Monday, February 27, 2012

72% of Americans think Obamacare Unconstitutional, Go Figure!



By Charlie Spiering Commentary Staff Writer

Gallup is out with new number about President Obama's health care bill. According to the poll, 47 percent favor a repeal of the law, should a Republican president get elected and 44 percent oppose it. Not surprisingly, Republicans favor repeal by 87 percent and Democrats oppose it by 77 percent.

More importantly, 72 percent of Americans believe that the law's individual mandate to purchase health insurance is unconstitutional, including 56 percent of Democrats.

It's a bewildering conclusion. Democrats support Obamacare even though they think part of it is unconstitutional? Perhaps the wording of the first clause, "If a Republican is elected president this November" throws Democrats into defense mode.

More importantly, should the Supreme Court rule the mandate unconstitutional, the most toxic part of the legislation will be removed.

This morning's USA Today polling numbers show that only 38 percent of voters in swing states view the health care law as a "good thing" while 53 percent of voters think it is a "bad thing."

As Philip Klein has noted, that makes for some interesting presidential politics this fall.



H/T The Examiner, Washington

Wednesday, February 22, 2012

Patients, Physicians, or unelected Bureaucrats..My Healthcare...I'm going with my Doctor!


Patients, Physicians, or unelected Bureaucrats….Who can make the best decision on patient Health Issues? Me…I’m going with My physician and my life experience when making my care decisions!  
There are two competing visions for health care in America. One centralizes control in Washington DC, while the other empowers families and individuals – i.e. the patients. When people are in control of their own health care decisions, they are able to choose the best care options in a market where competition can breed excellence and lower costs. Unfortunately, decades of centralized control has devastated patient-centered, low-cost health care, the destruction of which has been hastened with the passage of “Obamacare.” This lack of personal control leads to ever-increasing requirements to seek permission from either government or insurance bureaucrats about what kind of doctor you can see, how often you can see the doctor, what kind of procedures you are allowed to access, what kind of insurance policy you can purchase, what that policy will cost and what it will cover; virtually all health care decisions will be made by unelected, unaccountable bureaucrats.

Key Points

  • The American health care system was already broken before “Obamacare” came on the scene because individuals and families had minimal control over their health care decisions.
  • “Obamacare” makes the existing problems much worse because the “cure” it offers – more government control – is the cause of the disease.
  • The key features of “Obamacare” are the individual mandate, a budget-busting expansion of Medicaid, a huge expansion of the federal government, misuse of the Constitution’s Commerce Clause, the largest tax increase in American history that will affect all Americans, and job-killing costs and regulations.
  • Americans were promised they could keep their current health plan if they wanted to, and yet thousands of people have already been forced to change.
  • Decisions about health care, your child’s health care, and your elderly parent’s health care will now be in the hands of something called the Independent Payment Advisory Board (IPAB). It’s a board of fifteen bureaucrats, appointed by the President and unaccountable to you, who will have ultimate authority about all of our health care choices.

 HAT TIP   TTP

Wednesday, February 15, 2012

Physician’s believe Obamacare will destroy the American health system!


A physician’s view of President Obama’s budget



By Rep Bill Cassidy (MD) Published: 10:18 AM 02/15/2012 | Updated: 10:24 AM 02/15/2012

The Budget President Obama released this week demonstrates the administration’s detachment from our current fiscal situation. As a physician, I’m particularly concerned about the president’s refusal to offer a plan to reform Medicare so it will be here for future generations. The budget is a tremendous opportunity to create policy, yet the president’s budget of more spending, taxing, and debt won’t prevent Medicare from going bankrupt. If that happens, people will inevitably be denied access to care. And instead of increasing freedom and choice in the Medicare market, this budget focuses on increasing federal control — a tactic that continually fails.

The importance of saving and strengthening Medicare through reforms cannot be overstated. The Congressional Budget Office (CBO) recently announced that the Medicare Trust Fund will be exhausted by 2022. Republicans and Democrats have acknowledged that the program is at a crisis level. The bipartisan Wyden-Ryan plan, similar to a plan proposed by Democratic Senator John Breaux during the Clinton years, would strengthen and preserve Medicare for those who currently depend on it, as well as for future generations. The president ignores this plan and offers no alternative, making only small and insignificant tweaks to a system that all agree is going bankrupt fast. Even the president’s Bipartisan Debt Commission reported that federal health care entitlements are unsustainable and unless restructured will bankrupt the United States.

Incredibly, the president’s budget not only ignores entitlement reform, it makes things worse by continuing to push the health care law passed in 2009. The health care overhaul gutted $500 billion from Medicare to fund new entitlement provisions, ensuring Medicare’s bankruptcy even sooner, hurting America’s seniors today, and ensuring a diminished future for future generations.

As a physician with the responsibility of treating Medicare patients, I’m worried that the president is using this budget to increase the power of the Independent Payment Advisory Board (IPAB). This unelected panel of bureaucrats has the power to set rates paid to Medicare providers. IPAB sets a budget target and then cuts provider reimbursements until that target is achieved — in effect denying care to America’s seniors. It’s a scary thought but it’s about to be a scary reality.

These are just some of the reasons the president’s budget falls well short of being responsible. It increases our national debt without resolving any of the underlying problems associated with our entitlement system. It continues to increase the debt at an astonishing rate, even though the president had promised to halve our deficits by his fourth year in office. Even with $2 trillion in new taxes and significant military cuts, this budget still increases the deficit by almost $1 trillion — the fourth-straight year of trillion-plus deficits.

America deserves more than political tactics as we seek to address our short-term and long-term prosperity. This budget is the triumph of politics over responsibility and it’s unfortunate. When the president was first elected, he spoke to the Republican House members. He said that he’d rather be a good one-term president than a mediocre two-term president. This budget suggests that the president has changed his mind.

Rep. Bill Cassidy (M.D.) represents Louisiana’s Sixth Congressional District.


Hat tip: DC Caller

Monday, February 13, 2012

Doctors say the Affordable Care Act, as written, will result in care “being rationed and more expensive.”


Think Obamacare will lower insurance premiums? Think you get better care? Think you will see a doctor whenever you feel you should?
Think again.....

Obamacare architect: Expect steep increase in health care premiums



By Myles Miller Published: 12:56 AM 02/11/2012 | Updated: 5:46 PM 02/11/2012

Medical insurance premiums in the United States are on the rise, the chief architect of President Barack Obama’s health care overhaul has told The Daily Caller.

Massachusetts Institute of Technology economist Jonathan Gruber, who also devised former Massachusetts Gov. Mitt Romney’s statewide health care reforms, is backtracking on an analysis he provided the White House in support of the 2010 Affordable Care Act, informing officials in three states that the price of insurance premiums will dramatically increase under the reforms.

In an email to The Daily Caller, Gruber framed this new reality in terms of the same human self-interest that some conservatives had warned in 2010 would ultimately rule the marketplace.

“The market was so discriminatory,” Gruber told TheDC, “that only the healthy bought non-group insurance and the sick just stayed [uninsured].”

“It is true that even after tax credits some individuals are ‘losers,’” he conceded, “in that they pay more than before [Obama's] reform.”

Gruber, whom the Obama administration hired to provide an independent analysis of reforms, was widely criticized for failing to disclose the conflict of interest created by $392,600 in no-bid contracts the Department of Health and Human Services awarded him while he was advising the president’s policy advisers.

Gruber also received $566,310 during 2008 and 2009 from the National Institutes of Health to conduct a study on the Medicare Part D plan.

In 2011, officials in Wisconsin, Minnesota and Colorado ordered reports from Gruber which offer a drastically different portrait in 2012 from the one Obama painted just 17 months ago.

“As a consequence of the Affordable Care Act,” the president said in September 2010, ”premiums are going to be lower than they would be otherwise; health care costs overall are going to be lower than they would be otherwise.”

Gruber’s new reports are in direct contrast Obama’s words — and with claims Gruber himself made in 2009. Then, the economics professor said that based on figures provided by the independent Congressional Budget Office, “[health care] reform will significantly reduce, not increase, non-group premiums.”

During his presentation to Wisconsin officials in August 2011, Gruber revealed that while about 57 percent of those who get their insurance through the individual market will benefit in one way or another from the law’s subsides, an even larger majority of the individual market will end up paying drastically more overall.

“After the application of tax subsidies, 59 percent of the individual market will experience an average premium increase of 31 percent,” Gruber reported.

The reason for this is that an estimated 40 percent of Wisconsin residents who are covered by individual market insurance don’t meet the Affordable Care Act’s minimum coverage requirements. Under the Affordable Care Act, they will be required to purchase more expensive plans.

Asked for his own explanation for the expected health-insurance rate hikes, Gruber told TheDC that his reports “reflect the high cost of folding state high risk pools into the [federal government's] exchange — without using the money the state was already spending to subsidize those high risk pools.”

Gruber’s Wisconsin presentation previously available on the website of Wisconsin’s Office of Free Market Health Care, disappeared from the state government’s Web servers shortly after Wisconsin Gov. Scott Walker issued a Jan. 18 executive order scrapping the agency’s mission.

Minnesotans have already seen a 15 percent average rate increase because their state government is spending approximately $100 million to subsidize those high-risk pools. Gruber said they, too, will see a premium increase — even after subsidies are factored in.

In his presentaion there in November, he estimated 32 percent of Minnesotans will face premiums hike similar to those of their neighbors in the Badger State.

In his Colorado analysis, which he delivered last month, Gruber wrote that while some may benefit from new tax credits folded into Obama’s health care overhaul, “13 percent of people will still face a premium increase even after the application of tax subsidies, and seven percent will see an increase of more than ten percent.”

Sally Pipes, president of the Pacific Research Institute in San Francisco, told TheDC that the health care law’s mandates will ultimately result in far greater costs across the board.

“If [instead] we change the tax code and allow a competitive market to build, and put doctors and patients in power, then that would really solve a lot of the problem,” Pipes said.

Pipes said she believes applying the Affordable Care Act, as written, will result in care “being rationed and more expensive.”






Wednesday, February 8, 2012

Doctors do not support Obamacare and tell the AMA "I quit"!

Ms Pipes does some of the best work on this subjest! She is a true pro! Keep on reading!


Sally Pipes, Contributor

I cover health policy as President of the Pacific Research Institute


9/26/2011 @ 1:50PM |211,094 views

Doctors And AMA Split Over Contentious Issue Of ObamaCare



For more than 160 years, the American Medical Association has served as the self-appointed chief lobbying group for doctors. But the AMA’s lofty status has been under threat over the last several years — and is under attack today. In fact, the AMA now only counts about 17% of doctors as members.

According to a new survey, the majority of doctors do not believe that the AMA represents their views and interests. Much of that dissatisfaction stems from the organization’s support for President Obama’s contentious health care reform package.

That shouldn’t be surprising. The AMA declares that its core mission is to “help doctors help patients.” But ObamaCare undermines that pursuit by making life harder for physicians and driving down the quality of care available to patients.

The survey — conducted by physician recruitment firm Jackson & Coker — is a brutal indictment of both the AMA and ObamaCare. Just 13% of doctors agree with their trade association’s support of the health reform law.

Some doctors are even dissociating themselves from the AMA. Of those who have terminated their membership, 47% cited the organization’s continued backing of the health care law as the primary reason. Increasingly doctors are turning to associations like Docs4PatientCare and the Association of American Physicians and Surgeons that actually do represent their interests.

The Jackson & Coker survey joins a large stack of research with similar findings. In February, the National Physicians Survey discovered that more than three times as many doctors believed that the quality of American health care would “deteriorate” rather than “improve” under ObamaCare. Nine of ten physicians think ObamaCare will have a negative impact on their profession.

There’s no doubt that it will.

Why? For starters, the law doesn’t address one of doctors’ most serious concerns — reimbursement rates for patients covered by Medicare and Medicaid. In fact, it stretches these programs’ shaky finances even further.

On average, physicians treating Medicare beneficiaries receive 81% of the rate private insurers pay. For Medicaid patients, reimbursements are even lower — just 56% of the private rate. In 2009, underpayments to hospitals amounted to $36.5 billion.

Cheerleaders for Medicare and Medicaid claim that the government is just driving a hard bargain. But these underpayments end up hurting both healthcare providers and patients.

Doctors pocket about $20 for each Medicaid patient they see. By contrast, an hour with a privately insured patient means payment of up to $260.

To compensate for lower government rates, doctors must increase their patient load. Every patient consequently spends less time with the doctor.

In some cases, doctors are responding to low reimbursements by refusing to see patients with public insurance. The American Academy of Family Physicians found that 13% of doctors did not partake in Medicare in 2009.

The numbers are even worse for Medicaid. The Houston Chronicle reported that doctors in Texas are leaving the program because of declining reimbursements at an “alarming” rate, with more than 300 drop-outs between 2008 and 2010. In Dallas, just 38.6% of physicians participated in 2009.

Given the paltry amount they’re reimbursed for seeing a Medicaid patient — and the cost of overhead — a doctor may actually lose money on each additional public patient he or she sees.

As the number of doctors who will treat them dwindles, beneficiaries of public insurance often must resort to costly alternatives like emergency rooms (ER) — even if they only need routine care.

More than 30% of Medicaid enrollees visited an ER in 2007, compared to the less than 20% of Americans with private insurance.

These visits exert a huge burden on the U.S. health care system. A 2009 study in the Annals of Internal Medicine found that treatment for three common illnesses cost an average of $166 at a general practitioner’s office. The very same treatment could run upwards of $570 in an ER.

Up to 27% of visits to ERs across the country are for non-emergency medical treatment. These unnecessary visits end up costing the country approximately $4.4 billion each year.

ObamaCare will only make these matters worse. By 2019, Medicaid will cover at least an additional 18 million Americans. All these new beneficiaries may have nominal insurance coverage. But they’ll struggle to secure a doctor’s appointment and will thus turn to already over-worked ER staffs.

The AMA claims that its top priority is helping doctors. Yet the organization has backed a law that would force some physicians to work longer hours for less pay and others to operate in perpetually overcrowded emergency rooms.

If doctors — those on the front lines of American health care — don’t support this massive overhaul of our medical system, then who can?

Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Truth About Obamacare

Friday, February 3, 2012

You think Physicians make a lot of money?.....Read this and change your mind!

Dr. Brown sure does know what he's talking about!

The Deceptive Income of Physicians

Doctors do not make as much money as you think


Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher. Physicians spend over a decade of potential earning, saving and investing time training and taking on more debt, debt that isn’t tax deductible. When they finish training and finally have an income – they are taxed heavily and must repay their debt with what remains. The cost of tuition, the length of training and the U.S. tax code places physicians into a deceptive financial situation.
The road to becoming a licensed and board certified physician is a long one. Physicians spend the equivalent of 20 years of full-time work just learning how to be a physician. First, one must earn a bachelor’s degree. Attending college full time, this will take about four years or 6,400 hours of work. 4 years x 40 wks/yr x 40 hrs/wk = 6,400 hours. To be competitive for acceptance into medical school you will likely spend far more than 40 hours per week studying, doing research and volunteering. However, to keep it simple and consistent we will neglect that extra time. After college future physicians must attend medical school. Medical students spend about 80 hours per week for 48 weeks each year studying and training which amounts to 15,360 hours over four years. After medical school, physicians must complete post-graduate training known as residency. To practice medicine in the United States physicians must pass all 3 parts of the United States Medical Licensing Exam (USMLE©) and complete at least the first year of residency, which is known as internship. Residents work long hours, weekends, nights and holidays. Most approach the legal work hour limit of 80 hrs/wk for 50 weeks each year. Many residents exceed 80 hrs/wk studying and doing research in addition to their clinical responsibilities. To become board certified, future physicians must complete an entire residency-training program and pass all additional exams for that particular specialty. For example, to become board certified in Internal Medicine, one must graduate from medical school, pass all 3 USMLEs, complete a 3-year Internal Medicine residency and pass the Internal Medicine board exam. A board certified Internal Medicine physician will spend about 34,000 hours training. To become board certified in Thoracic Surgery – one must graduate from medical school, pass all 3 USMLEs, complete a 5-year General Surgery residency, complete a 2-year thoracic surgery fellowship and pass the Thoracic Surgery board exams. A board-certified Thoracic Surgeon will spend about 49,760 hours training. The shortest residency training programs are 3 years long and include the primary care specialties of Internal Medicine, Family Medicine and Pediatrics.

Spending 40,000 hours of one’s young adult life learning how to be a physician is an admirable sacrifice, especially considering one must spend more money than one earns to work those 40,000 hours. The long hours don’t necessarily end after residency. In 2007, physicians from over 20 specialties were asked how many hours per week they generally work – the average was 59.6 hours per week.1 So even after physicians finish their 40,000 hours of training they continue to work one-and-a-half times as much most Americans for the rest of their career. In short, physicians work two-full time jobs while in training and one-and-a-half full time jobs when they are finished. They have to work nights, evenings, weekends, holidays and take call. For most physicians, there is no such thing as overtime or holiday pay.

Why does it have to take so long?

There are no shortcuts to gaining the knowledge and experience one needs to be a competent physician, they need to put in the time to get the experience. Because there is no shortcut to gaining the experience one needs to be a competent physician, decreasing resident work hours from 80 hours per week to 60 hours per week is a terrible idea. If such a change occurs, residency training would have to become years longer in order to get the same experience. Making physician training longer will further increase student debt loads and decrease the number of years physicians are able to work after they are trained. It will increase the number of physicians in training and decrease the physician workforce.
Becoming a physician is expensive. For the 2009-2010 academic year, the average total student budget for public and private undergraduate universities was $19,338 and $39,028, respectively.2 If one attends an average priced institution, receives subsided loans and graduates in four years they will have about $100,000 of student loan debt from college. For the 2009-2010 academic year, the median cost of tuition and fees for public and private medical schools was $24,384 and $43,002 per year, respectively.3 This does not include the cost of rent, utilities, food, transportation, health insurance, books, professional attire, licensing exams fees or residency interview expenses. Therefore, the average medical student budget is about $45,000 per year; $30,000 for tuition and $15,000 for living expenses. If one attends an average priced medical school, receives 1/3 subsidized loans and graduates in 4 years; at a 7% APR they will have $200,527 of debt from medical school at graduation. If one borrows $22,500 bi-annually and two-thirds of this accrues interest compounded bi-annually at 3.5% – their total student loan debt for both college and medical school will then be $300,527. Forbearing this debt through 5 years of residency and paying it off over 20 years will cost about $788,880 of one’s net income.
Loan repayment programs such as those offered by the military are not a solution for the majority. Each year, about 22,000 medical students graduate from U.S. allopathic and osteopathic medical schools.4,5 Each year the military matches 800 students into its residency training programs, because that is the military’s anticipated future need for physicians.

The U.S. tax code allows taxpayers to deduct a maximum of $2,500 per year of student loan interest paid to their lender. This deduction is phased out between incomes of $115,000 and $145,000.6 Therefore, this benefit is of no help to most physicians. If one were to start a business, they could deduct nearly all of their expenses. Yet for unclear reasons, one cannot deduct the cost of becoming a physician; not the tuition or even the interest on the money they borrowed to pay their tuition.

During residency, if one makes payments of $1,753 per month, or $21,037 per year, to pay off the accruing interest, thier debt will be still be $300,527 at the end of residency. However, they will have spent $63,111 over the course of a 3 year residency or $126,222 over the course of a 6 year residency to keep their debt from growing. Though paying off the interest during residency is the responsible thing to do; coming up with $21,037 each year from one’s net pay of $40,000 may be quite difficult.

Time spent training, student loan debt and the U.S. tax code makes the income of physicians deceiving. A board certified internal medicine physician who is married with 2 children, living in California and earning the median internist annual salary of $205,441 will be left with $140,939 after income taxes and $106,571 after student loan payments.7 This is assuming a federal Income tax rate of 28%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%. You can go to www.paycheckcity.com to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc. Paying off a debt of $369,425 over 20 years at a 7% APR will require annual payments of $34,368. Those student loan payments will continue to consume about $34,000 of their net income for 20 years until they are finally paid off. What started off as $300,527 in student loan debt will end up costing $687,360. This debt that consumes one-fourth of their net income for 20 years wasn’t accrued because they bought a house they couldn’t afford – it is because they chose to become a physician.

Believe it or not, the amount of money reaching a physician’s personal bank account per hour worked is only a few dollars more than that of a high school teacher.
In order to make this calculation we will neglect inflation of the U.S. dollar by assuming that inflation will increase at the same rate as the purchasing power of the U.S. dollar decreases. We will also assume that physician incomes keep pace with inflation. We will also assume that tuition costs, student loan interest rates, resident stipends, physician reimbursements and the U.S. income tax structure are as described above and do not change.

The median gross income among internal medicine physicians is $205,441.7 The median net income for an internist who is married with two children living in California is then $140,939. Internal medicine is a three-year residency, so throughout residency they will earn a total net income of about $120,000 and spend about 35,000 hours training after high school. The total cost of training including interest, forbeared for three years and paid off over 20 years as explained above is $687,260. One study reported that the average hours worked per week by practicing Internal Medicine physicians was 57 hours per week.8 Another study reported the mean to be 55.5 hours per week.9 We will use 56 hours per week and assume they work 48 weeks per year. If they finish residency at 29 years old and retire at 65 years old they will work for 36 years at that median income.

[(140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)] = $34.46

The adjusted net hourly wage for an internal medicine physician is then $34.46

The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000.10 The median net income for a high school teacher who is married with two children living in California is then $42,791. This is assuming a federal Income tax rate of 15%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%. You can go to www.paycheckcity.com to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc. Teachers spend about 6,400 hours training after high school, the amount of time it takes to get a bachelor’s degree. The total cost of training if one attends an averaged priced institution and pay off their debt over 20 years at a 7% interest rate is $186,072. At this income one would be able to deduct the interest on their student loans from their income taxes; however, those savings are not accounted for in the calculation below. High school teachers have about 10 weeks off each summer, 2 weeks off during Christmas, 1 week off for spring break and 1 week of personal paid time off. Therefore, high school teachers who work full time average of 40 hours per week for 38 weeks each year. Yes, teachers spend time “off the clock” preparing for class, correcting papers, etc. However physicians also spend time “off the clock” reading, studying, going to conferences, etc. If a high school teacher finishes college at 22 years old and retires at 65 years old, they will work for 43 years. Most teachers also receive a pension. We will assume their gross annual pension including the value of benefits is $40,000 which is a net pension of $35,507. If they die at 80 years old they will receive this pension for 15 years.

[(42,791 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

The adjusted net hourly wage for a high school teacher is then $30.47

The median gross income among internal medicine physicians is $205,441.7 The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000 per year.10 Accounting for time spent training, student loan debt, years worked, hours worked per year and disproportionate income taxes – the net adjusted hourly wage of an internist is $34.46 per hour, while that of a high school teacher is $30.47 per hour. Though the gross income of an internal medicine physician is 4 times that of a high school teacher, the adjusted net hourly wage of an internal medicine physician is only 1.13 times that of a high school teacher. Most people would argue that high school teachers are not paid enough, yet for some reason most people would also argue that physicians are paid too much.

Isn’t taking care of patients rewarding regardless of income?

Yes, taking care of patients is rewarding. However, when physicians are unfairly reimbursed for their services they feel exploited. This feeling of exploitation or being taken advantage of is what bothers physicians the most. Physicians spend 40,000 hours training after high school and take out over a quarter million dollars in loans all so that when they are done they can work 60 hours per week, be paid less than they were expected, give about 40% of their income to the government in taxes and pay 25% of their net income to their student loan lender. They feel exploited because after all that they have sacrificed they are enslaved to the highly regulated healthcare industry, which unfairly pays them.

On June 18, 2010 the Centers for Medicaid and Medicare Services (CMS) instructed its Medicare contractors to start processing claims for physician payments at a 21.3% reduced rate.11 Should other payers follow Medicare, as they so often do, physicians may have to find another line of work. Decreasing a physician’s reimbursements by 21.3% doesn’t mean that a physician’s gross income will go from $200,000 to $157,400 – it will likely decrease much, much more. Let’s say Dr. Smith, an internal medicine physician, spends 15 minutes caring for a Medicare patient and bills Medicare $100 for this service. From that visit, Dr. Smith’s profit margin is say 40%, $60 to cover her overhead and $40 profit. Prior to this recent change, Medicare typically paid about 60 cents on the dollar, which is why most physicians barely broke even caring for Medicare patients. The 21.3% decrease in physician reimbursements will likely be 21.3% of that $60, so Dr. Smith will now be reimbursed only $47.22 dollars for that visit which is less than the $60.00 it cost Dr. Smith to see the patient. Therefore, Dr. Smith will spend $12.78 to care for that Medicare patient. This is generous of Dr. Smith and all, but it is unsustainable. It is unsustainable for Dr. Smith and unsustainable for the future of medicine.

In an era of skyrocketing healthcare costs, an increasing need for healthcare services and diminishing resources – Americans need to be cognizant of whom they exploit. Physicians want to work hard and do whatever they can for their patients. And like every other American, physicians also want to be appreciated and fairly compensated for their time and financial sacrifice.

Addendum #1 – The Net Adjusted Hourly Wage of Dentists and Nurses
The median gross income among general dentists who work full time in a group practice is $220,000.(12) The median net income for a general dentist who is married with two children living in California is then $149,681. General dentists who work full time in a group practice with partners work an average of 38 hours per week, 1,727 hours per year.(12) Dentists spend about 17,920 hours training after high school. The total cost of training if you attend averaged priced institutions pay off your debt over 20 years at a 7% interest rate is $558,216. If you finish dental school at 26 years old and retire at 65 years old they will work for 39 years.

[(149,681 x 39) – (558,216)] / [(1,727 x 39) + (17,920)] = $61.91

The adjusted net hourly wage for a general dentist is then $61.91

The median gross income of a registered nurse is $62,450.(13) The median net income of a registered nurse who is married with two children and lives in California is then $51,787. To become a registered nurse via the associate’s degree route takes 2 years, about 4000 hours of training. The average total student budget at a public 2-year university is $14,285.(14) The total cost of becoming an R.N. is then $28,570. If that debt is paid off over 20 years at a 7% interest rate it will end up costing a total of $53,160. At this income you will be able to deduct student loan interest costs from your federal income taxes, these savings are not included in the calculation below. If you finish nursing school at 20 years old and work until you are 65 years old you will work for 45 years at that median income. We will assume you work 40 hours per week, 50 weeks per year.

[(51,787 x 45) – (53,160)] / [(40 x 50 x 45) + (3,200)} = $24.43

The adjusted net hourly wage for a registered nurse is $24.43

What if an R.N. worked as much as an internal medicine physician? Unlike a physician, an R.N. would receive overtime pay for the hours they worked in excess of 2,000 per year.
Variables that will decrease a physician’s adjusted net hourly wage include: a shorter career, increased taxation, decreased income, working more hours for the same or less pay, spending more than average on tuition, spending more time training and decreased resident pay.

Variables that will increase a physician’s adjusted net hourly wage include: a longer career, decreased taxation, increased income, working fewer hours for the same or more pay, spending less than average on tuition, having less debt, paying off your debt early and increased resident pay.

Addendum #2. Residency Match Data.

Food for thought.

Data of applicants who successfully matched by specialty in 2009 (14-17)

(Calculations include both U.S. Allopathic Seniors and Independent applicants)

Specialty
Average
USMLE
Step 1
Average
USMLE Step 2
% US Seniors who were AOA
Average # Abstracts, Presentations and Publications
Plastic Surgery
242
242
42
9
Dermatology
240
248
51
7
Otolaryngology (ENT)
240
245
37
4
Neurosurgery
239
237
28
8
Radiation Oncology
238
241
35
8
Diagnostic Radiology
238
242
23
4
Orthopedic Surgery
237
240
28
4
Ophthalmology
235
-
-
-
Pathology
226
227
13
5
Neurology
225
229
12
4
Anesthesiology
224
230
10
2
Internal Medicine
224
229
15
3
General Surgery
224
230
12
3
Internal Medicine/Pediatrics
222
231
21
2
Child Neurology
221
-
-
-
Emergency Medicine
221
229
11
2
Pediatrics
218
227
12
2
Obstetrics & Gynecology
217
227
14
2
Physical Medicine & Rehabilitation
213
216
4
2
Psychiatry
213
217
4
2
Family Medicine
208
214
5
1