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Default Doctors going broke - 01-06-2012, 08:45 AM

Doctors in America are harboring an embarrassing secret: Many of them are going broke.
This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.
Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.
"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.
Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame.
Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."
Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.
"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."
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Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can't keep working this way."
Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.
Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.
Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.
Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes.
"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."
Donegan knows an oncologist "with a stellar reputation in the community" who hasn't taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn't reimbursed for.
Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors' ranking. Still, he is contemplating personal bankruptcy.
That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.
Changes in drug reimbursements have hurt him badly. Until the mid-2000's, drugs sales were big profit generators for oncologists.
In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.
"I grew up in that system. I was spending $1.5 million a month on buying treatment drugs," he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.
"Our reimbursements plummeted," Barth said.
Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.
"I was $3.2 million in debt by mid 2010," said Barth. "It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first."
He's since halved his debt and taken on a second job as a consultant to hospitals. But he's still struggling and considering closing his practice in the next six months.
"The economics of providing health care in this country need to change. It's too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."
If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he's turning away new patients whose care he can no longer subsidize.
"I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer," he said. "The moment has come to this that you now say, 'sorry, we don't have the capacity to care for you.' "
Small business 101: A private practice is like a small business. "The only thing different is that a third party, and not the customer, is paying for the service," said Lion.
"Many times I shake my head," he said. "Doctors are trained in medicine but not how to run a business." His biggest challenge is getting doctors to realize where and how their profits are leaking.
"On average, there's a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch."
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Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.
"It is embarrassing," he said. "Doctors don't want to talk about being in debt." But he's planning a new strategy to deal with his rising business expenses and falling reimbursements.
"I will see more patients, but I won't check all of their complaints at one time," he explained. "If I do, insurance will bundle my reimbursement into one payment." Patients will have to make repeat visits -- an arrangement that he acknowledges is "inconvenient."
"This system pits doctor against patient," he said. "But it's the only way to beat the system and get paid."
--- Are you a doctor who has made financial decisions you came to regret? E-mail Parija Kavilanzand you could be part of an upcoming article. Click here for CNNMoney.com comment policy.


Small Business: Doctors going broke - Yahoo! Finance


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A line[Durrand line] of hatred that raised a wall between the two brothers -Hamid Karzai

For generations, the Hindus of India prayed for deliverance from "the venom of the cobra, the teeth of the tiger and the vengeance of the Afghan."

The men of Kábul and Khilj also went home; and whenever they were questioned about the Musulmáns of the Kohistán (the mountains), and how matters stood there, they said, "Don't call it Kohistán, but Afghánistán; for there is nothing there but Afgháns and disturbances." Thus it is clear that for this reason the people of the country call their home in their own language Afghánistán, and themselves Afgháns. The people of India call them Patán; but the reason for this is not known. But it occurs to me, that when, under the rule of Muhammadan sovereigns, Musulmáns first came to the city of Patná, and dwelt there, the people of India (for that reason) called them Patáns—but God knows!

-Ferishta, 1560–1620
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Default 01-06-2012, 08:46 AM

This is just one of the reasons why I just can't recommend the M.D path, unless you are absolutely passionate about it.


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A line[Durrand line] of hatred that raised a wall between the two brothers -Hamid Karzai

For generations, the Hindus of India prayed for deliverance from "the venom of the cobra, the teeth of the tiger and the vengeance of the Afghan."

The men of Kábul and Khilj also went home; and whenever they were questioned about the Musulmáns of the Kohistán (the mountains), and how matters stood there, they said, "Don't call it Kohistán, but Afghánistán; for there is nothing there but Afgháns and disturbances." Thus it is clear that for this reason the people of the country call their home in their own language Afghánistán, and themselves Afgháns. The people of India call them Patán; but the reason for this is not known. But it occurs to me, that when, under the rule of Muhammadan sovereigns, Musulmáns first came to the city of Patná, and dwelt there, the people of India (for that reason) called them Patáns—but God knows!

-Ferishta, 1560–1620
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Default 01-06-2012, 06:45 PM

that is interesting, that the doctors are selling the drugs. as far as i know this does not happen in australia.
from what i have seen on news and documentaries about america, many people can't even afford health care and there are doctors and dentists that set up a free clinic, every now and then.
doctors could also be responsible for charging too much, thereby limiting their clientele. they may have loans for university, to pay back or just be greedy.
there is a psycholigist , where i was living last year, who is apparently charging $205 per a 50 minute consultation. that is outrageous.
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Default 01-06-2012, 10:11 PM

average dentist in a place like calgary makes like $2000 a day

you can never argue against jobs for docs or salaries, but it just takes too firkin long to become one


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Default 01-06-2012, 11:21 PM

Quote:
Originally Posted by Talal View Post
average dentist in a place like calgary makes like $2000 a day

you can never argue against jobs for docs or salaries, but it just takes too firkin long to become one
And during that process, you cumulate debt anywhere from 200K to 500K, plus interest.


$295,000 In Medical School Debt



It just makes NO sense to me. If someone really wants to "help" people, and they aren't in a good financial state(i.e no scholarships,funds,etc)why not study to become a P.A. Aside from dooming your household, such a student will end up with psychological problems. Many Afghans are now Physician assistants, and happily making nearly 100K with zero debt. I do however, know some Pakistanis and Afghans, who are now in med school and let me not even talk about their debt issues.

I generally recommend people to follow what their heart desires, but that shouldn't mean majoring in something that has a low demand(think Architecture majors), or pursuing a degree that could potentially destroy your future. You can't go to school, major in French or Middle eastern studies, and expect to make as much or find a job as quick as a STEM major generally would. The guys with STEM majors go through hell during their undergrad. In New York, head hunters have to pay staffing firms to find CS/CpE/EE grads. That's why they are creating a new, high tech university, on Roosevelt island. It's essentially going to be a Silicon Valley rival, and they hope it will cope with the rising, and unprecedented demand.


Even Adobe Photoshop can't change me.

A line[Durrand line] of hatred that raised a wall between the two brothers -Hamid Karzai

For generations, the Hindus of India prayed for deliverance from "the venom of the cobra, the teeth of the tiger and the vengeance of the Afghan."

The men of Kábul and Khilj also went home; and whenever they were questioned about the Musulmáns of the Kohistán (the mountains), and how matters stood there, they said, "Don't call it Kohistán, but Afghánistán; for there is nothing there but Afgháns and disturbances." Thus it is clear that for this reason the people of the country call their home in their own language Afghánistán, and themselves Afgháns. The people of India call them Patán; but the reason for this is not known. But it occurs to me, that when, under the rule of Muhammadan sovereigns, Musulmáns first came to the city of Patná, and dwelt there, the people of India (for that reason) called them Patáns—but God knows!

-Ferishta, 1560–1620
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Default 01-06-2012, 11:48 PM

Quote:
Originally Posted by Admin Khan View Post
And during that process, you cumulate debt anywhere from 200K to 500K, plus interest.


$295,000 In Medical School Debt



It just makes NO sense to me. If someone really wants to "help" people, and they aren't in a good financial state(i.e no scholarships,funds,etc)why not study to become a P.A. Aside from dooming your household, such a student will end up with psychological problems. Many Afghans are now Physician assistants, and happily making nearly 100K with zero debt. I do however, know some Pakistanis and Afghans, who are now in med school and let me not even talk about their debt issues.

I generally recommend people to follow what their heart desires, but that shouldn't mean majoring in something that has a low demand(think Architecture majors), or pursuing a degree that could potentially destroy your future. You can't go to school, major in French or Middle eastern studies, and expect to make as much or find a job as quick as a STEM major generally would. The guys with STEM majors go through hell during their undergrad. In New York, head hunters have to pay staffing firms to find CS/CpE/EE grads. That's why they are creating a new, high tech university, on Roosevelt island --it's essentially going to be a Silicon Valley rival, and they hope it will cope with the rising demand.
Finally someone understands!!!

I completely agree with you. A couple years ago a Kandahari man came to my mother for advice on PA school. He studied in Kabul back in the 80's and now just moved to the US with his family. He has 4 children all under the age of 10 so he needs a good career to financially take care of his children.

Now he finished his 3 years of professional schooling as a PA. He makes over $60/hr. And guess what? His $200,000 student debt is all being paid off in 5 years after working at an underserved clinic. His family held a small gathering at home for his graduation. The new house he just bought is absolutely beautiful. Just imagine, this man immigrated possibly 5 years ago from Afghanistan and is now leading a great life for not only his family here in the US, but also his family in Kandahar as well.

Many folks have a hard time grasping that MDs do not have it easy. Yes, they do make bank..... but under what price? There are plenty of rewarding careers out there that make a good salary with half the time and half the debt.

I am happy i got myself off the boat now

Last edited by Laila; 01-06-2012 at 11:50 PM.
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Default 01-07-2012, 12:01 AM

so how does this afghan man, new to america, afford a house and to pay off his fees and run a family all in such a short time, whilst these others are over their heads in debt?
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Default 01-07-2012, 12:07 AM

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Originally Posted by faye View Post
so how does this afghan man, new to america, afford a house and to pay off his fees and run a family all in such a short time, whilst these others are over their heads in debt?

Medical school is 4 years where as PA school is 2 or 3 years. Plus medical school has residency that follows after school. And you do not get paid much for that. Whereas PAs get right on doing their job after they are done with school. Now many PAs are offered to work in underserved areas or clinics that is government owned. And with that in a matter of 5-7 years the government pays off their student debt completely. I know for sure MDs also have this opportunity....but the government is not so lenient with them since they are more in student debt. Does that make sense? I guess it was easier for this man because was a doctor in Kandahar so he already had medical experience and had his credentials. After a year of applying to a PA school, he took his interview, got accepted into a 3 year program. Now he works full time 4 days a week.
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Default 01-07-2012, 12:19 AM

hi laila! that is good to have the debt paid off like that. it just sounded a bit too idyllic compared to what i have seen of the student debts and cost of living, in america. plus compared to the issues in the article admin khan put up.
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Default 01-07-2012, 12:36 AM

As once put:

If you want to be the person called in to look at the really crazy case that's very hard to figure out and may not have an answer even, become a doctor. You will still deal with the mundane, but you can provide a higher level of care, which is sometimes needed. If you want to take care of day-to-day cases (like in cardiology, standard CHF patients, post-MI care, atrial fibrillation if I had to guess) and have someone to go to when things get hairy, become a PA.

PA in NY, is a major, which can be chosen if accepted during their regular ordinary undergrad. You take certain courses, and apply to the P.A major. Upon graduation, you have a sweet job waiting for you. Not to mention, you will most likely be employed(InshAllah)far before the M.D guys, who will have 5-6 more years left. During those 5-6 years, the P.A's rake in the benjamins, while the M.Ds hit the books. M.D's have more authority, and more opportunities in moving up, but for someone who find ~100-120K enough,(with no where near as much debt as an M.D)P.A should be the ideal major for them. Provided that they are into the entire health-care thingamajagey.


Even Adobe Photoshop can't change me.

A line[Durrand line] of hatred that raised a wall between the two brothers -Hamid Karzai

For generations, the Hindus of India prayed for deliverance from "the venom of the cobra, the teeth of the tiger and the vengeance of the Afghan."

The men of Kábul and Khilj also went home; and whenever they were questioned about the Musulmáns of the Kohistán (the mountains), and how matters stood there, they said, "Don't call it Kohistán, but Afghánistán; for there is nothing there but Afgháns and disturbances." Thus it is clear that for this reason the people of the country call their home in their own language Afghánistán, and themselves Afgháns. The people of India call them Patán; but the reason for this is not known. But it occurs to me, that when, under the rule of Muhammadan sovereigns, Musulmáns first came to the city of Patná, and dwelt there, the people of India (for that reason) called them Patáns—but God knows!

-Ferishta, 1560–1620
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