IT'S TIME FOR UNIVERSAL HEALTH CARE

My father was a pulmonologist and internist, working at a hospital and a rehabilitation clinic.

He had one hour/day for "normal consultations" - since he was the only specialist in a larger - rural - region.
So, people could go consulting him either with a referral from another physican or their health insurance ID-card, like at any other doctor.

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Walter, are the German people relatively satisfied with their U system? Percentages would be nice.

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Walter Hinteler wrote:

georgeob1 wrote:

It would be interesting to get some comparative data on physician's salaries in different countries. In the cases of the UK and Canada in particular, I believe they are much lower than here. I don't know about Germany or France.

These data are from 2005, before tax, but after all operating costs, physicans practising as resident doctors, per year:

Internists 97.000 Euro
Orthopedic surgeons 92.200 Euro
Paediatrists 87.200 Euro
Ophthalmologists 85.800 Euro
Gynaecologists 80.200 Euro
ENT doctors 79.800 Euro
Urologists 78.400 Euro
General practitioners 77.900 Euro
Radiologists 75.100 Euro
Nervenärzte 68.800 Eur
Surgeons 63.900 Euro
Dermatologists 63.700 Euro

That's the average - some will a lot more, others work only part-time, ... ...

In the US, one of the highest paid groups is the orthopedic surgery group.

What's the conversion of EUROS to $$?

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georgeob1 wrote:

What is a "resident doctor"? Here I believe the term generally refers to a licensed physician working on a salaried basis in a hospital in pursuit of qualification in a specialty.

Taking internists as an example, I believe the compensation here (after operating expenses including malpractice insurance) is a good deal higher than the $140 thousand (or so) equivalent.

"resident doctor": in the US the residency follows medical school and lasts from about 3-6 years past medical school.

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georgeob1 wrote:

What is a "resident doctor"? Here I believe the term generally refers to a licensed physician working on a salaried basis in a hospital in pursuit of qualification in a specialty.

Taking internists as an example, I believe the compensation here (after operating expenses including malpractice insurance) is a good deal higher than the $140 thousand (or so) equivalent.

Internists fall into the speciality of Internal Medicine, a field that pays more than either Family Medicine or primary care ( as such ).

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Walter Hinteler wrote:

Well, we've got docors in hospitals - they work there (and may be allowed, especially the heads and deputy heads of the departments) to have some consultation hours, and the doctors practising independently, register with one of the 17 Associations of Statutory Health Insurance Physicians. The latters are those you would usually contact here, the former you'll normally only meet as an indoor patient of a hospital.

In the US these doctors are called HOSPITALISTS.
http://en.wikipedia.org/wiki/Hospital_medicine

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$1.46= 1 euro.

Thus the 2005 net salary of an Orthopedic Surgeon in Walter's data would be about $134,000. I believe that is a lot less than what the guy who did my rotator cuff gets - probably less than one half..

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georgeob1 wrote:

$1.46= 1 euro.

Thus the 2005 net salary of an Orthopedic Surgeon in Walter's data would be about $134,000. I believe that is a lot less than what the guy who did my rotator cuff gets - probably less than one half..

Many pharmacists in the US make more than $134,000/year. In the US, I'd guess Orthopedic Surgeons make in the ballpark of $350,000 depending
on the geographic location.

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This was Baltimore - Johns Hopkins, and I suspect he was at the high end of that range. Nice guy - he bought my inner harbor condo when we moved back to San Francisco.

More to the point, it seems clear that one of the key elements in the savings achieved under the government managed systems in Canada and Europe is a much lower wage scale for medical practicioners of all kinds. One could argue that, in this country, escalating salaries are one of the key drivers for the rising per capita cost of health care, and that a side effect of our various insurance schemes is to disconnect the consumers from the real cost of the services they are demanding - surely a contributing factor.

We both know the increasing incidence of doctors who resist taking Medicare patients due to the low (in their eyes) fees allowed by the government. HMOs of course have, to a large extent, already faced some of these issues, generally offering lower salaries than independent practicioners. However, all this suggests some serious shocks and turmoil following the implementation of any "universal care" system here. If the government is involved rationing and price controls are inevitable. How will doctors react to that?

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Quote:

HMOs of course have, to a large extent, already faced some of these issues,

They've also watered down their services. For example in an Opthalmology dept in an HMO, a patient would normally visit an optometrist before ever seeing an MD.

With increasing patients loads, today, when a patient vists an HMO for eye care, the first "health care provider" the patient now encounters is the optometric tech, who works the patient "up" for about 10 min. This is followed up by a very short exam by the optometrist ( less than 5min ). If a disease is suspected, the patient is then referred to an opthalmologist in the same network.

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georgeob1 wrote:

I believe that is a lot less than what the guy who did my rotator cuff gets - probably less than one half..

I suppose, someone who would do such would earn a bit to a lot more than those in my list - such is done in hospitals here, and those (senior) doctors earn more.

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Miller wrote:

Walter Hinteler wrote:
Well, we've got docors in hospitals - they work there (and may be allowed, especially the heads and deputy heads of the departments) to have some consultation hours, and the doctors practising independently, register with one of the 17 Associations of Statutory Health Insurance Physicians. The latters are those you would usually contact here, the former you'll normally only meet as an indoor patient of a hospital.

In the US these doctors are called HOSPITALISTS.
http://en.wikipedia.org/wiki/Hospital_medicine

Well, not really: in hospitals here, you've got the specialists who do their speicalists medical work with 'in bed patients' or outfoor patients.
Generally, all hospitals have a surgeon and interior department (with physicans, licensed and specialised in interior and general surgery).

Example from the two hospitals in our town (70,000 inhabitants): both have the departments noted above. Both additionally accident/trauma surgery and cardiology. One got a general children and a children surgery department, a gynaecologist and newborn department, a plastic surgery department, and a neurologist department; the other got an orthopedic department, an urologist department, a geriatric department, a phlebologic department, a radiologic department, a nuclear medecine department and a nephrologic department.

Both have some dozen beds with are used by "attending physicians" of various specialisations.

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Miller wrote:

Cycloptichorn wrote:
Miller wrote:
But, how will this PLAN function without participation of American Physicians?

Will the poor folks have to go to Walgreens for their healthcare?

Don't forget, that there are many, many MDs who will not take Medicare or Medicaid insurance and in fact, some will take nothing but cash.

Have you ever wondered how an American physician can see 50-100 patients in a single day??

They won't be allowed to do this any longer.

And who's to stop them? Physicians have the right to reject certain individuals as patients. As a matter of fact, some MDs now refuse treatment to many patients when past history with these individuals indicate they don't wish to follow a physicians order relative to health or are other wise troublesome in the physicians office/clinic or even the ER.

Additionally, some health insurance plans also have the legal right to terminate an individual's policy, when that individual has been found to "cause trouble" for the physician.

Mill and I are beginning to agree!

Sorry, Cyclo, you CANNOT force a doc to see a patient. He is not required to provide care for anyone who seeks it. Doctors routinely "fire" patients for non-compliance of orders.

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Miller wrote:

The primary care physicians in the US, on average probably make about $150,000/year based on what I know.

The specialists make any where from about $200,000 to $500,000/year depending on the speciality.

Specialists can earn upwards of $1M - interventional cardiology is one of such.

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Walter Hinteler wrote:

Miller wrote:
Walter Hinteler wrote:
Well, we've got docors in hospitals - they work there (and may be allowed, especially the heads and deputy heads of the departments) to have some consultation hours, and the doctors practising independently, register with one of the 17 Associations of Statutory Health Insurance Physicians. The latters are those you would usually contact here, the former you'll normally only meet as an indoor patient of a hospital.

In the US these doctors are called HOSPITALISTS.
http://en.wikipedia.org/wiki/Hospital_medicine

Well, not really: in hospitals here, you've got the specialists who do their speicalists medical work with 'in bed patients' or outfoor patients.
Generally, all hospitals have a surgeon and interior department (with physicans, licensed and specialised in interior and general surgery).

Example from the two hospitals in our town (70,000 inhabitants): both have the departments noted above. Both additionally accident/trauma surgery and cardiology. One got a general children and a children surgery department, a gynaecologist and newborn department, a plastic surgery department, and a neurologist department; the other got an orthopedic department, an urologist department, a geriatric department, a phlebologic department, a radiologic department, a nuclear medecine department and a nephrologic department.

Both have some dozen beds with are used by "attending physicians" of various specialisations.

This is a bit confusing. It seems you're mixing a lot of stuff together and I think that is where the misunderstanding is. A physician that works primarily on in-patient stuff is a hospitalist, regardless of his sub-specialty. A sub-specialist may or may not have his own clinic and admitting or surgery privileges for the hospital. An "attending" physician is an academic position and not all hospitals are academic hospitals. Attending physicians oversee the work of residents, who in turn oversee interns.

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USAFHokie80 wrote:

This is a bit confusing.

Yes, especially for someone who doesn't know other medical organisations than those he/she is used too.

USAFHokie80 wrote:

It seems you're mixing a lot of stuff together and I think that is where the misunderstanding is.

I do know that our system is different to yours - but that doesn't mean that we mixed it up - we do have it since .... I don't know, but the hospital in my native town was founded in 1374, and the first 'physican' with an own practise is noted in the early 17th century.

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In the U.S. most doctors and specialists do their work as independent agents; their practices are run as separate businesses or partnerships with a group of doctors. In doing this many have various affiliations with particular hospitals that grant them "rights" to practice there. However they are not employees of the hospital. This may be one of the main points of difference in our attempts to get comparative data that we can agree on.

Virtualy all doctors here serve a "residency" in hospitals, following graduation from medical school, a two to three year period during which they work to gain qualifications in various specialties. "Hospitalists" is a new term to me but I take it the reference

Increasingly Health maintenance Organizations (HMOs) are hiring doctors and other practicioners who serve in an organized program functioning through clinics and hospitals. However this still represents a relatively small portion of the medical establishment.

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I knew about that, George - therefor I'd tried to show the different system here. :wink:

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How is the German system different? Are doctors in Germany generally employees of hospitals or clinics or do they operate as independent agents in their own businesses or partnerships?

I recognize that in the UK and Canada doctors are mostly employees of the respective national health services.

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They are all employed, payed on tariff (in junior ranks), get a salary by agreement in the higher ranks.
[For instance my father was paid according to the payment system in the civil service - including all benefits (= permanent position, regularily any two years a higher salary, pension ...).]

Hospitals, which don't have many (major) departments, usually offer(ed) some beds for local physicans - nowadays, hospitals built some practises for those doctors as an annex to the hospital, so they work still independent from the hospital, but can get beds there (and e.g. the anaesthetists).

The head of larger departments, especially at larger hospitals, usually are professors - even at non academic hospitals like in my town with smaller hospitals (one 310 beds, the other 380) each got three professors, as a non-academic hospital!
Those most certainly earn a lot more (= are paid on private contract, like most deputy heads of a department and some ward doctors).

The salary differs to the hospital owners (town, state = equivalent to civil service), church run (actually the same as before, but nowadays with a lower tariff, generally), privately owned (lowest tariff).

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IT'S TIME FOR UNIVERSAL HEALTH CARE

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