Thursday, April 24, 2008

Follow the Money

America, here's what happens when you remove market forces from physician compensation. Seen above is a flier for a seminar where MDs can learn how to do botox injections and other cosmetic procedures for... drum roll please... money. Wonder where young Doc Jones went? He quit working under EMTALA and opened a botox clinic. I know the plastics guys hate this and I don't blame them... botox injections are expensive when done by an expert and Doc Jones might screw up a few faces before he gets the hang of it. Hope someone is there to replace him in the ER, and I hope that someone knows Vfib from normal sinus. Good luck patients!


  1. It sounds a lot like practicing law though: Potentially lucrative, but soul sucking, boring and meaningless. Is this your exit plan?

  2. not in my worst nightmare. i have a good friend who is an excellent plastic surgeon. part of the art of it is making sure your patients are good psychiatric candidates for the procedures. if someone is bargain-basementing their botox then it would be a freaking nightmare. it does pay well though.

  3. My pcp has taken on a Aesthetics practice. She offers botox injections and dermal stuff. There is a local peds office in town here that is also doing something called smartlipo and botox. It's amazing. He has patients that are on medicaid, yet their parents are ponying up thousands of dollars for this. It doesn't seem right. That practice is making a killing doing this.

  4. Who would have Botox after the recent evidence that it damages your brain. I need all my facial muscles to do all of the characters in Jack and the Beanstalk justiceezzm anyway.

  5. I want Botox. (In my case, I think it is irrelevant whether it damages the brain.)
    911: which plastic surgeon and psychiatrist would you recommend? Like, I mean, like who would you recommend if it were one of your own family members?

  6. 911: alternatively, should I just wait a bit till Doctor Jones has screwed up his quota of faces? Course, time is money......

  7. also, what is Vfib and normal sinus? do they cause alot of physician burnout in the ER's nowadays?

  8. So, what kind of case do they have if they sue you? Maybe some of my OBs can stop delivering babies and go into botox. The insurance is probably less expensive. The hours must be better. And folks aren't yet doing it home alone in their bath tubs because it is natural.

  9. ...
    Rhhhhhhhh.... drag soapbox. Climb on soapbox: if some women get their faces frozen (a la Priscilla Presley) because of sheer vanity, I do not feel sorry for them at all. I intend to age gracefully... or not, whatever Nature has in store for me.
    If some doctors get sued in the process because of sheer greed, I do not feel sorry for them at all either.
    Off soapbox. Rhhhhhh... put soapox away.
    Lastly, it is a very sad of affairs when doctors quit their jobs in an important field, where they are vitally needed, to cater to and become part of the rich and shallow.

  10. amy,

    nice soapbox! i think the whole aesthetic botox thing is a laugh. it only lasts for a few months. kinda like chiropractic, folks that swear by it keep going back every few weeks. cash up front baby!

    dead horse alert. folks who are not doctors have absolutely NO FREAKING IDEA about the commitment involved on the individual's part to get qualified, sign on, get admitted to med school, and then get trained.

    four years of college with, preferably a bachelors in a hard science and a second major is helpful. while your friends getting a BA in business are out partying and enjoying the whole college thing find a good seat in the library and make it yours for four years.

    debt accumulation starts for most here. no 'rocks for jocks', organic chemistry and advanced biochemistry please.

    getting into medical school used to be hard and i believe it still is. had a few friends who never got in. helpful hint, to get into medical school be a minority or a woman or get a sex change either way then you will be a great 'diversity' admit.

    four years of upper graduate level classes and, of those four years, two clinical years where you are not sleeping a lot and doing menial tasks for the real doctors.

    do very well in medical school if you want to get into a competitive specialty. more debt here. some, with undergraduate debt, now owe $150,000.

    travel and interview during fourth year at your own expense to obtain residency training.

    if you are a woman get married in med school or you will never meet anyone in your residency as all you will do is work, and sleep and accumulate more debt.

    depending on your residency plan on three to ten years of 80+ hour weeks at less than minimum wage, sleepless nights like you never knew before, and, probably a divorce (or two if you are going into super-duper surgery).

    if all goes well and if you have gone straight through from undergrad to residency, plan on starting your career as a physiican in your early thirties in $150 to $350k debt.

    now, for pediatricians for instance, start drawing your first real paycheck. how's $80k per year sound? for an internist how does $100k per year sound?

    if you do the 8-10 years to be a CT surgeon then you might really clean up and make over $500k but don't plan on getting on a regular schedule until you retire. family? have a few!

    now include EMTALA and surrender a good portion of your bills to enforced federal charity... this is not tax deductible.

    also, plan on working for administrative types who expect you to follow whatever policies they just dreamed up at the culimination of their various 'patient care initiatives'.

    plan on being ignored when you try to get things like you, the expert, need them to be in order to deliver good care. also, be prepared to receive lots of complaints from patients who are angry about having to wait so long to be seen.

    it is in this context that 'selling out' and taking a botox job with regular hours and 100% reimbursement starts to seem like a fine idea.

    botox and CAM. i love 'em.

  11. I know, going to med school and starting your professsional life highyly in debt is very hard.
    Having to bow down to others when you are the professional must be terribly frustrating also. I get all that.
    But surely, there must be a (somewhat)happy medium somewhere in the medical field where you do not have to deal with the pressures of hospital life without having to become a botox grocer. If I had had the education you have and paid that much for it, I would be extremely depressed spending my days injecting vain people who do not want to age.
    Could you also live with yourself doing CAM - even in that wonderful costume of yours - if you do not believe in it?
    I know you have a lot more integrity than that. I mean integrity to yourself, forget about the silly patients. :-)

  12. "probably a divorce (or two if you are going into super-duper surgery)."

    OK, I get the 1 divorce thing. Got it. But HOW the FUCK would a doctor pull off a 2nd divorce? (as described?)

  13. amy,
    no, i'm not doing botox or CAM or anything like it. i'll go teach school or something like that. i am looking outside of medicine but here's the bitch. in terms of what i know and my skill set, i actually LOVE doing emergency medicine. the stuff that kills me is the supervision by morons, the whole federal government intrusion thing, the rule by committee of non-practicing physicians, and the patients who abuse the ER. oh, the overnight shifts too.

  14. richter,
    good question. it usually goes like this. doctor starts residency married or newly married. husband and wife rarely see each other. wife does not understand why he is a son of a bitch all of a sudden. either wife has affair or surgeon has affair. divorce. surgeon remarries, usually to fellow doc or nurse, five years later they hate each other. divorce #2. in fact, the last time i heard, the duke university general surgery program boasted a %150 divorce rate for its residents. they actually used to be proud of it.

  15. 911-
    Just to update your debt figures, it's more like $250K-260K for those of us without wealthy uncles or who weren't fortunate enough to make the cut for our state school's limited seats.

    I was thinking about moonlighting as a sports medicine consultant 2 days a week with an ortho practice on the side after an EM residency and a Sports Med fellowship, or starting a sports medicine consultant service for a couple of the local ultra-expensive fitness centers. I'd be more than willing to cater to all of those local high school athletes/yuppie moms in need of orthotics, cortisone shots and a healthy dose of "Suck it up junior, you're not NCAA material anyway".

  16. This is a long thread but I get the jist. I am a Board Certified Plastic Surgeon it took alot of time and effort getting there, and what you have detailed above is classic for what I see every day. Every one wants to be a plastic surgeon these days - Internists, OB/GYNs, dentist, ER docs - you name it. Why?? - it's all about the money bro! Unfortunatley it is a lot easier to market yourself as a plastic surgeon than it is to be one. I see patient issues/ bad outcomes every month due to treatments/ procedures by plastic surgery wannabees.

    It is a bad idea - patients suffer the consequences and do not know better because of absurd anti-restictive trade rules.

    Bottom line is if you want to be a plastic surgeon - do the damn training!