Author Topic: There may be a cure. On the other hand, not finding a cure is very lucrative.  (Read 13455 times)

greaper007

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

So many factual errors I'm not even sure where to start.  I had hoped that airplane pilots had more sense than your post belies.  The ADA I believe is the American Diabetes Association.  If you are referring to the AMA (American Medical Association - not to be confused with the American Motorcycle Association), wow, I don't know of a single doc who belongs to that big bag of bloated shit.  In fact, more than 200,000 docs post at sermo.com and not one of them will admit to endorsing ANYTHING that organization believes in.  Most feel that the downfall of their profession is at least partially blamed on the AMA!  Every doc I know hates the AMA, and most have no idea who the ADA is.

It is against federal law for docs to unionize.

And you flew a plane with unsuspecting passengers/cargo on board?  Shame on you!

Wow, are you this douchey to your patients?   Shame on you!

The Happy Philosopher

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

What is the ADA?

I'm not aware of any doctor "union" that you are referring to. In fact I think it may be illegal for doctors to unionize.

You may be referring to the AMA (American medical association), which in part lobbies on behalf of doctors. I think you are overestimating the political power of the AMA. Residency positions determine supply of doctors, not medical schools. Excess residency slots are often filled with foreign medical grads. Who end up working in the us anyways. Generally oversupplied poor paying specialties have a harder time filling slots, which eventually leads to fewer docs in that specialty, shortages, better pay etc. it's a very slow inefficient market.

Doctors/hospitals negotiate with insurance companies for pricing. For Medicare/Medicaid you get whatever they decide to pay. Many providers can't break even with Medicare patients depending on overhead costs so one could argue that the AMA has done a poor job lobbying for doctors!

Many doctors making 300k or greater are sub specialists that have put in around 10 years of post graduate training. Average primary care doc probably makes closer to 200k.

Yes, that was a typo, not sure why it came out as the ADA.    I was under the impression that they were the organization that licensed medical schools, I apologize.

Still, compare doctors, lawyers and pilots.   What's the major difference?   There's essentially no barrier to entry to becoming a pilot.   Sure you have to pass check rides with the feds and get some hours before you can get a job that pays you to fly.    But there aren't officially licensed schools that only take a small number of graduates.     Law school is a little tighter, but the law profession has been saturated with lawyers from an ever increasing amount of law schools.    Many of these lawyers don't break $30,000 and have $200,000 in debt from a third rate school.

Now, doctors have a very high barrier for entry.   Whether you want to define that as medical school or residency doesn't really matter.    The fact is that there have never been too many doctors, thus doctor's pay has always been high.   Professional organizations seem to ensure that, I call that a union even if it isn't officially one.    I would put median pay in aviation at about $50,000-$70,000 a year.   There are a few very well paid major and legacy captains that skew the average.    My best year was $42,000 as a captain at a regional and I started at $17,000.

The supply of doctors does not change Medicare reimbursement which is by far the largest payer in the country. In many specialties there have been drastic fluctuations in supply and demand and in my experience has not been a major driver for salary. When the job market gets bad med students choose other specialties. The reason there is a shortage of primary care docs is not because the supply of medical students is constrained, it's because these specialties don't pay enough to attract people.  In the fee for service model doctors make more money by being more efficient and busier, not limiting supply. Also when the supply of doctors goes up, the cost of health care goes up because more marginal treatments are done to pay the bills. Same thing in law, more lawyers equals more lawsuits.

Also there is no shortage of docs in desirable places to live. There are shortages where no one wants to practice.

I'm sure law school and pilot school are challenging, but the training for physicians is much longer and many more hours.  I don't think you appreciate how difficult it is to be up every third night for months/years at a time or how stressful it can be.  No sane person would go through this without some reasonable compensation. These docs making 300k often have 10+ yrs of post graduate training/education. When you factor in the opportunity cost of training the "hourly wage" of physicians comes way down. Physicians should make more than pilots. No one in their right mind would be a neurosurgeon for 200k/yr.

It looks like you are being underpaid by the way. I would try and negotiate a higher salary.
http://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm

Here are the physician and lawyer links for comparison
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm
http://www.bls.gov/ooh/legal/lawyers.htm

Bakari

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They don't have to withhold it, just don't do the research in the first place.

What I do think is a HUGE amount of cures and treatments are 50-100% placebo, and that most of the money and time spent on healthcare is for things which the body would have fixed itself with enough time, and proper exercise, nutrition, sleep and rest.  I think a huge percent of healthcare is really just about making people feel better, whether it is treating symptoms or even just making them feel emotionally better because someone is "doing" something.
I think doctors are well meaning, but there is financial (and emotional) incentive for them to pathologize as much as possible, and to reinforce the idea that they are needed.  Not unlike priests.  Its easy enough to see how every "alternative" healthcare practitioner falls into that category, but I think it applies almost as well to much of real medicine as well.

I just wrote a whole essay on this exact topic, I'll try to remember to post the link here once I put it on my blog (it'll be a couple days because I have a single topic series going up one day at a time at the moment)

Do you have scientific justification for any of this? IMO the last century of biomedical research would like to have a talk with you. Hell, one of the main drugs in this thread - Sovaldi - is a CURE for Hep C, a disease that guarantees liver failure regardless of the amount of time/sleep/good nutrition.

Of course its not 100% of 100% of cures.  If you have diabetes or cancer or a bacteria infection modern medicine is the difference between life and death.  But the dramatic cases aren't what most doctor visits are for, they are for rashes and colds and hurting backs.
Up to 90% of all doctor visits are for "conditions" caused by stress:
http://www.webmd.com/mental-health/effects-of-stress-on-your-body

The scientific evidence?  Between 35 and 90% of people get better with either no treatment or placebo, depending on the condition
http://skepdic.com/placebo.html

Also, doctors don't keep up with the best available research anyway:
http://www.utne.com/science-and-technology/a-study-a-day-keeps-the-doctor-away.aspx

so even if a cure exists, it isn't necessarily what health care is going to consist of

The essay I alluded to earlier, to further support my claim that 90% of (1st world) health care is unnecessary:
http://biodieselhauling.blogspot.com/2014/04/healthcare-last-mainstream-superstition.html

greaper007

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The supply of doctors does not change Medicare reimbursement which is by far the largest payer in the country. In many specialties there have been drastic fluctuations in supply and demand and in my experience has not been a major driver for salary. When the job market gets bad med students choose other specialties. The reason there is a shortage of primary care docs is not because the supply of medical students is constrained, it's because these specialties don't pay enough to attract people.  In the fee for service model doctors make more money by being more efficient and busier, not limiting supply. Also when the supply of doctors goes up, the cost of health care goes up because more marginal treatments are done to pay the bills. Same thing in law, more lawyers equals more lawsuits.

Also there is no shortage of docs in desirable places to live. There are shortages where no one wants to practice.

I'm sure law school and pilot school are challenging, but the training for physicians is much longer and many more hours.  I don't think you appreciate how difficult it is to be up every third night for months/years at a time or how stressful it can be.  No sane person would go through this without some reasonable compensation. These docs making 300k often have 10+ yrs of post graduate training/education. When you factor in the opportunity cost of training the "hourly wage" of physicians comes way down. Physicians should make more than pilots. No one in their right mind would be a neurosurgeon for 200k/yr.

It looks like you are being underpaid by the way. I would try and negotiate a higher salary.
http://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm

Here are the physician and lawyer links for comparison
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm
http://www.bls.gov/ooh/legal/lawyers.htm

What drives pay?   Dangerous work conditions? Well then soldiers at war should be paid more than everyone, tell that to a PFC making $20,000 a year.   Need for a job?  Sanitation workers make what, $15 an hour?   Training?   My wife spent 7 years post grad (not including her dissertation) to become a psychologist, obtained probably 5x the amount of clinical hours that a psychiatrist obtains in training and if she still did clinical work, she'd make less than half what a psychiatrist does simply because her Dr. isn't followed by MD.   

You don't get paid based on what your job requires, you get paid based on what you negotiate.    So if you don't think there's an artificial scarcity, what's really driving doctor's salaries?   The feds negotiate with contractors just like everyone else, so who's negotiating here?

The median income you posted for pilots is accurate from a mathematical viewpoint, but doesn't really take a lot of things into consideration.   Pilot pay is based not on years worked, but years worked at a particular company.   All companies pay differently.   If your company goes under, you start over at year one at another company.    There's also a considerable difference between regional airline pay and major and legacy pay.   I opted for low pay in order to quickly upgrade to captain so that I would have enough hours to maybe move on to a decent carrier when the decent carriers opted to open their books (this sometimes doesn't happen for a decade).  Here's a more accurate view of pilot pay http://www.airlinepilotcentral.com/airlines/regional

Difficulty...I did the exact same thing you did.   Often flying things called standup overnights where we would fly the last few flights of the night, stay up all night, and then fly the first flight of the morning.   You're not working the whole time, but that's actually worse because it fatigues you even more to sit around.    We also had things like being forced to ferry broken airplanes all over the country once we timed out at our maximum duty day to fly passengers.   So on top of being tired you have to be more vigilant because you're flying a plane that may be missing key components like retractable landing gear, weather radar, or deicing equipment.   A crew from my airline was killed when the mechanics installed a trim tab upside down.   They desperately tried to relieve control pressure my trimming in the appropriate direction on takeoff, without realizing their efforts were actually causing a nose down condition.   That's what happens with an 18+ hour duty day.  I'm at the point that I can't even remember all the people I've known that have been killed in airplanes.    My dad has a picture of his flight school class from the Navy.   Every one of them ended up being killed in airplanes.

I don't want to imply that one job is harder or more important than the other, because I honestly don't believe that.   I also think it's awesome that doctors have been able to hold onto high pay in an environment that doesn't always reward traditional specialties.   From what I can gather though, there's a dedicated group that maintains high pay for doctors that doesn't exist in other professional labor type fields.

LowER

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

So many factual errors I'm not even sure where to start.  I had hoped that airplane pilots had more sense than your post belies.  The ADA I believe is the American Diabetes Association.  If you are referring to the AMA (American Medical Association - not to be confused with the American Motorcycle Association), wow, I don't know of a single doc who belongs to that big bag of bloated shit.  In fact, more than 200,000 docs post at sermo.com and not one of them will admit to endorsing ANYTHING that organization believes in.  Most feel that the downfall of their profession is at least partially blamed on the AMA!  Every doc I know hates the AMA, and most have no idea who the ADA is.

It is against federal law for docs to unionize.

And you flew a plane with unsuspecting passengers/cargo on board?  Shame on you!

Wow, are you this douchey to your patients?   Shame on you!

So few people see the bright side of being a douche. 

Hamster

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What I do think is a HUGE amount of cures and treatments are 50-100% placebo, and that most of the money and time spent on healthcare is for things which the body would have fixed itself with enough time, and proper exercise, nutrition, sleep and rest.  I think a huge percent of healthcare is really just about making people feel better, whether it is treating symptoms or even just making them feel emotionally better because someone is "doing" something....

The essay I alluded to earlier, to further support my claim that 90% of (1st world) health care is unnecessary:
http://biodieselhauling.blogspot.com/2014/04/healthcare-last-mainstream-superstition.html

I think part of what makes this tricky is: What do you mean by health care, and what you mean by necessary?

Most outpatient visits are for minor conditions, and most people want reassurance or treatment for symptoms.

Is it unnecessary health care if a worried patient comes in with a new rash? How about a cough with fever? How about some mild wheezing? How about a big nontender lymph node in the neck? Any of those could be benign watch and wait things, or they could be signs of cutaneous lymphoma, bacterial pneumonia, asthma, Hodgkin's lymphoma, etc. Any of those could kill someone if not identified and treated.  If the doc says watch and wait, then was the care necessary? If they work it up and it turns out to be nothing, was it necessary? If it turns out to be one of the more serious illnesses above, then was the care necessary?

What if someone comes to the doctor wanting advice about wieght loss? Comes in to have their infant's growth and development monitored and receive immunizations? Has cholesterol screening?

I think in the end it gets pretty arbitrary. There is science, there is art, there is psychology, and what is "necessary" varies greatly based on the patient.