An American psychiatrist summed up what may be the gut-level issue that plagues everyone who charges for services. He quoted an old Russian proverb: "The doctor is an angel when he tenders his cure and a devil when he tenders his bill."
Why Aren't Doctors Allowed to Care About Money? (Part 2)
By Leslie Kane/Medscape
Introduction
As politicians dither over Medicare cuts, Medscape readers are angry that society expects them to not be concerned about the bottom line.
A couple of consumer surveys had shown that some people wondered why doctors were not universally delighted with the healthcare reform plan. Respondents felt that doctors should be so pleased at the expanded coverage that they'd ignore their own income concerns.
When this question ("Why aren't doctors allowed to care about money?") was posted on The Kane Scrutiny blog on March 25, I suggested 3 possible answers to the question: (1) Consumers feel that doctors still make enough money; (2) people in helping professions aren't supposed to care about money; and (3) patients have an emotional need to believe that their physicians care only about patient well-being, not about money.
Reader Response
Medscape reader response was impassioned. Tens of thousands of physicians and healthcare professionals read the article, and over 380 physicians wrote in to express anger, sadness, and frustration. Many Medscape readers bemoaned the fact that society has lost its belief in the value of physicians' services and expertise. Some doctors chastised their own profession for allowing this situation to develop. Others said that the general public simply has no inkling of what it takes to become a physician and the level of responsibility carried on a daily basis.
Many responses provided keen insights and some useful venting. Several themes emerged:
The Medical Profession Is Different From All Other Professions
No doubt about it: Medicine has always been infused with an aura of altruism, and people expect doctors to be fulfilled by the knowledge that they're helping others. However, that doesn't allow for reaping financial rewards from their work. An anesthesiologist commented, "My plumber with no student loans, no education, and accepting only cash payments has an easier and more profitable career. Yes, medicine is a very altruistic career, but altruism doesn't pay for college, graduate schools, mortgages, food, etc. The CEO of United Healthcare with $23,000,000 in earnings last year couldn't give a hoot about the altruism in medicine."
Another anesthesiologist said, "Doctors are allowed to care about money, as long as no one's life depends on the service they provide. No one is proposing that plastic surgeons be required to provide a certain level of free care. That's the paradox -- the more life critical one's specialty is, the less they are afforded the opportunity to care about what they make."
"What really concerns me amongst people who are critics of physician salaries is the notion that physicians shouldn't care about their incomes," said a general surgeon. "This is a disrespectful and ignorant point of view that serves only to dissuade capable individuals from choosing a career as a physician in the first place."
People Resent Doctors' Success...
Both the material rewards and the general status accorded to doctors probably rankle many consumers. An emergency medicine physician said, "The two bases of human emotions are envy and greed. Joe Average is envious of physicians' status and earning ability, although he knows he was not smart enough to get the required training or disciplined enough to complete it. The latter emotion, greed, is simpler: He wants everything for free...We can't overcome these basic instincts. We have to watch out for ourselves. Ricky Nelson once sang, 'It's all right now, I've learned my lesson well, I can't please everyone, got to please myself. '"
An endocrinologist asked, "For all these patients who think that doctors make too much money, I would like some answers. Why is it okay for the entertainment world (athletes, movie stars, television personalities) to be millionaires? Is it not okay that your doctor who had to endure twelve or more years in medical school and residency be compensated for this? Should your doctor who works overtime every week be compensated for this? I believe every person has a right to be compensated for their achievements and success. I don't believe in redistribution of wealth. If people are constantly given everything for free, where is the motivation to excel in life?"
Another reader posted this comment: "It's not the doctors who make 90k or the ones who make even 200k that have most people thinking that costs could come down. It's the doctors who make 500k per year while someone with a 50k salary and a family of four might not be able to afford health insurance."
One family physician summarizes the irony of actually being an altruistic doctor: "It seems I help treat the needy and we see patients milking the system. We are in danger of being sued by the 'cannot make happy group.'"
....But Physicians Deserve Their Salaries
The years of medical school, the long hours, debts, and sacrifice seem to be irrelevant to many outside the medical profession. One preventive medicine physician noted, "At present, before expenses, the roofer gets $8 an hour more than my professional fee BEFORE EXPENSES; the electrician $12 an hour more, the mechanic, $13 an hour more and the plumber $30 an hour more." Added a psychiatrist, "My plumber, my TV repairman, the guy who mows the lawn, all demand immediate payment. Don't we all at least deserve as much respect as them?"
Said a cardiologist: "Our salaries are because we work our butts off, give up time with our families to take calls and work weekends, deal with stress most business people could never imagine (telling someone their mom has died or is dying, etc.), studied hard AND LONG (anyone get a chance to really enjoy their 20s or even early 30s? Didn't think so), and we should never have to apologize for being successful through diligence and sacrifice."
Are Doctors Partly to Blame?
A number of readers felt that doctors have abetted the decline in reimbursements.
"Doctors have allowed the insurance companies and other payers to substitute for their own collection efforts," said an emergency medicine physician. "Because of this, they have become even more uncomfortable with receiving payment in any other way. We have suckered in for 'the only ethical way to receive money is if others just GIVE it to us.' We didn't take responsibility for our own incomes and that is why we are here. It was just easier to let 'the big daddy' do it -- albeit with huge pressure from 'the big daddy.'"
A urologist added, "We have failed to take control of our collective destiny for years. When you participate in a cents-on-the-dollar agreement with an insurance company or accept crummy reimbursement from Medicare/Medicaid, you are giving up your autonomy. We gave it up years ago, and now it will haunt us. "
The Herculean effort required for doctors to get paid is also unseen by patients. One reader's suggested solution is to change the current procedure so that patients -- instead of doctors -- submit claims to insurers. Suggested an anesthesiologist, "It's time that physicians make patients deal with the insurance companies and get their medical care paid for. If large numbers of physicians stopped taking the responsibility of holding the patient's hand through the insurance process and instead let the patient deal with the hassle, a lot would change. Patients would see how dysfunctional the system is and begin to demand change."
The Public Has a Misguided View of Physicians
Some readers noted that patients have a negative view of doctors based on some notorious physician offenders. Said an emergency medicine physician, "The problem is that the public's impression of our profession is colored by the worst 10% of doctors (as they say, it is a profession in a fish bowl). The fact is there are doctors who let money come before the lives and health of others. In the ER I've seen specialists ask for a wallet biopsy before they would see a patient."
Another reader, in an overall sympathetic posting, noted the occurrence of medical errors and fraud, "showing hospital coding violations, deaths due to poor physician handwriting, unneeded surgeries (not related to defensive medicine), and some bad doctors." The reader asked, "If you were a legislator throat-latch deep in an HC Reform debate, how much confidence would you have that medicine ought to continue policing itself?"
Some postings suggested that doctors have been too quiet about expressing the situation to the public, and that speaking up might make a difference. A cardiothoracic surgeon suggested, "Every opinion expressed above reflects the genuine frustration of a profession committed to doing good for their public. For some reason, all these honest observations have never been presented to the public in ways that will gain their attention and support for needed fair change. The conversation seems to begin and end in doctors' lounges and at conferences.
"Maybe someday in the not too distant future," he added, "a critical mass of physicians will stick their heads out of windows and express their undeserved frustrations to their public. Perhaps only then will the public wake up to the fact that their 'doc' is working under hostile conditions which need to be alleviated."
Yet a general cardiologist felt that even that won't make a difference. "Unfortunately, I am convinced that the only 'yells out of the window' that the public will hear is the locking of our office doors as we quit."
Time to Take Action?
A couple of readers suggested a more activist stance. A family physician recommended: "Just say no. Let the doctors, except for a skeleton crew of ER docs, go on strike one day a month. Go to Washington, NY, LA with white coats on. Nothing medical happens in this country without physicians; not prescriptions, procedures, examinations, or even home care orders. There are fewer than 800k of us, way too few for a population of 300 million. Doctors have been far too passive, perhaps because we are afraid of being accused of "being in it only for the money."
Yet Doctors Still Express Positive Notes
While frustration was clearly the emotion of the day, there were still positive feelings for the profession. One internist said, "I enjoy my job and love my patients. And I make above average money for an internist, 240k or so. I own my own practice and work pretty hard. When I compare what I make to what the local public teachers make on an hours worked basis and figure in their benefits, it's about the same pay. I guess I have nothing to apologize for, in terms of income."
A psychiatrist summed up what may be the gut-level issue that plagues everyone who charges for services. He quoted an old Russian proverb: "The doctor is an angel when he tenders his cure and a devil when he tenders his bill."
MEDICARE IN USA: DOCTORS NOT ALLOWED TO CARE ABOUT MONEY (PART 2)
MEDICARE IN USA: DOCTORS NOT ALLOWED TO CARE ABOUT MONEY (PART 1)
Patients generally place a lot of trust in their doctors and want to believe that this benevolent authority figure cares deeply about their welfare and nothing else. Believing otherwise could be very distressing.
Why Aren't Doctors Allowed to Care About Money?( PART 1 )
By Leslie Kane/Medscape
A number of consumer websites are taking polls that ask the public how they feel about the healthcare reform bill. Most response was positive, although some consumers expressed surprise that not all doctors are happy about the healthcare reform plan.
Their premise is: given the societal benefit of having millions more Americans with insurance coverage, some doctors should be putting income concerns aside.
Obviously most patients know very little about the details of physician reimbursement problems. They can't sympathize with something they don't know about, and probably wouldn't sympathize even if they did.
This isn't a new issue, and doctors know better than anyone that there's not a ton of sympathy out there for declining physician incomes. And even though it's mostly all about income-envy, there are a couple of reasons why people feel doctors should not be concerned about income at this time:
They say: Doctors still make enough.
This is a 'duh.' People seem to have an internal barometer of how much money they think is enough for someone else to make. Anything beyond that is unnecessary.
So, if a worker makes $50,000 and is supporting a family of four, he doesn't think doctors need to make more than, say $90,000 (maybe $120,000 for top cardiac surgeons). His thought is, "Doctors make more than I do, so they should be happy with what they have."
Consumers barely know or care about physicians' student loans, malpractice premiums, extra years spent in medical school, or remuneration for taking on life and death responsibility for patients' health.
People in helping professions aren't supposed to care about money.
This is a very pleasant myth.
The world is much less complicated when you dichotomize things into black and white. If you're in a helping profession, you--like Mother Teresa--should care only about others and not about yourself.
Patients see their doctors as good people, and find it jarring to realize that this good person could place financial self-interest (or even the desire to cover office overhead!) equal to or perhaps ahead of helping others.
The Caring Authority Figure
Even with today's trend toward a patient/physician partnership, a doctor is still an authority figure who dispenses life-changing treatment and advice.
Patients generally place a lot of trust in their doctors and want to believe that this benevolent authority figure cares deeply about their welfare and nothing else. Believing otherwise could be very distressing.
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Of course, I'd be remiss in not pointing out that there are many consumers who fully support doctors' financial concerns. I've heard patients say, in effect, 'for what doctors do and what they put up with, they should not get a raw deal.'
Amen to that.
Leslie Kane
Leslie Kane is Editorial Director of Medscape's Business of Medicine site. She is the former editor-in-chief of Medical Economics magazine. Ms. Kane is on the Board of Trustees of Valley Hospital in Ridgewood, NJ. She has also been named as a Population Health Associate (non-faculty affiliate) with the Jefferson School of Population Health at Thomas Jefferson University. She has a master's degree in counseling. Ms. Kane has held corporate positions in marketing, business reengineering, and advertising.
TEMPOH PRAKTIKAL DR SISWAZAH BERMASALAH DIPENDEKKAN
Memandangkan umur doktor siswazah yang mendapat kelulusan dari Universiti luar negara yang tidak diiktiraf kian meningkat, ada yang sudah mencecah empat puluhan, maka kerajaan bersetuju untuk memendekkan tempoh praktikal mereka dari tiga tahun ke lapan belas bulan sebelum menduduki peperiksaan khas.
Jika mereka lulus peperiksaan ini, barulah mereka didaftarkan penuh dengan Majlis Perubatan Malaysia atau Malaysian Medical Council (MMC) sekaligus melayakkan mereka untuk menjadi pengamal perubatan di Malaysia.
Lulusan dari Universiti Russia, India, Taiwan dan Indonesia dianggarkan berjumlah 250 orang buat masakini perlulah menghubungi Hospital-hospital yang telah ditetapkan bagi menjalani praktikal khas tersebut.
Semoga berjaya. Bagi ibu bapa serta para pelajar yang bercita-cita hendak melanjutkan pelajaran ke negara di atas dalam jurusan perubatan haruslah berhati-hati. Sila rujuk post saya yang terdahulu.
Tempoh latihan graduan universiti luar dikurangkan
PUTRAJAYA:Bernama/ BeritaharianOnline
Tempoh latihan khas bagi para graduan perubatan dari institusi luar negara yang tidak diiktiraf oleh kerajaan dikurangkan daripada tiga tahun kepada 18 bulan, kata Menteri Sumber Manusia, Datuk Dr S Subramaniam hari ini.
Beliau berkata, pihaknya sudah mengemukakan masalah yang dihadapi oleh graduan berkenaan kepada Kementerian Kesihatan dan meminta agar tempoh latihan yang perlu dijalani oleh mereka dikurangkan.
“Selepas menimbang masalah yang dikemukakan, Kementerian Kesihatan kemudian bersetuju supaya tempoh latihan itu dikurangkan daripada tiga tahun kepada 18 bulan,” katanya dalam satu kenyataan hari in.
Subramaniam berkata, antara alasan untuk meminta pengurangan tempoh latihan itu termasuk atas faktor usia memandangkan kebanyakan graduan tersebut sudah berusia 40-an dan mereka menganggap tempoh tiga tahun itu terlalu lama.
Sambil berterima kasih kepada Menteri Kesihatan, Datuk Liow Tiong Lai, kerana bersetuju mengurangkan tempoh latihan itu, Subramaniam meminta semua 250 graduan terbabit supaya segera mendaftar di institusi yang ditetapkan dalam Jadual Kedua Akta Perubatan 1971 untuk menjalani latihan.
Tahun lalu, Ketua Pengarah Kesihatan, Tan Sri Mohd Ismail Merican, mengumumkan format baru peperiksaan untuk graduan perubatan dari universiti luar negara yang tidak diiktiraf.
Beliau berkata, peperiksaan itu disusun oleh kementerian dengan kerjasama Majlis Perubatan Malaysia (MMC) dan tiga fakulti perubatan universiti iaitu Hospital Universiti Sains Malaysia, Kubang Krian di Kelantan; Pusat Perubatan Universiti, Universiti Malaya dan Hospital Universiti Kebangsaan Malaysia.
Beliau berkata, pelajar perubatan lepasan universiti seumpama itu perlu menjalani pemeriksaan di bawah Seksyen 12(1) (aa) Akta Perubatan 1971 untuk melayakkan diri sebagai Doktor.
Para graduan berkenaan adalah lulusan universiti dari beberapa buah negara seperti Rusia, Indonesia, India dan Taiwan.
MEDICAL EDUCATION IN RUSSIA: SOMETHING TO CONSIDER
Studying medicine in Russia? Yes. Parents and would be students after SPM need to consider carefully the pros and cons of pursuing medical degrees in Russia. First of all, one needs to consider the fact that Russia or its former member states was once communist countries and their ideologies are still or to a certain extent communism in nature. You cannot change people overnight even though the former USSR has been liquidated. As parents you would be worried wouldn't you to expose your sons or daughters to communism for several years. The worst thing that can can happen is that your children would be indoctrinated by the system or got married to a Russian prince or princess.
Secondly, to study medicine in a foreign country means one has to learn the native language and its culture. In medicine, to learn effectively one has to study the slang of the language, the likes and dislikes of the people, their bed side manners, the tradition and the culture as a whole. To elicit symptoms and signs from patients, a student of medicine has to interview patients, their parents as the case with paediatric patients, their relatives as the case with unconscious patients or aphasic/ dysphasic patients after an attack of stroke.
In other fields of study like engineering or computer, students can excel at the subject just by swotting hard in the libraries, finishing the assignments and attending practical classes in the laboratories. This is not the case with medicines and its related disciplines like obstetrics and gynaecology, community health and general practice etc. In addition to knowing the theories, a student of medicines has to spend at least seventy percent of his or her time in the wards or clinics seeing patients, interviewing and examining them. There is no way one can pass the clinical examination or viva voce if the student cannot interview or get the relevant information from the patients. Of course not every patient can speak English even though the medium of instruction in the medical school is English and the textbooks as well as the references are in English.
Many universities try their best to attract foreign student enrollments as a way to boost their incomes and improve their image overseas and locally. In order to lure the would be students, all the good aspects about the universities are potrayed in their brochures and prospectus. We discussed under the post"TERTIPU HIDUP-HIDUP LAGI" on 7th of May 2008 how to avoid the pitfalls of being conned or cheated by agents purporting to represent established Medical Schools in Russia, India, Indonesia or Latin America.
Medicine in Russia
RUSSIA has for the past few years been gaining recognition as a “preferred choice” for medical education, compared to when medical education in the country first became available to Malaysian students in 1996.
That is also how long Russian Resources has been focusing its efforts to help students with limited income realise their dreams of becoming doctors.
More than 1,550 medical students, both government and privately sponsored, have with the assistance of Russian Resources, gained entry into four world-class medical universities – Moscow Medical Academy (established in 1758), Volgograd State Medical University (1995), Nizhny Novgorod State Medical Academy (1920) and Russian State Medical University (1906).
These institutions are among the top 10 medical universities in Russia. The Moscow Medical Academy is also ranked second in the world by the United Nat-ions Educational, Scientific and Cultural Organisation and the World Health Organisation.
More than 40 doctors assisted by Russian Resources are serving in national hospitals throughout Malaysia. Affordable fees have been the key attraction.
Conventional medical institutions such as those in the UK and Australia are costly, not only in terms of tuition fees, but also living expenses which amount to not less than RM1 million for the full five to six years. Even local private medical institutions cost more than RM400,000.
The total cost in Russia, inclusive of tuition fee, hostel and living expenses and annual return ticket home varies between RM250,000 and RM300,000 for a six-year degree programme conducted in English.
Russian medical universities strongly emphasise on clinical exposure from the third year onwards, so that students can handle real life medical experiences after graduation.
As a professional agency, Russian Resources provides student counselling and placement services, which include university application and registration, visa processing, travel arrangements, accommodation and assistance in obtaining approval from relevant government departments. It also conducts language training for students prior to departure, with a full-time staff in Moscow coordinating communication and ground transfer arrangements. Parents can be assured of their children being properly settled in, and the agency will act as a liaison between parents, students and the university.
The 2008 September/October intake for both pre-medical and the first year is open for registra-tion. Seats are limited. You can also choose to enrol for a pre-medical course locally, commencing in early January 2009. Students can be admitted based on actual or forecast SPM results.
Read More “MEDICAL EDUCATION IN RUSSIA: SOMETHING TO CONSIDER” »»
