wnyc.org / 93.9fm / am 820

I'm a Psychologist and a Medicare provider. Yes I would sign up for a gov't plan. They can't be worse than the commercial insurers.

continued from Marcia Angell's 2009 article:

"In view of this control and the conflicts of interest that permeate the enterprise, it is not surprising that industry-sponsored trials published in medical journals consistently favor sponsors' drugs—largely because negative results are not published, positive results are repeatedly published in slightly different forms, and a positive spin is put on even negative results. A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies were published.[8] But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome. It is not unusual for a published paper to shift the focus from the drug's intended effect to a secondary effect that seems more favorable."

"The suppression of unfavorable research is the subject of Alison Bass's engrossing book, Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial. This is the story of how the British drug giant GlaxoSmithKline buried evidence that its top-selling antidepressant, Paxil, was ineffective and possibly harmful to children and adolescents. Bass, formerly a reporter for the Boston Globe, describes the involvement of three people—a skeptical academic psychiatrist, a morally outraged assistant administrator in Brown University's department of psychiatry (whose chairman received in 1998 over $500,000 in consulting fees from drug companies, including GlaxoSmithKline), and an indefatigable New York assistant attorney general. They took on GlaxoSmithKline and part of the psychiatry establishment and eventually prevailed against the odds."

And Elena, since you think this all stopped in the 1970's, here's the money quote from Marcia Angell:

"A few decades ago, medical schools did not have extensive financial dealings with industry, and faculty investigators who carried out industry-sponsored research generally did not have other ties to their sponsors. But schools now have their own manifold deals with industry and are hardly in a moral position to object to their faculty behaving in the same way. A recent survey found that about two thirds of academic medical centers hold equity interest in companies that sponsor research within the same institution.[6] A study of medical school department chairs found that two thirds received departmental income from drug companies and three fifths received personal income.[7] In the 1980s medical schools began to issue guidelines governing faculty conflicts of interest but they are highly variable, generally quite permissive, and loosely enforced."

"Because drug companies insist as a condition of providing funding that they be intimately involved in all aspects of the research they sponsor, they can easily introduce bias in order to make their drugs look better and safer than they are. Before the 1980s, they generally gave faculty investigators total responsibility for the conduct of the work, but now company employees or their agents often design the studies, perform the analysis, write the papers, and decide whether and in what form to publish the results. Sometimes the medical faculty who serve as investigators are little more than hired hands, supplying patients and collecting data according to instructions from the company."

from Angell's article:

"Recently Senator Charles Grassley, ranking Republican on the Senate Finance Committee, has been looking into financial ties between the pharmaceutical industry and the academic physicians who largely determine the market value of prescription drugs. He hasn't had to look very hard.

"Take the case of Dr. Joseph L. Biederman, professor of psychiatry at Harvard Medical School and chief of pediatric psychopharmacology at Harvard's Massachusetts General Hospital. Thanks largely to him, children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration (FDA) for that purpose and none of which were approved for children below ten years of age."

Smidely, thanks!

Elena,

"Eva, sounds like your thinking of MDs from the seventies who had loads of Big Pharma sponsored fun."

Not at all. To read Marcia Angell, the former editor of The New England Journal of Medicine, or to read The Financial Times, The New York Times, or The New York Review of Books, or to read Melody Petersen's book "Our Daily Meds" is to understand that the situation has only grown WORSE in the past 35 years.

And, of course, there's my personal experience from the health care field - but I'd prefer to confirm those experiences with tangible evidence provided by investigative reporters as listed above.

Here's an article by Marcia Angell in The New York Review of Books titled "Drug Companies and Doctors: A Tale of Corruption":

http://www.nybooks.com/articles/22237

And not just drug companies, but medical equipment suppliers, such as Medtronic, according to The New York Times:

http://query.nytimes.com/gst/fullpage.html?res=9E04E4D6133FF937A15752C0A9609C8B63&sec=&spon=&pagewanted=print

"(Medtronic's) 'bribery program,' as it was described in the suit, ''has not only failed to cease, but continues unabated with increased payments made to many physicians,'' the suit said.... A doctor in Virginia, Hallett Mathews, for example, made $300,000 in consulting fees in 2003 but only $75,000 in 2004. Last year, the company paid him nearly $700,000 for his consulting work through September."

I could go on, but I am offering citations from former editors of The New England Journal of Medicine, and articles from NYTimes writers. You, however, are offering your singular... opinion. At this point, I do doubt you are an M.D. - again, I know no M.D.'s who aren't very concerned about how many of their peers have colluded with the pharmaceutical industry.

Thanks for the article tips, Eva, and I appreciated your comments and admire your patience. I was waiting for you to break but you didn't! I read neither of the articles you have recommended but will read both. Elena I hope you read them too.

Not a part of the AMA. They are interested in taking care of subspecialists predominantly. Eva, sounds like your thinking of MDs from the seventies who had loads of Big Pharma sponsored fun. Smidely, your lucky your healthy and that has nothing to do with being young. And I'm new to commenting on-line and to be honest neither of you are interested in seeing much other views besides those that fit your sterotypes. Birds of a feather...

Smidely,

Did you read this piece on health care "rationing" by Davi Leonhardt? It just came out on The New York Times website.

Brilliant.

http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html

Smidely,

Perhaps we should consider the possibility that Elena and Cale are not M.D.'s, but "professional" writers from the marketing department of the AMA. Perhaps they are directoed to go on message boards such as these and post passionate, if misguided, defenses of a dying association and its remaining members. I don't recall seeing those names before (OTOH, it's not like I'm keeping records.)

Yes, I've known difficult doctors. But Cale took the cake, and I frankly don't know any doctors who actually believe the pharmaceutical industries are doing "important new research" or however Elena referred to it yesterday. Perhaps ER docs are a cynical lot, but they mostly thought pharma was doing "important new MARKETING." It didn't stop them from taking the samples and having the "girls" entertain them.

Elena/63 --

re your comment
"2.It is unfortunate Smidely doesn't have a primary MD he has a decent relationship with..."

Fortunately I am not in dire NEED of a decent relationship w a primary MD since I am healthy, strong and relatively young. But given the incredible cost, in more ways than one, of my coverage -- combined with my determination to find a competent, organized, clear minded GP and subsequent settling instead for just another self-righteous twerp, I am irritated that this attitude that I assumed was my bad luck is actually a full-fledged professional position, ardently and blindly defended.

is this is doctor bashing? is it doctor bashing to question a doctor? Is it doctor bashing to suggest that doctors should reduce their insurance by being more careful, better listeners, less busy, less prideful, more educated, and put a shoulder behind preventive medicine even if it means less short term money in their pockets? yes and i'm sorry.

Elena,

Thanks for your response. I'll respond point by numbered point.

1) I agree that the call for reform should come from doctors and nurses - they have the most power within the establishment.

BTW, please don't include me in the accusation of "doctor-bashing" - I am persistently critical as one should be of any group that one has confidence in. But when I write that doctors deserve their salaries (which I have repeatedly, and that you are hardworking and often brilliant, that's HARDLY bashing.

2) I have no comment on Smidely's situation.

3) As my attending physician once remarked, "you need more research on Type II diabetes? Don't eat so much! Get off the Wii and run around the park."

We don't need more "research" of the type you seem to suggest- we KNOW what the problem is. Hello? We know that T2 and heart disease are PREVENTABLE. So why do you need more pharma research? (So you can get more pens? Throw those pharma reps out the door, PLEASE, I BEG YOU!) We don't need statins given to 10-year-olds, which is the neat research that pharma funded in the last year. Do you understand? THROW THE BUMS OUT. STOP DEFENDING THEM. SHOW SOME SPINE.

4) If you want the nurses and other support rated, I think it's a great idea.

5) Why aren't insurers held responsible? They are. People hate them. People have hated them for years. But make the connection - as Gawande has - between doctors and the insurance companies. That is, you none-too-neatly evaded the issue of the Gawande article, which is now mandatory reading at the White House. Did you read it? What are your thoughts on the complicity that he brings up regarding the relationship between M.D.'s and the insurers?

Eva,
1.I do believe that what you are saying is quite valid as physicians had abdicated their responsibilities in the past 30 years and that has contributed to the decay of the health care system. But I reiterate that all health care providers are equally guilty of their abdication of responsibilty and MD bashing is not the solution to the issues we face.
2.It is unfortunate Smidely doesn't have a primary MD he has a decent relationship with. 3.As for DM and heart disease management, people are living longer and with less complications as a result of the advances that are made in medicine and that is unfortunately being funded by Big Pharma because there is not many other industries out there to pay for the studies. Research requires money and the government isn't paying for it. Philanthropy isn't paying for all the research out there and the American public demands a cure for Alzheimers, lupus, etc. Will our fellow Americans pay for the cost of research also?
4.Commercial insurers are already ranking their MDs on the quality of their care when compared to national standards and I hope all health care providers are ranked as well.
5.Why aren't the insurers held responsible for not keeping up with the standard of care and basing their decisions primarily on costs?
My point remains... it's not just the MDs fault. There is pleny of blame to go around. The question is will you be a part of the solution and not merely point the finger.

Elena wrote:

"There is a price to pay for technology understandably but the cost of care has not risen so much due to health care providers salaries but due to pharmaceutical costs."

I agree to an extent, and again, I do not begrudge doctors their well-earned salaries, as I have already stated. But since pharma costs are such a big factor, why have doctors failed these past twenty years to speak up against the corruption of the medical field by the pharmaceutical industry?

My issue isn't M.D. salaries - it's M.D. performance. It's their failure to criticize a deeply broken system.

Why have they rested silent while the peer-reviewed journals were corrupted by M.D.'s in the pocket of big pharma? Why have they continued to push "treatment" instead of "prevention" regardless of the cost to the patient?

Please. Clean house.

Lastly, I am going to ask you how you could read Dr. Atul Gawande's lastest New Yorker article and still insist that individual M.D.'s are not a significant part of the problem?

Please consider acknowledging how you've been co-opted by the pharmaceutical companies. On issues from heart disease to Diabetes Type II - many, many doctors have been playing for the wrong team.

You're supposed to play for the patient. The patient also needs to take responsibility here.

But to pretend that the medical profession has somehow not been part of the overall problem these last twenty years is not credible.

Elena,
1. I appreciate your comment and reply but I stand by my own (58).

2. To correct, when I said that patients demand that doctors tell them "What the F is going on and what the F they are going to do about it," I was referring very specifically to the collective, ever louder whine coming from doctors as a group, about only one single issue: how their suffering is worse, and more unfair, than all the other moving parts in the health care system. While doctors have as much of a right as any other group to feel that way, they cannot also beg for sympathy from their patients and honestly expect them to extend it. It would be preferable for doctors to take an industry-wide position that is preferably also beneficial to patients, then fight for it with passion and heart. This is their moment to do so! As part of that fight, they can instruct their own patients on the steps to take to achieve these common objectives. To state the obvious, if the doctors don't take the lead, then Big Pharma forever will.

By the way, you suggest that I "walk a day in the shoes of your health care provider (I hope you have one you can talk to) and experience it for yourself." I don't feel that I have a health care provider I can talk to (though I have what passes these days for excellent coverage); nor do I have any desire to experience one of their workdays. But as a patient and a professional person I have no doubt that I am qualified to suggest that doctors extend their reportedly exhausting tiring jobs to include even more duties, political ones. To their benefit.

Physicians are trained to work more hours and function accordingly. Also when I speak of 60+ hours I speak of the general care provider who is speaking to his or her patients and explaining "what the F is going on" so they don't get sued and these care providers are not getting sued. Again the discussion is not just about the MDs but the people who are making the money and are not responsible morally or ethically about human lives i.e the pharmaceutical company that will not donate or at least pro rate swine flu vaccines to third world countries most affected because it will not be essentially profitable to them.
Smidely, walk a day in the shoes of your health care provider (I hope you have one you can talk to) and experience it for yourself.

The real enemy in this process is the fact that those in power have great health care at the expense of the public. They do not have an incentive to address the issue. If there was an Executive Order stating that the health coverage for members of Congress is suspended until the health care system is equitable for all citizens, I would bet all obstacles would evaporate and the issue would be a top priority.

Elena/57 --

Let's say you are right, that the real blame lies with Big Pharma and Big Insurers.

Then why on earth are the doctors participating in this online discussion be lashing out so viciously at...the patients?

So long as the primary argument asserted by doctors boils down to "we need to get more money and see our kids more" -- and that legal accountability should be reduced, they will continue to face resistance from the public and direct, imploring questions from their patients about what the F is going on and what the F they are doing about it. As an industry.

PS -- 60+ hour workweeks sound like another issue that you need to deal with! I work more than 50 hours a week & I start to make mistakes. In my line of work I would get fired or sued for a dumb mistake that led to a client's misfortune. Lord knows ibankers work 90+ hours and they're not bragging about their performance anymore. Let's hope our surgeons do not share this weakness.

Calle you need help dude.

Too much doctor bashing. Many of the commentators are missing the additional point. Cost of care is not mostly attributable to the salaries of physicians but administrative costs of the for profit insurance companies, pharmaceutical companies, and the cost of technology. Don't fall into the trap that the insurance companies and pharmaceutical companies set every time there is a discussion about health care reform. We are all paying for the Boniva commercials, the CEOs salaries and the bonuses to the drug reps. There is a price to pay for technology understandably but the cost of care has not risen so much due to health care providers salaries but due to pharmaceutical costs. Also, you know something with our American system when a person can play ball and get a million dollar contract plus 3 months off a year but the health care provider who works 60+ hours per week is criticized for wanting to break even. It is not an equitable thing our American society. At least be fair.

Cale,

Uh... as an ex-ER worker, let me remind you that not everyone in ER is there with a gunshot wound. There are a lot more Diabetes Type II patients and cardiac. So, prego.... enough with your John Wayne act.

You asked how many of us worked in ER? I can only speak for myself.

I worked in an urban ER. I did all the grubby work to support you. I saw when you guys were brilliant WHICH WAS OFTEN - and I saw when you guys stumbled, fumbled, and passed the ball because, contrary to what you claim, you didn't always love it. And while you didn't quit, it didn't necessarily make you more honorable.

As for getting spit on by AIDS patients, uh, big deal? It no doubt happened more frequently to me than to you.
That's why, uh, I wore large glasses? As a non-doc, I had much more direct contact with patients, so I got more abuse than the docs did (but I also learned to treat patients with kindness to prevent getting spit on - TRY IT, IT MOSTLY WORKS.)

Does it occur to you that it's unbecoming for a doctor to whine as much as you do? (Or maybe you don't love being a doctor as much as you claim?)

If you are what you claim to be, then you didn't clean out the homeless person's green abscesses - the nurses and assistants did. You didn't treat the homeless patients for scabies - the underlings did. And YOU didn't have to take the homeless AIDS patient's three-day-old post-surgery bandages off, which were all clotted on the outside (but not on the inside), wash the sometimes violent patient with loving care, then dry them off and rebandage them as best as possible while they were still bleeding, while you the doctor conferred with the other doctors.

I'm not saying you don't have direct patient contact, I'm just saying: GET OVER IT.

It's not about you, Cale. It's not about your vaunted doctor wife. It's about: The system is broken.

I am not complaining. I love my job. I love helping people. I have no desire to quit. I want to do my job better. It is overwhelming at times. I am an adrenaline junkie as are most ER docs. Bring it on. We excel when the pressure is on and we revel in it. How many of you have spent time working in the ER? Do we get tired and frustrated. Hell yes. But we do not quit. You cannot be a quitter and get this far. Sorry, you cannot judge (as you are doing) unless you have walked in my shoes. But go ahead, keep trying to put me down. I have very broad shoulders and I carry illness and death every time I go to work. You people criticizing what I do pales in comparison. I have been spit on by aids patients, had aids blood splashed in my eye, punched, kicked and believe it or not even verbally abused. I have seen the best and worst of humanity in the thirty years of working in ERs. I still go back. I fell that I do a service to the community. Thanks goes a long way for me. So thank your doctor the next time you see her. She has earned it.

Cale,

Did I say that alternative medicine would fix a gunshot wound?

I'm glad you're open to alternative/preventative. It would in fact make your job easier. Something else would make your job easier, and American health care stronger:

The next time that good-looking, flirty pharma rep (the one with the fancy pens that inexplicably appeal to Ivy League-trained physicians) comes by the ER, do me a favor. Show her the DOOR.

Do you know the door I'm talking about? It's the door with the red sign above it that says "EXIT."

God bless you for the work you do. Just please make sure the work is effective. That means cleaning house.

Also, try the Gawande article. Just try it.

Cale, I hear you, but did you even read my post? Or are you just sticking to your talking points today?

Is the fact that you're worked to death a justification for failing to consider how the medical profession has failed to provide real results over the past twenty years that you've been practicing?

We spend more on health care in the US than anyone else - and yet we have some of the worst outcomes. In fact, the more we spend, the sicker we get, per the Atul Gawande article in this month's New Yorker - an article which is now mandatory reading in the White House.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

Why, Cale? Is there a possibility that you're so overworked that you can't see the forest for the trees?

I saw the same phenomenon in the banking sector - people from the top of their class at Harvard, but who couldn't (or wouldn't) anticipate that credit default swaps were going to end in a global disaster. Oddly, if you had explained credit default swaps to a house painter, he probably would have said, "you know, that really doesn't make sense."

I honor your expertise and your dedication, but you need to take a good hard look at your profession. I know you work your tail off. But as much as you're part of the upcoming solution, you have to admit that your profession has also been part of the problem.

Cale, did you not have any idea that this was the type of lifestyle you were signing up for when you decided to go to medical school?

youre the equivalent of a soldier that complains about fighting wars.

Tell me something please. How does alternative medicine fix a gunshot wound to the chest? Or the person who has taken a bottle of Tylenol and is in a coma. I believe in the alternative/preventative. It would make my job easier. But that is not the reality that I live in.

Thanks JUST and IN THE MERCY. I am grateful for doctors, but they need to clean house.

There are some really heroic M.D.'s who are getting the word out on preventive care and "alternative" approaches, such as yoga and meditation, or, on the clinical side, accupuncture, accupressure, and traditional medicines.

But now that we have clinical studies showing the effectiveness of "alternative" approaches, maybe these approaches should stop being stigmatized as "alternative."

Dr. Esther Sternberg has written powerfully on the role of stress hormones on inflammatory conditions, such as arthritis and heart disease (these conditions are great moneymakers for pharma.)

Asthma is also a condition in which inflammation plays a major role, and I find yoga to help fight my asthma. It's not as easy as an inhaler but it's undoubtedly safer, and it has other beneficial effects.

MERCY, I'm glad you found relief through herbal meds. After watching the pharma industry at work, I too would prefer we investigate using existing, naturally occurring compounds from plants to help treat illness - rather than create new compounds. We're beginning to see how these pharma-created compounds are "recycled" into the water supply every time we flush - so the pernicious effects can be shared with wildlife and oceans. Terrible!

Sternberg's work backs up the work of UCSF's Dr. Dean Ornish, whose "lifestyle" program, which includes "alternative" yoga and meditation as well as diet and exercise, gives patients a fighting (and sustainable) chance. It's also healthier for the planet.

OK you all are hired for the July 4th weekend so my wife and I can take off and enjoy. So you can start your night shift in the ER 7p-7a Friday PM and do 4 nights in a row. You will not have enough staff because it is a holiday weekend and you will be overwhelmed by the number of people who come to see you because there will be no other place for them to go. It will be a disaster (where the resources are outstripped by the demand). People will die, and you have to tell their family(the hardest part of my job by far). And you will leave each morning not thinking about how much money you have made, but that you wished that you were a little less tired so that you could have seen a couple more of the more that thirty people who have been waiting in the waiting room for hours to see you and your colleagues. Oh, and you need to find one of your friends to cover my wife. That person will also need to be a cardiologist who was top 5 in her med-school class. Actually that person will have to be a Professor of Cardiology and a wonderful mother of 3. That person will have to leave from home at 6 am and also work 12 hours plus being on call and available to return to the hospital at anytime on the weekend. Caring and loved by her patients, she cannot make enough office hours to see all that wish to see her. She teaches cardiology fellows and other cardiologists.

So when are you ready to start? It has been like this for the more that 20 years that we have been together. We need a break. But our patients count on us being there. Can you handle the dedication and responsibility for someone elses life like we do 30-40-50 times a day? Sign up. Do the job.

Lloyd/3

Love that Udall quote! Wish we could bring that man back, he sure would love being himself during these times...ah well.

Yes Cale no. 32 don't dis other cultures' meds! Why not learn from them instead of putting them and their patients down? Right there could be why docs can be so unpopular.

YEAH EVA!! (#41)

43 and
TAKE A STAND FOR PREVENTIVE

regarding statement from "Cale from New Jersey"

Your statement absolutely underlines why we are furious with the likes of Docs such as youself: ARROGANT, SELF-PROMOTING, EGOTISTICAL. Not that long ago, American Medicine Puh-hha-haa on eastern healing. My Shaman prescribed centuries of herbal wisdom that ABSOLUTELY took care of my aesthma. Im sure your wealth of medical knowledge would have been useful to scribble SINGULAIR should I ever need your medical attention.

listen to eva.

#32,

Cale,

I agree with your post 90% - doctors do deserve those salaries, as nurses deserve theirs.

However, I took exception to this:

"Maybe your local shaman can treat your kid's asthma over the July 4th weekend at 3 am. If not, we'll be there at your local ER and we'll get it right."

As a former ER worker, I do wish you guys got it right more. Unfortunately, as a group, you've been co-opted beautifully by the pharmaceutical industry. I've seen ER doctors sell out to pharma reps for little more than a fancy pen. After decades of study for your credentials, WHY???

It is so bizarre. It is also a big reason that so many ordinary Americans - who follow the misadventures of the pharmaceutical industry in the NYTimes and WSF and FT are deeply distrustful of the US medical system right now.

Doctors as a group "got some splaining" to do.

Also: why are cardiologists as a group so wary of Dr. Dean Ornish's approach to reversing heart disease, when he has clinical studies that show better results through his "lifestyle" (diet and exercise) plan than through invasive procedures such as stents?

Is it because you can't bill for common sense?

I wish more doctors - for the same salary - were enlisted in a massive preventive care program in US schools - team them up with athletic trainers and dieticians. We could save hundreds of billions of dollars.

I am disgusted by the ignorance of the lives of doctors I see here and anyway teh bias against success of any kind. That is the listener's issue! It used to be that doctors made good money, and certain people have practices that generate big bucks, but most doctors are middle class - how can you begrudge them? They go through hell to get educated - they are bullied throughout the process of their education - and are used like slave labor, almost while being trained - and sleep deprived - and they seldom work 9-5 and they have the pressure of the welfare of other people (sometimes life-and-death) all day every day and they're hugely restricted - trivialized, almost - by insurance companies - can't really ply their trades -

BTW Literally every certified doctor in-network (AETNA and CIGNA) that I've sourced in North Jersey has proven practically certifiable -- from the one doc whose blood pressure machine didn't work -- for over a year! ("Stop at WALMART and call me w the reading") to the GP who sent me to 3 specialists about my "Ulcer". Turned out to be my aspirin intake (yes I figured that out on my own). So let's not puff ourselves up here.

32 -- best doctors I've had in the US were from Asia. If you don't like it, quit. I'm sick of overpriced McMansions governing how much time parents spend w their kids. What's the cure for that again?

Despite my having lived in a socialist country for some years, a deep and knowledgeable interest in the subject of America's state of health care, and the goal of maintaining a totally open mind politically -- the term SOCIALIZED MEDICINE to me has and continues to have zero meaning. Is it a slander meant to have impact on ignorant people?

Talk about abusing the system. Plaintiff's lawyers sue everyone who even spoke to the patient, whether they have any impact on the patient's care or not. Spaghetti method: throw it against the wall and see what sticks. (Or who the lawsuit sticks to). No regard for the impact it might have on those not involved. Go through a law suit and come back and tell me the method is fair if you have been named but dropped from the case(as I have 3 times, just because I also saw the patient). It is part of the ER landscape.

I cant believe all the "cry me a river" outbursts of these doctors that called in. Hey, if you havent noticed, you're not the only people that has to work long hours, pay for child-care, pay for a high education loan, and have risks of decrease pay & increase costs. The difference between you (Docs) and Us (people) is that though you view $400/job is a huge reduction in pay from $1200 for a typical hernia surgery job that takes 30-50 minutes out-patient; THIS IS a far cry for some of us who make less than $400 in a typical day (even with an expensive MBA Education).

So let's do the Math: $400/hr * 5 surgeries/day * 15 work days/mth = $30,000 that medicare will pay you!! CLEARLY, You can Afford the MalPractice insurance of $60K a year!!

the 15 minute in-office procedure w/my OB-GYN's nurse showed up as $8000 on my insurance line-item.

There's nothing wrong with people making the most of their profession, but please SPARE ME THE SOB & TEARS about how expensive it is to live your life.

I am a physician who is not happy with the state medical practice in the US today. Since the entry of managed care into the system, thanks to Hillary Clinton's fiasco, there has been a dramatic shift in the quality of care as time (especially that wasted in being on hold while waiting for approvals or justifying care) and income per minute have become such major issues for docs. (and while a major part of health care expenses goes into the managed care bureaucracy and the salaries of its executives skyrocket)

I also dislike the AMA and it's purely financial self interest politics.

I think that right now we have a four tier medical system.

1. those with much money and/or good insurance without managed care restraints

2. a large proportion of the population relying on insurance and being deprived of good care because they are restricted to overworked doctors in their networks, and for whom finding a specialist who will see them is nearly impossible.

3. people on medicare who can largely see the doctors they want but for whom the population of doctors who take medicare is rapidly dwindling.

4. people on medicaid or with no insurance, for whom getting to see a doctor is extremely onerous even if it's free or for whom it is both onerous physically and financially.

I fear that a public system competing with the private with make care for those with insurance worse because the managed care and insurance companies will tighten belts even more to compete.

I further fear that it will make medicare less good by driving more doctors out of it.

People on medicaid will get the same quality of poor medicare care and the additional people now on government insurance will join them waiting in even longer lines to see fewer practitioners, as doctors leave the public systems, but at least the people with the government insurance won't fear being hounded by bill collectors as their reward for getting their medical needs attended to.

Those who apply hysterical socialist claims to single payer systems need to reflect on the perversions to capitalism created by the current systems.

The recent statistics on bankruptcy (~60%) being due to health care bills alone is a fact on which these people should meditate.

Combine this with people not maximizing their value to society (and themselves) by weighting career decisions on insurance, and the decreased value of 'long term outcomes' when people change insurers, including Medicare after you start really getting sick and expensive (65+).

I'm a capitalist and I am from Australia. My ability to be a capitalist is facilitated by access to Australian health care. The purchasing power of Australia and the health economic analysis required for access to many new technologies keep health care growth affordable.

I'll bet that OB/Gyn has worked nights, weekends, holidays for years. She has missed a lot of her children's growing up as have I and my wife. Show me another profession where the demands are SO high for absolute perfection. Airplane pilots maybe. They earn what they get paid too. Technically trained professionals who have your life in their hand and go through the training that we have and continue to train all of our lives, are a rarity and a valuable part of society. If you think we are not worth it, shop around. Maybe your local shaman can treat your kid's asthma over the July 4th weekend at 3 am. If not, we'll be there at your local ER and we'll get it right.

Brian,

I think that this conversation -- at least the one with your guests -- is dishonest, and you are partially responsible for that. If they complain about costs and how they are being squeezed, why don't you ask, "Excuse me, Doctor. What is your taxable income? Is that before or after your malpractice insurance?"

Look at what the Merritt Hawkins & Associates 2008 report on recruited doctor's salaries (tinyurl/meqsxo). Low paying specialities (internal, family, peds) get offers of at least $120,000/year, and average over $170,000. Of course, they get benefits, too -- and their malpractice insurance paid by the employers. Imagine how much more doctors who own their own practices take home if they can pay their employees that.

Yes, they have debt, I understand that. But they are paid during their residency years, so that is not part of the debt equation. Lawyers have debt, and nurses, too. As do architects, teachers and other professions. And anyone who went to college.

(Obviously, the issue for academics of all sorts is different. But that's not the problem we are talking about.)

It is misleading -- if not downright dishonest -- to talk about costs and reductions in reimbursements and not put them in the context of doctors' actual incomes. Most people have no idea how much their doctors make, so it would illuminate the issues if you made sure this information was part of your shows on the topic.

The callers raised tort reform and the debt incurred during medical school. Let's talk about that second point a bit more. Why are medical schools in the USA so expensive? are the medical schools influencing the AMA's position.

Please air the subject again, Brian, at the beginning of the program. You gave very little time at the end today.

To the "Woman Dr" from Bridgewater --aren't there any MEN who both have children and are DRs? 5 times you asserted that spending more time caring for, or as you put it, "looking after", your children is an additional problem that "Women" doctors have. If for no other reason than politically why not include men drs? in this issue? Aren't men doctors charged the same rate for malpractice insurance?

Take this up with the AMA and your local rep -- This is your fight as you have rightly perceived. By standing up for yourself and your family you will be helping your patients too.

And do us all a favor -- doctors AND nurses AND other staff -- DO NOT WEAR YOUR SCRUBS WHEN YOU DROP OFF AND PICK UP YOUR KIDS FROM DAY CARE AND SCHOOL!!!!!! It would add to your (collective) credibility.

Why is it the calls coming in from physicians are attacking the consumers of health care in the United States and not malpractice insurers? Are malpractice insurers in such dire straits that these companies cannot survive without their exorbitant rates; are physicians happy with the profits insurers make wanting to maintain profits and lower payment of claims? Any talk of reigning in insurers’ profits, medical device manufacturers’ profits, or prescription drug manufactures’ profits was completely absent from the president’s speech. Apparently he is ok with profiteering that puts investors first and health and safety last… that’s capitalism, but what’s the physicians excuse. Doctors are worried about not being made whole for care they provide, but they seem perfectly ok telling the ones they care for they have no right to be made whole when their negligence causes irreparable harm. Good Job!

Why does no one question the insurance companies about their outrageous raising of malpractice insurance rates? Don't blame plaintiffs' lawyers, who are representing injured patients - patients who are at the mercy of their doctors and are entitled to protect their own rights and ask for compensation if the doctor messes up and harms them further. Insurance companies collect premiums every month, for doing no work, with the purpose of accumulating a fund to pay out claims. Yet the minute a claim is made, they raise rates, so they continue to make profits and not assume the risk that is their reason for existence. Don't reduce patients' rights - reduce insurance companies' outrageous abuse of their position. "Tort reform" is not the answer - insurance reform is.

No offense to the OB/Gyn caller, but I graduated from _art_ school owing around $60k, so your 100k of medical school debts don't really tug at my heartstrings. None of my doctor friends are eating ramen. Not even the ones who came from poor families and do work for the needy.

Doctors complain that they have to deal with administration without compensation, so do most of us in the professional sector. They complain that they have school debt and childcare costs -- just like the rest of us. What is implicit, but not stated by doctors crying poverty, is that doctors are much wealthier than most people in this country and that they are squarely in the upper middle class at the very least.

In order to have affordable and equitable health care in this country we will all have to accept that most of us will not get the best anything, and that includes doctors who will not get the best (ie highest) salary they could get in a raw capitalist market.

This segment should have been longer. What are we as patients supposed to do when injured? Maybe if there was stronger discipline against the physicians causing the malpractice against patients, the rates would decrease. You never hear of doctors being suspended in New York State.

To the obgyn that just called and talked about all of the things that she has to pay and deal with and child care and mortgage, etc. etc .... well, welcome to the life of most Americans.... must of us have the same bills of the same amount and the same struggles earning les... this is real life....

The AMA represetns less thean 21% of physicians. The professional organizations representing different physician specialties esp primary care physicians are much more open to single payer health care.

The public option, as structured, will not save money and will not be as effective as single payer.

With a single payer plan we can drastically decrease the 30% of medical costs that go to insurance companies and use that to sinsure all the uninsured without all the controtion that are being recommended to cut costs and save money. single payer is budget neutral period.

Waah, waah, waah.

The rest of us, these are problems we have to deal with every day plus medical bills. Hard to shed a tear for your last call in and the AMA party line.

This woman OB/GYN is VERY entitled - to think that somehow her childcare cost should be somehow be covered by her patients. I work 70 hours a week AND go to business school. I am 31. I have chosen my career is important to me, and I can't afford to have children now, so I don't. How dare she think we should cover her childcare. Boo hoo for the poor doctor. Give me a break.

I am a dermatologist in academics. I have over $100,000 dollars in school debt. I do not own a home and I drive a 10 year old car. I think the public needs to stop looking at doctors' salaries and start focusing on the excesses of drug companies and the practices of HMO's. I support a single payer plan, financial aid for young physicians' school debt and reformation of medical malpractice.

Re: Mary Ellen (the high-risk ob/gyn speaking right now)... who said that you can have it all -- a medical career, a mini-mansion, and kids?!!
Perhaps you should reconsider the expectation of having it all. The rest of us certainly don't have so many options...

at least you guys make money, try being an architect...lots of debt with no reward

I don't get the NYC doctor complaining about tort reform. I thought that NYS was about the toughest state in the US to sue for medical malpractice. Take a look at http://www.pulseofny.org

New Jersey on the other hand is another matter

a friend of mine told me several years ago, that her father, an obstretrician, was successfully sued for malpractice, and of course, his rates were through the roof already. She also said that his main complaint was that the Pennsylvania State Licensing Board was, in her dad's opinion, part of the problem because they refused to take away the licenses of the 5% of doctors who were creating 50% percent of the malpractice lawsuits, thus making the whole situation worse for everyone else.
Who's choosing these licensing boards in the first place, and how would Pres. Obama's plans affect them?
does comment #1 about have anything to do with this question?

Everyone should be able to go to the Doctor when needed.

The AMA does NOT speak for me. Even with a reduction Doctor's will still make more per day than I do in 1 year.

Public Option the Enemy? Not sure what that means exactly.

AMA basically hands out ransom notes: pay us or you die.

I am a primary care physician. I have been in pratice 23 years. I have never been an AMA memeber. I have been a memeber of my state and local societies as well as my national speciality organization.

I support a governmentally structured competition for health insurance companies. The current industries do not and will not incorporate all Americans into their plans as it is too expensive.

It is my opinion that The Obama Administration must have all parties involved negotiate a reasonable solution. This includes the physisican, which he has just begun to court; the insurance and pharmaceutical industries as well as the trial lawyers. Until ALL parties are respectively brought to the same table, we will be pointing fingers and going round and round until nothing gets done.

The current situation needs to change. All parties need to compromise in order to obtain a reasonable resolution.

Love your show, hate your politics.

Our system is broken. The AMA is irrelevant. I work in an inner city ER where we are seeing record people. People waiting to be seen, but walking out without having seen a physician are record levels. Eighty percent of what comes to our ER is not even close to an emergency. However it is the only place for a lot of people to turn. If you want government managed medicine, look to the government funded clinic system at our institution. People wait months for appointments for acute problems, and when it gets unbearable, they come to my ER and overcrowd it so that REALLY sick people have to wait in the waiting room until a bed is open. How to fix it? We see preventable illness all the time (trauma, diabetes and hypertension out of control) But we are a society who thinks that our indiscretions should be fixed by someone else. And you can thank the liberal NJ malpractice laws, not for causing it, but for contributing to the problem. So has the AMA helped our problem? I haven't seen it.

If a public option will supposedly be inefficient and ration care, then why are private insurers afraid? By market logic, shouldn't private insurers still be able to thrive if they are able to offer a better 'product' at a lower price?

If we consider medicine as a business, then we get what we have. If we want medicine to be public policy, then we need a single payer system. Private insurers only want clients who pay premiums and require little outlay of services. That's capitalism, not healthcare. If you just "follow the money," then it's very difficult to arrive at a different conclusion. Most doctors don't belong to the AMA because it's views are far removed from patient care and centered more on policy effecting pay. Many of us didn't go into this business to reap financial reward above patient health.

As a practicing physician in a storefront clinic on the westside of Manhattan, Single payer system is the only way to provide quality health care to all Americans. The two biggest problems we face are first, the control of medical choices by insurance companies who continue to make fifty cents on every dollar spent, and the second problem; the largest expenditures occur in the end stage of life, and in the very begining of life due to complications at birth. The latter would be tremendously improved with good pre-natal care for all, the former requires some very tough choices that as Americans we continue to avoid.

My wife and I are both doctors and we do not feel the AMA speaks for us. As medical residents, we are disgusted by the AMA's stance, as are most of our generation. We will not be renewing our memberships with them this year. I guess this is one reason why they only represent 29% of the nation's doctors.

Most physicians would support a single-payer plan (59% in a poll last March), but doubtful the AMA ever would. They invented the bogeyman idea of Socialized Medicine in the first place, though they aren't as monolithic as they used to be. Obama and other politicians just need to be honest about how effective single-payer would be. Instead, they put their worst foot forward: a public option (as he emphasized is NOT single-payer) that will not pass muster with right or left forces. This has been tried in many states and it doesn't drive costs down. It just dumps patients private insurance doesn't want into that public option while private insurers continue to cherry pick healthy patients to insure.

This what the late Rep. Morris Udall of Arizona said about the AMA in 1965, during the debate about Medicare which the AMA opposed, "In the 1930s the AMA denounced Social Security itself as a 'compulsory socialistic tax' which would lead to totalitarianism. Later the AMA opposed extension of Social Security benefits to the permanently and totally disabled at age 50, calling it 'a serious threat to American medicine.' It tried to stop Federal grants for maternal and child welfare programs, charging that this program to reduce the death rate among mothers and children tended 'to promote communism.' And, finally, the AMA fought long and hard against adoption of Blue Cross-type voluntary health insurance programs, the very thing they now praise most highly. 'It is a sad fact," the Journal of the American Hospital Association wrote in 1949, "that through the 1930s and early 1940s the AMA did not believe in voluntary sickness insurance, did almost everything possible to prevent its development.'"

My father never belonged to the AMA - he belonged to the American College of Surgeons. He retired in the 80s. He's in the big OR in the sky now but he always had a distaste for the AMA, and money-grubbing was part of it. He was all about service, treated people who couldn't afford him for free - but definitely did NOT want the govt telling him what to do!

I am a doctor. The AMA is deeply in the pocket of for profit, so called health insurance companies. America needs and deserves not for profit national health care system. The devious for profit so called insurance companies exclude three important patient groups: The very sick, the very poor and the very old. They dump these patients on the State and they say the oppose public system. Outrageous!! dr dave in NYC