Medicine and cost

[dieseltaylor]

Now the US is joining the civilised world it is probable that medicine and cost will become a more researched subject. The Harvard Business Review has an interesting article on US costs which have revealing comments something like "if GM was paid by bolts on car as procedures are done in medicine GM would make a car full of bolts"

And amazingly the median for a pediatrician was something like $460000 pa a huge multiple on general doctors pay. Unfortunately my copy has been nicked before I have fully digested it but I will recover!

This is a goody:

http://search.nejm.org/search?w=niacin

basically Vitamin B3 Niacin is more effective than prescription drugs for certain types of arterial treatment. It is also 5800% cheaper per dose. Turning it into English comes from here

http://www.naturalnews.com/028473_Zetia_Vitamin_B3.html

a study published in the New England Journal of Medicine which showed that niacin (a low-cost B vitamin) out-performs Merck's drug Zetia for preventing the build-up of arterial plaque, a symptom of cardiovascular disease.

As the study reveals, Zetia failed miserably. Patients taking niacin showed a "significant shrinkage" in artery wall thickness, while those on Zetia showed no such improvement. At the same time, the rate of "cardiovascular events" in the niacin group was only one-fifth that in the Zetia group, demonstrating that niacin is far more effective at preventing heart attacks and other similar events than Zetia.

[JonS]

... It is also 5800% cheaper ...

AAoooGA AAAoooGAAA AAoooGA

Meaningless figure alert. Repeat, meaningless figure alert.

This is not a drill.

[dieseltaylor]

AAoooGA AAAoooGAAA AAoooGA

I often wondered how to spell that

[Stalins Organ]

Politics alert too I think - expect the big shiney scalpel of Moon or Steve to excise this one shortly.....

Hi Mom!

[YankeeDog]

And amazingly the median for a pediatrician was something like $460000 pa ...

Eh?? Are you talking about median pay? If so, your figures are way off. I come from a family of pediatricians (both grandparents on my father's side, both parents, and one sister). Median Pediatrician pay in the US is nowhere near $460,000; that's would be an exceptional salary for a pediatrician. It depends on which source you look at and how you count it, but average yearly income for a General Pediatrician in the US is somewhere in the mid-$100,000s. According to most sources, choosing to be a pediatrician puts you below the 50th percentile of the compensation scale compared to doctor specialties as a whole.

Also, when considering doctor compensation, it's very important to look at exactly how compensation is calculated, and how it factors in things like # years training required, # hrs. worked per week, etc. before drawing any conclusions.

For example, my sister is currently midway through her Pediatric Infectious Diseases fellowship. She is also simultaneously studying for a Ph.D in Public Health. This MD-PhD route requires a huge amount of schooling; in terms of rigor and time commitment it is comparable to what it takes to become a highly specialized surgeon, such as a cardiac surgeon or neurosurgeon. However, a doctor completing one of these surgery fellowships will probably make far more money than my sister will when she finally finishes her training. From an economic standpoint, my sister's choice of specialty is illogical. But it's what she really wants to do, so she's OK with that. There's more to life than money.

Cheers,

YD

[Stalins Organ]

US median pay site says $120-160k , general practitioner not much different

[Affentitten]

I just looked at the article. It says "Family practitioners' median annual compensation is about $180,000, according to the Medical Group Management Association, whereas orthopedic surgeons make $476,000. Increase compensation and redirect government training dollars to attract doctors to general medicine."

The context of this section of the article is the increasing number of medicine grads opting for high status/reward specialities and a decline in those wanting to do general practice. I doubt that is a US only problem.

[JonS]

Is d-i-e-s-e-l the new spelling of k-e-t-t-l-e-r?

[dieseltaylor]

Teach me to do something from memory - it is orthopedic not pediatric - I thank you for all the research. I get my HBR back tomorrow.

However the point that Affy quotes is the one HBR were quoting.

[bitchen frizzy]

Supply and demand has a lot to do with it, too.

There are bazillions of pediatricians in the U.S. Very few neurologists.

[YankeeDog]

Supply and demand has a lot to do with it, too.

There are bazillions of pediatricians in the U.S. Very few neurologists.

While agree with your point that Supply and Demand is one of the many factors that influences variances in physician compensation, pediatricians vs. neurologists isn't necessarily a good example of this. It is true that the supply of pediatricians in the US is a lot higher than the supply of neurologists. But it's also true that the demand for neurologists is a lot lower. Many people go through their entire lives without ever needing to see a neurologist. But ideally, every child should be seeing a pediatrician at least every other year until they turn 18, and actually more more often than this in the younger years. Put another way, the average individual, over their lifetime, consumes far more pediatrics services than they do neurology services.

It's also noteworthy In terms of "supply," in many areas of the country there is a serious shortage of primary care specialties like pediatricians, family practice, internists, etc. Predicting purely by supply and demand, these specialties should therefore be highly paid in these areas. But this is not the case. Since compensation rates are often set by the Medicare or Medicaid and/or insurance companies (who in turn often derive their rates from Medicare/Medicaid rates), it's not a "free market" and supply and demand forces aren't free to set pricing or compensation. It's been argued that this has created a negative trend where fewer and fewer medical students are interested in primary care specialties because the pay is relatively low, which in turn creates greater shortage.

[bitchen frizzy]

Good. That means the market is driving new entrants in the correct direction.

The wait lists for specialists like neurologists and nephrologists are very long, because there are too few of them.

When you need a neurologist, you really need a neurologist, and six months is a long time to wait to see one if you've got something wrong with your brain.

But ideally, every child should be seeing a pediatrician at least every other year until they turn 18, and actually more more often than this in the younger years.

Why? Here is an example of advertising creating a need that didn't once exist. Little Johnnie will be fine if he doesn't see a pediatrician once every six months. The insurance industry correctly assesses the value of those wellness visits, ergo, lower pay than for life-and-death services. So for medical care that actually matters, supply and demand is working fine. To put it another way, what's a pediatrician going to do if Johnnie really is sick with something serious? Refer him, of course.

For that matter, pediatrics is largely a made-up speciality. Not long ago, GP's in family practice did fine treating children. But then doctors discovered they could charge more for pediatrics - like foreign car specialist mechanics - because it's the children.

So the market is correcting this, and that's fine.

[Stalins Organ]

Trouble is the correction takes years to be obvious enough to drive the recruitment & training system, and in the mean time if you need a neurologist now you still can't get one for years and years.....

[costard]

...unless you have a bucket of money to give him, in which case they will be knocking each other down to get a hold of the bucket.

Sorry, that should have read ".. knocking each other over to aid you with their neurology expertise."

[dieseltaylor]

Just read a nice article helping to make medicine cheaper:

Earlier this week, a federal judge struck down patents on the BRCA1 and BRCA2 genes. These are the genes used by many doctors to attempt to predict breast cancer risk. Of course, the very idea that genes alone can determine your cancer risk is provably false, but that's another story altogether. For the point of this story, just keep in mind that lots of women have their DNA tested for the presence of these BRCA genes in order to (they think) determine their breast cancer risk.

But one corporation called Myriad Genetics holds seven patents on these genes. Although the patents are shrouded in lawyer's language, this company essentially claims to own these genes as if it had invented them! Furthermore, this company held that the mere act of testing for these genes was a violation of their patents.

Now, a more sensible person might instantly recognize that your genes existed long before Myriad Genetics came around. Depending on your frame of belief, your genes were either created by God or by Mother Nature, and to grant monopoly IP ownership over those genes to a corporations seems absurd beyond all reason.

But no: This corporation and its lawyers argued with a straight face that they alone effectively owned your BRCA genes and that no one could even test for the presence of those genes without paying them a royalty!

United States District Court Judge Robert W. Sweet disagreed with the patents in his 152-page decision (see NY Times PDF file at http://graphics8.nytimes.com/packag... ) which strikes down seven patents formerly belonging to Myriad Genetics. This victory was achieved, in part, by the American Civil Liberties Union which helped challenge the BRCA patents last year. The ACLU argued (quite correctly, in my view) that human genes are products of nature and should never be owned by Man.

As stated in a NY Times article (source below), an ACLU lawyer explained it like this: "The human genome, like the structure of blood, air or water, was discovered, not created. There is an endless amount of information on genes that begs for further discovery, and gene patents put up unacceptable barriers to the free exchange of ideas."