Is a doctor's practice one of the safest and most profitable businesses?

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HawkeyeJD
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by HawkeyeJD » Wed Oct 18, 2017 7:10 pm

jayk238 wrote:
Wed Oct 18, 2017 6:09 pm

.....

And I leave you with this.

The outcomes of prostate cancer in the US for survivial in 5 years is 95%. In UK? 49%. Nearly 50% of men will have prostate cancer
The outcomes for patients with an Acute MI is 80%+ in the US depending on rural vs urban center- in the UK? < 60%
There is more data like this but its never EVER presented by NYTimes and others because this data is contradictory to their narrative for a single payer system.

End rant. Yes I know I ranted.
Speaking of possible misinformation...

A quick google search leads to UK statistics which indicates 5-year survival rates from prostate cancer is 84.8%
http://www.cancerresearchuk.org/health- ... r/survival

American Cancer society puts American survival rates at 99%.

Certainly a win for American medicine on this but not as dramatic a difference as your numbers suggest. From what I can tell, the 49% number was true back in the 1970s and 1980s but then the American number was much lower than too I would imagine.

Similarly, Germany has a 5-year prostate survival rate of 93.3% just as a point of reference (since you mentioned Europe). Note that research at least suggests that the German disadvantage relative to Americans can be attributed to differences in incidence and stage distributions over time and across countries. https://www.researchgate.net/publicatio ... tributions

Also, note that the UK has particularly worse cancer survival rates as compared to the industrialized European nations so it may not be the best to use to broadly declare that the European model is fundamentally worse. https://www.theguardian.com/society/201 ... ries-study

As to the Acute MI statistic - multiple sources call in to question your statistic e.g. one example from the Lancet (see table page 1309) discussing 30-day mortality rates that are generally in the single or low double digits for the UK and Sweden.

http://www.sciencedirect.com/science/ar ... 361362070X


Anyways, just wanted to point out what appears to be some dated statistics in your discussion and to note that perhaps NYTimes and others do not report your statistics because they are not actually true? Just a thought to consider.

Teague
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by Teague » Wed Oct 18, 2017 7:14 pm

I don't care what google engineer can do with his MIT degree or a dentist giving braces or an optometrist learning how to look at eyes. Standing in front of apatient and deciding whether to intubate on my own in the middle of the night because his sats are dropping -but wait! they dropped yesterday and he didnt need it- but now he's declining more because his fluid status has declined- is one of the most stressful and scary moments I have experienced. Doctors spend money on things because they feel they have not been appreciated.
I feel the need to respond to this one, too.

Doctor, I'm in a field (not an MD, but a different doctorate) where emergency and ICU physicians call me at all hours to ask whether they should intubate an unstable patient immediately or suggest a different intervention, which vasopressor to use for the crashing BP case in front of them, asking me what to do about the combined digoxin/ calcium channel blocker/ beta blocker overdose in the ICU circling the drain, etc. I work rotating shifts, all hours of the day and night. I make nowhere near what most physicians make. You can be sure that if I make a bad call I will hear about it, possibly from lawyers.

Spare me.
Last edited by Teague on Wed Oct 18, 2017 7:44 pm, edited 1 time in total.
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climber2020
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by climber2020 » Wed Oct 18, 2017 7:22 pm

nisiprius wrote:
Wed Oct 18, 2017 7:09 pm
goodenyou wrote:
Wed Oct 18, 2017 4:07 pm
nisiprius wrote:
Wed Oct 18, 2017 3:02 pm
Another point, which I can't speak to from personal experience, is that doctors, veterinarians, etc. can and do sell their practices. Indeed, the business model for a sole-proprietorship practice pretty much assumes that you can sell the practice at the end, otherwise it isn't a very good business at all. So if you are curious, try to find out what you can about what doctors say about selling practices.

This gets into real-estate-like risks, if the practice is in an area with a certain social class and income level, and the neighborhood changes before the doctor sells the practice.
This is wrong. You cannot “sell” a practice. It has no value, because there are regulations on the prohibition of selling a practice for any value above hard assets. It is construed as a kick-back and buying referrals. You can sell a practice and get hired for what a doctor in reasonably making in your specialty. There is no good will or multiples of revenue. Most “sell” a practice to get out of the headache of running a practice. Patients then get the customer service similar to the local DMV.
I stand corrected and will note your posting in my previous posting. I'm a little confused at the moment because climber2020 thinks what I said wasn't crazy...
I don't really understand this either.

Doctor A wants to retire. Doctor B wants to buy Doctor A's practice. They agree upon a price. Doctor B gives a set amount of money to Doctor A who then goes away.

The main hangup for this transaction is the purchase price, but as long as both parties agree on a number, I'm not aware of any laws that are broken in such a transaction. You can sell for whatever someone is willing to pay (which nowadays is not much).

stoptothink
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by stoptothink » Wed Oct 18, 2017 7:24 pm

sawhorse wrote:
Wed Oct 18, 2017 4:14 pm
WanderingDoc wrote:
Wed Oct 18, 2017 3:30 pm
EnjoyIt wrote:
Wed Oct 18, 2017 12:12 pm

Earning $500k busting your butt all day working 60 hours per week is a hell of a lot of money. Primary care and psychiatry make much much less.

Most doctors make a lot of money. The rest make good money. They have a lot of student debt however, and running a private practice is difficult as you're essentially running a small business but with more administrative tasks. As a result more doctors are ditching private practice.

For comparison, a 7th year cancer researcher (roughly 13 years out of college) with a biochemistry PhD, who got equally good grades in college in the same classes as doctors, gets $54k at one of the nation's leading cancer research centers albeit usually with little or no student debt and slightly better hours.

A Nobel Prize winner in chemistry whose discoveries are the foundation of a lot of modern medicine made $218k last year at UNC as a professor of biochemistry. An early career hospitalist can make the same amount working an average of 40-45 hours a week.
This. I respect the heck out of physicians. I chose not to go to medical school because my grandfather, the owner of a large and very successful family practice for 40+ years, talked me out of it because he saw how things were changing. That being said, I had equally good grades in similar classes as future physicians (in many cases, better), followed my undergrad with 7 more years of university education, have a few dozen peer-reviewed publications to my name, have a decade of experience and an impressive sounding title at a health megacorp, and it is doubtful that I'll ever make what the average 1st year family physician makes. I am not complaining, my job is awesome and I am well compensated. Yes, physicians in this country still make very good livings, $500k/yr is a ton of money regardless of how much you work, and have almost unmatched job stability (and I am in no way saying they don't deserve it).

JBTX
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by JBTX » Wed Oct 18, 2017 7:33 pm

I'll say off the bat that this graphic is probably loaded, distorted and not totally accurate...but nonetheless there is somewhat of a valid point to it.

https://www.bestmedicaldegrees.com/salary-of-doctors/

I'm surprised more docs haven't chimed in here.

My take (also not a doc) is that yes, some docs make very good money, but on average it isn't as lucrative as it used to be. If you can build a good practice you can still make more than most professions. However, many more doctors work on salary. Insurance limits how much you can charge. Malpractice insurance can be quite costly. And there is an enormous commitment of time, lost earnings and debt to get to the point of earning the above average earnings.
Last edited by JBTX on Wed Oct 18, 2017 7:36 pm, edited 1 time in total.

jayk238
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by jayk238 » Wed Oct 18, 2017 7:34 pm

Jazztonight wrote:
Wed Oct 18, 2017 6:43 pm
jayk238 wrote:
Wed Oct 18, 2017 6:09 pm
...Next, doctors are in a cognitive field that is unique on its own. It is different from dentists, from optometrists, and from engineers. Our work can lead to a patient dying pretty rapidly in fact, or a missed diagnosis leads to earlier death later on...

...I don't care what a google engineer can do with his MIT degree or a dentist giving braces or an optometrist learning how to look at eyes...
Well, forgive me, doctor, but you brought it up.

I suppose that my examining the eyes of 40,000 patients during my career (not looking "at" but "in") and seeing tumors, hemorrhages, hypertensive and diabetic retinopathy, detached retinas, etc. didn't lead me and every other licensed optometrist in the US to want to know how to diagnose to avoid an earlier death.

I've talked to dentist friends about their own roles in diagnosing all kinds of tumors as well as systemic diseases.

I know we're off the subject here, but the days of physicians as God is well past. I respect the work you do and hope you will do the same.
I appreciate your comment and I agree that optometrist do a fine job diagnosis but the insurance industry seems to disagree in terms of the risk of the diagnosis and work done. Just look at the malpractice rates for an internist vs an optometrist in many states.

finite_difference
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by finite_difference » Wed Oct 18, 2017 7:55 pm

There is also demand and supply.

So if there are not enough doctors being trained to meet demand of all the patients, then supply is low and demand is high, leading to higher costs.

I think there’s currently a fairly strict limit on the number of new trainees due to the limited number of med schools (in the US). That should also keep standards high but there’s a bit of a balance there between having good standards and producing enough graduates.
The most precious gift we can offer anyone is our attention. - Thich Nhat Hanh

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Pajamas
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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by Pajamas » Wed Oct 18, 2017 7:55 pm

jayk238 wrote:
Wed Oct 18, 2017 6:09 pm
I wish I responded sooner so more people would read this but a lot of misinformation here:

I am a doctor and I see a lot of comment I disagree with including those from doctors
1. Doctors income- the idea that they make 'enough' or ' a lot' is an absurd statement. Taken alone everyone in America makes 'too much' or 'enough.' While this sounds callous compare us to the billions in poverty in Asia India Africa etc. We are truly lucky in many ways even the poorest considering the safety nets we have (for the most part).
Next, doctors are in a cognitive field that is unique on its own. It is different from dentists, from optometrists, and from engineers. Our work can lead to a patient dying pretty rapidly in fact, or a missed diagnosis leads to earlier death later on. Cognitive function only is as good as its user. Pay us little, stress us more and chances are our ability to perform well declines.
2. This idea of delayed gratification and 'I deserve it' so I will spend a lot on things is not accurate. Doctors do not go about life thinking I want to buy this this and this because Im rich now. No- its because we are conditioned as a group to hate our existence in a relatively short time. Residency is first and foremost one of the most challenging experiences you will encounter. I don't care what google engineer can do with his MIT degree or a dentist giving braces or an optometrist learning how to look at eyes. Standing in front of apatient and deciding whether to intubate on my own in the middle of the night because his sats are dropping -but wait! they dropped yesterday and he didnt need it- but now he's declining more because his fluid status has declined- is one of the most stressful and scary moments I have experienced. Doctors spend money on things because they feel they have not been appreciated. No one gives me a pat on the back, no recognition from the intubated and unconscious patient no satisfaction from the family not present. Only that I get yelled at when small mistakes happen like not getting their meals on time. We buy things because we feel like after all this hard work we are hardly appreciated except for the dollars we receive and we spend it so we can feel like there is some meaning. In effect we trade our time, or life (decade of schooling and training) and our existence for money. I suspect that doctors would be happier with less money if we were given more respect, more time off, and more recognition. None of which happens in a country when NPs, PAs, CRNAs, government and everyone else sees us as money grubbing bad people
3. Finally, medicine is not lucrative. It is only time when machine learning takes over our practices, when bernie-care becomes a reality because of false information out there about how cheap medical care in europe is and how it is so much better. Is medicine the only field where you can have both cheapness and great products (outcomes) ? Because cheap airplanes and cheap cars (Im not referring to Hondas but rather companies cutting corners- Takata) do not lead to better quality only more accidents.

And I leave you with this.

The outcomes of prostate cancer in the US for survivial in 5 years is 95%. In UK? 49%. Nearly 50% of men will have prostate cancer
The outcomes for patients with an Acute MI is 80%+ in the US depending on rural vs urban center- in the UK? < 60%
There is more data like this but its never EVER presented by NYTimes and others because this data is contradictory to their narrative for a single payer system.

End rant. Yes I know I ranted.
If you are underpaid you chose the wrong specialty.

Doctors rank #1 for occupational prestige and are in the top ten for respected professions. Maybe they would rank #1 in respected professions if so many didn't have attitudes like yours.

My suggestion to you would be to find a job that doesn't require you to have contact with patients. Seems like you would be happier and the patients would be, too.

Also, if you don't have the respect of the nurses and other health care professionals that you work with, it's because of you, not them. They generally respect doctors who are respectable.

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Re: Is a doctor's practice one of the safest and most profitable businesses?

Post by LadyGeek » Wed Oct 18, 2017 8:10 pm

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