitals in the United States. 67 percent of the 688 eligible department chairs completed the survey.
It showed that "almost two-thirds (60%) of department chairs had some form of personal relationship with industry, including serving as a consultant (27%), a member of a scientific advisory board (27%), a paid speaker (14%), an officer (7%), a founder (9%), or a member of the board of directors (11%). ... More than two-thirds of chairs perceived that having a relationship with industry had no effect on their professional activities, 72% viewed a chair's engaging in more than 1 industry-related activity (substantial role in a start-up company, consulting, or serving on a company's board) as having a negative impact on a department's ability to conduct independent unbiased research."
The authors concluded:
"Failure to address the existence and influence of industry relationships with academic institutions could endanger the trust of the public in US medical schools and teaching hospitals."
The Associated Press reports:
Dr. Jerome Kassirer, a former New England Journal of Medicine editor and frequent critic of industry influence over doctors, called the study eye-opening.
"I was appalled by the results," Kassirer said. "No one knew that so many chairs of medicine and psychiatry were paid speakers. We've never had that data before."
-WJ
What is Health News Review?
HealthNewsReview.org is a website dedicated to:
improving the accuracy of news stories about medical treatments, tests and procedures
helping consumers evaluate the evidence for and against new ideas in health care
We support and encourage the ABCs of health journalism:
Accuracy Balance Completeness
What news stories are reviewed?
HealthNewsReview.org reviews news stories that make a therapeutic claim about:
specific treatments
procedures
investigational drugs or devices
vitamins or nutritional supplements
diagnostic and screening tests
Who conducts the reviews?
A multi-disciplinary team of reviewers from journalism, medicine, health services research and public health assesses the quality of the stories using a standardized rating system. Stories are graded and critiques are published on this website.
HealthNewsRevier.org also has a fine blog, written by Gary Schwitzer of University of Minnesota School of Journalism & Mass Communication. It’s a great read. Here is sample of a recent entry:
Influence of industry on academic medicine
A new study published in the Journal of the American Medical Association gives perhaps the best picture yet of how extensive are industry-academic relationships are in medicine. The authors surveyed department chairs in the 125 accredited allopathic medical schools and the 15 largest independent teaching hospitals in the United States. 67 percent of the 688 eligible department chairs completed the survey.
It showed that "almost two-thirds (60%) of department chairs had some form of personal relationship with industry, including serving as a consultant (27%), a member of a scientific advisory board (27%), a paid speaker (14%), an officer (7%), a founder (9%), or a member of the board of directors (11%). ... More than two-thirds of chairs perceived that having a relationship with industry had no effect on their professional activities, 72% viewed a chair's engaging in more than 1 industry-related activity (substantial role in a start-up company, consulting, or serving on a company's board) as having a negative impact on a department's ability to conduct independent unbiased research."
The authors concluded:
"Failure to address the existence and influence of industry relationships with academic institutions could endanger the trust of the public in US medical schools and teaching hospitals."
The Associated Press reports:
Dr. Jerome Kassirer, a former New England Journal of Medicine editor and frequent critic of industry influence over doctors, called the study eye-opening.
"I was appalled by the results," Kassirer said. "No one knew that so many chairs of medicine and psychiatry were paid speakers. We've never had that data before."
-WJ
Tuesday, October 16, 2007
From around the horn......
Here are two articles from both Family Practice Management and Medical Economics that are pretty interesting. Enjoy!
- WJ
From AAFP’s Family Practice Management
Recruiting and Retaining the Right Physicians
Your practice can hire the best candidates by knowing its needs and anticipating theirs.
Are Your Patients Ready for Electronic Communication?
This simple survey will help you gauge patients' ability to interact with your practice via the Internet.
From Medical Economics…
How to stop staff infighting
Employee conflict leads to high turnover and alienates patients. Here's how to achieve détente.
My web rating: Oh no!
Thanks to the Web, everyone's a critic. The author describes her chilling experience with online reviews.
- WJ
From AAFP’s Family Practice Management
Recruiting and Retaining the Right Physicians
Your practice can hire the best candidates by knowing its needs and anticipating theirs.
Are Your Patients Ready for Electronic Communication?
This simple survey will help you gauge patients' ability to interact with your practice via the Internet.
From Medical Economics…
How to stop staff infighting
Employee conflict leads to high turnover and alienates patients. Here's how to achieve détente.
My web rating: Oh no!
Thanks to the Web, everyone's a critic. The author describes her chilling experience with online reviews.
Monday, October 15, 2007
Time off and a new read.
Forgive me for my recent silence. My wife and I had our 2nd child last week and I’ve been away enjoying some family time without giving any thought whatsoever to the PR Blog. I am quite happy to say that both are doing well and our experience with the St Vincent’s Hospital maternity ward was once again fabulous.
I did have the opportunity to kick around the web a bit this morning and stumbled across a new blog that I had not yet seen covering a subject of particular interest: Health Care and the Media. Take a look, this one seems promising.
-WJ
The Antidote: Counterspin for Health Care and Health News
Casting a critical eye on health and health care news and policy.
Emily DeVoto, Ph.D., is an independent health care consultant, epidemiologist, and journalism groupie. She is exploring ways to promote, via the Internet, the use of evidence to improve health care and health journalism.
I did have the opportunity to kick around the web a bit this morning and stumbled across a new blog that I had not yet seen covering a subject of particular interest: Health Care and the Media. Take a look, this one seems promising.
-WJ
The Antidote: Counterspin for Health Care and Health News
Casting a critical eye on health and health care news and policy.
Emily DeVoto, Ph.D., is an independent health care consultant, epidemiologist, and journalism groupie. She is exploring ways to promote, via the Internet, the use of evidence to improve health care and health journalism.
Monday, October 8, 2007
Malpractice, Microsoft and Taxes.
Here's a recent article, with some key quotes, from the NY Times about the hospitable malpractice climate in Texas. Followed by links to 2 interesting Wall Street Journal articles.
Enjoy!
- WJ
More Doctors in Texas After Malpractice Caps – From NY Times
“Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.
The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count.”
“It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.
“Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.”
“The measure changing Texas’ malpractice landscape, Proposition 12, was narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries.
For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.
All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here.”
“The increase in doctors — double the rate of the population increase — has raised the state’s ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.
The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications.
Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100).”
“Adding to the state’s allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.”
“To help state officials monitor the influx of doctors, the medical board recently got money to hire six more employees, said Dr. Patrick, the director since 2001. It now has 17 lawyers, compared with no more than four when he arrived, he said.
Since 2003, investigations of doctors have gone up 40 percent, patient complaints have gone up 25 percent, and disciplinary actions about 8 percent, said Jill Wiggins, a board spokeswoman. But the figures may reflect greater regulatory diligence rather than more misconduct, Ms. Wiggins said.”
.
“We’ve lost our system of legal accountability, said N. Alex Winslow, executive director of Texas Watch, a consumer advocacy group. “Just having more doctors doesn’t make patients safer. It remains to be seen who is coming to our state.”
Texas Watch, in a report last February, questioned the decline in malpractice insurance rates, saying they must be seen in light of increases of as much as 147 percent before the 2003 referendum. And Bernard S. Black, a law professor at the University of Texas, has published studies showing little increase in Texas insurance awards from 1990 to 2002, casting doubt, he said, on the “malpractice insurance crisis.”
Professor Black also said that data was too scant to attribute the rise in the number of doctors to the damage caps. “I don’t doubt there’s an effect,” he said, “but I think it’s a small one.”
“Texas Watch also contends that many poor rural areas of Texas remain underserved, and rural West Texas has actually lost several physicians since 2003. But Dr. James Baumgartner, a pediatric neurosurgeon at Memorial Hermann Hospital in Houston, is among many doctors who believe the new malpractice caps have helped.
Dr. Baumgartner said it was now far easier to recruit doctors to a state where close to 30 percent of children lack health insurance and Medicaid reimbursements are low.”
“Dr. Keith Hill, a recently discharged Army doctor with a specialty in foot and ankle reconstruction, said the change in state law was the reason he moved from Georgia to open a practice in Beaumont, a poor city in East Texas long seen as plaintiff-friendly.
Had it not happened, said Dr. Hill, 40, “I can say I would not have considered Texas.” “
Microsoft's Health Push Faces Obstacles – From The Wall Street Journal
Beverly Hills and Surgeons Face Off Over Higher Taxes- From the Wall Street Journal
Enjoy!
- WJ
More Doctors in Texas After Malpractice Caps – From NY Times
“Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.
The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count.”
“It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.
“Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.”
“The measure changing Texas’ malpractice landscape, Proposition 12, was narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries.
For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.
All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here.”
“The increase in doctors — double the rate of the population increase — has raised the state’s ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.
The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications.
Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100).”
“Adding to the state’s allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.”
“To help state officials monitor the influx of doctors, the medical board recently got money to hire six more employees, said Dr. Patrick, the director since 2001. It now has 17 lawyers, compared with no more than four when he arrived, he said.
Since 2003, investigations of doctors have gone up 40 percent, patient complaints have gone up 25 percent, and disciplinary actions about 8 percent, said Jill Wiggins, a board spokeswoman. But the figures may reflect greater regulatory diligence rather than more misconduct, Ms. Wiggins said.”
.
“We’ve lost our system of legal accountability, said N. Alex Winslow, executive director of Texas Watch, a consumer advocacy group. “Just having more doctors doesn’t make patients safer. It remains to be seen who is coming to our state.”
Texas Watch, in a report last February, questioned the decline in malpractice insurance rates, saying they must be seen in light of increases of as much as 147 percent before the 2003 referendum. And Bernard S. Black, a law professor at the University of Texas, has published studies showing little increase in Texas insurance awards from 1990 to 2002, casting doubt, he said, on the “malpractice insurance crisis.”
Professor Black also said that data was too scant to attribute the rise in the number of doctors to the damage caps. “I don’t doubt there’s an effect,” he said, “but I think it’s a small one.”
“Texas Watch also contends that many poor rural areas of Texas remain underserved, and rural West Texas has actually lost several physicians since 2003. But Dr. James Baumgartner, a pediatric neurosurgeon at Memorial Hermann Hospital in Houston, is among many doctors who believe the new malpractice caps have helped.
Dr. Baumgartner said it was now far easier to recruit doctors to a state where close to 30 percent of children lack health insurance and Medicaid reimbursements are low.”
“Dr. Keith Hill, a recently discharged Army doctor with a specialty in foot and ankle reconstruction, said the change in state law was the reason he moved from Georgia to open a practice in Beaumont, a poor city in East Texas long seen as plaintiff-friendly.
Had it not happened, said Dr. Hill, 40, “I can say I would not have considered Texas.” “
Microsoft's Health Push Faces Obstacles – From The Wall Street Journal
Beverly Hills and Surgeons Face Off Over Higher Taxes- From the Wall Street Journal
Tuesday, October 2, 2007
Doctors vs Patients vs Insurance Industry
On Sunday Matthias Muenzer of A Physician On Job Search and Practice made what I feel is a very important post regarding his opinion on physician income, the direction it is going and possible affects on the quality of care Americans will receive because of it. I found it enlightening and well written. The only thing I would take exception to is where he blames patients for physicians financial woes and glosses over the affects of the insurance industry. Bottom line, while costs (including insurance costs) are going up and in many places out pacing increases (if there are any) in gross income for physicians, patients are facing similar issues. For example, here at Professional Publishing, we've seen double digit increases in insurance premiums every year. At the same time, about every other year we're also seeing increases in copays and deductibles. Moreover, over the last 6 years, we've seen a decrease in the amount of services provided by our insurance carrier. We shop our coverage every year, too, and we've still got the best option avaialbe to us.
So, if physicians are working harder, paying more and earning less AND consumers are paying more and receiving less, then it follows that there is a huge cash windfall going to the insurance companies. Now I have no doubt that the insurance industry is affected by rising costs, too, but I also know that they are capitalist entities and exist mainly to make their stockholders and investors money.
While I'm no politician or expert on the economics and politics of the health care system, it seems pretty evident that the place to start addressing these issues is with the insurance industry.
I've attached Matthias' entire post (I hope he doesn't mind), because I think it's a valuable read. I strongly recommend A Physician On... as a regular read, as it's a very good source for information re: practicing medicine, especially when he shifts focus from his crusade against recruiters.
- WJ
Healthcare Heading towards Mediocrity
An anonymous comment on my blog: Doctors are working harder and harder to make a living and the cost of medical education is just about 60k per year. I believe declining medical school applications suggest that the word is out that medicine, while rewarding in many ways, is not a great way to make a living, much less pay off education related debt. In fact, the decline in physican incomes shows no signs of abating. Soon, a primary care physician in our area (Northeast US)will make less than 100K per year (many probably do already). When you consider that median family income in the US is about 50K, that is astounding. What effect will this have on future physician supply?
I agree, physicians early dramatically less than 20 years ago, and the incomes just keep dropping and dropping and dropping with no end in sight.
What message does this send to physicians? "We do not value what you do" or "We do not want you to earn much" "we do not care about your overhead" and "we do not care if and how you make ends meet"
This is what our patients are actually telling us physicians, yes, the same patients that demand to receive more attention, more time, more care, more presence, more sensitivity, more quality, more efficiency, more of everything. Actually medicine has been called "the worst business", because overhead increases, liability increases and you cannot pass on any of these increases to your clients and you get paid less and less!
The message Americans are sending physicians is "We do not care about you, just give as great service, now".
Where does this lead? We compensate, work more, harder, smarter, improve, improve more and then, when there is no more room for improvement, here comes "P4P", another thinky veiled slogan that allows HMOs to pay us less, the same old abuse, just with a different slogan, a different disguise.
I have a better idea for quality impovement: pay more, and physicians will be happy, proud and eager to work. This is obviously not going to happen. What will happen is what has happened in Germany, where I have seen the future of American healthcare: Lower pay to physicians lowers quality, lowered quality spawns more bureaucratic supervision, more hassle and indirectly less income, this again lowers quality and so on. In 15 years we will be in the realm of mediocrity in medicine. Money will be scarce, research will be superficial and less rewarding, clinical practice will be an 9-5 affair, and afterwards everybody goes to the ER. Your doctor does not see you when you are in the hospital, a hospitalist does. Training of physicians will be difficult, since it will be hard to get enough cases to gain sufficient experience, and training will be handicapped by the separation of office based and hospital based medicine. And everybody will complain and nobody will understand why.
Here is the explanation: You get what you pay for. And doctors are the crucial element in healthcare. We see the patients, we diagnose, we treat, we write the prescriptions, we decide.
Until Americans return to understanding that crucial point and return to taking care of those who care and decide over their health, we will continue on the path to mediocrity.
MEDIOCRITY. Continuing on the present path of decrasing pay and increasing bureaucratice hassle for physicians will lead straight to medicrity and over-administration - the two evil twins.
And that is exactly what the above quoted commentator thought. Pay physicians less and you chase them away. And why do we have a "primary care physician shortage" in Massachusetts? Easy to explain: Cost of living one of the highest in the US, housing cost one of the highest in the US, reimbursement one of the lowest in the US. Result: Physicians leaving the state. How stupid do expect doctors to be? Work for dramatically less than everywhere else in the US? There is a kind of silent agreement among doctors that you only stay in Masssachusetts if you work in academia (in this regard the state is a great place to be) or you have family that keeps you here.
So, if physicians are working harder, paying more and earning less AND consumers are paying more and receiving less, then it follows that there is a huge cash windfall going to the insurance companies. Now I have no doubt that the insurance industry is affected by rising costs, too, but I also know that they are capitalist entities and exist mainly to make their stockholders and investors money.
While I'm no politician or expert on the economics and politics of the health care system, it seems pretty evident that the place to start addressing these issues is with the insurance industry.
I've attached Matthias' entire post (I hope he doesn't mind), because I think it's a valuable read. I strongly recommend A Physician On... as a regular read, as it's a very good source for information re: practicing medicine, especially when he shifts focus from his crusade against recruiters.
- WJ
Healthcare Heading towards Mediocrity
An anonymous comment on my blog: Doctors are working harder and harder to make a living and the cost of medical education is just about 60k per year. I believe declining medical school applications suggest that the word is out that medicine, while rewarding in many ways, is not a great way to make a living, much less pay off education related debt. In fact, the decline in physican incomes shows no signs of abating. Soon, a primary care physician in our area (Northeast US)will make less than 100K per year (many probably do already). When you consider that median family income in the US is about 50K, that is astounding. What effect will this have on future physician supply?
I agree, physicians early dramatically less than 20 years ago, and the incomes just keep dropping and dropping and dropping with no end in sight.
What message does this send to physicians? "We do not value what you do" or "We do not want you to earn much" "we do not care about your overhead" and "we do not care if and how you make ends meet"
This is what our patients are actually telling us physicians, yes, the same patients that demand to receive more attention, more time, more care, more presence, more sensitivity, more quality, more efficiency, more of everything. Actually medicine has been called "the worst business", because overhead increases, liability increases and you cannot pass on any of these increases to your clients and you get paid less and less!
The message Americans are sending physicians is "We do not care about you, just give as great service, now".
Where does this lead? We compensate, work more, harder, smarter, improve, improve more and then, when there is no more room for improvement, here comes "P4P", another thinky veiled slogan that allows HMOs to pay us less, the same old abuse, just with a different slogan, a different disguise.
I have a better idea for quality impovement: pay more, and physicians will be happy, proud and eager to work. This is obviously not going to happen. What will happen is what has happened in Germany, where I have seen the future of American healthcare: Lower pay to physicians lowers quality, lowered quality spawns more bureaucratic supervision, more hassle and indirectly less income, this again lowers quality and so on. In 15 years we will be in the realm of mediocrity in medicine. Money will be scarce, research will be superficial and less rewarding, clinical practice will be an 9-5 affair, and afterwards everybody goes to the ER. Your doctor does not see you when you are in the hospital, a hospitalist does. Training of physicians will be difficult, since it will be hard to get enough cases to gain sufficient experience, and training will be handicapped by the separation of office based and hospital based medicine. And everybody will complain and nobody will understand why.
Here is the explanation: You get what you pay for. And doctors are the crucial element in healthcare. We see the patients, we diagnose, we treat, we write the prescriptions, we decide.
Until Americans return to understanding that crucial point and return to taking care of those who care and decide over their health, we will continue on the path to mediocrity.
MEDIOCRITY. Continuing on the present path of decrasing pay and increasing bureaucratice hassle for physicians will lead straight to medicrity and over-administration - the two evil twins.
And that is exactly what the above quoted commentator thought. Pay physicians less and you chase them away. And why do we have a "primary care physician shortage" in Massachusetts? Easy to explain: Cost of living one of the highest in the US, housing cost one of the highest in the US, reimbursement one of the lowest in the US. Result: Physicians leaving the state. How stupid do expect doctors to be? Work for dramatically less than everywhere else in the US? There is a kind of silent agreement among doctors that you only stay in Masssachusetts if you work in academia (in this regard the state is a great place to be) or you have family that keeps you here.
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