Family Doctor or Family Nurse? Pay now or Pay Later?

We docs often hear that advance practice nurses could do 80% of what Family docs, pediatricians and internist do. But, it’s knowing the difference between that 80% and 20% that will kill you!

I’m printing the whole of this letter from Dr. Valenti published by the Texas Medical Association, because it says so much that we doctors are saying these days. Here’s more about the crisis among Texas Doctors who still see the poorest elderly in Texas.

Money is vital to keep practices open, but what’s scary is that there’s a move to allow “mid-levels” to do more. Specifically, Dr. Valenti objects to an opinion piece in the DMN that includes this statement: “Hardly anyone doubts that most veteran registered nurses, with a little more training, could do a fine job setting broken bones, stitching wounds and even dispensing drugs for common ailments.”

Tuesday, July 31, 2012
Setting the Record Straight on Doctor Pay
The following is a response by Joseph Valenti, MD, to commentary published Friday in the Dallas Morning News by Eli Lehrer, president of R Street. In the article, Mr. Lehrer claims U.S. physicians and health care workers make too much money and are responsible for the high cost of medical care in America.

Dear Sir:

I am a physician in Denton, Texas. This morning, I sat and read your article in The Dallas Morning News titled “Your Doctor’s Big Fat Paycheck.” Frankly, I am in awe of the breadth of your ignorance.

Fact: Of the health care dollars spent in this country, physician salaries make up about 8.5 percent. That is one of the lowest percentages in the industrialized world. Germany, by contrast, is at 15 percent.

Fact: The graduate level course of study for nurse practitioners (NPs) and nurses is not even close to that of physicians — we have a little something called residency. Perhaps you’ve heard of it. When I did mine in OB-Gyn from 1994 to1998, it was 90-100 hours a week for four years with a take home pay of $20,000. I was raising a family on that, as my wife had to stay home to take care of premature twins. NPs and nurses do none of that.

Fact: Private insurers are already too strong. “Weak bargaining position”? If you don’t like the contract they offer, they tell you to take a hike. Doctors are the ones with no bargaining position. I haven’t had an increase from United Healthcare for 54 months. Meanwhile, it paid its shareholders an 11-percent dividend last year. And regarding your comment about how individual plans rarely cover one-half an area — do your homework! States like Alabama have Blue Cross and Blue Shield covering 90 percent of insured lives! In any other industry, this would constitute a monopoly.

Fact: Medicare increases have been had by every segment of the health care industry except doctors. (See the charts.)

Fact: Pilots may make less than doctors. They also belong to unions and walk out when they don’t get what they want. Doctors never walk out, and the pro bono and free care we hand out can’t even be deducted from our federal taxes as charity. Then try breaking it down per hour. Pilots fly about 60 hours/month. Doctors work in the office and hospital about 60 hours/week. And that doesn’t take into account nights and weekends on call. Don’t get me wrong — pilots are vital and do a great job. But on a per-hour basis, they are clearly ahead. By the way, I don’t know a single primary care doctor who makes $200,000 a year. Most of the ones I know are barely getting by, and many are closing their practices or selling them to hospitals.

A huge doctor shortage is looming. We cannot and will not attract our best and brightest students to medicine unless their pay is commensurate with the level and intensity of work and commitment needed to fund a modern medical education. The student loan burden alone, which is now often exceeding $200,000, keeps many away.

The huge amount we spend in this country for health care has far less to do with medical professionals’ salaries than it does with the cost of almost everything else. Case in point: The same Mirena IUD, from the same single factory that Bayer uses in Finland, costs $700 in the United States but costs $250 in Canada. Really? That same case can be made for tens of thousands of drugs and medical products here.

Medicine is one of the only businesses I know of where the increasing cost of doing business can’t be passed on to the customer. Every year, the cost of running my office and paying my employees goes up, while insurance payments stay the same or go down. I am left to eat the difference. My salary the last three years is less than I made 14 years ago when I started in private practice. Hardly a source of bankrupting the health care system.

Shakespeare said that the eye sees what the mind knows. With that in mind, ask yourself if you would feel comfortable entrusting your care or that of your family to someone with less training, less knowledge, and less expertise. Would you? I think not. Now ask yourself how happy one of us would be treating someone like you, who wrote an article that is so misleading about us and who we really are and what we really have done to become really good at taking care of patients. Surprise. We would love to take of you. Why? Because that is what we took a vow to do, a vow that doesn’t allow us the luxury of being judgmental. So the next time you are lying in bed needing emergency surgery, remember this — we will be there. Pay or no pay. Assign a value to that ideal, and then consider whether or not we are “overpaid.”

Sincerely,
Joseph S. Valenti, MD, FACOG