Thanks for all the feedback and information. It explains some of the confusion about various costs and gives perspective.

Matte I don’t make judgements on parking lots. I make observations.

“Us doctors keep seeing the same things over and over and you patients dismiss it, much like you do our work concerns”

I will think on this.

yes organic is kind of dull but as I understand it, it tests your ability to think logically. I don’t really buy that but it isn’t my call. Biochemistry on the other hand verges on miraculous. You take random little molecules and apply them in the most complex patterns. Human biology is the ultimate comlplex system. The best part is step up from quantum mechanics to Pchem to organic to biochem to cellbio to neuroscience and watch the magic unfold. Then to recognize that a poem is grounded in vibrations of a string. I think that is almost as cool as philosophy and is an artform-my opinion of course.

As for applying my experiences about poor people and premeds to the world-I only know what I see and what others tell me. If it looks like a duck and it quacks like a duck it just might be a duck..or maybe its a moscovy which kinda looks like a duck but is really in a different species and seems to be a bit more clever but can crossbreed with a duck with sterile offspring of course.

A quote for you jb:

Believe nothing, O monks, merely becauses you have been told it…or because it is traditional, or because you yourselves have imagined it. Do not believe what your teacher tells you merely out of respect for the teacher. But whatsoever, after due examination and analysis, you find to be conducive to the good , the benefit, the welfare of all beings-that doctrine believe and cling to and take as your guide-buddha.

Thanks to the wonderful care you guys have supplied there are lots of more complicated medical cases now. I like being alive. It’s a good start. Much appritiation for that opportunity. So now you guys have to take the next step and address that medicine is much more than keeping someone alive now days.

So I walk in the door, having learned as much as I can about my condition, to be told I don’t know what I am talking about, treated like an idiot and to go home and take my pills. If I try and use the dr as a consultant and question what he tells me, to better expand my own knowledge then I am insulting him. I can’t help but question that a bit. As the pharmacogenomics link attests to, treating the human condition is becoming much more complicated. Not all patients are alike, not all will respond the same. Some will be downright wierd. Science that was absolute yesterday is totally disproven today opening whole new avenues of medical possibilities.

Dur to her genetics, My new coworker will die under many types of seditives. Yet she spends lots of time trying to convince every new dr of that. It makes you bitter.
You seem a bit bitter yourself jb.

When it comes to my health it is my job to take care of myself. You guys don’t have the time to do that nowdays. You have admitted as much. So try listening to my question and answer it given the time you have. Say you don’t understand or admit you just don’t know. This isn’t a fault. It is a reality. I think this will be a huge start in improving the way physicaians and patients interact. Rather than apologize for the referal recoginize why the patient is so unhappy.

Hey Dr.Bob,
I asked around and my office mate had a good primary one in NH. Bit far for us in TX. My new endo is a very good guy. He is very young-only one week old in the world on my first visit. He admitted he didn’t have any idea what was wrong with me, listened to my suggestions I found on an internet support group about treatment, and now I am doing much better even though he has no idea why.

Most of what you are talking about is hospital charges, which are horrendously high. Also, the $168 pregnancy test is kind of like the list price on a car. Very few pay that price unless you have no insurance. After adjustments from BC/BS it may be more like $20. If Medicaid, more like $5. (That’s why a lot of docs don’t like to take Medicaid as our costs for Medicaid are about the same. Medicaid just covers overhead, so we don’t make any money when we see Medicaid patients. We in effect see them for free).

As far as BMW’s at the hospital, those belong to the surgeons. Most of us primary care docs aren’t parked at the hospital (except outside of normal office hours). If you look at my office parking lot you’ll see that I drive a Civic, my partners – another civic, a subaru wagon with 120k miles, 2 used honda accords, and a jeep wrangler.

Most of the complainers are talking about surgeons & their incomes, not us primary care docs. Although admittedly many of us make about $120 to $150 thousand a year, which still is pretty good. I’m happy with our income range personally. But when you pencil it out it may not be adequate for today’s grads if they owe over $200,000 in eductaion debt which is very common these days. Plus they don’t start making any money until they’re 30, pretty lake if you’re married with kids.

Med school tuition is rising very fast due to funding cuts from the government. We’re on the axe every year (I teach at a residency like DB).

And maybe you’re looking at the wrong kind of doc. Ask around for recommendations and I’m sure you can find someone in your office who is happy with their primary care doc (Family or Internal Medicine.)

Great site! check us out at http://www.c1d1t1.com

some key points.
ER care…… is vastly more costly than a
office visit. ER care is costly for many reasons but hospitals set the rates for all radiology,lab, nursing services etc…. Most insurance plans have pre determined rates that doc’s can charge. check out the E/M
codes as set by medicare ( on the medicare webs sites) Most insurance pay only a few percent more than medicare.

Office visits are usually 80-170 dollars/visit. Office pregnancy test are charge is $21.00 not $168.00

you certainly are mis informed if you do not know that doctors fees are largely set by insurance payors.

The Hysterectomy was 18,000 $ but then you add the missing phrase…”complications”… complications can be very expensive to manage. If you take an average medical bill you will see line items for costs thst have nothing to do with the physician charges (E/M codes)

Do doc’s like complications?
No…most insurers , medical Boards, hospital reviewers and other doc’s look for doc’s with high complication rates. Doc’s try hard to avoid them.

Medical school costs…. Good luck moving out of state for one year and then applying to medical school. Most schools have serious road blocks to such dishonest behavior. Residency requirements when applying to state medical school are stricter than applying for college. also remember that obtaining a slot in a state supported medical school is harder becuase of the sheer number of bona fide residents who do apply… mainly for the cheaper tuition.

Unfortunately, if you look closely at the average tuition costs they far exceed the average vet costs.

also, vets can start practice immed post vet school. Physicians still are in minimum wage training for an average of 4 extra years.

it is unfortunate that medicaid is not universally accepted in all areas. You assume however that your experiences are universal and generalize your experiences to the medical field at large . This is a false genralization. In our area most practices are hospital owned and patients with medicaidd are never turned away. I seldomly make a referall to a specialist who does not provide care to patients who have medicaid. Geographic differences do exist. Many doc’s do free care on a daily basis, many times over. Your experiences , although true for you are not true in many areas of the country.

Tons of BMW’s in the parking lot…. there are also tons of honda civics, mini vans and clunkers. I certainly do see BMW’s in the parking lot. Many doc’s who have worked for decades do reward themselves with good cars.
My electrician has a mountain summer home? do I villify him for that.? One of my neighboors (retired accountant) lives in a beautiful lake side home. do I rebuke him. ?

Do you really make judgements based on parking lots?

many people choose medicine to make money. Of course they do, you cannot take make such a huge investment in years and money and not hope to make it worthwhile economically. In countries that have socialized medicine
med school costs are covered by taxpayers and so incomes are limited. Both systems have their drawbacks. Just log onto the British Health Service, there are lots of complaints by patients and doc’s. Tax rates in Britain per capita are much higher in Britain.

I too like my vet. Funny thing happened today,I saw admitted 6 patients to the hospital three nights ago.
All were new to me. 2 have no insurance and will never be able to pay. I have spent about many hours helping them the best I can. Once they leave the hospital they will see me in the office for follow-up probably at least two or three times. these patients are very greatful. Thats the PR I get constantly. all my colleagues do likewise.

In your words
” Us patients keep seeing the same things over and over again and you guys dismiss it, much like you do our health concerns.”
thats is as invalid as

” Us doctors keep seeing the same things over and over and you patients dismiss it, much like you do our work concerns”

you taught organic chemistry? I thought that course was VERY boring. I very much liked Philosphy and History courses, in fact many , many of my medical school classmates were not science majors and did and learned things that were not anything like organic chem. again your experiences are anecdotal and seem foreign to what my experiences were. Perhaps this illustrates the difficulty in taking personal experiences and proclaiming that to be “the truth”. My experiences are alsoanecdotal but I do know people have all sorts of motivations.

I do know doc’s are people, thus I assume doc’s have all sorts of motivations.

The prices I listed are medicare rates. The price you list for the preganacy test is “cash” rates. You can be certain that while the lab (not the doctor, at least not in my state) may charge you $168 for the pregnancy test, NO insurance company pays full price. Not if the lab wants their business.

You should also be aware that even though the ER or Lab uses the same test that you can buy in the drug store for 10 or 15 dollars, the lab and ER are required to adhere to a set of rules called CLIA, which require that they demonstrate proficiency in administering the test, and peform quality controls, and meet certain regulatory guidelines and reporting rules. They cannot bill directly for these costs, so they have to include the cost when they perform the test. When you perform the test at home, you are not required to do this, so the test is cheaper. The same also applies when some tests are done in the doctor’s office. He/she has to follow costly rules that you do not have to follow at home, increasing the costs associated with performing the test.

Your new hire who hates her docs is probably the kind of patient that we apologize about when we refer to our colleagues. A little perspective is in order. You say you have “complicated medical issues.” A century ago, people did not have complicated medical issues because one simple issue was survivable, but two simple issues or one complicated one meant you were gonna die. That’s why the average age of death in 1900 in the USA was 42 years. We’re such worthless jerks, dismissing your health concerns, that our profession and our allies have managed to double the average lifespan in the country in a century. Yeah, we need better PR. Give me a break! And please tell your new hire to stay the hell out of my office. With her attitude, I would be tempted to refer her to the vet for appropriate management.

Probably similar to vet school, this is rarely a “choice.” I grew up in California, had pretty good grades, GREAT test scores. They wouldn’t interview me. So I had no choice but to go out of state. Out of state public schools when I went, at least those that would interview me, were 15K+/yr. Private ones were 22K+/yr. (This is in 1990). Not much choice, except not to go.