Thursday, December 13, 2012

It's Time for Doctors to Leave the United States

As I have pointed out before, the necessity for workers in a given sector of the economy to leave the United States will vary from sector to sector.  If you are a major league, football, baseball or basketball star, the United States is still a very good place to earn a living. Not so much for physicians. Thanks to Obamacare, regulations are getting more and more onerous for medical doctors. More and more, they are being regulated and are not free to use their own judgement in treatment and must simply follow treatment programs designed by the state. This, of course, suffocates the most creative and innovate in the field. But soon things will get worse. The state is going to come after the pay of physicians and limit it, and ultimately the state will force physicians to take on government subsidized patients. Medical care will become factory line work.

A column by Christopher Flavelle, a health-care policy analyst for Bloomberg Government, is simply shocking in its failure to understand how a free markets work, how wages are established in a free market society and how government controls over any prices (including wages) kills incentive  and distorts supply and demand, ultimately resulting in less product, poorer quality and log jams.

Yet, here is Flavelle calling for just such government control of physicians wages:
As Democrats and Republicans argue about how to spread the pain of health-care spending cuts, one group has been curiously excluded from the discussion: doctors. There’s good reason to change that.

Everybody likes doctors. They deliver our babies, treat our ailments and often save our lives. In surveys of public trust, they rate higher than college teachers, police, even clergy, and vastly higher than journalists or politicians. Norman Rockwell painted doctors as kind, patient and wise. You probably hope your child marries one.

That public adulation is one reason why the 2010 health- care law, which imposed immediate and heavy cuts on hospitals, drugmakers and insurers, left doctors relatively untouched. A 1997 law that reduces doctors’ Medicare payments is consistently overridden by Congress. And none of the proposals for entitlement reform now circulating around Washington calls for significant sacrifices from physicians.

It’s worth asking whether doctors, who account for almost one-fifth of health spending, really need the special treatment...

So what’s the answer? One option is to cut Medicare rates for specialists, using part of the savings to fund current rates or even gradual increases for primary-care physicians. That would ease some of the pressure on the broader economy, because Medicare rates affect payments by private insurers. It would also change the incentives that drive so many medical students away from family medicine toward more lucrative specialties.

Another option is to replace the current law on Medicare payment rates, which Congress consistently overrides, with legislation that would reduce payments by a smaller amount for all doctors and link them to the rate of economic growth. Congress has failed to stick to this approach before, but if lawmakers believe their own rhetoric about the dangers of rising Medicare costs, this is one way to act on it...

The solutions aren’t easy. But the question isn’t whether doctors deserve to be paid less. It’s whether they deserve a level of protection that’s unlikely to be afforded hospitals, nursing homes or Medicare beneficiaries.

Excluding doctors from spending cuts means greater sacrifice from the rest of the health-care world -- including their own patients. That’s not a picture Norman Rockwell ever painted.
Where does Flavelle get off telling us that primary care physicians should earn more relative to specialists? The only way to really know how the structure between rate should be is to allow the free market to operate and get government out of the healthcare sector. But, instead, Flavelle wants government to micro-manage the sector, a prescription for sure disaster.

Sadly, given the current attitudes of most Americans, regarding the need for government to interfere in every sector of our lives, the call by Flavelle for micro-management of the medical sector, will not be limited to him. The calls to further increase regulations and control pay will escalate. For doctors, the Flavelle column should be the signal to start planning to leave the country as soon as possible. Don't think you will get around the government micro-management by not taking medicare patients. At some point, the dysfunctional government system will have far more patients than it can handle. This will become obvious and the government's uncared for sick will be forced upon the rest of the medical industry at government determined wages.

Physicians should read the writing on the wall and head out now, Mexico, the Bahmas, South America should all be considered. Medical tourism for Americans is going to become big, as the government micro-management, regulatory clamp destroys healthcare in the United States.

53 comments:

  1. I'm guessing his next column will be about how to reduce the cost of soaring tuition by paying professors less.

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    1. Ha!! Very good! :)

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    2. I can't imagine congress reducing their pay and using the same medical insurance coverage that everyone else has to live with. Congress -- get real!

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    3. The notion that doctors, members of congress or anybody else should receive special treatment to preserve their incomes is a bunch of huey. Doctors in the U.S> already average more than five times what the average family makes in a year. The suggestion that they could better themselves by setting up shop somewhere in South America or elswhere is not realistic.

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    4. After reading all the comments about pay, etc. I have noticed NO ONE mentions how to stay well & healthy. I am 76 yrs old & pay my nutritionist to keep me well & my immune system in top condition, There is a reason why nutritionists are NOT included in health insurance because being ill, requiring transplants, repaired joints is very big business. Cancer is curable without the cut, burn, poison treatments with no guarantee you will survive. WE, the people have a responsibility to maintain our own health without the government interference.

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    5. Excellent point "STAY WELL AND HEALTHY" should be promoted. Doctors are here to serve people, in the case of accidents and somebody becomes unconscious of his/her well being, that is their duty.

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    6. Yet the people who do take care of themselves will have to pay insurance rates the same as those who smoke and drink and drug to their hearts content. Also personal family health histories will not be factored in. WERE ALL IN THIS TOGETHER.

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    7. Yes indeed doctors make more than the average family. But how many average families have taken on 200k in personal debt, done 8 years of school after high school, worked for 80+ hours per week for 4-10(+) years making less than the average family makes per year while paying 1/3 of after tax income to student loan payments and then work 100 hours or more per week dealing with people who 75% of the time are only at the doctor because of their long term stupidity (smoking) or short term stupidity (I didnt know I shouldnt put my finger in there)... So we need lots of doctors out there so how about those who are crying about how much drs make come on out and go through the hell like doctors do so you too can be sued every few years or so because you made one small mistake out of the 1200 or more surgeries you did per year, many of which happened after you worked a 30 hour shift.

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  2. Medical procedure rates are already in the Affordable Healthcare Act legislation. The government will set the rates that specialists can charge, and it is generally held that they will reduce these rates. In this way, they will drive doctors into GP rather than specialized fields. They are simply following the European/Canadian model. And where do Canadians go when they need a very specialized procedure performed? They go South.

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  3. Yes, I suspect medical tourism will flourish. Some medical entrepreneurs should establish a world-class medical center in the Bahamas. Get healed and a suntan in paradise for an all-inclusive price.

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    1. If you think the paperwork is bad in the U.S., Oh Man!!

      The water is fine though!!

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  4. This is a perfect example why we don't want our health care system determined by some health care "expert" writing in Bloomberg, but rather by people's choices in the marketplace. In my experience, primary care physicians are largely referral machines. Their skill set works for diagnosing and treating something like a cold or poison ivy, but anything really serious these days gets referred to the specialist. You also have plenty of trained nurses--actually, nurse-practitioners--successfully doing primary care physician work at a fraction of the cost of a primary care physician. Then you have a lot of technology being developed and deployed at the moment to assist, if not automate, diagnosis and treatment, and this makes the primary care physician job even more expendable in the health care system.

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    1. As a primary care physician I can tell you that reason that is sometimes the case is that we understand that specialists are paid more because there is a procedural bias in the current payment system, and since they are paid more we let them do a little more work.
      Now in a capitated model where the primary care physician is at risk (can participate in financial upside of good care) we do much more and refer only when we absolutely need to because we realize that upwards of 30% of what specialists do, is unnecessary and just pads their paychecks.
      What lay people and don't realize is that the only way to actually change the trajectory of spending in a healthcare system is to change the proportions of primary care physicians to specialists, once that is done costs come down and quality goes up.
      I am as libertarian as the next guy, but no one wants a free market running rampant when you are having a heart attack and now you are haggling over price, there is too much regulation in medicine, but you would not want to see what it looks like with none.

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    2. In a free market you haggle for price BEFORE you get a heart attack, with your insurer. Who is then obliged to cover all costs of treating the covered condition (and of course is in a strong position to negotiate the price with the hospital while you're being busy surviving).

      The problem is that medical insurance in US is not insurance at all, it's a (national) socialist redistribution program.

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    3. Anonymous @ 6:10, I take it you have never seen free market healthcare. Murray Rothbard explained your viewpoint before. Imagine everyone's shoes were regulated by the government. There are regulations for the color of the shoes, the design, the arch support, materials, etc. And then someone says, let's get rid of the regulations. You would say "Oh, no I don't want to see what a free market would look like. Our system is bad, but I would hate to see what a free market would look like. Who would determine the colors, materials, sizes, and arch support?"

      That may be a simple explanation, but your viewpoint is a very simple viewpoint.

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    4. I am sure you could reduce doctor's pay by a significant amount by implementing tort reform and thereby significantly reducing their liability insurance cost, but that would result in a considerable cut to many attorney's pay - think the congress with ~75% of the members with a law degree will ever address that??????

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    5. Oh how contrare' Anon 6:10. Heart surgery prices would be known, tremendously less expensive and competitive. The monopoly of medicine and underserved arrogance of the profession would be rightfully destroyed and muted respectively. Escalation in costs of medicine and doctor salaries is the result of regulatory monopoly and a corrupt monetary system; same as in all other industries that are always complained about by the consumers and by the same rat-nick politicians that had their hand in the creation of.

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    6. Tony got it almost right. A specialist is often paid more because of more time being educated; oftern 3-5 additional years as compared to family physicians. As a cardiologist, I am working a 60 hour week, and more on the weekends. The hospital calls may occur anytime night or day and the liabilities of malpractice are far greater than the general practice doctor. I may often give lengthy advice over the telephone for which there is no re-imbersement as opposed to the lawyers who charge for every second of the attention they give. Finally, as physicians we have no unified voice. The AMA represdents less than 20% of physicians and is heavily influenced by academics who have no appreciation of the physician in the field. The onerous paperwork and regulations now take far more time per pt than the actual time spent face to face. Be careful! As John Arbuckle said, "you get what you pay for". Most physicians now, specialist or otherwise, will find it hard to justify remaining in medical practice if they have any other alternative. Those seeking to follow a medical career may eventually not be the best and brightest of our college students, and the level of care, concern and innovation will severely suffer.

      Mark M

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  5. Anon. You're right.

    OK, what we need is an offshore location with free trade and cash basis medicine.
    St. Maarten isn't bad, but they ARE Dutch. Although they've got a medical school, I don't know what they've got as far as specialists. Also, it's very first world and not especially cheap (except booze).

    Maybe a Club Med setup for meds etc. on some small island that needs the bucks. A free trade zone for medicine. I know there are a lot of medical tourism destinations (India, Costa Rica, Cuba,etc. etc.), but it would be nice to see it expressed as an overtly liberty minded enterprise. Great advertising for the cause and all.
    Who's with me?

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    1. I've always wanted to do massage on beach somewhere. Count me in!

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    2. Good point. They have the Free State Project. Why not a Free Country Project?

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    3. They started that one back in 1776... It didn't last very long.

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  6. My wife is a 38-year-old Pediatrician who is only now going into practice.

    Why so late getting into the work-force?

    Well... she is from Russia, where she worked as a Pediatrician. I brought her here under a fiance VISA in 2005 when she was 30 years old.

    The AMA does not accept medical credentials or education from outside the US. There are a wide variety of controls to prevent foreign doctors from practicing here, some reasonable, most not so reasonable.

    Before I list how we've spent the last 8 years and hundreds of thousands of dollars so that a fully-qualified foreign doctor could work here, consider these statistics from the AMA on "International Medical Graduates":

    - IMGs make up approximately 25% of the U.S. physician population.
    - The heaviest concentration of IMGs is in New Jersey (45% of doctors); New York (42%); Florida (37%); and Illinois (34%).
    - The largest national group is from India (20.7% of total).
    - Among the top four primary specialties, the IMG population represents 37% of total physicians in internal medicine; 28% anesthesiology; 32% in psychiatry; and 28% in pediatrics.
    - The total physician population increased by 350,386 between 1970 and 1994 (or 104.9%), while IMGs accounted for over one fourth (27.8%) of this increase by gaining 97,359 physicians.
    - In this 24-year period, non-IMGs grew by 91.4%, while IMGs increased by 170.2%.

    Now, what have we had to do in order for my wife to practice here?:

    - We had to seek an 'externship' where my wife was supposed to PAY to work for six months. Unfortunately it was illegal for a technically unqualified person to perform any medical duties, so she just watched the doctor for a few months. Shortly before my wife had completed her 'externship' this requirement was dropped.

    - We had to pay several thousand dollars to an organization called ECFMG to get transcripts. Unfortunately, ECFMG (who is in charge of documenting IMG educational qualifications) was unable to contact my wife's school - though it was on their list, and had no way to translate what it received. So we contacted the school and payed them to contact ECFMG - though we'd separately already paid ECFMG to contact the school.

    -This got us to taking the US Medical Licensing Exam Step 1 (USMLE Step 1). EXCEPT... ECFMG decided the wanted us to pay a new fee for one of their crony translators rather than the foreign medical school's own.

    Luckily, my wife scored well into the 99th percentile of USMLE Step 1 graduates on her first (and only) try. Only a handful of others who took the test that year scored as well.

    - Next was the USMLE Step 2 "Clinical Knowledge (CK). But... we had to show ECFMG was in process. Meanwhile ECFMG had either lost or failed to store the entire record - back to square one for a few months before we actually could take the test.

    -Then it was the USMLE Step 2 "Clinical Skills" (CS). But GUESS WHAT???? ECFMG again!! Yes, the whole run-around yet again. Many months of delays (AGAIN). And when she finally took the test? 99th percentile (AGAIN). And we had to do the entire litanny yet again before USMLE Step 3.

    -ECFMG certification (supposedly) was only a requirement to take USMLE Step 3. Actually it was required duplicatively at every step.

    Would you perhaps guess we had to go through the entire process YET AGAIN to apply to a residency? You would be right.

    Do you think we had to do the ECFMG treadmill yet again before starting residency? You'd be right.

    -So, my wife attended residency, where she was the top Resident, graduated after three years, went through yet another round of ECFMG madness before taking the certification exams.

    So, in this process, I've dumped HUNDREDS OF THOUSANDS OF DOLLARS IN EXPENSES into a 'certification' that certified nothing and which purchased NOT ONE SINGLE DAY OF EDUCATION.

    So, Mr. Christopher Flavelle, I can't hear your words because the rattling of your eeency weeency little brain in your cavernously empty skull is drowning you out.

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    1. And yet, this was still preferable to you moving to Russia for her?

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    2. A totally dumb response that avoids confronting the reality of
      the ridiculous govt. mess.
      I am facing similar govt. stupidity. It's why communism fails
      which is where we are headed at breakneck speed.

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  7. The MD fees are already dictated by Medicare/Medicaid, and largely by insurance comanies as well. Good luck on setting up in the Bahamas as they zealously guard against any foreign workers. Best bet is a large ship 14 miles off the coast of FL. Then docs could fly or boat out, collect their fees, and then come back. And declare them on their taxes. Heh,heh.

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    1. A cruise ship format would be a good idea.

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  8. Where do you suggest that US doctors move?

    They currently make at least 2-3x what doctors make anywhere else in the world!

    Even under reduced US government payments, they will lose money anywhere else they move to.

    And how amusing it is that you free-market advocates are complaining because Government isn't paying doctors enough!

    The solution is simple - Doctors can refuse to accept insurance of any sort, and see how their extravagant fees work out for them in the REAL person-to-person free-market!

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    1. It's actually happening...to the extent that it's possible, given government control.

      For primary care, many experienced physicians are joining 'concierge' medical services where they only see private patients who pay a 1500 annual fee just to be in the system. There is no shortage of patients willing to pay. They get appointments on short notice and a good hour to talk their doctor.

      Even for some specialties such as general surgery, there are cash pay only surgeons who take no insurance except for their original patients. There are several patients willing to pay cash to fix their hernias are get their gallbladder out.

      As for refusing to take medicare, it can be hypothetically be done, but not easy, since if you want hospital admitting privileges, you need to accept medicare.

      And of course, there are cosmetic surgeons, who take no insurance, charge what the market will bare and do very well...Or not if they aren't very good, but that's how the market is supposed to work, isn't it?

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  9. Yes, I am sure at some point, it will be a requirement for me to accept all medicare and medicaid patients, in order to renew my medical license. Glad I began formulating my exit strategy as soon as I started practicing 15 years ago. I'm finished at the end of next year with dealing with all these whiny, entitled people....ahhh....life outside of medicine at 45 is going to be great.

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    1. Me, too. (I am a physican in the process of leaving practice) What people fail to see is that when government decides that healthcare is a right of every citizen, they have to find a way to make people provide that care.

      The enslavement of the physician population is in progress.
      The use of coding and electronic heath records is driving small practices out of business and making physicians into employees instead of independent business owners.
      Then the government will lower payments to physicians but this won't cut the costs of health care because at least a third of the costs come from administrative costs which will continue to rise.
      Many physicians will leave practice, causing shortages. Then the government will mandate that all physicians accept health care. I think Massachusetts has already done something along these lines.
      Slavery is defined as the state of being bound in servitude. When doctors are mandated to care for groups of patients instead of having free choice (as appears to be in the early stages of occuring) then the enslavement of the medical profession will be complete. If you don't like your medical care now, just wait til you see what it looks like then.

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  10. doctors are still coming to the USA because even under Obamacare they can make ten times as much money as any where else in the world.

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    1. Except that they can't. Doctors are well paid everywhere in the world (except some socialist hellholes, of course). You've got to visit outside world someday, you'll learn that US is nothing special.

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  11. What would the system be like if Congress had to utilize all the same medical restrictions applied to them that Obamacare applies to the citizens being covered? Would Congress be willing to reduce their income like they would like to reduce our doctors income? Do we really want Socialized Medicine?

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  12. @anon 5:15 and @anon 5:38 - you realize just saying "doctors make more in the US" is a completely worthless statement without factoring cost of living, yes?

    Beyond that, its the principals involved ... "first they came for the jews ..."

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  13. He really is out to destroy America.

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  14. What I suspect is happening is that the government is trying to turn doctors into hospital employees. On the day after the election, when the market tanked, hospital stocks soared 9%. No reason to wonder why, since now perfectly healthy Americans will have to buy health insurance, and once they have it, well then they might as well use it, bringing more patients to hospitals.

    Meanwhile, private practice physicians will find it harder to sustain themselves an will rush into the arms of the hospital which will offer them steady salaries and no worries about overhead.

    I suspect doctor employees will be doing ok at first but salary cuts will come later.

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    1. I worked in healthcare for 38 years before retiring; and I would say Amen to that

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    2. Nearly all of the MDs in our small town now work for the hospital - may work for them for a while until the hospitals start cutting salaries. Oh, and the hospital is already the largest employer in the County by the way.

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  15. You should not assume physician pay is market based, because it is not. Through the powerful lobbying of the AMA they limit the number of medical schools and the enrollment. Since they control the supply of doctors in the US they create an artificially high pay scale for doctors through this manipulation. I agree his proposal is absurd, but don't think there is really a free market for physicians, because there isn't. SLT

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  16. If you are not a government zombie, you can leave also. If you got the guts. Your criminal banker Bernanke just made your decision easier for you. Get out while you can Yankees, your fuse on the economic time bomb is getting smaller.

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  17. I can't help but note the irony of a butt-wipe complainer like this Flavelle jerk would point out that doctors have a higher trust rating than almost any other occupation in society, and then he goes on to say that doctors' pay should be restricted by...wait for it...politicians! That point says all one needs to know about the stupidity of people who rant against doctors' incomes.

    Flavelle...does that rhyme with "go to hell"? Because there's a room down there, just getting warmed up for him.

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  18. Primary care doctors refer to specialist for the same reason that there are so many unnecessary test done in medicine - to shift the risk. Specialist spend a LONG time more in residency and thus defer loans longer than primary care. It takes many years for them to make up the difference in earnings given that they start later and pay vastly higher malpractice. Creating more primary care doctors or changing the ratio of primary care to specialists will only make the care provided by specialists more valuable. This rhetoric is cover for extending more rights to nurses and physician assistants who will take over more of the primary care professions with less education, lower pay and all the while paying union dues. Good luck getting your heart surgery, knee & hip surgery, or any reconstructive surgery from primary care physicians, ooops I mean the PA, no the nurse practitioner. Regulation only provides incentive for a grey market. Come find me for quality care when you wake up and realize how many of us are/will go GALT !

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    1. sounds like you are a physician.Modern healthcare can only exist if the top of the hierarchy exists. the doctor is the top of the hierarchy. but the physician has abdicated his responsibility for the economics of healthcare to insurance and government managers who are not accountable to the doctors.the results you see are the consequence of that abdication. the same is true for religious charity and government welfare. I don't believe the Beast can be caged again.

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  19. Some FMG are excellent, many are mediocre, some are very dangerous. Doctors are paid more here partly because the standards are so high in training, better that most countries except for Germany, Sweden and others. Medical shcool is much cheaper there too, without the average $150+ thousand debt after med school that we have. And, I'm sorry, but neurosurgeons have had a really tough residency and more years of training than family practice docs, and try to get into a NS residency.
    The specialists deserve more money than the FPs, IMs that have less training. And, by the way I am not a NS.

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  20. Primary care doctors do 2-3 years of residency after medical school. Their call is minimal (except pediatricians) because hospitalists now admit and take care of patients in the hospital. As a neurosurgeon, if they are going to take money from specialists who spend 7 years after medical school in grueling residency programs then I look forward to the primary care doctors taking some of my trauma call.

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  21. How many countries outside the US were studied by any members of
    Congress or anyone else concerned with "health for all"...before this legislation was voted into law? Life expectation in many of these lands is HIGHER than in the US: so they may be able to teach others something. Health tourism is on the rise and bringing in lots of $ into overseas health systems that give adequate treatment and keep the specialists concerned from running off to the US where things are obviously not as rosy as they might seem. There may be something to be learned from offshore locations beyond opening bank
    accounts and getting a tan or a massage or whatever...

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    1. Actually yes poor-ish nations have higher longevity because they can't afford "diseases of affluence". After certain wealth gains life expectancy goes but after more wealth gains life expectancy starts going down. Many Third World children are unhealthy from lack of food while First World children are unhealthy from too much food.

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  22. My neurosurgical colleague was talking to a canadian surgeon last month who stated in Canada all the surgeons take off the last 3 mos of the year (except for call) because the Canadian Government money allotted for surgery every year runs out in October so I am looking forward to 3 month vacations at the end of the year, unless I myself need surgery then. We live in a country where the uninsured drunk who takes out a family on the highway gets flown by a helicopter to the nearest trauma center where he gets the top, state of the art treatment. In Canada, Natasha Richardson dies from a surgically treatable blood clot to the brain because they had no helicopter and the ambulance got her to the nearest neurosurgical center 6 hours after her injury. This is what the people in this country voted for the last election and this is what they will eventually get, along with alot more food stamps.

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  23. My wife and I recently started a third party free and payment due at time of service primary care medical practice (she is the doctor and I'm the part time office manger). She has filed all the paperwork to opt out of the system after many years of working for hospitals. Since opening our doors two months ago, business and the response has been great. Our patients and small staff are extremely happy and our compliance overhead is so low we can charge half or less than the conventional clinics and still make good money. The best part is that my wife enjoys being a doctor again since people with "a little skin in the game" expect more than just another pill and a referral to a specialist and she can practice the art of medicine in a way a glorified bureaucrat never could. It isn't a large or wealthy metropolitan area we operate in either.

    As a sad aside, I see Obamacare only strengthing our business model as rationing and lack of quality set in the other health care system.

    I noticed several doctors commenting, if you are interested in breaking free of the system, I recommend visiting AAPSonline.org as great reference in all the legalities of opting out, it was a great help for us. (Yes I do see the irony in filing out paperwork to become a little more free)

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  24. or those who think medical tourism will provide a ready escape to the problem of limited treatment availability as a result of obamacare, think again! How long do you think it will be before the gubmint catches on that people are leaving the country to get medical treatment? Do you really think they will sit by while citizens travel overseas to escape the hideous beast they put in place to control the population? Please!! At some point you will be required to state a specific purpose for your trip, location you will be staying at, (including documents to show reservations), how long you plan to be gone, documents showing return travel, etc... I understand you can lie about your purpose but keep in mind a destination that the USG has identified as a "foreign medical treatment area" will probably raise suspicion and they will do one of two things: Deny you your travel request/exit visa or charge you a steep fee for travel to that specific destination. Remember, this whole disaster was passed to establish CONTROL, not for any medical betterment of society!! If gubmint controls your health, they control YOU Totally!!!

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  25. The end-game is easy to see: doctors, to dispense of the stigma associated with making money 'privately', will embrace their newfound identity as pseudo-government employees, and will thus unionize like the TSA to extort higher wages. Under these auspices, Flavelle will backtrack and laud the good that doctors bring to society via government, and the worthiness of their union's cause. He will tell us we all need to pay higher taxes, because the doctor's unions deserve higher wages. Power to the people!

    What a circus.

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  26. You good people had better realise that the move to limit physicians pay that you are now looking at has been the norm in the UK and European Health services since the Second World War.

    The number of Physicians working outside the Public Health Service Schemes throughout Europe has since post WWII been reduced to less than 12% of the total number of practising Physicians in Europe.

    The point I make is that the vast majority of Physicians working in Europe (UK included) are employed in Public Health Care Schemes and their pay has been cut in real terms, year on year for the last forty years. FACT.

    I have worked in Private Medical Care in the UK for almost thirty years (ie NOT the Public Healthcare Schemes).

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