via Galen’s Log, Curious Troll JD (see also Adversarial Process) is at it again — this time the hyperbole is at Kevin’s.
Dear Dr. Kettle:
(Curiosity #1) “Has there ever been a more highly paid profession that whined as much as physicians these last few years? How much more money do you need to make it worth doing? To whom much is given, much is expected.”
(Curiosity #2) “I’ve never seen the God complex laid out so nicely. And coupled with a victim mentality as well! So tell me, how much money would it take for you to feel adequately compensated for saving all our lives?”
Sincerely,
Mr. Pot, Esq.
When [your] profession has a governmental or third party imposed and enforced fee schedule, as opposed to a reasonable fee; and [you] serve as a major food source for another profession — then [you] have earned the right to suggest that a profession, whose shoes [you] have never walked in, may be whining too much.
8 Comments
Symtym,
I’ll ask you what I asked Kevin - how much would it take to make you feel loved?
You know that physicians on average make much more than lawyers, correct? And all lawyers have restrictions on what they bill. Insurance defense lawyers have the same insurance reimbursement problems physicians have. And for the rest of us, we’re in the private market, competing with everyone else and with cost conscious clients. Do clients who pay the bill not count as third parties? What makes you think that being in the private market would be such a boon for physicians? Do you think physicians wouldn’t undercut each other on price?
A major food source for another profession? Can you define that for me? How many lawyers make their living doing med mal plaintiff’s work? What’s your definition of major? One thing law school will teach you is that bullshit phrases like that don’t hold much water without facts to back them up.
My question is simple - how much would it take to make physicians feel loved. We keep hearing how tough it is - so what would make it worthwhile?
Physicians go on and on about how much lawyers make, and how med mal is a “windfall” for victims, but they won’t talk about how much they make or how much they want to make. They just complain about their expenses.
Symtym,
I'll ask you what I asked Kevin - how much would it take to make you feel loved?
You know that physicians on average make much more than lawyers, correct? And all lawyers have restrictions on what they bill. Insurance defense lawyers have the same insurance reimbursement problems physicians have. And for the rest of us, we're in the private market, competing with everyone else and with cost conscious clients. Do clients who pay the bill not count as third parties? What makes you think that being in the private market would be such a boon for physicians? Do you think physicians wouldn't undercut each other on price?
A major food source for another profession? Can you define that for me? How many lawyers make their living doing med mal plaintiff's work? What's your definition of major? One thing law school will teach you is that bullshit phrases like that don't hold much water without facts to back them up.
My question is simple - how much would it take to make physicians feel loved. We keep hearing how tough it is - so what would make it worthwhile?
Physicians go on and on about how much lawyers make, and how med mal is a “windfall” for victims, but they won't talk about how much they make or how much they want to make. They just complain about their expenses.
I don’t believe it really is a question of about “feel[ing] loved,” but rather about not feeling the love for the profession many of us felt in medical school and in the early years of practice. The complexities of practice are ever increasing — not just the litigous aspects, but also the risk avoidance, regulatory, etc. aspects.
And both the physician and the lawyer make much more than the general population. So what? I’m unaware of any linearity between income and “feel[ing] loved.” And just because X makes more then Y is no argument that X should be happy and not whine (isn’t that the gist of your argument?).
No, lawyers have a reasonable fee imposition. “Insurance defense lawyers” [may] have the same reimbursement issues that physicians have. But it is the rare physician that is not reimbursed, in whole or part, by insurance or from governmental sources (third parties). There is a vast gulf between “reasonable fee” and “may” participate in insurance work and mandatory third party fee schedules.
C’mon, “attorney-client” relationship — that’s the first and second parties. No, clients are not third parties! You know that! That is a basic legal ethics question — who is the client and who are the third parties.
You are confusing terms, I see no such argument for a “private market.” What is being compared is a marketplace where competition is based upon a “reasonable fee” vs. a marketplace where competition is based upon who can survive or prevail based upon third party payments.
There are no reasons to suspect (or suggest) that physicians and lawyers would act and perform in similarly situated marketplaces; however, the crux of your argument is that you believe they are similarly situated. I believe the economic dynamics of their respective marketplaces are vastly different.
The point? You don’t like being baited either. The more subtle points are: predation is commonly felt (albeit sans facts, but such is the nature of feeling) and there is no medical discipline that specializes in the treatment of lawyers (although one can envision a variation of acupuncture using 16G needles). Psss, I have my stethoscope on, I’m way too young to be wearing scales …
You have asked two very different question, and the asking suggests (at least to your mind) that they are linked. Anyone going to a professional school has some expectations as to what they will be earning. Many professionals soon find the realities of the marketplaces do not fit with the images they had during professional training. It is the clashing of the realities and the aspirations of medical practice. To some degree more income may compensate for the shortcomings of the practice environment, but their will be limits.
To answer your questions succinctly, there are no linear relationships between “how much would it take,” “feel loved,” and “worthwhile.” To use a legal phrase, those are highly factual questions. To ask for simple answers trivializes the complexities of the issues at play. I would not expect a lawyer to be able to answer those questions for their profession either.
In medicine, over the last generation we have seen legal actions against physician morph from contractual and tortious theories to negligence as the all prevailing theory of malpractice. Not dissimilar from the legal profession’s theoretical bases for malpractice.
In that same generation, medicine has gone from fee-for-service (not dissimilar from the legal profession’s “reasonable fee”) to predominantly (if not exclusively) third party payment (governmental and private) based upon schedules. Coupled with this are the regulatory burdens.
Some physicians do — here’s another irony, you traipse into the medical blogosphere with the expectation that physicians writing (predominately personal perspectives) would be anything different from a physician’s perspective and not voice commonly held themes amongst the medical and greater healthcare communities (whether or not factually based is not really the point). Try criticizing the argu[ment] and not the holder of the beliefs.
Not talking about income and only complaining about expenses — well that sounds just like everyone that works!
I don't believe it really is a question of about “feel[ing] loved,” but rather about not feeling the love for the profession many of us felt in medical school and in the early years of practice. The complexities of practice are ever increasing — not just the litigous aspects, but also the risk avoidance, regulatory, etc. aspects.
And both the physician and the lawyer make much more than the general population. So what? I'm unaware of any linearity between income and “feel[ing] loved.” And just because X makes more then Y is no argument that X should be happy and not whine (isn't that the gist of your argument?).
No, lawyers have a reasonable fee imposition. “Insurance defense lawyers” [may] have the same reimbursement issues that physicians have. But it is the rare physician that is not reimbursed, in whole or part, by insurance or from governmental sources (third parties). There is a vast gulf between “reasonable fee” and “may” participate in insurance work and mandatory third party fee schedules.
C'mon, “attorney-client” relationship — that's the first and second parties. No, clients are not third parties! You know that! That is a basic legal ethics question — who is the client and who are the third parties.
You are confusing terms, I see no such argument for a “private market.” What is being compared is a marketplace where competition is based upon a “reasonable fee” vs. a marketplace where competition is based upon who can survive or prevail based upon third party payments.
There are no reasons to suspect (or suggest) that physicians and lawyers would act and perform in similarly situated marketplaces; however, the crux of your argument is that you believe they are similarly situated. I believe the economic dynamics of their respective marketplaces are vastly different.
The point? You don't like being baited either. The more subtle points are: predation is commonly felt (albeit sans facts, but such is the nature of feeling) and there is no medical discipline that specializes in the treatment of lawyers (although one can envision a variation of acupuncture using 16G needles). Psss, I have my stethoscope on, I'm way too young to be wearing scales …
You have asked two very different question, and the asking suggests (at least to your mind) that they are linked. Anyone going to a professional school has some expectations as to what they will be earning. Many professionals soon find the realities of the marketplaces do not fit with the images they had during professional training. It is the clashing of the realities and the aspirations of medical practice. To some degree more income may compensate for the shortcomings of the practice environment, but their will be limits.
To answer your questions succinctly, there are no linear relationships between “how much would it take,” “feel loved,” and “worthwhile.” To use a legal phrase, those are highly factual questions. To ask for simple answers trivializes the complexities of the issues at play. I would not expect a lawyer to be able to answer those questions for their profession either.
In medicine, over the last generation we have seen legal actions against physician morph from contractual and tortious theories to negligence as the all prevailing theory of malpractice. Not dissimilar from the legal profession's theoretical bases for malpractice.
In that same generation, medicine has gone from fee-for-service (not dissimilar from the legal profession's “reasonable fee”) to predominantly (if not exclusively) third party payment (governmental and private) based upon schedules. Coupled with this are the regulatory burdens.
Some physicians do — here's another irony, you traipse into the medical blogosphere with the expectation that physicians writing (predominately personal perspectives) would be anything different from a physician's perspective and not voice commonly held themes amongst the medical and greater healthcare communities (whether or not factually based is not really the point). Try criticizing the argu[ment] and not the holder of the beliefs.
Not talking about income and only complaining about expenses — well that sounds just like everyone that works!
How do you highlight the previous posts? That’s cool. Anyway, starting from the bottom:
You’re right it is what everyone does. But not everyone seeks legislation that harms third parties in an attempt to right that wrong.
While my initial comment was over the top, and indeed designed to invite comment, do not mistake the respect I have for physicians. I vehemently disagree with the legislative proposals many are backing these days, but I would not denigrate the profession as a whole. Personally, I think it’s sad how the two most noble professions have turned on each other. We’re all so quick to paint with a broad brush these days.
And my initial comment was not meant as a personal attack on Kevin, it was an open question to all. Although I do wonder when physicians became so sensitive, considering the things regularly said about lawyers.
It’s not a hard thing to understand. The medical blogosphere is filled with stories expressing dissatisfaction with the practice due to reimbursement rates, patient attitudes, the perceived legal climate etc. (not that different from the legal blogosphere I might add). But at some point, there is a dollar value that makes it all worthwhile. What is that dollar value? That’s all there is to my question. And so far only one brave soul has dared answer.
I sympathize greatly with the reimbursement issues. Dealing with insurers is one reason I don’t do insurance defense work anymore. By the way, just because you can CHARGE a reasonable fee, that’s no guarantee you will be paid. Being in business for yourself is one of the great risks of our professions. That’s why some lawyers do insurance defense work, for the guarantee of the steady paycheck even if you do have to fight some to get reimbursed fully. And there are some lawyers, just as there are some physicians, who would rather set their own fee schedule. It’s a matter of who is willing to take the risk.
How do you highlight the previous posts? That's cool. Anyway, starting from the bottom:
You're right it is what everyone does. But not everyone seeks legislation that harms third parties in an attempt to right that wrong.
While my initial comment was over the top, and indeed designed to invite comment, do not mistake the respect I have for physicians. I vehemently disagree with the legislative proposals many are backing these days, but I would not denigrate the profession as a whole. Personally, I think it's sad how the two most noble professions have turned on each other. We're all so quick to paint with a broad brush these days.
And my initial comment was not meant as a personal attack on Kevin, it was an open question to all. Although I do wonder when physicians became so sensitive, considering the things regularly said about lawyers.
It's not a hard thing to understand. The medical blogosphere is filled with stories expressing dissatisfaction with the practice due to reimbursement rates, patient attitudes, the perceived legal climate etc. (not that different from the legal blogosphere I might add). But at some point, there is a dollar value that makes it all worthwhile. What is that dollar value? That's all there is to my question. And so far only one brave soul has dared answer.
I sympathize greatly with the reimbursement issues. Dealing with insurers is one reason I don't do insurance defense work anymore. By the way, just because you can CHARGE a reasonable fee, that's no guarantee you will be paid. Being in business for yourself is one of the great risks of our professions. That's why some lawyers do insurance defense work, for the guarantee of the steady paycheck even if you do have to fight some to get reimbursed fully. And there are some lawyers, just as there are some physicians, who would rather set their own fee schedule. It's a matter of who is willing to take the risk.
Use the blockquote tag and I use an HTML editor to compose with (I cheap
)
I don’t necessarily disagree, but that’s what the legislative process is all about. What can be enacted by the prevailing influences of constituencies — the heart of democracy. Are there unintended consequences? Sure, there will always be third parties that may or may not be benefited or harmed with every legislative action.
As with many legislative actions, to a certain degree, they represent the collective angst of the proponent constituencies. Medicine, not unlike many professions, is too complex to legislative without significant downsides. I don’t believe legislation per se will fix the “medical malpractice crisis.” Part and parcel with the need for a “fix” should be how do we “fix” medical errors and how are the truly harmed reasonably compensated.
Understood. Perhaps it is the inherently adversarial nature of our legal system and the average physicians’ contact with that system will by necessity and design be adversarial in nature. Contrast that with the average lawyers’ contact with the medical system — by-in-large it is not adversarial …
I probably follow as many legal blogs as I do medical blogs, and I agree there is a difference — I’m not sure there is a single or multiple factors that I could identify. I would venture a guess that it has more to do with fundamental differences between lawyers and physicians as to training and communication abilities. Additionally, what is happening to medicine is widespread, pervasive, and seemingly longlasting — not just malpractice, but managed care, regulatory burdens, etc. Again, I don’t think you’ll get a specific dollar value — it is much more complex. I’m sure many physicians would settle for a lot less if there was no regulatory burden, no third party authorizations, etc. Conversely, there are certain practice setting no one will take at any cost.
I think you answered your own question, regarding a dollar value — it depends. Depends on the work, the risk, guaranteed compensation, etc.
There are tremendous similarities between the medical and legal professions — and both have similar metrics for measuring value for what product they produce and what compensation they should receive. On our side of the street 50-60% of our reimbursement can be traced to governmental sources and 40-50% to non-governmental sources (third parties) based upon payer sources. Very few patients pay cash. Analogizing medicine to the legal profession, there is no pro bono pool of 45 million clients that can not pay or pay much less than a reasonable rate. Healthcare is very much perceived as a right or a basic utility, yet funded at a level orders of magnitude less than that demand. Legal representation is not, except for constitutional protections in criminal actions and the ethical recommendations (MRPC) for pro bono work.
Use the blockquote tag and I use an HTML editor to compose with (I cheap <img src=”http://symtym.com/rsc/smiling.gif”> )</img>
I don't necessarily disagree, but that's what the legislative process is all about. What can be enacted by the prevailing influences of constituencies — the heart of democracy. Are there unintended consequences? Sure, there will always be third parties that may or may not be benefited or harmed with every legislative action.
As with many legislative actions, to a certain degree, they represent the collective angst of the proponent constituencies. Medicine, not unlike many professions, is too complex to legislative without significant downsides. I don't believe legislation per se will fix the “medical malpractice crisis.” Part and parcel with the need for a “fix” should be how do we “fix” medical errors and how are the truly harmed reasonably compensated.
Understood. Perhaps it is the inherently adversarial nature of our legal system and the average physicians' contact with that system will by necessity and design be adversarial in nature. Contrast that with the average lawyers' contact with the medical system — by-in-large it is not adversarial …
I probably follow as many legal blogs as I do medical blogs, and I agree there is a difference — I'm not sure there is a single or multiple factors that I could identify. I would venture a guess that it has more to do with fundamental differences between lawyers and physicians as to training and communication abilities. Additionally, what is happening to medicine is widespread, pervasive, and seemingly longlasting — not just malpractice, but managed care, regulatory burdens, etc. Again, I don't think you'll get a specific dollar value — it is much more complex. I'm sure many physicians would settle for a lot less if there was no regulatory burden, no third party authorizations, etc. Conversely, there are certain practice setting no one will take at any cost.
I think you answered your own question, regarding a dollar value — it depends. Depends on the work, the risk, guaranteed compensation, etc.
There are tremendous similarities between the medical and legal professions — and both have similar metrics for measuring value for what product they produce and what compensation they should receive. On our side of the street 50-60% of our reimbursement can be traced to governmental sources and 40-50% to non-governmental sources (third parties) based upon payer sources. Very few patients pay cash. Analogizing medicine to the legal profession, there is no pro bono pool of 45 million clients that can not pay or pay much less than a reasonable rate. Healthcare is very much perceived as a right or a basic utility, yet funded at a level orders of magnitude less than that demand. Legal representation is not, except for constitutional protections in criminal actions and the ethical recommendations (MRPC) for pro bono work.