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I worked out an out of network surgery center which targeted high reimbursing insurance companies. The standard tact is to lie to patients, telling them not to

I worked out an out of network surgery center which targeted high reimbursing insurance companies. The standard tact is to lie to patients, telling them not to worry about high deductibles because the surgery center won’t collect on them. I seen an endoscopy be reimbursed $28,000 from a major county’s government employee insurance program in CA. At a hospital, it would cost around $2,000. I heard established surgeons say that some surgeons would purposely perform shoddy hernia surgeries to require further surgeries. Or add more procedures etc to inflate the charges. They’ll bill as much as possible, using billing codes in the most strategic ways. Insurance companies would then reimburse 15-20% on average. The entire system is flawed and opaque so it’s hard to know who is exploiting who.

rb808 7y ago
>The entire system is flawed and opaque so it’s hard to know who is exploiting who. Doctors are by far the highest paid career in the USA. Surgeons are paid enormous salaries. Its pretty clear who is winning. I know there is a complaint that medical school is very expensive. If we offered free medical school for cutting salaries in half, I'm pretty sure doctors would prefer to keep as it is.
- Ididntdothis 7y ago
  Especially surgeons can easily make >500k. they can pay off their debt in a heartbeat and then the dough keeps rolling in.
  - IG_Semmelweiss 7y ago
    Love when people that are not in healthcare have an opinion about how healthcare pays
- bradleyjg 7y ago
  > Doctors are by far the highest paid career in the USA. Surgeons are paid enormous salaries. Its pretty clear who is winning. Right. People talk about drug company executives. There are a few hundred at most. We have hundreds of thousands of specialist doctors making hundreds of thousands of more dollars a year than their counterparts in other countries.
- programmertote 7y ago
  Exactly! Medical training in the US is unnecessarily long. The med students don't need 4 years of undergrad studies on top of another 4 years of med school. In my home country, 5 years of med school and 2 years of residency is sufficient to train a competent generic physicians (not brain surgeon). Physicians from my country, when they came over to the US to be trained in the residency programs here, found that the medical exams and residency training to be not that difficult (it is extremely difficult to get into one because they are foreigners, but once they get in, almost every one of them become multi-millionaires by their 40s). My gf externed at a hospital just outside of LA in California. The attending physician there earn ~300K/year for a total of 14 days of work per month. She met two physicians (both from my country again), who work at two hospitals near that area as attendings; they go to one hospital for one week; then work at another the week after; and the cycle repeats. Each of them makes easily >$500K/year (one of them said so to my gf). Despite majority of Americans are led to believe by doctors, born and trained in the US, that they are the most hardworking folks out there doing 70-hours/week shifts, it is simply an exaggeration. Sure there are some outlier residency programs that made its first or second year residents work maybe 60-hours/week, but 70 to 80-hours? I know so many former and current residents in a the biggest metro area in the US (and another one who just finished her residency at JHU), and asked them about their working hours. NONE of them had to work that much. The average for first year residents is ~50 hours. Then it drops off to normal 40-hours/week starting second year and third years.
  - pixelmonkey 7y ago
    Spouse of young doctor here. I have worked in tech for two decades. During that time, my spouse did 12 years of post-secondary pre-med and medical training. Undergrad, postbacc, med school, and residency; she is now in a fellowship. You said (paraphrasing): “despite majority of Americans being led to believe doctors are doing 70-hour shifts per week, it is simply an exaggeration.” First, most Americans don’t believe it. Second, my wife worked 60-100 hours per week for her entire 4-year residency. That included month-long stretches on nights doing 6pm-6am shifts, 6 days per week. That included more 24-hour (or, even 28-hour) shifts than I could count. I know the hours precisely because I worked from home the entire time for my tech startup job, and we lived a 5 minute walk from the hospital. It’s a top academic hospital. I once attended a wedding where all her med school friends were guests, all in their 3rd and 4th year of residency. Polled them about work hours. All similar. Group of 7 or 8 residents at programs all across the US, mostly top programs. Some exceptions in residencies like geriatrics and pediatrics, but any surgical or specialty residency is brutal. The happiest resident had recently quit medicine altogether — to go into tech. They work that hard whilst earning essentially sub-minimum-wage. The contrast couldn’t be greater vs tech. My company employs over 50 people, mostly college educated, and it is not even remotely comparable. Residents get paid less than our lowest paid staff, and work twice the hours, with higher stakes, a higher emotional toll, and worse working conditions. And it just gets more unequal from there. She is now in fellowship and the hours are slightly better. But she is now in a more urban area with a longer commute, higher taxes, higher cost of living, and debt hanging over her. As a fellow, she only makes marginally more money for her 13th and 14th years of post-secondary training. This week she worked approx 55 hours so far (if you don’t count the 4 hours of “journal club”, also required), and will need to commute an hour by car on her Sunday morning to round on a single patient — part of her unscheduled, but required, call. If she becomes a multi-millionaire in her 40s, as you suggest is inevitable, I will be pleasantly surprised — but considering fellowship, for her, ends at age 37, I think it unlikely. First, she has to pay down over $300k of student debt, since none of the journey was paid by her parents. Then she has to earn for awhile, and make up a little for lost time, since she doesn’t have decades of savings behind her, living right at the breakeven mark for cost of living for so many years. And even if it does happen, I’ll think it a justified renumeration for her countless sleepless and low-paid nights saving lives in her 30s, not to mention the opportunity cost (and real cost) of educational years. After all, should we expect the personal sacrifice of one’s 20s and 30s have no reward at all? Doctors should be paid much more, sleep much more, and they should suffer much less ire from people like you. As someone with two decades in tech and first-hand, concurrent experience of the contrast, I feel that much more now than ever. Some earlier comments: https://news.ycombinator.com/item?id=20437414 https://news.ycombinator.com/item?id=20437414 https://news.ycombinator.com/item?id=15182632 https://news.ycombinator.com/item?id=15182632
- pixelmonkey 7y ago
  Doctors are the highest paid career, if you have no concept of opportunity cost. To earn a surgeon’s salary, you need a surgeon’s training. In the US, that means 4 years undergrad, 4 years of medical school, 4 years of medical residency, and often a few more years of specialty fellowship. My wife will have racked up $300k of debt and done 14 years of training before earning her first year of a “surgeon’s salary”. I suspect a tech salary earned 10-14 years earlier, and earned for 10-14 years running, without debt, combined with smart savings and the miracle of compound interest, will beat her every time.
  - Scoundreller 7y ago
    The training requirements aren’t much different in other OECD countries. Their med schools and residencies are still at capacity. Their outcomes are better and their doctors are paid much less, but still more than most others.
    - pixelmonkey 7y ago
      I doubt the outcomes being better has much to do with the lower physician pay. But it wouldn’t surprise me that you can “get away” with paying doctors less, while maintaining outcomes above some level. My question is: why bother? Or, put another way, what if we paid them more, reduced their hours, and had more of them? What might that do for outcomes — especially since physician salaries are a rounding error of total healthcare system costs, and since the best and brightest working in medicine means more patient lives saved and more physician happiness?
      - rland 7y ago
        1) is it a rounding error? There are a lot of doctors, every one of them making a lot of money. I don’t know but every doctor making a lot more every year has got to add up. 2) Doctors are overtrained. This is by design, to keep salaries high. Nothing about their job demands the salary they command other than the artificial scarcity imposed by regulation. How about: streamline the process of becoming a doctor; remove 4 year degree requirement, lower cost of med school or make it free. This has the benefit of both improving care (more doctors/patient) and making care cheaper (fewer ludicrous salaries). Absolutely I believe doctor pay is a big part of the racket on the hospitals end. A fair amount of it goes to the higher education racket via student loans, but I guess that is a different problem.
- ip26 7y ago
  However, doctors are by definition done with medical school.
koolba 7y ago
> I heard established surgeons say that some surgeons would purposely perform shoddy hernia surgeries to require further surgeries. This is hands downs the most disgusting thing I’ve read in this thread. I hope for humanities sake it’s not true.
- IG_Semmelweiss 7y ago
  Its well known. But not for FFS. For the most part i believe that is nonsense. Instead it was SOP. Like doing blodletting on a sick patient. You did it because it qas the thing to do. In 1970s it was hip replacement 1980s it was tonsil removal Etc

rb808 7y ago

>The entire system is flawed and opaque so it’s hard to know who is exploiting who. Doctors are by far the highest paid career in the USA. Surgeons are paid enormous salaries. Its pretty clear who is winning. I know there is a complaint that medical school is very expensive. If we offered free medical school for cutting salaries in half, I'm pretty sure doctors would prefer to keep as it is.

Ididntdothis 7y ago
Especially surgeons can easily make >500k. they can pay off their debt in a heartbeat and then the dough keeps rolling in.
- IG_Semmelweiss 7y ago
  Love when people that are not in healthcare have an opinion about how healthcare pays
bradleyjg 7y ago
> Doctors are by far the highest paid career in the USA. Surgeons are paid enormous salaries. Its pretty clear who is winning. Right. People talk about drug company executives. There are a few hundred at most. We have hundreds of thousands of specialist doctors making hundreds of thousands of more dollars a year than their counterparts in other countries.
programmertote 7y ago
Exactly! Medical training in the US is unnecessarily long. The med students don't need 4 years of undergrad studies on top of another 4 years of med school. In my home country, 5 years of med school and 2 years of residency is sufficient to train a competent generic physicians (not brain surgeon). Physicians from my country, when they came over to the US to be trained in the residency programs here, found that the medical exams and residency training to be not that difficult (it is extremely difficult to get into one because they are foreigners, but once they get in, almost every one of them become multi-millionaires by their 40s). My gf externed at a hospital just outside of LA in California. The attending physician there earn ~300K/year for a total of 14 days of work per month. She met two physicians (both from my country again), who work at two hospitals near that area as attendings; they go to one hospital for one week; then work at another the week after; and the cycle repeats. Each of them makes easily >$500K/year (one of them said so to my gf). Despite majority of Americans are led to believe by doctors, born and trained in the US, that they are the most hardworking folks out there doing 70-hours/week shifts, it is simply an exaggeration. Sure there are some outlier residency programs that made its first or second year residents work maybe 60-hours/week, but 70 to 80-hours? I know so many former and current residents in a the biggest metro area in the US (and another one who just finished her residency at JHU), and asked them about their working hours. NONE of them had to work that much. The average for first year residents is ~50 hours. Then it drops off to normal 40-hours/week starting second year and third years.
- pixelmonkey 7y ago
  Spouse of young doctor here. I have worked in tech for two decades. During that time, my spouse did 12 years of post-secondary pre-med and medical training. Undergrad, postbacc, med school, and residency; she is now in a fellowship. You said (paraphrasing): “despite majority of Americans being led to believe doctors are doing 70-hour shifts per week, it is simply an exaggeration.” First, most Americans don’t believe it. Second, my wife worked 60-100 hours per week for her entire 4-year residency. That included month-long stretches on nights doing 6pm-6am shifts, 6 days per week. That included more 24-hour (or, even 28-hour) shifts than I could count. I know the hours precisely because I worked from home the entire time for my tech startup job, and we lived a 5 minute walk from the hospital. It’s a top academic hospital. I once attended a wedding where all her med school friends were guests, all in their 3rd and 4th year of residency. Polled them about work hours. All similar. Group of 7 or 8 residents at programs all across the US, mostly top programs. Some exceptions in residencies like geriatrics and pediatrics, but any surgical or specialty residency is brutal. The happiest resident had recently quit medicine altogether — to go into tech. They work that hard whilst earning essentially sub-minimum-wage. The contrast couldn’t be greater vs tech. My company employs over 50 people, mostly college educated, and it is not even remotely comparable. Residents get paid less than our lowest paid staff, and work twice the hours, with higher stakes, a higher emotional toll, and worse working conditions. And it just gets more unequal from there. She is now in fellowship and the hours are slightly better. But she is now in a more urban area with a longer commute, higher taxes, higher cost of living, and debt hanging over her. As a fellow, she only makes marginally more money for her 13th and 14th years of post-secondary training. This week she worked approx 55 hours so far (if you don’t count the 4 hours of “journal club”, also required), and will need to commute an hour by car on her Sunday morning to round on a single patient — part of her unscheduled, but required, call. If she becomes a multi-millionaire in her 40s, as you suggest is inevitable, I will be pleasantly surprised — but considering fellowship, for her, ends at age 37, I think it unlikely. First, she has to pay down over $300k of student debt, since none of the journey was paid by her parents. Then she has to earn for awhile, and make up a little for lost time, since she doesn’t have decades of savings behind her, living right at the breakeven mark for cost of living for so many years. And even if it does happen, I’ll think it a justified renumeration for her countless sleepless and low-paid nights saving lives in her 30s, not to mention the opportunity cost (and real cost) of educational years. After all, should we expect the personal sacrifice of one’s 20s and 30s have no reward at all? Doctors should be paid much more, sleep much more, and they should suffer much less ire from people like you. As someone with two decades in tech and first-hand, concurrent experience of the contrast, I feel that much more now than ever. Some earlier comments: https://news.ycombinator.com/item?id=20437414 https://news.ycombinator.com/item?id=20437414 https://news.ycombinator.com/item?id=15182632 https://news.ycombinator.com/item?id=15182632
pixelmonkey 7y ago
Doctors are the highest paid career, if you have no concept of opportunity cost. To earn a surgeon’s salary, you need a surgeon’s training. In the US, that means 4 years undergrad, 4 years of medical school, 4 years of medical residency, and often a few more years of specialty fellowship. My wife will have racked up $300k of debt and done 14 years of training before earning her first year of a “surgeon’s salary”. I suspect a tech salary earned 10-14 years earlier, and earned for 10-14 years running, without debt, combined with smart savings and the miracle of compound interest, will beat her every time.
- Scoundreller 7y ago
  The training requirements aren’t much different in other OECD countries. Their med schools and residencies are still at capacity. Their outcomes are better and their doctors are paid much less, but still more than most others.
  - pixelmonkey 7y ago
    I doubt the outcomes being better has much to do with the lower physician pay. But it wouldn’t surprise me that you can “get away” with paying doctors less, while maintaining outcomes above some level. My question is: why bother? Or, put another way, what if we paid them more, reduced their hours, and had more of them? What might that do for outcomes — especially since physician salaries are a rounding error of total healthcare system costs, and since the best and brightest working in medicine means more patient lives saved and more physician happiness?
    - rland 7y ago
      1) is it a rounding error? There are a lot of doctors, every one of them making a lot of money. I don’t know but every doctor making a lot more every year has got to add up. 2) Doctors are overtrained. This is by design, to keep salaries high. Nothing about their job demands the salary they command other than the artificial scarcity imposed by regulation. How about: streamline the process of becoming a doctor; remove 4 year degree requirement, lower cost of med school or make it free. This has the benefit of both improving care (more doctors/patient) and making care cheaper (fewer ludicrous salaries). Absolutely I believe doctor pay is a big part of the racket on the hospitals end. A fair amount of it goes to the higher education racket via student loans, but I guess that is a different problem.
ip26 7y ago
However, doctors are by definition done with medical school.

koolba 7y ago

> I heard established surgeons say that some surgeons would purposely perform shoddy hernia surgeries to require further surgeries. This is hands downs the most disgusting thing I’ve read in this thread. I hope for humanities sake it’s not true.

IG_Semmelweiss 7y ago
Its well known. But not for FFS. For the most part i believe that is nonsense. Instead it was SOP. Like doing blodletting on a sick patient. You did it because it qas the thing to do. In 1970s it was hip replacement 1980s it was tonsil removal Etc