× Medical Specialties

Obstetrics Malpractice Premiums

More
13 years 4 months ago #57622 by susanwa1ker

Originally posted by AnnaM:
So in other words, the answer is to work harder and make less money.

Did you become a doctor to make tons of money?

Originally posted by AnnaM:
Gee, seems fair to me when you compare what insurance company executives make to what they think OB's should make.

Insurance doesn't "think" what people should be paid. It pays what the market can bear. If no one were signing up for insurance contracts, the companies would go out of business.

Originally posted by AnnaM:
I don't mean to be flip, but has anyone noticed how much easier it has gotten to get into OB-gyn residency in the last few years?

It has always been easy. When there were few or no women in med school, it was for the bottom of the class, the impaired physicans and the alcoholics. There was a breif surge in interest from female students.

It has never been very sought after. Why should something uncompetitive pay so much?

Originally posted by AnnaM:
The people in this country will get what they pay for in deciding how much OB's are worth, and it's sad.

I had two kids. The doctor didn't show up on time for either one. They both still tried to bill the insurance.

Please Log in or Create an account to join the conversation.

More
13 years 4 months ago #57623 by susanwa1ker

Originally posted by XildUpNawth:

It's "simply" simplistic to compare the loss of autoworker jobs with the OB malpractice situation. You can't outsource obstetrical care to Japan (yet).

You can outsource it to a midwife.

Originally posted by XildUpNawth:
You don't spend 12 years of post-secondary education becoming qualified to work the assembly line. If you screw up building a Chevy, generally nobody dies. Also, at the end of your shift building cars, you go home, and are highly unlikely to be paged in the wee hours to do an emergency auto assembly.

[/b]

There are plenty of autoworkers kids like myself who would be happy to do all that and they'd do it better and for much much less. But, there isn't equal opportunity. The admission to the profession is controlled by people from upper middle class professional backgrounds who favor their own to no end.

Originally posted by XildUpNawth:
I highly doubt any pregnant woman would agree with your statement that the OB profession is worth less than it was in past generations.

You can doubt all you want. But the fact of the matter is a lot of average women hate you. They go off and do herbals and home births and other things to avoid the manipulativeness of the OBs. They complain that they are inundated with technology at birth for your convenience and profit. After seeing their charts, I have to agree with them.

Originally posted by XildUpNawth:
[QB]It's all about who's paying the bill, and insurance companies generally are, not patients, and they have way too much say in how much the OB profession is "worth."

[/b]

You are perfectly free to not take insurance. Patients could submit their own claims and pay you the difference. Why don't your patients value you so much that they go do this?

Your colleagues (the ones that are good and get results anyway) in IVF can do this. They get patients forking over 10s of thousands without any insurance.

Originally posted by XildUpNawth:
Last time I checked, we spend a higher proportion of our healthcare dollars on administrative costs in this country than in any other industrialized nation, and anyone who has tried to settle a dispute with their insurance company can tell you that the quality of healthcare admin we get in return does not equal the cost.

It costs so much because entitled american docs cheat the most. Primary cares who stick their head in the door and say "hi' everyday when their patient is having surgery -- just to bill. Making patient come back over and over for frivilous reasons so you can bill for a 5 second visit. How about OBs who induce so the woman doesn't deliver while they are on vacation and miss the fee? or just because they are taking too long and they want to go to lunch?

Originally posted by XildUpNawth:

Perhaps your profession isn't the wisest soapbox from which to lecture on this subject.

My profession is medicine. I got out of clincal practice because I got tired of all my rich doctor's kid/ upper middle class colleagues who thought they didn't get paid enough and thought it was OK to dump their work on me. They'd run to their daddy the cheif of medicine or their uncle on the hospital board to enforce their entitlement to my free labor.

You see while you complain about the stanglehold insurance has over you, the only reason you are in the profession is because your segment of socity has a stranglehold on the profession.

Something tightly controlled by a weak group of people is bound to be controlled by someone else.

If you are so desesrving of more, than why don't you just go and do something else? Because there is no patronage in all the something elses.

You live by the sword, you die by the sword.

Please Log in or Create an account to join the conversation.

More
13 years 4 months ago #57624 by susanwa1ker

Originally posted by XildUpNawth:
Check out this article. Just one more reason physician pay is reduced by admin costs and inefficient insurance companies. You may have to log in or sign up, which is free.

The Check Is Not in the Mail

The main reason docs don't get paid is because they hire minimum wage employees to file their claims. The throw it together and run it up the flag pole twice incorrectly. Then, they sell it to a colleciton agency for pennies on the dollar, so they can say they are done.

And this is a violation of their contract, which states that you must file correctly and not try to collect from the patient.

I would encourage any patient who has had their credit damaged to inform their insurance company (it can take legal action in the form of damages and discontinue the contract) and take legal action themselves against the doctor's office (this is a violation of credit reporting acts).

Please Log in or Create an account to join the conversation.

More
13 years 4 months ago #57625 by XildUpNawth
You are disturbingly willing to generalize about a large group of people, and to assume that your own small, limited set of experiences is representative of the whole. I really don't see any reason to discuss this with someone so intellectually immature. I'm not sure I understand why you want to be a physician, when your own profession is clearly superior and your medical colleaugues will be such pathetic human beings who lie, cheat and steal their way to underserved riches.

Please Log in or Create an account to join the conversation.

More
13 years 4 months ago #57626 by susanwa1ker

Originally posted by XildUpNawth:
You are disturbingly willing to generalize about a large group of people, and to assume that your own small, limited set of experiences is representative of the whole.

Pot. Kettle. Black.


"**anyone** who has tried to settle a dispute with their insurance company can tell you that the quality of healthcare admin we get in return does not equal the cost"

"**they** have way too much say in how much the OB profession is 'worth.""

"I highly doubt **any pregnant woman*** would agree with your statement that the OB profession is worth less than it was in past generations."

Originally posted by XildUpNawth:
I really don't see any reason to discuss this with someone so intellectually immature.

What you really mean is that you pointed out holes in your argument that you could drive a truck through.

You have decided to take a childish route to attempt to save face (another sign of someone with a sense of entitlement the size of Texas)

You claim you are worth so much and being unfairly denied it by insurance companies.

I repeat:

Why don't you stop taking insurance? Patients could submit their own claims and pay out of their own pockets the difference between what you want and those evil insurance companies pay.

Why don't your patients value you so much that they go do this? I thought you said ANY pregnant women would agree OBs are worth as much as in they were in the past.

If you are so deserving of more, than why don't you just go and do something else?

There are plenty of people in and out of medicine who can write their own ticket. Why can't you?

Please Log in or Create an account to join the conversation.

More
13 years 4 months ago #57627 by AnnaM
First of all, we need to stop the name-calling here. This is what got the affirmative action thread closed and some posters banned (and I suspect that since susan is now registered under a slightly different spelling of her name, that she may have been one of them.) I enjoy polite discussion, but if this thread degenerates like that one did, I won't continue to contribute.

Second of all, I'm not in the mood for a lot of cutting and pasting tonight, given the number of points that have been made, so I will just ramble instead and try to hit the high points.

Re: the suggested income level for OB's leveling off at $150,000 a year: If Lynne is working 80 hours a week, that works out to about $30 an hour (allowing time and a half for overtime, which is what auto workers get, though not allowing for double time on weekends, which you can get for standing around holding a road construction sign). Lynne didn't start her career right out of high school at age 18 with no debt. She started her career at age 30 with, most likely, a pile of debt (over 100,000). I topped out at the incredibly massive salary of $130,000 a year 5 years ago (level since then) and the folks in my former department are now subject to a 6% salary withold, so I'd be making 122,2200 if i hadn't quit. As you can see, Susan (and in answer to your question), I did not go into medicine to make piles of money. I went into medicine because once upon a time, it was my passion and the one thing I loved and wanted to spend my life doing. That was a long time ago and things have changed. When I referred to "what insurance company executives think OB's should make", I was referring to you specifically, Susan, as you specifically seem to have decided that's what OB's should make, and said so in your first post. I may be in error in concluding that you are an insurance company executive, so please correct me if I'm wrong. Neither of your profiles has any information in it.

Re: OB's being at the bottom of their class, impaired physicians and alcoholics: that is an incredibly sweeping generalization with no evidence to support it, and an insult to the OB's in the forum. Please provide documentation of that.

Re: OB's not showing up in time for deliveries. It happens. I've missed a few myself (had a pt. go from 2cm to delivery in under 10 minutes). Yes, there are docs who try to stay home or in their offices until the last minute, but the flip side would be to come in at 2 or 3 cm on every patient and end up sitting for hours and hours on L&D. You must also take into account labor nurses who don't track a patient closely (or can't because they're understaffed and overworked) or don't believe a woman when she screams "I gotta push NOW". Hospitalists and laborists will eventually take over deliveries, and women will complain about the fragmentation of care.

Re: Doctor charging for a delivery s/he missed: OB is usually a global fee. The doc is responsible for your entire pregnancy, and gets paid the same whether the baby comes in 10 minutes or 10 hours, or 3 days. Global fee reimbursement around here averages about $1500. That includes a complete physical and pelvic exam, 12-14 prenatal visits, attendance on L&D for up to several hours, performance of a high-risk procedure, rounds in the hospital, and another pelvic exam 6 weeks later (plus usually a bunch of phone calls, and that's only if things go normally). My mechanic recently wanted to charge me $2200 to replace my transmission, a 2-day job.

Outsource OB to midwives? (actually, I am in favor of more of the normal OB being done by midwives in this country, but last I heard, hospitals are cutting back on midwives because they consider having them on staff to be high-risk.) And Susan, you yourself cautioned us not to leave things to midwives, but to go into the hospital and see the patient ourselves.

Average women hating OB's? There are a few who have issues with them (I think midwives do about 3% of births in this country), but the technology they hate is increasingly dictated by insurance companies and hospitals. I used to routinely monitor labor with intermittent auscultation, but staffing levels in hospitals and the "standard of care' in many places no longer permits that. I was once written up to QA/I for taking a patient OFF a monitor (actually, she stood up on the bed and ripped it off herself) with thin meconium, even though I did q 5 min auscultation until she delivered 15 minutes later and all was well with baby.

Technology for profit? I don't see it. When you get paid a flat global fee, where's the profit in using more technology. The doc does not get paid any extra for using monitors, epidurals, etc. Please clarify.

Fertility specialists get 10's of thousands of dollars extra because their patients are desperate to get things that are not covered by insurance to a large extent. If people were as desperate to get their diabetes and blood pressures under perfect control as infertile couples are to get a baby, I would have been a wealthy woman years ago (I was in primary care, BTW). It's the same reason most plastic surgeons are extremely wealthy. A woman will pay thousands out of pocket for a boob job and quibble over a $10 copay for her annual exam. You know it's true.

Entitled American docs cheating? Another broad generalization without evidence to support it. I know a couple of bad apples(and EVERY profession has them) , but the majority of docs I know are honest, hard-working folks. Charging for sticking their head in the door and saying Hi: We call that social rounding around here, and most primary care folks I know do it for free, because patients expect it. Insurance companies will not pay for concurrent care of one diagnosis. If the doc is managing a separate diagnosis from the surgeon, they should be paid. Monitoring diabetes pre-and post-op may not require much face-to-face time, but is important, sometimes critical, and does require time on the unit, expertise, and usually several phone calls a day, something which the patient may not appreciate because they don't see it.

5-second office visits? I have never seen it. Even the simplest of problems or followups requires a few minutes of history and physical, decision-making, and documentation. Multiple followup visits are usually dictated by the fear of liability suits. A tiny cut can become necrotizing fasciitis overnight (or even in hours) Will it? Probably not, but no one can afford to take chances anymore. Lynne has been sued 4 times. I have only been sued once, and the case was dismissed (after 2 years). It was the worst experience of my life, and though some may brush it off because the case was dismissed ("no big deal"), it WAS a big deal to me. A uniformed county sheriff walked into my office and handed me a stack of papers accusing me of killing a woman by supposedly failing to do what the record clearly stated i did do. Try it sometime. Just for fun.

Elective inductions? Almost always done at the request of the patients. Women now start pressuring me to induce at 38 weeks, sometimes earlier (I still help out in an outreach prenatal clinic). An induction is MUCH more work for the doc than spontaneous labor, requires more time on L&D if there is no in-house coverage and the OB doesn't live next door to the hospital. Wanting to go to lunch but the woman is taking too long? Hospitals have cafeterias and we eat in them all the time. I've never seen anyone start pitocin so they could go to lunch.

Doctors a weak group of people? That's how they made it to the top of their class and through all those years of school, by being weak. Doctors do not have the time to get political, and organizing would be illegal anyway.

Hiring minimum wage employees for billing? Trained billing people are paid well. The docs in the article Xild posted were paying theirs over 3X minimum wage just to chase down their money for them from the insurance companies.

Stop taking insurance? Many doctors have, and many of them are happier and making more money that way. I hope the concept spreads. I know docs charging 25-50 bucks cash up front per visit (not much more than a co-pay these days) and doing well. Perhaps it is the jobs and salaries in the insurance industry that will be the next to disappear. Works for me.

Bottom line, 22 years ago I started out in a career I loved. Last year I quit in disgust. When I was working, I left the house at 8AM (6:30 or 7 if I was on rounds or had a meeting) and returned at 7PM, if I didn't have to go to the hospital for an admit, recheck rounds on an unstable patient, or a delivery. Back home, I spent most of my evenings second-guessing what I had done during the day, and never realized how poorly I slept and how many nightmares I had until I quit the job and the nightmares stopped and I started sleeping like a LOG. For that I should be paid less than someone who pushes papers in an office all day and goes home at 5, or (on a per-hour basis) less than a high school teacher with a bachelors degree, an auto mechanic, a plumber, or an auto worker?

Long rant, but there you go. Most of us have posted our stories in the Introductions thread. I didn't see yours there, Susan. Feel free to fill us in on your odyssey in medicine and how you ended up where you are now. I'd love more information.

Please Log in or Create an account to join the conversation.

Moderators: TexasRoseefex101
Time to create page: 0.210 seconds
Find us on Facebook!
Find us on Twitter!
Find us on Pinterest!