The Healthcare Collapse

Where We've Been and Where We Need to Go

Eldo Frezza

• Publisher: Productivity Press
• Year: 2018
• ISBN:
  9780429015779
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

The evolution of the healthcare system in the U.S. has seen numerous changes in the last 30 years where fee-for-service was the mainstay of reimbursement models and hospitals were managed by physicians and patient care was key. The early 1990's saw the emergence of HMOs and other managed care models with physicians handing over leadership roles to corporate entities whose main concern was the bottom line and profitability while patient care and satisfaction suffered.

The Healthcare Collapse: Where We've been and Where We Need to Go explores the low morale of physicians in this corporate healthcare culture as well as the expansion of hospitals owned by corporations. The author focuses on recovering healthcare morals and return value to the individuals who provide active care and not just business. This book also examines the possible repercussions of Medicare and Medicaid while address the question of single payer healthcare.

This book looks at where healthcare has been, what has worked and what hasn't, and recommends solutions to create a system that focuses on the patient and providing quality care in this age of reimbursement cuts, demands for better technology and providing a safer environment for both the patient and clinicians who work in hospitals. The author also advocates for a shift in management and recommends hospitals leaders engage physicians and other clinicians in process improvement and other initiatives which can result in a more efficient system – one where quality patient care dominant. The book also outlines programs which can be championed by hospitals such as patient engagement activities, community health and other outreach and education programs.

PHYSICIAN STRUGGLES

II

Chapter 7

The Economics of Being a Doctor in the US

Cost of US Medical Schools vs Rest of the World

In this chapter I will dissect the different stages to becoming a doctor in the US, how much it costs to attend medical school, and how many more hours US doctors work than in other countries.

Medical School

First, let me start with medical school. We are importing doctors from other countries, which has been the norm for many years. Since medical schools outside the US are less expensive, students who wish to become physicians have more opportunties and possibilties to become one by attending medical school outside the US. To offset the cost of an excellent medical education, NYU recently launched a program designed to provide free admission to medical school predicated on tuition and living expenses of more that $100,000 a year. All told, by going to school in the US, a medical student spends about $50,000 for each of the four years undergraduate, which is equal to $200,000 and then $60,000 a year for medical school, which comes to $240,000. So every graduate in this country who becomes an MD spends around $440,000 to go to school, plus room and board. Moreover, they have to pay to take the MCAT (an exam that allows students to apply for medical school) and the USMLE which is an exam that helps them go from being just a graduate to having a valid license in the US. The USMLE is composed of four parts, all which have a separate fee. Taking both exams costs between $1000 and $2000. So when it is all said and done, a student in the US, who graduates and officially becomes a doctor going into a residency program, starts their career with a deficit of more than $500,000 to be paid when they start working.

If you take a medical school graduate from a foreign country (and I know this because I am a graduate from a foreign country), the cost of attending medical school is between $1000 and $3000 a year. The length of the program outside the US is six years between college and medical school, not the eight years required in the US. Therefore, if you calculate even the highest, most expensive school, let’s say the $3000 a year, multiplied by six years, the total medical school expense is around $18,000. There is only one state exam that costs less than $1000, so rounding it all off, a student attending a university outside the US can graduate from medical school for about $20,000. So why would anybody send their children to medical school in the US and spend half a million dollars to do so, when they can go to another country, including England, and come out of school with only a $20,000 deficit?

Of course, we are talking about state schools that, even outside the US, are more affordable than private schools, which can cost a lot of money. For example, let’s say you want to go to Cambridge University in the UK. Cambridge is a very well-known academic institution and probably the oldest university in the world. If you want to go there to study political science or something else, you spend perhaps $30,000 for undergraduate college and then the expense for medical school and so forth. But if a student goes directly to medical school instead, they embark on a six-year program, and even if they go to a private medical school in England, Italy, or France, it could cost $30,000 a year for six years or $180,000. That is to attend a private school, compared to $500,000 that the average student in the US will have to pay to go to medical school.

How Much Money Do U.S. Doctors Earn Compared to the Hours They Work?

After medical school, the new doctors enter residency programs, and residents work a lot of hours. When I was a resident, I worked 120 hours a week. Now, I work about 80 hours a week as a physician. The corporations that own hospitals around the country pay the physician for a 40-hour work week, plus extra if they are on call. The average week in Europe is 36 hours. In France, it is about 34 hours. The difference between the physician in Europe and a physician in the US is that after the physician in Europe finishes his 40-hour week, he’s done, his work week is done, and he goes home. In the US, it is never just a 40-hour work week because physicians in the US are always available for their patients. In Europe, when you finish the shift another physician comes in and starts their shift. In Europe, it becomes a shift job for the physician, not a 24/7, 365-days-a-year job as in the US.

So, let’s take an example. Let’s say that we bring the same concept they have in Europe to the US, which is a 36-hour work week. So, if I am a surgeon and I am on call for 24 hours, it means a day and a half and I’m on call all day. Healthcare is not an office job. This is a 24-hour job. The patient does not get sick when we have office hours; they get sick whenever they get sick. If I am a physician in Europe, the physician is on call for 24 hours and in the morning, you go home. You come back the day after to do a 6-hour shift or 12-hour shift. I take one 24-hour shift and one half-day shift, and I am done. The other four days are covered by another physician. To illustrate, you need four doctors to cover services for a week. If you pay each of them $100,000 a year, that $400,000 for four physicians instead of one reduces the risk of physician burnout.

I might take three night shifts, 7 p.m. to 7 a.m. Or I may take three days shifts, 7 a.m. to 7 p.m. It doesn’t matter, I only work three shifts or three days a week; the other four days are free. I am okay with that because they are going to pay us less, but hey, we have four days off.

I remember one year practicing in the US. I probably had a total of five days off. Physicians in Europe have the opportunity to take a three-month holiday versus in the US where the typical vacation is 28 days. In Europe, you can take up to three months of sick leave or to recuperate from an illness. In the US, you typically have five days. Between the time required to see patients and be on call, plus administrative responsibilities (patient records, etc.) and the typical holiday pay, shouldn’t physicians in the US be paid more to compensate them for their time?

Healthcare Is Not a Shift Job for Physicians

I think that most people talk about healthcare as a shift job. It’s about time that we talk about healthcare as an entirely different type of situation in this country because as a physician, we take care of patients, so if the patient doesn’t sleep, the physician can’t sleep! Patients are not a car. They are not animals. People don’t always get sick at convenient times during normal work hours. We as physicians, need to be there when the patient is sick, not by scheduled hours. If you want to change the whole system and part of that change is a decreased salary for physicians, then physicians are going to become hourly workers. If this is the case, then the patient can’t say, “But you are a doctor. You are supposed to take care of me because that’s what you went to medical school for.” What patients don’t understand is that physicians have families to support, children to send to college, and expenses just as they do. Even doctors need money. They cannot just work for nothing. Physician reimbursement is getting more complicated every day. With the expense of current technologies, it harder than ever for physicians today to make a living.

Reimbursement Issues for Physicians: The 33% Rule

The last issue I want to tackle is the reimbursement. If you work in Europe, you work for the federal government. Therefore you always get paid. It is like having Medicare patients all the time. You can work in the private sector to supplement income which means you get paid before you perform the surgery. In the US, one-third of patients do not pay because they do not ...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• Synopsis
• Author
• Introduction: Review Our Mistakes and Look to the Future
• SECTION I THE EVOLUTION OF HEALTHCARE
• SECTION II PHYSICIAN STRUGGLES
• SECTION III BROKEN SYSTEM
• SECTION IV CORPORATE HEALTHCARE
• SECTION V MEDICARE AND MEDICAID
• SECTION VI TOWARD THE PERFECT SYSTEM - WHAT NEEDS TO BE DONE AND WHERE WE NEED TO GO
• Index