Dr. Tammy on Healthcare

A woman caller identifying herself as Doctor Tammy responded to the topic of Nationalized Health Care. She recounted her operating costs.

She said her practice, in order to cover the office costs, must charge at least $60.00 per patient she sees.

If her patient is on Medicare, her total reimbursement is $15.00.

How long would you stay in business if you got $45.00 less than your costs, per customer?

I wonder…

And this has what to do with cars or car repair/maintenance again?

I thought I posted it here: General Discussion

I am on Medicare and I see what my doctors are paid by Medicare (you get a statement to look over, the idea is to combat fraud) It is a lot more than $15.00 per visit. I had a 15 mile ambulance ride to the hospital a few weeks ago $1400.00, paid by Medicare.

But the ambulance fee does not go to your doctor at all. You are correct about being more than $15 per visit. Usually a regular visit is paid $50. When you look at your bill, you will see a difference between the billed amount and the paid amount. Ignore the billed amount, it is wishful thinking on behalf of your doc. Depending on the area offices have a 50-70% operating cost and also medicare payments could be as late as 6-12 months. The rent and staff salaries can not be late. So overall it ends up not being as lucrative as some think, esp if you look at net income per hour of work. Having said that it is still a good living, that is if you exclude the education loans, years spent and quality of life issues.

When you post your message, there is a box to choose the topic. It defaults to ‘Repair and Maintenance’. Just remember to pick the correct forum.

Medicare is like WalMart. The government pays less because they are providing a huge volume of business to build from. The theory is that old folks are good repeat business so the physician can afford to get a little less. I can tell you that whenever I get a recap of the fees paid by my PPO, they are a lot less than those requested by the provider.

While I did not hear the call, I wonder if Dr. Tammy is driving a new Benz, living in a 400k dollar home, and taking vacations to the Bahamas while carping about this.
As far as I know, a doctor does not have to accept Medicare assignment and can opt out.
If Dr. Tammy chooses to accept assignment then she has no beef.

What about other professions who suffer far worse than that?
I recently read about a dealership where the techs are paid .08 of an hour for an oil change. Yes, point “0” 8, not point 8.
This means if a tech makes 20 bucks an hour and spends 20 minutes total time on that oil change he has made the princely sum of about a 1.60. Do the math on that while figuring his hourly pay. And that’s before taxes, tool payments, and uniform fees, etc.

Warranty repairs can be even worse. One morning I repaired 4 Subarus with assorted warranty problems between 8 in the morning and noon. I received not one dime for any of these repairs. My gross pay for 4 hours was 0 dollars.

Wonder if Dr. Tammy carps about the cost of getting her car repaired; especially if it’s a Benz or Porsche. If it’s warrantable then the techs are likely taking a far worse financial beating than her. :wink:

Almost all primary care physicians have to accept Medicare to survive. There aren’t many 40-50 year olds running around with medical problems and good PPO insurance. The Walmart concept is true, the caveat is that most old folks have many medical problems and that makes them high maintenance. It is like working on a rusted out car, can be frustrating. A 15-20 minutes visit could take much longer, hence the long wait time every time you go to see your doc.

Most Docs that drive luxury brands are NOT in primary care. If they are, usually they have made a wrong financial decision to lease one because they “write it off” in their business expenses.

Being a mechanic is hard work, but the training required is different, both as far as time dedication to become a Doc and the financial set backs. Liability is another issue; you can not throw parts at human beings and when things go wrong you are liable for years of life lost and all the other stuff.

Again docs make a good living, but when you put it in the context of all the other issues surrounding the job the picture is not as colorful. Most of the mechanics on this board would laugh at what I said here, but hopefully when your kids become an MD you will know.

A typical doctor schedules 15 minutes maximum per patient, so our Doctor makes $60 per hour on Medicare patients. I heard of a doctor who wrote prescriptions and did other cursory exams and “saw” 150 patients per day. If they were all Medicare, that would be grossing $2250 per day. This is an extreme example of course.

The US has the world’s most expensive health care system, and part of it is the income of doctors; the rest is a dysfunctional system run essentially by income maximizing private hospitals and health insurance companies. Japan spends about 25% of the US level per capita on health care and its citizens live longer!

US doctors have turned their profession into a BUSINESS which should generate the most net revenue. They are the best paid doctors worldwide. This type of whining smacks of Hypocracy (not to be confused with the Hippocratic Oath) about “serving the people”.

As mentioned, doctors do not have to load up their practice with 100% Medicare patients. I advise all foreigners visiting the US to take out a $1 million accident insurance policy, since it is the world’s most expensive place to get injured!!! All as a result of those “UNDERPAID” doctors.

Once someone makes a certain amount for a year or two, they come to expect it. If their income drops or does not increase at the rate they are accustomed to, they consider themselves underpaid. Look at the professional sportsmen who say that they are underpaid. They make more than $1M, many much more, and whine about how they can’t afford to live on it and have to double it during the next contract.

I sat on a plane next to a professional baseball player in the 1980s. He wondered what anyone would do with the the money required to by CBS, assuming that Ted Turner would just pull it out of his bank account and pay cash. I commented that I no only didn’t know what I’d do with that unimaginable sum, I didn’t know what I’d do if I had $3000. He looked at me like I was crazy; $3000 was easily walking-around money for him. It’s orders of magnitude worse now.

I wonder if Dr. Tammy’s overhead costs are too high. Perhaps she should cut costs that don’t benefit the patient.

Frankly, I don’t think $60 per visit is too much to ask, but Dr. Tammy might benefit from something I like to call “the four walls theory.” According to this theory, you can’t control what happens outside the four walls of your business. So your business needs to react to things that happen outside the four walls. Dr. Tammy’s business hasn’t cut costs to adjust for the changing economic environment. Most capitalists believe Dr. Tammy’s business should either adapt or go the way of the dinosaur. Her business certainly isn’t “too big to fail.” Just like Chrysler, the failure of Dr. Tammy’s business is Dr. Tammy’s responsibility.

Um…even the “General Discussion” section is supposed to be for car and/or auto related discussions. Perhaps a forum on medical costs or Medicare issues would be more relevant.

This post reminds me of a local story along the same vein. About 4 or 5 years ago the Sunday paper had a supplement talking about health care. A local doctor was quoted in there as saying that Medicare was a losing deal financially for the medical profession, etc.
A new gated community is currenty going up on the edge of town and the minimum purchase price of a new home there is approx 1 million dollars and this is in an area where the median price of a new home is 114k dollars.
Guess who one of the first buyers was? Yep, the same doc who said Medicare reimbursement was killing him. So either he’s inherited a ton of cash, raised his customer pay rates, or he’s quadruple billing Medicare; the latter not being a rare thing to occur.

I also disagree about the training involved, odd problems occurring, etc.
As an editorial I read in a trade publication some years ago stated; the human body has been the same for millions of years but there are currently 800 different car models each with their own set of quirks.
My feeling is that one profession is no more difficult than the other.

I would also state that doctors are more frequently wrong on a diagnosis and make more mistakes than auto mechanics. However, they have the word doctor in front of their name so that means credibility.
In surveys, many people “swear by” their own doctor but don’t trust many others. The same surveys show this attitude exists when people are questioned about their local school or politician.
They feel their local school is fine but others need work. Their elected representative is fine, but the other members of the legislature are crooks, etc.
Move over to another school district or legislative district and the people there have the same attitude about the neighboring district or politician.

Bottom line. If Dr. Tammy doesn’t like the system don’t accept Medicare assignment.
If Dr. Tammy can’t make it without Medicare assignment then get out of the medical profession and find another career.

“Bottom line. If Dr. Tammy doesn’t like the system don’t accept Medicare assignment.
If Dr. Tammy can’t make it without Medicare assignment then get out of the medical profession and find another career.”

Very true, but that doesn’t make medicare look better. The problem with medicare or any other insurer is not underpayment. The problem is the amount of time and effort required to get payment. That is why the system is inefficient, the offices have a lot of staff time tied up to get payment or get approvals for tests. There are some docs that have gone into cash only practice and are able to charge equal or less than medicare and have a higher profit margin than 30-20%. That would be the free market. Seeing anything more than 30 patients a day is outright crazy and prone to mistakes and mishaps. I wonder if the docs buying the million dollar homes are in primary care. There are a lot of specialties that make a lot more than they should. The system has not caught up with them, yet. Also I don’t know the exact percentage but the portion of health care cost that goes to docs is very low compared to the hospital/lab/radiology etc.

I am not trying to defend anybody here, but there is a side to medicine that most people are not aware of. Having worked as a mechanic I am somewhat aware of why putting in a $45 water pump could cost upwards of $600. Going in a shop I am much calmer than your regular costumer and that makes me a better consumer of the system. The same should be done for medicine so we become a smart consumer.