Gifted Issues Discussion homepage Forums General Discussion Against the bachelor's degree

Let the OEs fly!

Tigerle,

I grew up in a small town in the mid-west, which affords me the use of lots of colorful colloquialisms


I've submitted a claim to the insurance for authorization, so hopefully they will cover it. I had the same logic. Wouldn't they want to if it is cheaper overall? But with these big corporations often times if something is not already standardized in the playbook they try to avoid dealing with it.

The insurance doesn't profit, but the entire medical system does, which is run like a for-profit corporation. So, you're right that the doctor's benefit from this system. (Some, not all. My husband is a pediatric endocrinologist and makes a salary on the lower end of the MD spectrum. Diabetes patients are the bread and butter of his profession and most of their care is dealt with at home - so no regular billing for office visits.)

Do you expect that if the doctor's have lower debt burdens that they will, out of the goodness of their hearts, take a salary cut? Some doctors choose their particular profession strictly because of the take home pay incentive. The current system allows some to inflate their take home pay by gaming the billing system, sending unnecessary charges to the insurance, who then pay the medical facility. All of this drives up out-of-pocket costs as well as insurance costs.

In a private clinic setting, you're correct, it's the doctors making these decisions. In a larger facility, these decisions are taken out of doctors' hands.

On the surface, your logic about insurers would appear to be correct. However, given that they're mandated to spend a certain percentage of their income on healthcare, they're incentivized to pay for more costly procedures. More spending equals more profits, so long as they can continue to pass on the costs to their customers. And the insurers have figured out a basic truth, which is that their customers will dig deep into their pockets and accept all kinds of quality-of-life compromises when the alternative is suffering for themselves and their loved ones.

I am not so naive as to think that everyone with less student loan debt will ask for less compensation, but I will note that those with higher debt are forced to seek higher compensation. One of the reasons my sib in family practice is able to maintain (barely) a private primary care practice open to underserved populations is that med school at an elite was accomplished without any student loan debt at all--but that's also owing to the investment of a few additional years and effort into an MD/PhD. Peers from the same med school cohort did not have the same option, since they had to find specialties and positions that would optimize student loan payback in short(er) order.

And I would agree that primary care and almost all pediatric specialties are significantly disadvantaged by the current reimbursement system. Which, incidentally, also disproportionately affects female physicians.

On another note, I admit to considerable ignorance regarding economics (but I have friends who are economists!), but I'm still finding aquinas and tigerle's exchange quite entertaining.

Now you are talking about individual doctors again.

It is all ab It how you incentivise a system, and which lobbies shape the incentives.

Clearly, a system in which office visits are artificially inflated benefits neither insurers nor patients, but doctors - as long as every single office visit is reimbursed on a scale that makes economic sens. The insurance simply won’t care, as long as they can shift the cost to the patients in the long run. So, inflating office visits must be a policy that has been lobbied for by doctors‘ professional associations, whose primary motivator is driving up income.

Can there be any other motivator, you ask? Sure, there professional ethics and pride, but those need room to work! If the system ie shaped diffentlym eg if insurance contributions are capped, or if a single payer acts to keep costs down, you can cap the revenue from office visits. Suddenly, patients who turn up are more work than they are worth. Overworked NHS GPs do not lobby for more office visits, even if they were to generate a somewhat higher income, because they do not have astronomical debts to service.
Hopefully, doctors then should have an incentive to lobby to be reimbursed for exactly the number of office visits from a patient they need in order to do their job, and do it well.

If you have a workforce made up of servants indentured to their student loan companies, the primary motivator must always be driving up income generating costs, It’s not about doctors being good or bad people, it’s about whether professional ethics endanger your preofessional and financial existence.

Edited to add that I do hope this situation works out with the least burden on you and our child!

I’m not really just talking about individuals or good vs bad. But we have a system that encourages profit seeking over patient care. They try to mitigate this with patient satisfaction surveys, but these tend to be unreliable. And I’ve witnessed pressure from the top to meet office visit quotas. When working in a larger system the doctors are made to conform to certain profit models.