This morning I read a few posts and comments about the Physician reimbursement cuts proposed by the Medicare Payment Advisory Commission (MPAC) and the Presidents Student Loan program. What a great way to start your day: depressed. Does the world seem to be backwards to anyone else? I don't understand why we take issues and make them more complicated instead of finding a simple solution.
As a medical family that is on the horizon of starting a full fledged career in a specialty the thought of having reimbursements cut while trying to establish a practice and pay back hefty student loans is overwhelming. Medicare reimbursements set the pace for all other insurance company negotiations with physicians and hospitals. What they do, the rest of the industry usually follows.
Instead of worrying about student loan repayment why aren't we talking about why student loans have risen so high in the first place? The tuition at my husbands medical school was $32,000 in 2004. This year (2011) it is $50,000. Debt will be increasing at the same time anticipated salaries will be decreasing. It doesn't make sense to me. My DrH and I talked about this last night. The reason schools continue to increase their tuition is because people will pay it! The reason they are willing to pay is because they aren't actually paying - they are taking out loans that they will pay in the future. As long as they can get access to loans in greater numbers what is to stop a school from raising tuition. At what point will people stop paying? If doctors can't make a commiserate salary with their investment, maybe they will choose not to be doctors. Does anyone pay for their education at the time it is received any more?
I know that the vast majority of Americans are completely unaware of what a doctors lifestyle is like. How can we change that? Maybe my little blog will help, but probably not. Where are the doctors and their families? Who is perpetuating this idea that a doctor is some rich, selfish, high and mighty snob that is out to rip them off? The bill they collect for services provided pays for more than just their salary. Doctors are also employers. They have to pay the person who answers the phones, the medical billing coder, the office manager, the book keeper, the medical tech, the nurse, benefits for the employees, rent for the building and utilities, investment in equipment and tools, and medical liability insurance.
Of course we would be perusing a specialty with one of the highest rate. Obstetrics and Neurosurgery are at the top of the list. At the end of the day, the doctor isn't making nearly as much as people think they are. True they are making more than the average person, but I would argue that their investment isn't average, and their exposure to risk is anything but average.
The average person only sees the income and refuses to acknowledge the sacrifices that were made and are continually made. How much should a doctor be compensated for 4 years of undergraduate studies, 4 years of medical school, 7 years of 80 hr/week training, and $300,000 of education debt, so that when a patient (who may sue them) comes in at midnight, on Christmas Eve, with a brain tumor that threatens their life they can be seen by a skilled professional? I suppose the answer to that question depends on whether or not you are the person with the tumor.
On a brighter note, it is Friday. Our student loans are paid for the month, and this weekend the DrH might be home long enough to do something fun, or something really boring, but we'll be together!