Thursday, April 30, 2015

What Is The Net Worth Of Anesthesiologists?

Medscape recently released its annual physician compensation survey. As usual, anesthesiologists did very well, coming in fourth overall in income. But the more important question is the net worth of physicians. After all, one can make a million dollars a year and still have a zero or negative net worth if they're a profligate spender. For those who are still unfamiliar with basic financial terms, net worth is total assets (house, car, investments, bank accounts) minus total liabilities (mortgage, car payments, school loans, credit card debt).

Never fear, Medscape has a follow up poll asking precisely this question. As to be expected, the more money one makes, the higher the net worth one will attain. In this case, anesthesiologists come in fifth among all physicians, with an average net worth of $2.68 million. The doctors with the highest net worth are the orthopedists. Not surprising since they also make the most money. The lowest net worth belong to family physicians.

The net worth also changes with age. Over 90% of physicians less than 28 years old had net worth of less than $500,000. By age 50, about 55% of doctors have a net worth of over $1 million. And when they reach 65 years old, 49% reported net worth of over $2 million. So be patient all you poor medical students and residents. Your time will come.

What are the major expenses experienced by doctors? Over two thirds have a mortgage to pay. This is followed by car loans, with about one third, and student loans, also about one third. Despite all these expenses, 61% of doctors claim they live within their means with little debt. Only 11% say they live beyond their ability to pay for things like credit card debts.

Most physicians claim to have sharp financial acumen. More than three quarters say they have suffered no significant financial losses in the last year. Eleven percent claim that practice issues had caused them to lose net worth. Just six percent say that they lost money in the stock market in the past twelve months.

When broken down by specialty, anesthesiologists seem to be the doctors who are most likely to play with stocks. Forty percent of anesthesiologists say they lost money in the market, the highest among all physicians. Most other doctors average in the 20's to 30's percentage losing money in stocks. Anesthesiologists are also one of the most likely to make bad choices in real estate and and other investments that cost them money. Overall, anesthesiologists seem to be bad investors, with only 42% reporting not making any financial mistakes in the last year, the absolute lowest number among all the specialties reporting. The endocrinologists seem to be the brightest, with 67% claiming they didn't make any business missteps.

The takeaway message here is that physicians still do well financially. Most of us are smart enough to realize that we need to save more than we spend and build up a nice fat retirement nest egg. And we have the means to do it more than other people. Anesthesiologists should be careful reading all those financial websites while sitting in the OR reading their iPhones. Seems like this leads to worse financial performance. The old adage about investing for the long term may have gotten lost among too many of our anesthesia colleagues.

Wednesday, April 29, 2015

My iPhone Says I'm A Slug

I love my iPhone 6 Plus. It's large screen and extended battery life makes it a delight to use. Unfortunately it has one flaw--it's a total nag. Why? Because it reminds me every day how sedentary my life as an anesthesiologist can be.

Anybody who uses iOS 8 has Apple's Health app on their iPhone. The annoying thing about Health app is that it cannot be turned off or deleted. It is always working in the background tracking your every movement. I discovered this a couple of months after getting my new iPhone when I happened to open the Health app out of curiosity. Lo and behold it had counted how many steps I'd been taking and how many stairs I'd climbed every day since I bought the phone.

At first I thought this is great. Who needs to spend extra money on a fitness band when my phone can already track my steps for me. Pretty soon the Health app became an obsession. I started checking it several times a day to see how active I was. Quickly it became clear that my gluteus maximus was supporting more of my body weight than my calfs.

Most days I average a little over 5,000 steps a day. Not great I know. I'm just telling it like it is. But those 5,000 steps are made very episodically. On a long, uneventful case, I discovered I sometimes take as few as 8 steps an hour. EIGHT! I take more steps than that walking from a bathroom stall to a sink. It's really pathetic that sometimes my longest walk of the day is from the doctor's parking lot to the operating room.

Since I do 100% of my own cases I have the luxury (or curse) of being involved in lengthy uninvolving procedures. If I was supervising several CRNA's I'm sure I would add a few thousand more steps to my daily routine. Since I don't, I have forced myself to go back to the gym more regularly. (One more reason why I haven't blogged as regularly recently.) I found out if I run a couple of miles on the treadmill then I will just barely edge past the magical 10,000 steps per day regimen.

Now I'm not so sure I want to get the Apple Watch anymore. I don't need another device to tell me to get up and walk around. One of the main purposes of purchasing the watch is for its fitness tracking functions. But I'm already aggravated by my phone's ceaseless stalking of my daily routines. If I wanted more nagging, I would just stay at home more often.

Tuesday, April 28, 2015

iTunes Phishing In Kenya

I got this email supposedly from Apple yesterday. It claimed that my iTunes account has been locked out because of multiple failed attempts to enter it. I thought to myself, hmmm. I did type in my password incorrectly one time last week. Maybe Apple is now super sensitive to hacking into its system after the Jennifer Lawrence nude photos debacle last year. The page looks like it just might be from Apple. The typeface is similar to the one that Apple uses. The Apple logo up in the corner looks legit.

Therefore I naively clicked on the link to verify my Apply information. And this is the page I got.
Now my suspicions are starting to be raised. I've never come across a login page in iTunes that looks like this. Then I looked up at the address bar. The URL was extremely unusual. Instead of Apple.com, it read mu.ac.ke. Where the hell is that from? I googled the address and out popped a page for a place called Moi University. It definitely has nothing to do with iTunes or Apple. At least it wasn't the home page of some Nigerian prince who needed to stash his millions in my personal checking account. The Moi University URL has since been taken down.

It's no wonder computer systems get hacked all the time. Scammers send out millions of these phishing attacks every day. It only take one person to complete the process for sharing their password to corrupt the entire network. I'm publicizing this hoping that nobody else gets tricked into releasing their personal information.

Monday, April 27, 2015

Doctors Got Screwed By Congress And The AMA Rejoices

Doctors' livelihoods were seriously damaged by the SGR fix that was recently passed by Congress. How can that be? The American Medical Association has been trumpeting its involvement in finally repealing the dreaded Sustainable Growth Rate legislation that has threatened the incomes of physicians every year for nearly two decades. How can removing this cloud over medicine be a bad thing?

No matter what the numbers say in the bill, the final outcome is that doctors will continue to lose money taking care of Medicare patients. And this loss continues at a steadily increasing rate over time. The Medicare Access and CHiP Reauthorization Act (MACRA) gives physicians a 0.5% raise every year for five years followed by a freeze for the next five. Seriously? We're supposed to be happy we've been given extra handouts worth a total of 2.5% over five years and nothing after that? That's barely more than what one year of medical inflation is currently running, which is about 2.46% in the last twelve months. At the end of ten years, physician incomes will be severely diminished by the ravages of inflation.

By comparison, the Los Angeles teachers union recently won approval of a 10% salary increase over the next two years. And if you count the back pay the teachers lost during the recession and that the union managed to claw back during negotiations, they are looking at nearly a 15% salary increase over the next 14 months. If doctors got a 15% raise in Medicare reimbursements, there would be parties at every medical office and Mercedes dealer across the country.

Let's not forget the poor primary care physicians who got seriously bait and switched by Obamacare. As part of the ACA's attempt to lure more PCP's into accepting Medicaid patients, they were granted a two year time period where Medicaid reimbursement was increased to the same as Medicare. Now that thousands of new Medicaid patients have found doctors, the government has taken that money away. MACRA sends PCP's down the river by not returning reimbursements back to the already abysmal Medicare levels, saddling thousands of doctors with Medicaid patients.

This new law also is not fully funded and will cost the government over $100 billion over the next decade. It will pass that debt down to our children and grandchildren and their grandchildren. If Congress wanted to sweep the cost of fixing the SGR under the rug so expeditiously, it could easily have done the same thing last year, or even ten years ago when it would have been much cheaper. Now that it's completed, I suppose an extra $100 billion added to the government's $18 TRILLION debt isn't such a big deal.

It's no wonder that barely one fourth of all doctors in the country have joined the AMA. Who would want to join an organization that thinks maintaining the status quo is a victory for doctors? The group needs to get their executive directors out of corporate headquarters and start practicing real medicine before all they are left with as members are medical residents and retirees.

Sunday, April 26, 2015

Tara Reid And The High Cost Of Health Insurance

One of Ms.Reid's more demure photos.
This is a story about one of the largest health insurance companies in the country, the company's former chief technology officer, and the married executive's affair with a B-List actress. Blue Shield of California has filed suit against its former CTO, Aaron Kaufman, over improper charges he made on his corporate account, much of it spent to see his girlfriend Tara Reid. They claim he misspent over $100,000 in a job that he held for less than two years.

Mr. Kaufman is accused of spending over $17,000 to go to Florida to visit Ms. Reid, over $800 for one night at the W Hotel in Fort Lauderdale, and more than $1,300 for drinks at a nightclub in Hollywood. However it was a bowling party that really got the company's attention. Mr. Kaufman spent $879.84 at the bowling alley in which Ms. Reid was present. Ms. Reid, star of such seminal films like Sharknado 2 and American Pie 2, started acting inappropriately and passing around pictures of herself doing said acts.

Shortly afterwards, the executive's transgressions became public knowledge at the company's offices and Mr. Kaufman was fired on March 10. The company said that 75% of his corporate charges could not be verified as being legitimate.

This being America, Mr. Kaufman sued Blue Shield for wrongful termination. He claimed that he was let go right before he was supposed to receive his annual bonus of $450,000. He said he had to use his corporate card because he is currently going through a divorce and his bank and credit accounts have been frozen. Don't shed a tear for Mr. Kaufman though. He has landed on his feet quite nicely and is now executive vice president and chief product officer of a Las Vegas company called SocialWellth.

Blue Shield of California will also do just fine. In 2013 the nonprofit insurer made a net income of $171 million. Its top ten executives together earned over $14 million. You just have to wonder how many shenanigans are going on with the company's corporate accounts if one person can ring up six figure expenses after working only two years. How much of the escalation in insurance premium costs is due to corporate cover up of their profligate employees instead of rising medical costs like the company claims?

Friday, April 24, 2015

MOCA 2.0. Pay Now Rather Than Pay Later

The world of maintenance of certification as imposed by the American Board of Medical Specialties is facing a backlash as never before. Following the spectacular expose published in Newsweek about the greed and impropriety at the American Board of Internal Medicine, in which millions of dollars were paid out in executive salaries, real estate, and first class air travel, hundreds of doctors rose up in protest. In a surprising turnaround, the ABIM apologized for the excessive burden that the MOC has become and promised to reform the process.

Every physician wondered which medical board would follow the ABIM's changes. Now the American Board of Anesthesiology has decided that its MOCA program also needs to be changed. In an email to anesthesiologists yesterday, the ABA calls its new program MOCA 2.0.

MOCA 2.0 has several major modifications from 1.0. One of the biggest is the removal of the much despised simulation exam. This portion is hugely disruptive to most anesthesiologists, requiring them to spend thousands of dollars for the exam, travel to a simulation center, and time spent studying for and taking the test. It was one of the most divisive tests ever devised by the ABA and the ABMS, no matter how popular the organizations claim the simulations are. I count myself as one of the lucky ones who was first board recertified before the simulation was enacted and now it is being abolished before my next recertification. Hallelujah. There will be no tears shed for the end of this monstrosity.

Next, the recertification exam itself is gone. Can you believe it? No more exams again, EVER! Instead, the ABA has instituted an online program called MOCA Minute. Once a week, the ABA will post a question on its website that had the highest failure rates during certification exams. The user will have one minute to answer the question. If they answer the question incorrectly, there will be a brief explanation of the answer but it doesn't count against anything. No punishment. No repeating another question. The diplomate will have to answer 30 questions per calendar quarter or 120 per year. They can be bunched up together so one doesn't have to log in every week. But the ABA will only count 30 per quarter even if you answer more. This prevents people from doing all their requirements at the end of the year. The MOCA Minute does not replace the CME requirements that are already a part of MOCA or for your state medical licensure.

MOCA Part 4, or the Improvement in Medical Practice, is still evolving. This portion has always been nebulous in its requirements and implementation. They are withholding details of the new system for now.

Has the ABA also changed the cost of participating in MOCA? Yes and no. Thousands of dollars have now been saved by eliminating the simulation exam. But the ABA still expects one to pay $2,100 to be recertified. Instead of paying it all at once to take the exam, now they want to extract $210 every year for ten years. Credit cards accepted.

What hasn't changed? The need to be board certified by the ABA in the first place. Many lifetime certified physicians are still incensed that their certificates now read certified but not participating in MOC on the ABA's website, an asterisk in a perfectly legitimate career. Even these new changes will not appease doctors who feel any extra work to maintain their certificates is overly burdensome. These are the people who are flocking to the alternative certification program NBPAS. But for now, the removal of the recertification exam and the simulation is a huge step forward. Hopefully the ABA will continue to be responsive to the outcry of its members for simplification of a process that has huge implications for their livelihoods.

Wednesday, April 22, 2015

All Work, No Pay

Here are the latest numbers for anesthesiologists' salaries as compiled by the physician placement firm Jackson & Coker. This is based on the income of over 31,000 anesthesiologists that the company his hired out.

The average annual salary is $355,413. The average benefits is $71,083. This produces a total compensation of $426,495. Hospitals can afford this income because an anesthesiologist brings in an annual revenue of about $1,352,120.

When calculated on an hourly basis, the average anesthesiologist earns $171. Add in the benefits and the average total compensation works out to $205 per hour. An anesthesiologist will bring in revenue of about $650 per hour.

It's easy to see that anesthesiologists bring in a lot of money to hospitals. Meanwhile, despite all the hard work and potential medical malpractice, about two thirds of the money goes to somebody else besides the physician. That speaks volumes about the state of medicine in the country today.

Tuesday, April 21, 2015

The 2015 Medscape Anesthesiology Compensation Report

It's that time of year again. Medscape has released its annual physician compensation report for 2015. Full disclosure, I participated in the survey but again I didn't win the prize for filling out the poll. Darn you Medscape. This year there were nearly 20,000 doctors who joined the survey and about 1,200 of them were anesthesiologists. As a comparison, there are nearly 65,000 practicing anesthesiologists in the country so take this small sample size with a grain of salt.

So how much money did anesthesiologists make last year? Drum roll please. Aaaand the answer is--we are doing pretty darn good. Medscape found that the average anesthesiologist made $358,000. That is up 6% from the previous poll. We came in fourth place amongst all physicians, trailing only the orthopods, cardiologists, and gastroenterologists.  This is better than last year when we came in sixth place, following urologists and radiologists too.

If you're looking for the most income, being self employed is where it's at. Male private practice anesthesiologists made $420,000 and females made $362,000. If employed by a hospital, the income drops to $328,000 for men, $289,000 for women. That is a significant difference in anybody's book. Why is there such a large difference between men and women? Is there gross sex discrimination in the anesthesia workplace? Part of the answer maybe that twenty percent of the female anesthesiologists said they work part time while only eight percent of the men did. Pay commensurate with hours put in, the great American way.

The location of the job also figures into the compensation. A single specialty group practice anesthesiologist made the most money, averaging $429,000. Meanwhile if one worked in an outpatient clinic, the income falls to $316,000. The least compensated anesthesiologist works in an academic institution, pulling in an income of only $247,000. It also helps to work in the South Central states like Texas and Oklahoma. The chintziest states are located in the Northwest and Northeast.

With our rising incomes this year, are anesthesiologists happy with their profession? Survey says 53% of us are satisfied with our jobs, about middle of the pack of all physicians. Forty nine percent of anesthesiologists said they would do the same thing all over again. The most satisfied physicians not surprisingly are dermatologists, where 73% said they would choose the same field. This is a number that is far and away much higher than any other specialty. The least happy doctors are, unsurprisingly, internists. Only one quarter of them would choose to do the same thing over again. Sad that so many doctors out there are not doing a job they love.

In summary, anesthesiologists who filled out Medscape's survey made more money this time than the last one. We're still satisfied with our jobs. And we're very glad we didn't go into Internal Medicine. Hopefully this will provide additional incentive for all the medical students who just matched into an anesthesiology program.

Sunday, March 22, 2015

No Match Day For Law Students

Another year, another Match Day has come and gone for our nation's medical students. This is the moment every medical student looks forward to as he or she powers through another sleepless night of study and clinical rotation. The exhausting work all becomes worthwhile when the soon-to-be physicians are told where they are going to be working for the next several years. Cheers erupt. Champagne, or beer, is consumed. Everybody gets a slap on the back as the end to medical school is finally in sight.

Meanwhile, our professional colleagues over at the law school next door don't get quite the same exaltation. Many of them will not have a job when they finish school in just a few short months. In fact, quite a few were probably deceived by their own schools in the beginning when they advertised the job placement success rate of their graduates.

The U.S. News and World Report has ranked law schools for years. One of the criteria is how many of the graduates have jobs after graduation. The definition of jobs has proved to be slippery. At first, the schools counted any jobs held by their graduates as a success, whether it was negotiating international contracts for a Fortune 500 company or slinging hamburgers at McDonald's. Once that deception was discovered, the magazine tightened up eligibility so that only jobs requiring a law degree were counted. This dropped the employment rate of 2011 law school graduates to a shockingly low number of 55%.

Now another law school trick has been uncovered. Many students are still not able to find jobs that use their expensive degrees. So the schools are paying employers to hire their graduates. The schools subsidize the employers up to $4,000 to hire their students for one year, which conveniently falls within the guidelines of meaningful job placement of nine months that the magazine uses. This helps both the students pay off their school loans and increases the status of the school in that precious rankings list. News of this manipulation has caused the the American Bar Association and U.S. News to deemphasize jobs that the school purchased for their graduates.

How big of an affect will this new criteria have? At some schools, it will make a huge material difference. George Washington University law school reported that only 469 graduates of 603 students from 2013 had a job requiring a law degree nine months after graduation. In other words, over twenty percent of their students couldn't find a job that utilized their expensive degrees at least nine months afterwards. Horrible numbers for any job. However now we know that 88 of those jobs the students held were actually sponsored by the school. So the under employment rate for GW law school graduates is in reality almost 37%. If a school advertised that 37% of their graduates won't be able to find a meaningful job after graduation, do you think anybody will apply there?

What's worse, GW subsidized the employers $1.8 million to hire their graduates for one year. Guess who has to pay that money? Not the school or their faculty. That money is surely factored into the expensive law school tuition of the students who are still in the classrooms. These kids are heading towards a brick wall at graduation while paying to take care of older students who have already hit that unemployment wall.

George Washington University isn't the only law school to manipulate its numbers. Similarly, The College of William and Mary and Emory University also pay for the jobs of about 25% of their recent graduates. W&M used $814,000 last year to subsidize their students' jobs.

Of course the schools defend their actions in this deception. As the dean of GW law school, Blake Morant, puts it, "I tend to look at the program as back-end financial aid." It's a pathetic aid package being paid for on the backs of their new students.

So for all the medical students who have their new jobs all lined up starting in July, congratulations to all of you. Whether you got your first, second, third, or lower choice location, at least all of you will have a job following graduation. Your buddies who went into law school can only look at you enviously as they pour another Venti caramel latte behind the counter at Starbucks.

Saturday, March 21, 2015

Proof That Doctors Have Lost Control Of Medicine

I recently received this email from the California Society of Anesthesiologists. It's headlined, "Setting Up PQRS Reporting Through the ASA QCDR (NACOR)." Huh? What the hell did I just read? It looks like some toddler had just randomly lined up a bunch of alphabet letter blocks. Am I supposed to make sense of this?

Alas, these abbreviations are all important initiatives doctors have to know in order to receive their already compensation from the government. Medicare demands that doctors prove they are giving their patients high quality services or their reimbursements will be penalized. Thus we have the Patient Quality Reporting System, the Qualified Clinical Data Registry, and the National Anesthesia Clinical Outcomes Registry established by the American Society of Anesthesiologists. I won't even go into the details of TIN levels, NQS, or AQI.

This goes to show how inconsequential doctors now are when Washington makes healthcare policies. Medical students and residents are too busy studying real medicine. There are thousands of facts to memorize before one is conferred a medical degree. Yet they are taught none of these acronyms as part of their medical school curriculum. But these letters are actually more important to their careers as doctors than knowing which erectile dysfunction drug is the longest acting. No matter how smart a doctor you are, or how much your patients love you, the feds will cut your income unless you can document you are giving "quality" care. Quality as defined by them, not you, your colleagues, or your patients.

Maybe med schools should devote a semester to teaching future physicians about how to survive in a government run healthcare world. It will certainly be more practical and beneficial than memorizing the Krebs cycle.