Dr. Cranquis' Mumbled Gripes
(Disclaimer: Questions related to medical topics will be answered to the best of Dr. Cranquis' (and Google's) knowledge, but the internet-delivered wisdom on this blog CAN NOT AND SHOULD NOT SUBSTITUTE for your Real-Life Doctor's personal attention + examination, and your own common sense too! If you think you're having a medical emergency, hang up and go email 911. The author of this blog takes no responsibility for any medical, relationship, scholastic, financial, or other decisions you may make based on information found in this blog.)
And since people seem to be a bit confused about this: any "real-sounding" patients names are just horrible puns, and not HIPAA violations.
![thuc:
The Dedicated Doctor [infographic]
No doubt about it, becoming a physician is hard work and a long road. Healthcare reform is here so…
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An inspirational infographic by the Alpha Infographicist thuc.
One not-so-inspiring comment, though: yes, more doctors are needed, yes, more spots are opening up in med schools, more jobs will be available for med school graduates, more patients are going to become insured under Obamacare — BUT since jack-squat is being done about proportionally improving reimbursement for all those doctors (new and old) and alleviating the massive debt which med students have to incur in order to become underpaid doctors, it’s still going to be tough to keep those doctors in business. Because it IS a business.
/rant](http://25.media.tumblr.com/1c8797d5094eea77bd148fd10fe5cf38/tumblr_mlapd3sjOf1qzjvqlo1_r1_500.png)
thuc:
The Dedicated Doctor [infographic]
No doubt about it, becoming a physician is hard work and a long road. Healthcare reform is here so…
An inspirational infographic by the Alpha Infographicist thuc.
One not-so-inspiring comment, though: yes, more doctors are needed, yes, more spots are opening up in med schools, more jobs will be available for med school graduates, more patients are going to become insured under Obamacare — BUT since jack-squat is being done about proportionally improving reimbursement for all those doctors (new and old) and alleviating the massive debt which med students have to incur in order to become underpaid doctors, it’s still going to be tough to keep those doctors in business. Because it IS a business.
/rant
A terrific piece of commentary/creative writing/self-expression, by the ever-hilarious Dr. Grumpy (no relation). Click through for the whole article.
Monday, December 10, 2012
Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5/visit. He doesn’t take insurance.
This led to several online threads featuring comments such as “Finally! A doctor who cares!”
Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don’t care.
I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.
It isn’t until almost the end that the article notes Dr. Dohner is supported by his family’s farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and “Dancing with the Stars” results, and therefore are left with the impression that any doctor can do this for $5 a head.
Bullshit.
I do care.
But that doesn’t mean I don’t have my own responsibilities: like office rent. And paying Annie & Mary. And a mortgage. A wife. 3 kids. If I can’t support those things, then I’m not going to be able to keep my office open to care for people.
Regardless of what people may think, just because I charge for my services doesn’t mean I don’t care.
I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you’re out of pills, even though you knew you needed a refill for at least a week.
I care enough to…
We at Sherpaa wanted to write a little something about how Obamacare affects you. It’s exciting news in many, many ways.
How will the Affordable Care Act affect you?
The Affordable Care Act, sometimes referred to as Obamacare, was officially passed in 2010, but will not be fully put into place until 2014. There has been a ton of information about this act that has been made available, but we wanted to provide you with the top 6 elements of the act and how they affect you personally:
Summary of Benefits and CoverageHealth insurance plans are now required to provide you with an easy to understand summary about your specific health plan’s benefits and coverage information.
Why You Care: Healthcare can be super confusing. We’ve all been there…it’s your first day of work, you have mountains of paperwork to fill out, and on top of it all, you need to select an insurance plan right away. Oh, and they all look pretty darned similar. With this new requirement, a lot of the confusion will be totally eliminated.
Preventative CareCertain preventative services are now covered. These include services such as blood pressure screenings, cholesterol screenings, depression screenings, HIV screenings for high risk adults, diet consultations for at risk adults, certain STD screenings for at risk adults, folic acid supplements for women who are pregnant, and mammograms for women over 40.
Why You Care: Prevention is, very often, the best medicine. It’s great to be able to take advantage of important preventative care and services that were previously super expensive or difficult to access.
Pre-Existing conditionsHealth insurance companies can no longer deny healthcare coverage to people with pre-existing conditions.
Why You Care: People who want to purchase health insurance, either on their own or through their employer, should be able to afford to do so.
Appealing Health Plan DecisionsConsumers now have the right to appeal health insurance plan decisions, particularly when a claim has been denied. You will also now have the right to information from your insurance carrier such as the reason your claim was denied.
Why You Care: Power to the people! You will now have the opportunity to take more control of your health, and no longer be entirely at the mercy of the insurance companies.
Patients Bill of RightsThese include allowing young people under the age of 26 to remain on their parent’s insurance plan, eliminating the lifetime limits on coverage, eliminating arbitrary cancellation of coverage due to honest mistakes, forcing insurance companies to justify any truly egregious premium increases year over year, and eliminates insurance company barriers to emergency care.
Why You Care: Power to the people again! A clear set of rights for consumers and expectations from insurance companies is a truly great thing.Tax Credits for Small Employers
Small businesses (fewer than 25 employees) and non profits will receive some tax credits (up to 50%) for purchasing insurance for their employees.
Why You Care: Health insurance is expensive. Any little bit of help is great for businesses as they continue to grow.
Birth ControlThe Affordable Care Act allows for many types of birth control to be covered without co pays or deductibles. Depending on the type of health insurance plan you have, this benefit either has already kicked in, or will be kicking in by 2014. It should be noted that this is not for every type of birth control on the market. Health plans are allowed to limit free coverage to some generic drugs/devices. To find out if your specific birth control is covered, go to your health insurance company’s website or call the member services 800 number located on the back of your insurance card.
Why You Care: Birth control can be super expensive. In some cases, this can mean more than $800 back in your pocket!
Mental HealthThe Affordable Care Act now requires that mental health services be part of the “essential benefits package” that must be covered by certain plans. This is great news for people who depend on these services.
Why You Care: This is a great benefit for people who require mental health care. It should be noted, however, that many mental health professionals do not take insurance of any type. This means that there may still be costs relating to this type of care.
10 part-time clinical jobs for American MD’s looking to make some extra cash. (I’m posting this PRIMARILY to point out that in today’s economy, even us “rich golf-playing Porsche-driving” doctors are scraping to make ends meet).
- Supervise midlevel providers
- Provide telehealth consults (hiring telehealth companies include Ringadoc, American Well, Teladoc, iSelectMD, NowClinic, and SoliantHealth). **UPDATE! As of 2013, US medicaid/medicare regulations are now allowing docs to charge for “prolonged medical visits without direct face-to-face interaction”… i.e., telehealth visits! This is a win! :)**
- Work as an Expert Witness
- Perform insurance claim reviews
- Perform Independent Medical Exams for insurers
- Work with a pharmaceutical company (speeches, clinical reviews)
- Make house calls (more info through American Association of Home Care Physicians)
- Work at a nursing home
- Staff special events (races, festivals, health screenings)
- Work as a cruise-ship physician
(I already do #1, and I think I’d enjoy doing 2, 7, 9, and 10)
1. Student Perks- Just about every program, school, or organization has student perks that you can score. Some conferences and resources are free just because you’re in a medical school, like medical journals or various website memberships. To find out more offers, you should ask your peers or…
10 solid tips for the financially-savvy med student — the usual high-quality advice from Navamon!
thuc:
Finally !
Here’s the news I’ve been aching to tell you all about.
I teamed up with ObizMedia to create this infographic about physician salaries and costs of education (financial and time related). It’s been under wraps for a few months now and is finally ready for release!
Head over to my blog, MD Salaries for more information.
Enjoy!
update: reposting this as a photo post for easier viewing for my tumblr readers.
Great infographic is great. In summary: don’t go into medicine if you wanna get rich.
By popular demand (aka Cranquis asked so nicely and I had to oblige) here is the previous post in re-blog-friendly format!hi, why do you want to be a doctor? other than prestige and money________________________________________________________Hi there, ramennekko!
I’m going to answer your question in 3, THREE parts! Because you bring up what I believe to be three critical components to this classic question that really needs to change. So I’m glad you brought this up!
So this post is part 1 of 3 of my answer to you.
My personal opinion is that NO ONE SHOULD GO INTO MEDICINE FOR THE SOLE PURPOSE OF GAINING PRESTIGE OR MONEY. Do what you love, and those things tend to follow…
If you are considering becoming a doctor, you NEED to read this post (and probably the next 2 posts in the series, which md-admissions hasn’t even posted yet, but which will probably be just as unabashedly AWESOME as this post is.) It is full of Truth.
You know what’s awkward to talk about? Money. It’s so weird and personal. Like religion, politics, and sex, people tend to get very up at arms when the topic of finances comes up.
So, in advance, I’m just going to let you know this post might be a little uncomfortable, like wool trousers…
Very good summary of financial factors to consider — for med students (AND ANYONE ELSE WHO USES MONEY).
Just 11% say they consider themselves “rich” — and 45% agree that “my income probably qualifies me as rich, but I have so many debts and expenses that I don’t feel rich.”
And here’s a really excellent comment:
With regard to the compensation bit, it is important to recognize that the student loan burden is enormous. Not only are you carrying over the loans from college, but your loans from medical school, and all of these tend to be held in limbo (“forbearance”) where they continue to earn interest that is capitalized/principalized, because during residency and fellowship (3-6 years beyond medical school graduation for medical specialists and 5-9 years beyond medical school graduation for surgical specialists) you’re making only $50K or $60K a year for your 80 hours a week work.
But I think one of the hardest bits is that during your school and training there’s never enough money to set aside, and certainly no 401(k) or pension, for retirement savings. So many of us start our “financial adulthood” in our 30s or even early 40s with a huge hole to fill - the need to save for retirement, to pay off the student loans, and at the same time, the need to start living like an adult (kids, house, non-disposable furniture, reliable transportation). And you start to get tired. When you’re 20-something or even in your early 30s, you can do the up-all-night/up-all-day thing, but when you’re in your early or mid 40s, it just gets really hard.
Yep, I agree.
amisanthropichumanist submitted (and later gave me permission to publish):
Hi Dr Cranquis!
Thanks for posting that article. To be honest, the cynical part of me isn’t totally surprised.
No idea what it’s like in the states, but the sheer cost of medical school across the pond in the UK is horrendous. I’ll start at the beginning.
As someone going into Graduate Medicine (just finishing a 3 year undergrad course then starting 4 years of medicine in september) I’ve had no opportunity to build up any funds for myself and thus am somewhat strapped for cash.
But for some reason the graduate medical aptitude test (GAMSAT) is £195, with no refund or reimbursement, and no grant for those who can’t stump up this hefty sum. They’ve upped fees as well to £9000 a year (previously £3000, even more previously £0) thought the NHS have said they help out with a fair chunk of that.
Perhaps they’re using finance as another way to select candidates? Considering test scores are now very similar, everyone’s leaving university or high school/college with high grades, the only way I can see that one candidate would be different from another is in terms of who can afford to pay the most, and how much experience one has over another (the latter being mostly due to luck and knowing people in the trade).
I thought I’d share, though I’m sure you know of it already, from one mild cynic to another.
Wow, I like the way you concynicize! (That’s a mixture of “criticize”, “cynical”, and “conspiracy theory”, btw.) I am clueless about the UK’s med-school process, but I definitely have felt/still feel your financial pain. Unless I win the lottery (which I don’t play, so…), I’ll be paying off my med-school loans until I’m 55 — despite a small med-school grant + an excellent 3.25% interest rate locked-in for my loan repayment! But it sounds like in the UK, you guys are really locked-in with few financial-aid options or opportunities.
Any more opinions on this situation from my UK Cranquistadors?
I’m really not sure about the reliability of the survey method… but at least those students are getting some early experience at getting screwed over by the sad financial state of healthcare reimbursement. :(
k-m-a-r-i-e submitted:
Hey Dr. Cranquis, I really enjoy reading your blog (I am another reader who read all of your posts to the very beginning, but I did so about a month ago). I think you may find this article interesting, as I certainly did. Do you think it is financially easier working at an Urgent Care rather than running your own private practice? I suppose it would be, but you always have interesting responses so I’m curious as to what you think… So that’s about it! Here is the link.
Another Archive Surfer surfaces! Well since it costs me nothing to hand out titles: I dub thee k-m-a-r-i-e-the-over-hyphenated, Archive Surfer exultate, and Keeper of the E-K-G. :)
Interesting article, and not surprising to me at all. I don’t know if this makes me “financially astute,” but one of the main reasons I chose to join a healthcare-organization-owned Urgent Care straight out of residency was because it made financial sense: getting paid on a mixed salary + productivity formula, so I always have a basic guaranteed income with the chance to earn more. A private-practice physician has to pay himself — along with his staff, lenders, suppliers, start-up costs, etc… too much stress for a young husband/father who doesn’t know beans about running a business. I just show up to work on time, document and bill properly, and get a paycheck every 2 weeks. Bing bang boom, money in the bank.
I agree, most doctors are clueless about finances. I didn’t start to even think about the finances of practicing medicine until during my senior year of residency, and even then just in a vague “Oh, I guess all my chart documentation is being used by someone somewhere to determine how much the patient/patient’s insurance will be billed for this visit.” But since US med students are paid at all, and US residents just get a set slave-wage stipend irregardless of how much work they do, there’s no system-level “meaningful” reason for a med-student/resident to learn about finances during training! Sure, there’s a few lectures/noon conferences on the topics, but hardly enough to make you business-savvy.
Anyways, that’s my comments. Hope they were worthwhile. Oh, and before I forget, this topic reminds me of thuc’s MD Salaries blog, which has excellent posts about, well, MD salaries and related financial issues. Check it out.
***Pending Cranquis-Mails: Yeah yeah, still 7 — things are hectic around here lately. But things should slow up a bit in the next week or so, and I’ll try to get cracking on those looming replies.***
thuc:
Here’s a cool infographic showcasing salaries of jobs and their relation to happiness. Surgeon’s have a higher salary but Pediatricians have a higher happiness rate!
Click through for the original post and graphic.
I was particularly struck by the graphic’s comment that “Salary only positively affects happiness up to $75k/year; no matter how much more $ is earned above that mark, no greater degree of happiness is reported.” This doesn’t mean that doctors (who obviously have gross incomes above $75k) can’t be happy — but it DOES mean that doctors cannot expect for their happiness to increase just because they start making more money. You have to have internal investment (compassion for others, pride in a job well done, etc.) in the job you perform in order to be satisfied.
This is true. Student loan forgiveness is possible if you are willing to go certain routes. A few examples are:
- Performing military service (aka Medical Corps in the Army, etc)
- Practicing medicine in certain types of communities (rural and under served)
![Um, ok: “everything else in life will not be impossible because you have to take out a huge loan, especially in this economy.” Feel better? ;)
Let me begin by addressing a fundamental issue about this topic: If you are entering the American healthcare professions (MD, PA, nursing, whatever) in order to be rich, DON’T DO IT. I’ve reblogged this realistic look at the Rich Doctor MYTH before, and I think everyone (patients, politicians, and practitioners) should read it, even though many won’t “get” it. In today’s economy, American doctors/healthcare providers do NOT get rich, though we can be financially comfortable, if we are reasonable with our spending and budget our finances carefully during the first 15-30 years post-school when we’re paying back our loans.
And don’t feel like your parents’ lack of hidden pirate treasure chests scholastic funds is something unique or insurmountable. Most medical students finance their schooling primarily/largely with financial aid loans + scholarships/grants, and only a fortunate few have wealthy parents or prior savings to cover the enormous debt of their training.
Personally, I played the Financial Aid tune to the cost of $160,000 through med school (plus another ~$32,000 in scholarships), but my loan payments aren’t horrible. I consolidated all my med loans into a 30-year repayment schedule, and was lucky enough to do so when interest rates were quite low, so I have only 3.35% interest. For the first 8 years after med school, my minimum payment is only $419/mo (although I’m paying $600/mo, in order to chisel down the loan principal). After year 8, the minimum jumps to $650/mo, and then by year 16, it jumps to $880/mo and stays there until the loan is scheduled to be paid off by year 30. I plan on always paying more than the minimum, so I should be done paying off by post-school year 20-25, which isn’t too shabby.
Currently, my monthly med loan + car loan + mortgage payments come to ~$3100/month. That’s slightly less than one 2-week paycheck, so I still have money to spend on necessities, savings, retirement investments (sob… the stock market is raping me…) and even little fun things now and again, like trips to France. As I’ve mentioned before, 2 of my strongest “assets” financially are (1) having [intentionally] chosen a partner/spouse who is realistic about money and likes to live within her means — most of the time, and (2) hooking up with a financial advisor EARLY in the residency—>career transition. (Try to get these two things in your life if possible — but you can’t have MY spouse.)
And as for your implication that “If I have a huge grad-school loan, lenders won’t want to accept me for house and car loans” — that’s just not correct. As long as you have been nice to your credit rating (by making all your school loan and credit-card payments on time, and by not having a lot of outstanding high-interest-rate credit-card debt), most lenders will see your big grad-school loan as proof that you have invested a lot of time into becoming a professional, and so you’re gonna have a steady flow of income and ability to pay back their loans. Healthcare providers don’t change geographic job locations very easily/frequently either, so you’re likely to keep the house that you mortgage — another reassuring fact for most mortgage lenders.
Here’s more that I’ve written/reblogged about finances. Don’t stress about the money (too much) — as long as there are sick people in the world, you’ll get paid (somehow… if not in insurance reimbursements, then in Obama-credits… or zucchinis.) :S
***Pending Cranquis-Mails: ZERO! Ask Box: Ok, as I’ve been warning you guys, I’m gonna open a different Ask Box this time around. I’m gonna try using the TumblrMSG application, so you’ll need to install the app and submit Cranquis-Mails through it. The “normal” Tumblr Ask and Submit boxes will NOT be open (this time). If all goes well, I hope to eventually just use TumblrMSG for Cranquis-Mails, and be able to leave my regular Ask Box open all the time for non-Cranquis-Mail communication with my awesome readers! The TumblrMSG ASK BOX WILL OPEN ON Friday September 9 @ 7:30AM US Mountain Standard Time. Consider yourself notified. :) ***](http://25.media.tumblr.com/tumblr_lquoqpcsCq1qcw86wo1_500.png)
Um, ok: “everything else in life will not be impossible because you have to take out a huge loan, especially in this economy.” Feel better? ;)
Let me begin by addressing a fundamental issue about this topic: If you are entering the American healthcare professions (MD, PA, nursing, whatever) in order to be rich, DON’T DO IT. I’ve reblogged this realistic look at the Rich Doctor MYTH before, and I think everyone (patients, politicians, and practitioners) should read it, even though many won’t “get” it. In today’s economy, American doctors/healthcare providers do NOT get rich, though we can be financially comfortable, if we are reasonable with our spending and budget our finances carefully during the first 15-30 years post-school when we’re paying back our loans.
And don’t feel like your parents’ lack of hidden pirate treasure chests scholastic funds is something unique or insurmountable. Most medical students finance their schooling primarily/largely with financial aid loans + scholarships/grants, and only a fortunate few have wealthy parents or prior savings to cover the enormous debt of their training.
Personally, I played the Financial Aid tune to the cost of $160,000 through med school (plus another ~$32,000 in scholarships), but my loan payments aren’t horrible. I consolidated all my med loans into a 30-year repayment schedule, and was lucky enough to do so when interest rates were quite low, so I have only 3.35% interest. For the first 8 years after med school, my minimum payment is only $419/mo (although I’m paying $600/mo, in order to chisel down the loan principal). After year 8, the minimum jumps to $650/mo, and then by year 16, it jumps to $880/mo and stays there until the loan is scheduled to be paid off by year 30. I plan on always paying more than the minimum, so I should be done paying off by post-school year 20-25, which isn’t too shabby.
Currently, my monthly med loan + car loan + mortgage payments come to ~$3100/month. That’s slightly less than one 2-week paycheck, so I still have money to spend on necessities, savings, retirement investments (sob… the stock market is raping me…) and even little fun things now and again, like trips to France. As I’ve mentioned before, 2 of my strongest “assets” financially are (1) having [intentionally] chosen a partner/spouse who is realistic about money and likes to live within her means — most of the time, and (2) hooking up with a financial advisor EARLY in the residency—>career transition. (Try to get these two things in your life if possible — but you can’t have MY spouse.)
And as for your implication that “If I have a huge grad-school loan, lenders won’t want to accept me for house and car loans” — that’s just not correct. As long as you have been nice to your credit rating (by making all your school loan and credit-card payments on time, and by not having a lot of outstanding high-interest-rate credit-card debt), most lenders will see your big grad-school loan as proof that you have invested a lot of time into becoming a professional, and so you’re gonna have a steady flow of income and ability to pay back their loans. Healthcare providers don’t change geographic job locations very easily/frequently either, so you’re likely to keep the house that you mortgage — another reassuring fact for most mortgage lenders.
Here’s more that I’ve written/reblogged about finances. Don’t stress about the money (too much) — as long as there are sick people in the world, you’ll get paid (somehow… if not in insurance reimbursements, then in Obama-credits… or zucchinis.) :S
***Pending Cranquis-Mails: ZERO! Ask Box: Ok, as I’ve been warning you guys, I’m gonna open a different Ask Box this time around. I’m gonna try using the TumblrMSG application, so you’ll need to install the app and submit Cranquis-Mails through it. The “normal” Tumblr Ask and Submit boxes will NOT be open (this time). If all goes well, I hope to eventually just use TumblrMSG for Cranquis-Mails, and be able to leave my regular Ask Box open all the time for non-Cranquis-Mail communication with my awesome readers! The TumblrMSG ASK BOX WILL OPEN ON Friday September 9 @ 7:30AM US Mountain Standard Time. Consider yourself notified. :) ***
