Doctors and Barbers

The comments on my recent post Fighting Chaos are some of the most interesting ones I have had.  One which particularly sparked my thoughts (not an easy thing to do, mind you) was one that compared being a physician to being a barber.  It states:

I’m a licensed barber. Does this mean I get to give you a buzz cut because I can do those faster, and make more money in an hour, or am I suppose to take the time needed to give you the kind of haircut you want, and expect, even when you wait until the very end to to say, “Take it just a little bit shorter all over!”?

You see, being a barber is a public service, but so is being a physician. A patient is a customer, paying for your service, just like you are the patron, paying for a haircut. Sure you don’t get all of the money, but neither does a barber. We have fees, supplies, chair rent, taxes, etc., just like you. If my profits are eaten up because you require twice the time that a normal haircut would, it doesn’t mean I have a right to give you a rotten haircut. Consider this, you probably wouldn’t even pay for it, and if you did, you would never come back! Should doctors expect more from their patients for shabby service?

I pay around $300 a month just to have insurance coverage for my husband and I. On top of that, I also have my co-pays, and my portion of the bill, that insurance doesn’t cover. I have max out of pockets and deductibles, which also run into the thousands! Doctors don’t see all of that money, but I’m sure paying for it! I expect my doctor to spend as much time with me as needed! I’m not out to take up extra time from my doctor, but when I have a valid problem, I expect to be taken care of appropriately. No short cuts!

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This is interesting because I take care of some hair stylists and have commented how similar our jobs are.  Here are the similarities I see:

  • You are your own source of income
  • Reputation brings business
  • A full schedule is the norm if you are good
  • People will wait if you are worth it
  • You get to hear people\’s secrets
  • \"llama_knuttz\" You deal with sharp objects
  • You have out-of-date magazines in your office
  • Doctors\’ offices and barbershops both smell funny
  • Little kids hate going to both
  • \”Doctor\” and \”Barber\” both have six letters
  • In the middle ages, barbers were doctors…or was it the other way around?
  • There are llama barbers and llama doctors (although the llama does not do the doctoring or barbering).

There is a good point to what the commenter says, and it does seem to make sense.  These similarities seem to imply that physicians should just accept a lower income.  It is our desire for higher salaries, not the system itself that is making things bad.

Maybe.

But here are some very important differences:

  • \"07t.hair_.jpg\" Physicians train for 7-8 years before earning significant income.
  • Physicians generally incur over $100,000 in debt – I am 14 years out and still paying student loans.
  • Neither should use a flamethrower in caring for their customer.
  • Barbers can set how much they charge, but doctors can\’t.  Others (Medicare, insurers) set how much physicians can earn.  A high-quality physician with excellent customer service can\’t charge more.  A bad physician with poor service earns the same, if not more.
  • Third-parties pay for medicine, not hair care.  This means that patients are often not aware how much (or little) a doctor is paid for the visit.  The rising insurance rates have not gone into the pockets of doctors – in fact, the salaries of doctors have dropped while insurance costs go up.
  • A baseball can be \”doctored,\” but cannot be \”barbered.\”
  • There is not a shortage of barbers, but there is a shortage of primary care doctors.  This means that to serve the entire population, PCP\’s must see high volume.
  • Physicians have an enormous amount of unpaid work, whereas barbers do not.  Barbers are not called many times a day with people asking for free haircuts.  Physicians get patients calling for medical advice and wanting it done over the phone to avoid paying.
  • Barbers\’ malpractice is not quite the same as doctors\’.
  • Doctors are not as good at Foosball.
  • There are no subspecialty barbers making 4-5 times the income of regular barbers.  Some stylists command more, but that is based on reputation and quality of work.  Reputation and quality have no influence on how much a physician can charge.
  • Obviously, the responsibility of a doctor is at a different level than that of a barber.  This is no disrespect to barbers; but nobody would suggest that barbers should earn what physicians earn (although some primary care physicians actually are earning what some barbers earn).

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I must also mention that I am also a small-business owner, being stung by the high cost of health insurance just as much as any other business owner.  I do understand the cost to the consumer because I am a consumer too.

This is not to defend the shabby service that some physicians give.  My purpose in the post was to point out that a system that is not sensitive to the quality (both the quality of service and care) but instead is only sensitive to volume, will produce bad care.

Quality must be recognized.  It is for barbers, but not for physicians.  It\’s not surprising that things are so messed up.

56 thoughts on “Doctors and Barbers”

  1. I hate to tell you, CA, but people get angry and many even comment to me that we “forced” them to come in to be seen. I wish it was just being polite, but most seem to be thinking about money. They have not been seen for 6 months and they don’t want to come in for their diabetes. They have depression and want meds called in without coming in. It happens many times every day.

  2. I hate to tell you, CA, but people get angry and many even comment to me that we “forced” them to come in to be seen. I wish it was just being polite, but most seem to be thinking about money. They have not been seen for 6 months and they don’t want to come in for their diabetes. They have depression and want meds called in without coming in. It happens many times every day.

  3. Healthcare Today

    Doctors and Barbers…
    A system that is not sensitive to the quality (both the quality of service and care) but instead is only sensitive to volume, will produce bad care. Quality must be recognized. It is for barbers, but not for physicians. Its not surprising that things…

  4. Good post! I think lots of people understand healthcare in the US as being a typical fee-for-service industry just lining individual physician’s pockets.
    Weren’t barbers precursor to the modern day surgeons? I’ve seen some of those blood letting instruments at Mutter Museum… makes me real glad I wasn’t around in the days of barber surgeons!

    as a side note, I’d be excited beyond belief if my spouse and I only had to pay $300 a month for insurance. I totally am living in the wrong body for affordable insurance, lol.

  5. Good post! I think lots of people understand healthcare in the US as being a typical fee-for-service industry just lining individual physician’s pockets.
    Weren’t barbers precursor to the modern day surgeons? I’ve seen some of those blood letting instruments at Mutter Museum… makes me real glad I wasn’t around in the days of barber surgeons!

    as a side note, I’d be excited beyond belief if my spouse and I only had to pay $300 a month for insurance. I totally am living in the wrong body for affordable insurance, lol.

  6. Dear Dr. Rob,
    I watched Michael Moore’s propaganda-ish “Sicko” and was struck by one point: It appears in the U.K., the doctors receive bonuses for certain health indices of their patients, such as a bonus if you can get a patient to stop smoking, or lose weight, or bring cholesterol down. Now, as a doctor’s daughter (and sister), I am not for socialized medicine. I know how my friends in the U.K. and Canada must wait for months just to get an MR — I can get one this week, with the right precert.

    Once, I checked my Aetna online billing and saw that my primary care doctor bills $80 for a visit, $70 of which is DISALLOWED!!!! This means the only money she makes on me is my measley $10 copay. It’s outrageous!!!! I suppose this is because she is a rural D.O. who accepts Medicaid….but I feel badly for her. I don’t think she is compensated enough. I also am constantly amazed how she has her finger on the latest research, whether it be about a drug she’s prescribing or a new ailment (and with Cushing’s, I’ve got a lot) I bring to her.

    She, too, has $100K in loans and will be paying on her student debt until she is 58.

    Dr. Rob, I think y’all are in the wrong profession — quit your practice and open a barber shop! :o)

    Supportively,
    Kate

  7. Dear Dr. Rob,
    I watched Michael Moore’s propaganda-ish “Sicko” and was struck by one point: It appears in the U.K., the doctors receive bonuses for certain health indices of their patients, such as a bonus if you can get a patient to stop smoking, or lose weight, or bring cholesterol down. Now, as a doctor’s daughter (and sister), I am not for socialized medicine. I know how my friends in the U.K. and Canada must wait for months just to get an MR — I can get one this week, with the right precert.

    Once, I checked my Aetna online billing and saw that my primary care doctor bills $80 for a visit, $70 of which is DISALLOWED!!!! This means the only money she makes on me is my measley $10 copay. It’s outrageous!!!! I suppose this is because she is a rural D.O. who accepts Medicaid….but I feel badly for her. I don’t think she is compensated enough. I also am constantly amazed how she has her finger on the latest research, whether it be about a drug she’s prescribing or a new ailment (and with Cushing’s, I’ve got a lot) I bring to her.

    She, too, has $100K in loans and will be paying on her student debt until she is 58.

    Dr. Rob, I think y’all are in the wrong profession — quit your practice and open a barber shop! :o)

    Supportively,
    Kate

  8. Rob, I can understand the plight of a pcp, you guys get to deal with everyone in the system and all of their problems. Then you get to figure out if they need to take two aspirin, or send them to the surgeon for a brain transplant. All in a 10 minute appointment.But isn’t this the life of a pcp?

  9. Rob, I can understand the plight of a pcp, you guys get to deal with everyone in the system and all of their problems. Then you get to figure out if they need to take two aspirin, or send them to the surgeon for a brain transplant. All in a 10 minute appointment.But isn’t this the life of a pcp?

  10. “Physicians get patients calling for medical advice and wanting it done over the phone to avoid paying.” I don’t know as they might be seeing it this way. Some may think they are sparring you a visit, when it is a quick question. They might feel they are being courteous to other patients that need you more, and so won’t take up valuable office time.

  11. “Physicians get patients calling for medical advice and wanting it done over the phone to avoid paying.” I don’t know as they might be seeing it this way. Some may think they are sparring you a visit, when it is a quick question. They might feel they are being courteous to other patients that need you more, and so won’t take up valuable office time.

  12. It is very much about numbers. I work in an ER and let me tell you it is about numbers. I hear administration talking about numbers all the time. Numbers are down, you don’t need that many nurses you only have this number of patients. Healthcare is so not about numbers. I honestly do not understand why healthcare leaders focus on numbers and not quality and not acuity. Actually I do, because those numbers are attached to dollars.

  13. It is very much about numbers. I work in an ER and let me tell you it is about numbers. I hear administration talking about numbers all the time. Numbers are down, you don’t need that many nurses you only have this number of patients. Healthcare is so not about numbers. I honestly do not understand why healthcare leaders focus on numbers and not quality and not acuity. Actually I do, because those numbers are attached to dollars.

  14. as long as someone else (insurance company) is paying for the services sought by the customer (patient), the incentives will be screwed up.
    Doctors play the games and learn the tricks to get money from insurers. What the patient wants isn’t necessarily a part of that.

    Examples:

    “but I just need something simple handled over the phone.” — please come in and talk to me face to face so your insurer will pay me.

    “but my diabetes is controlled, my sugars are great at home, I’ll can wait another 3 months before rechecking any labs. It saves me some out of pocket costs” — your insurer says I’m a “low quality” doctor if I don’t check your labs every 6 months, whether you really need it or not.

    “I have a few more issues I hoped to address at today’s visit” — sorry, we’ve already maxed out what your insurer is willing to pay for today’s visit, and I’ve got bills to pay, staff to support, so you need to take off work next week and come back for those issues.

    “I don’t understand my disease as much as I should, can you spend some time again explaining that?” — your insurer doesn’t really have a way to pay me for that, so you’ll need to talk to someone else.

    “I think, all things considered, my LDL is pretty good at 105. Given my high HDL levels, I don’t think I need an even higher dose of my Zocor.” — your insurance comapny says you need to have the LDL less than 100 so I get paid a P4P bonus. Your individual preferences, no matter how well thought out, are secondary here.

    and on and on……

    This isn’t rocket surgery. 🙂

    If you, as a patient, want to align your interests with that of the doctor, join a concierge practice. Then you, as the patient, are the “insurer” and can decide, with the doctor, what you want to pay for and how to pay for it.

    The current model is fundamentally broken.

  15. as long as someone else (insurance company) is paying for the services sought by the customer (patient), the incentives will be screwed up.
    Doctors play the games and learn the tricks to get money from insurers. What the patient wants isn’t necessarily a part of that.

    Examples:

    “but I just need something simple handled over the phone.” — please come in and talk to me face to face so your insurer will pay me.

    “but my diabetes is controlled, my sugars are great at home, I’ll can wait another 3 months before rechecking any labs. It saves me some out of pocket costs” — your insurer says I’m a “low quality” doctor if I don’t check your labs every 6 months, whether you really need it or not.

    “I have a few more issues I hoped to address at today’s visit” — sorry, we’ve already maxed out what your insurer is willing to pay for today’s visit, and I’ve got bills to pay, staff to support, so you need to take off work next week and come back for those issues.

    “I don’t understand my disease as much as I should, can you spend some time again explaining that?” — your insurer doesn’t really have a way to pay me for that, so you’ll need to talk to someone else.

    “I think, all things considered, my LDL is pretty good at 105. Given my high HDL levels, I don’t think I need an even higher dose of my Zocor.” — your insurance comapny says you need to have the LDL less than 100 so I get paid a P4P bonus. Your individual preferences, no matter how well thought out, are secondary here.

    and on and on……

    This isn’t rocket surgery. 🙂

    If you, as a patient, want to align your interests with that of the doctor, join a concierge practice. Then you, as the patient, are the “insurer” and can decide, with the doctor, what you want to pay for and how to pay for it.

    The current model is fundamentally broken.

  16. Quick observation – the Medievil role was “barber surgeon”.
    Serious comment – I agree totally with the previous comments that “targets based medicine” is fundamentally broken, whether it was insewerers (US) or politicians (UK) who broke it!!

  17. Quick observation – the Medievil role was “barber surgeon”.
    Serious comment – I agree totally with the previous comments that “targets based medicine” is fundamentally broken, whether it was insewerers (US) or politicians (UK) who broke it!!

  18. For me, the doctors I see most frequently simply don’t take insurance. Less office staff, more doctor time. I pay a 30% out of network copay, which often doesn’t work out to much different than what my office visit charge would have been anyway. those doctors take phone calls during the day, call back at night, etc. The minor difference in cost is worth it!! they are always booked and seem to be doing fine financially. In this area, in certain specialities, if a doctor is any good, they have opted out of insurance.
    If you can’t get an incentive system with the insurance companies, I would consider the no insurance model to be a good one.

  19. For me, the doctors I see most frequently simply don’t take insurance. Less office staff, more doctor time. I pay a 30% out of network copay, which often doesn’t work out to much different than what my office visit charge would have been anyway. those doctors take phone calls during the day, call back at night, etc. The minor difference in cost is worth it!! they are always booked and seem to be doing fine financially. In this area, in certain specialities, if a doctor is any good, they have opted out of insurance.
    If you can’t get an incentive system with the insurance companies, I would consider the no insurance model to be a good one.

  20. Hi Dr. Rob,
    Your post had me cracking up! I’m glad you got a kick out of mine as well. You are right, when you are talking about barbers vs. doctors education level and tuition cost, there is no comparison. We do have many similarities though.

    Even though I would not get called many times a day with people wanting free service or advice, it does happen. People try to cut, color, or perm their hair at home, then when it’s messed up, call to see how to fix it over the phone! Phil got my point. All of these things are part of the territory. It’s a day in the life of our vocation.

    It seems that in different parts of the US, pricing on everything is so different. I know a lot of it has to do with insurance companies too. I was shocked to read that Kate’s doctor only gets her $10 copay! My PCP gets much more! He charges $68.00 for an office visit. He gets $50.86 of that. I pay $10 of it, and there is $7.14 negotiated out by the insurance company. They pay the rest. Maybe that’s why I get better care from my PCP, and I love my PCP? 😉 He is a great doctor, and I hope I never have to change doctors. I do let him know that I appreciate him too!

    Insurance is so frustrating! I’m thankful that I have insurance, but I also get frustrated with it. One thing I really hate is that when there is a billing discrepancy between the insurance, and doctor, I’m the one who has to call both parties to get it figured out, and straightened out. That requires many calls back and forth, because I’m in the middle! I don’t understand why they do not deal with each other directly. I don’t get paid to do their job!

    I can’t set the rate for haircuts. If you are not the shop owner, you charge what they have set. Example: if the shop owner charge $8 for a haircut, I can’t charge $14. I could go out on my own and have my own shop, and I could charge what I wanted. You could get rid of the insurance company issues, like Debra suggested. I fly from Ohio to California to see a specialist. He does not accept insurance. He will give us a super bill to turn in for reimbursement. He is out of my network, as is everyone who is out of Ohio. Thankfully, I don’t have to see him often, because he is expensive! It’s well worth it though. He got to the bottom of my problems. I’ll tell you, he charges $450 an hour. He also charges for phone appointments, and e-mail appointments. Insurance will cover some, but my out of network coverage is only 60/40! I pay the price because my life depends on it!

    I hate it that my insurance governs who I can see, and who gets paid what. Insurance companies, at least mine, appear to be stupid. They don’t get it that they are paying big bucks for a doctor that is in network, but not getting to the bottom of my problems. Technically, he should have been able to, but didn’t. He is considered a specialist in that area as well. He ran labs, and I had one office visit on the same bill, and he was billing my insurance over $3,000! All for nothing! Rather than chasing my tail in circles, I decided to fork out the big bucks, and head to CA! You would think that insurance would be willing to pay more for the doctor who is saving them LOTS of money in the long run. Nope!

    Insurance needs a major overhaul, in my opinion. Dr. Rob, what can we do to change the system? I honestly don’t know! I’m just a sick barber!

    By the way, I hope you have a good day today!

  21. Hi Dr. Rob,
    Your post had me cracking up! I’m glad you got a kick out of mine as well. You are right, when you are talking about barbers vs. doctors education level and tuition cost, there is no comparison. We do have many similarities though.

    Even though I would not get called many times a day with people wanting free service or advice, it does happen. People try to cut, color, or perm their hair at home, then when it’s messed up, call to see how to fix it over the phone! Phil got my point. All of these things are part of the territory. It’s a day in the life of our vocation.

    It seems that in different parts of the US, pricing on everything is so different. I know a lot of it has to do with insurance companies too. I was shocked to read that Kate’s doctor only gets her $10 copay! My PCP gets much more! He charges $68.00 for an office visit. He gets $50.86 of that. I pay $10 of it, and there is $7.14 negotiated out by the insurance company. They pay the rest. Maybe that’s why I get better care from my PCP, and I love my PCP? 😉 He is a great doctor, and I hope I never have to change doctors. I do let him know that I appreciate him too!

    Insurance is so frustrating! I’m thankful that I have insurance, but I also get frustrated with it. One thing I really hate is that when there is a billing discrepancy between the insurance, and doctor, I’m the one who has to call both parties to get it figured out, and straightened out. That requires many calls back and forth, because I’m in the middle! I don’t understand why they do not deal with each other directly. I don’t get paid to do their job!

    I can’t set the rate for haircuts. If you are not the shop owner, you charge what they have set. Example: if the shop owner charge $8 for a haircut, I can’t charge $14. I could go out on my own and have my own shop, and I could charge what I wanted. You could get rid of the insurance company issues, like Debra suggested. I fly from Ohio to California to see a specialist. He does not accept insurance. He will give us a super bill to turn in for reimbursement. He is out of my network, as is everyone who is out of Ohio. Thankfully, I don’t have to see him often, because he is expensive! It’s well worth it though. He got to the bottom of my problems. I’ll tell you, he charges $450 an hour. He also charges for phone appointments, and e-mail appointments. Insurance will cover some, but my out of network coverage is only 60/40! I pay the price because my life depends on it!

    I hate it that my insurance governs who I can see, and who gets paid what. Insurance companies, at least mine, appear to be stupid. They don’t get it that they are paying big bucks for a doctor that is in network, but not getting to the bottom of my problems. Technically, he should have been able to, but didn’t. He is considered a specialist in that area as well. He ran labs, and I had one office visit on the same bill, and he was billing my insurance over $3,000! All for nothing! Rather than chasing my tail in circles, I decided to fork out the big bucks, and head to CA! You would think that insurance would be willing to pay more for the doctor who is saving them LOTS of money in the long run. Nope!

    Insurance needs a major overhaul, in my opinion. Dr. Rob, what can we do to change the system? I honestly don’t know! I’m just a sick barber!

    By the way, I hope you have a good day today!

  22. What is the incentive to accept payments from insurance companies? I know that we all “need” insurance to cover the huge bills, but why does a pcp participate?Wouldn’t there be much less frustration on both ends if everyone knows up front that a billable hour is $360.( or whatever)?

  23. What is the incentive to accept payments from insurance companies? I know that we all “need” insurance to cover the huge bills, but why does a pcp participate?Wouldn’t there be much less frustration on both ends if everyone knows up front that a billable hour is $360.( or whatever)?

  24. The main reason is that you grow attached to your patients and don’t want to lose a bunch of them. Not all will be willing to switch to a doctor who doesn’t accept insurance. Plus, some require authorization for referrals and in-network doctors to prescribe medications to get them at the insurance company rate.
    From a business standpoint it does make the most sense, but change is very hard, and it is going out on a limb to some extent. You have to be REALLY sure your patients will follow you.

  25. The main reason is that you grow attached to your patients and don’t want to lose a bunch of them. Not all will be willing to switch to a doctor who doesn’t accept insurance. Plus, some require authorization for referrals and in-network doctors to prescribe medications to get them at the insurance company rate.
    From a business standpoint it does make the most sense, but change is very hard, and it is going out on a limb to some extent. You have to be REALLY sure your patients will follow you.

  26. Hi. New to blogging and just found you. I just went to my barber for a haircut that cost 10% of what our clinic charges for a routine visit. Interesting points you made…. BTW, as a Swede I was intrigued by your use of “Å”. It’s not how I use it, but it’s better than neglecting such a beautiful letter!

  27. Hi. New to blogging and just found you. I just went to my barber for a haircut that cost 10% of what our clinic charges for a routine visit. Interesting points you made…. BTW, as a Swede I was intrigued by your use of “Å”. It’s not how I use it, but it’s better than neglecting such a beautiful letter!

  28. Health news - Doctors are not barbers

    […] M.D. – Medical Weblog Here’s why. Rating:  (Not Rated)   Loading … Share This […]

  29. Devil's Advocate

    I’ll tell you why doctors have to accept insurance. Because if insurance didn’t exist, there’d be no way to actually get any tests done, nor would there be any way to actually pay for in-patient care. Do you know anyone who can pay cash for an MRI of the brain with and without gadolinium out-of-pocket? Or a five day stay in the CCU after having a heart attack and getting urgently stented? So what’s the alternative. Do we just devolve to the model of medicine practiced by developing countries? If you can’t pay, you die? You call that civilized?

  30. Devil's Advocate

    I’ll tell you why doctors have to accept insurance. Because if insurance didn’t exist, there’d be no way to actually get any tests done, nor would there be any way to actually pay for in-patient care. Do you know anyone who can pay cash for an MRI of the brain with and without gadolinium out-of-pocket? Or a five day stay in the CCU after having a heart attack and getting urgently stented? So what’s the alternative. Do we just devolve to the model of medicine practiced by developing countries? If you can’t pay, you die? You call that civilized?

  31. What does insurance have to do with the model of medicine? Other than providing a means to finance the hospital/labs/ doctor charges, insurance has nothing to do with medical care. Or rather, should have nothing to do with medical care.Does insurance negatively impact the primary care physician and the patient who needs to see him? Absolutely.
    Doctors do not need to accept insurance in their private practice in order to get testing done. My endocrinologist does not deal with the insurance companies, yet through him I was able to have extensive lab work, 2 MRIs( dynamic, with and without contrast) of my pituitary and brain, and an Inferior Petrosal Sinus Sampling( invasive procedure). And ultimately, brain surgery. All of these were covered by my insurance plan with no trouble.

    I never called any of this civilized…

  32. What does insurance have to do with the model of medicine? Other than providing a means to finance the hospital/labs/ doctor charges, insurance has nothing to do with medical care. Or rather, should have nothing to do with medical care.Does insurance negatively impact the primary care physician and the patient who needs to see him? Absolutely.
    Doctors do not need to accept insurance in their private practice in order to get testing done. My endocrinologist does not deal with the insurance companies, yet through him I was able to have extensive lab work, 2 MRIs( dynamic, with and without contrast) of my pituitary and brain, and an Inferior Petrosal Sinus Sampling( invasive procedure). And ultimately, brain surgery. All of these were covered by my insurance plan with no trouble.

    I never called any of this civilized…

  33. I agree, this has been a very interesting post and comment. It makes me realize there are a few “humble” and insightful people out there.Philb.
    Yes, you are correct. When my parents raised me…they paid for ordinary doctor visits, and yes the fees were much lower. I remember less than 20 dollars/visit and that with an immunization. They carried major catastrophic coverage for the hospital. There weren’t as many (often useless) lab tests, and MRIs were non existent. (often over utilized) because of malpractice issues.
    They carried catastrophic coverage for hospitalizations. equivalent to high deductibles HSAs but without all the B.S. I remember the coverage would start at 10,000 dollars…
    What has happened is that we all expect cradle to grave access to health care, for colds, aches and pains…We have allowed and even encouraged insurance companies to take over and rule.

    We sit and wait for someone else to fix the system do not become proactive, and wait each year for the bad news from the insurer, medicare, etc.

    Patients….fire your classic insurance company, opt for a very high deductible or a major medical polilcy.
    Doctors….stop taking insurance except for surgeries, hospitalizations and/or major workups.

    You will see how fast the insurers belly up and change their tune…..Americans unite, we do not need them…

  34. I agree, this has been a very interesting post and comment. It makes me realize there are a few “humble” and insightful people out there.Philb.
    Yes, you are correct. When my parents raised me…they paid for ordinary doctor visits, and yes the fees were much lower. I remember less than 20 dollars/visit and that with an immunization. They carried major catastrophic coverage for the hospital. There weren’t as many (often useless) lab tests, and MRIs were non existent. (often over utilized) because of malpractice issues.
    They carried catastrophic coverage for hospitalizations. equivalent to high deductibles HSAs but without all the B.S. I remember the coverage would start at 10,000 dollars…
    What has happened is that we all expect cradle to grave access to health care, for colds, aches and pains…We have allowed and even encouraged insurance companies to take over and rule.

    We sit and wait for someone else to fix the system do not become proactive, and wait each year for the bad news from the insurer, medicare, etc.

    Patients….fire your classic insurance company, opt for a very high deductible or a major medical polilcy.
    Doctors….stop taking insurance except for surgeries, hospitalizations and/or major workups.

    You will see how fast the insurers belly up and change their tune…..Americans unite, we do not need them…

  35. Doctors will never be unemployed because there will never be a shortage of sick people.What will happen to barbers if having dreadlocks becomes as popular as getting tattoos and piercings.

  36. Doctors will never be unemployed because there will never be a shortage of sick people.What will happen to barbers if having dreadlocks becomes as popular as getting tattoos and piercings.

  37. Since Gracie is having surgery tomorrow to remove a pituitary adenoma, I’ll answer in her place. (Forgive me, Gracie..lol…I know you’d do better than I!)
    Never happen…dreadlocks are totally out of style. 😉

    But I bet Gracie would make a mean tattooist.

  38. Since Gracie is having surgery tomorrow to remove a pituitary adenoma, I’ll answer in her place. (Forgive me, Gracie..lol…I know you’d do better than I!)
    Never happen…dreadlocks are totally out of style. 😉

    But I bet Gracie would make a mean tattooist.

  39. Interesting post.
    You said”The main reason is that you grow attached to your patients and don’t want to lose a bunch of them.”

    That’s sweet. 🙂

  40. Interesting post.
    You said”The main reason is that you grow attached to your patients and don’t want to lose a bunch of them.”

    That’s sweet. 🙂

  41. I don’t know where I stand on all this; but with respect to the point about the huge debt doctors usually carry long after they begin practice, shouldn’t we consider the tax dollars that fund the medical education system? I suspect that physicians pay a small percentage of the cost of their medical education. Also, federal payroll taxes fund the Medicare system that, despite its faults and inefficiencies, provides an automatic and steady income stream to physicians.

  42. I don’t know where I stand on all this; but with respect to the point about the huge debt doctors usually carry long after they begin practice, shouldn’t we consider the tax dollars that fund the medical education system? I suspect that physicians pay a small percentage of the cost of their medical education. Also, federal payroll taxes fund the Medicare system that, despite its faults and inefficiencies, provides an automatic and steady income stream to physicians.

  43. 1. I have cut my hair myself for about the last 10 years. (Granted, some of it has fallen out, but correlation does not equal causation.) It’s actually very easy.
    2. I have also removed my own stitches, after an ACL operation. I was supposed to go into the surgeon’s office to have it done, but why bother? Snip and pull–it’s not brain surgery.

    3. I won’t change my own oil. That’s going too far.

    4. There is indeed a shortage of barbers. Find me a barber who will use the razor on my neck, not bend my ears around–ouch!–and won’t charge more than $14.

    5. Dr. Rob, leave Georgia immediately! The Russians have invaded! And they don’t have insurance!

  44. 1. I have cut my hair myself for about the last 10 years. (Granted, some of it has fallen out, but correlation does not equal causation.) It’s actually very easy.
    2. I have also removed my own stitches, after an ACL operation. I was supposed to go into the surgeon’s office to have it done, but why bother? Snip and pull–it’s not brain surgery.

    3. I won’t change my own oil. That’s going too far.

    4. There is indeed a shortage of barbers. Find me a barber who will use the razor on my neck, not bend my ears around–ouch!–and won’t charge more than $14.

    5. Dr. Rob, leave Georgia immediately! The Russians have invaded! And they don’t have insurance!

  45. I love your post, Dr. Rob. I see you are being cited as saying doctors are not barbers! But actually you seem to be saying that doctors should be more like barbers–with respect to being rewarded for quality. I completely agree.
    @Ralph–Medical education doesn’t just educate doctors. Because doctors learn by doing, a lot of patient care gets done in the process. That’s why so much money is involved. I hope you’re not suggesting that the docs in training pay for that too. Hahahaha of course not.

  46. I love your post, Dr. Rob. I see you are being cited as saying doctors are not barbers! But actually you seem to be saying that doctors should be more like barbers–with respect to being rewarded for quality. I completely agree.
    @Ralph–Medical education doesn’t just educate doctors. Because doctors learn by doing, a lot of patient care gets done in the process. That’s why so much money is involved. I hope you’re not suggesting that the docs in training pay for that too. Hahahaha of course not.

  47. I know I’m getting in on the tail of this but another point is that since the barber is able to collect cash for service, they don’t have to hire an additional ten people per barber just to try to collect monies owed by a third party. This, therefore, lowers their overhead dramatically.

  48. I know I’m getting in on the tail of this but another point is that since the barber is able to collect cash for service, they don’t have to hire an additional ten people per barber just to try to collect monies owed by a third party. This, therefore, lowers their overhead dramatically.

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