No wonder drugs are so expensive...

[cowboydoc]

Now that post you are about 100% right on Bob except that product liablility does play more of a role than a flea, it's about 10% of profit. I agree that drug companies are definitely profiteers no doubt about that. You are right about there not being alot of wonder drugs and people being overmedicated. BUT there have been significant advances in both the treatment of cancer and heart disease. People are living much longer than they ever were before due to these advances. We have earlier detection methods, better surgical procedures, many of which are minimally invasive. There have been advances, no doubt about it. But you want to know the single most preventitive cure for cancer and heart disease? Exercise and diet! Your lifestyle contributes significantly to these diseases and once you have them your lifestlyle as well is the most important part to battling and getting over them. No doubt about it we're overmedicated and half of the drugs people take are little more than a two or four hour cure. All they do is mask the problem and do little to fix it.

 

[cowboydoc]

Todd,
You are right on what you say but the COST of the rvu is considering figuring in all the costs that a doctor has. The RVU is based on what the current costs to provide that unit of care to the patient. It most certainly does reflect malpractice. My malpractice insurnace account for 20% of my gross practice. $25,000 may be the cost where you are at to fight a malpractice claim but according to the AMA it's closer to $50,000 for a case that never makes it to court and there is no settlement. For those that do make it to court the cost of just fighting the lawsuit runs up to $100,000 or more. It's not cheap by any means and is a significant factor of doing business, at least where I'm at. You are right about everyone else making a dollar and the high cost of doing business. BUT you are wrong in that you don't order a test to rule things out. If you didn't order it and someone else does and it comes back that person had a problem that that test would have found then you are going to get sued. The guys that I practice around all order tests to not miss anything. It used to be that you would wait before ordering tests but not so much anymore. The cost of an $800 MRI just isn't worth a lawsuit. I had a friend last year get sued for a patient that came in complaining of hip pain. He took x-rays and did an exam everything was ok. He gave him some nsaids and sent him home. He came back a week later and said the pain was worse. Another exam and nothing positive. He sent the guy to PT. A month goes by, he didn't go to pt, and he came back and he was even worse. He took another x-ray and half the left ilium is gone. He immediately sent him up to the university and the guy died a month after that from metastatic carcinoma. Two months after that he gets served that he's being sued. I looked at the x-rays and they were completely normal. To make a long story short every expert that testified said that there was no way he could have known. However, the other side brought in their "experts" who said that there were other tests that could have been done. If he had done an MRI and bone scan they would have caught it earlier. They even agreed that the guy would have probably still died but he would have had a few more months of life. The jury found in their favor and awarded 1.2 million for the extra month or two of life that the guy would have had. The judge found that excessive and knocked it down to around 600k. That is the world that we practice in. Make one mistake and you're screwed. His malpractice insurance now is $4000 a month and he's a GP!!! I know of many cases like this and have been a part of Blue Cross/Blue Shield's RVU board for the last four years. When the RVU is figured insurance and liability is figured from 15-30% of the RVU depending on the specialty.

 

[DrDan]

Richard...

There's still time to go to Vet School! LOL

Dr Dan

 

[cowboydoc]

You know what Dan if I had it to do all over again I would. I would have loved to have been a large animal vet. I have thought many times about still doing it. The biggest reason that I don't is because of my little girls. I don't want to be in school for another three or four years and miss anything with them. Right now my office is right by the school. I take them to school and pre-school every morning. Pick them up and they have their own room in the office to play and I can go see them between patients. I love what I do but I hate dealing with insurance and the constant pressure of knowing if you make even one little mistake you are going to be sued.

 

[hess]

I live in the Philadelphia area, and on a recent visit to the doctor I was handed a letter explaining how physicians in our area are being forced to either quit the profession, move their practice to neighboring counties, or drastically reduce the types of cases they will see. This is a direct result of the malpractice insurance in this region, supposedly one of the highest in the country.
Apparently, Philadelphia has a reputation for juries awarding outrageous amounts of $$ in damages, so much so, that lawyers from neighboring counties seek to move these cases into the city of Philadelphia for trial.
Doctors make mistakes, and patients should have the right to seek damages, but the tail is definitely "wagging the dog" when many doctors cannot afford to stay in business.
hess

 

[DrDan]

Go for it Richard. You no dout can test out of all kinds of classes. I was going to change and become a physician anesthesiologist but I think I'm glad I didn't. My girls were very young when I was in vet school and they loved all the parties and it all worked out just fine. The wife worked and I cared for the girls summers and after school. Ames is a nice place to live too.

I wouldn't put up with the pressure you guys are under. Life is too short to be stressed all the time. Horse doctors make pretty good money too.

Dr Dan

 

[Wingnut]

DrDan .... several reasons that drugs are SIGNIFICANTLY less expensive in Canada than in the US. One reason is that the drug companies were given longer copyright periods (before the generic companies can zap their profits) in exchange for the government keeping tabs on the costs. An example: in Alberta, the drug store (over the counter) price for one of the non-drowsy antihistimines was about $1 pill ... while I was paying (at the company store - discounted) about $0.15 per pill ... and we're talking Canadian dollars here. I was perscribed the same pills here last year when I had an allergic reaction to something ... and my "share" was $58 US. I know the prices of a fair number of the drugs that my wife was taking before she died ... and I've seen the prices here 'cause my current mother-in-law is taking some of the same arthritis drugs. On one of the older drugs that had become generic many, many years ago ... the cost here is about 5 times what it is in Alberta.
The second reason is, as you surmised, the legal system is much different. It used to be, and may still be, that a lawyer cannot work on "spec". There's no such thing as the lawyer getting a percentage of an award ... they get paid for their time, period. Also ... there's very little in the way of "punitive damages" ... and have been very, very few class action suits. If you can prove damage ... you get paid for the damage. Also ... one reason people are not quite so quick to sue as they are in the US .... you lose ... you pay. The loser gets to pay court costs ... and in some cases, pays the winners costs too. And judges do not get elected in Canada ... they're appointed and therefore ... well, since they didn't pay $100,000+ for their election costs ... they're seemingly more interested in the justice system than in social re-engineering.

Just my jaundiced view ....

too bad that common sense ain't

 

[DrDan]

Those all sound like reasonable items to stop this madness, Wingnut. Only problem in the US is that most of the politicians and judges are lawyers so they make the laws for the legal profession. I don't know what the answer is but sooooon something is going to break loose.

Dr Dan

 

[cowboydoc]

Thanks for explaining that Wingnut. I knew that Canada did not have the kinds of problems that we do here with lawsuits but wasn't sure exactly why. I wish we had that same system here in the US. Where did you like to live more Canada or here?

 

[Bird]

I find it hard to believe that as powerful a source as the AMA is, that they haven't been able to get the same kind of deal in every state as Wingnut describes in Canada, and as we have in Texas. Sure, we can sue a doctor if we want to, and have enough money up front, but first off you've got to have other doctors willing to testify that the defendant really screwed up (and they're going to stick together unless it's a blatantly intentional screwup), and secondly if you lose, you pay your own and the doctor's legal expenses, and you know the doctor's going to hire the most expensive lawyers in the state. So doctors in Texas can just about get away with murder and not be touched. And yet the doctors in Texas cry about their malpractice insurance just as loud as in any other state, and use that as the reason for their exorbitant fees (maybe the insurance companies spread it around whether the particular doctor or state is safe or not).

Bird