Blogging Doctors

Emergency Medicine News had a recent article looking at the growing trend of physician bloggers.

While some bloggers have been able to monetize their sites, most simply write for fun.  Physicians who blog must be especially careful to protect their patients' privacy if clinical cases are discussed, and physicians must realize that things written on the internet are permanent.

KevinMD.com had a recent post discussing the importance of a physician's online reputation. Blogging can be a useful tool for both physician and patient, but needs to be realized as a potential risk as well as benefit.

If you want to know more about your own reputation online, Joy Tu of Medical Justice wrote this excellent post on influencing your online reputation.

Atlas Shrugged and the American Healthcare Reforms

Atlas Shrugged was written in 1957 by Ayn Rand. Considering all that has happened in healthcare recently the work seems prophetic. Here's a quote by a character in Atlas Shrugged named Dr. Hendricks who retired from Neurosurgery when the healthcare system became nationalized:

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards - never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it - and still less safe, if he is the sort who doesn't."

Physician Salaries Around The World

Here's what the U.S. Bureau of Labor Services (BLS) report as the average salary of a physician in the US.

In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738."

Let's look at a few specific specialties, in ascending order:

• General Pediatricians $161,410
• Psychiatrists $163,660
• Family and General Practitioners $168,550
• General Internists $183,990
• Obstetricians and Gynecologists $204,470
• Anesthesiologists $211,750
• Surgeons $219,770

• Physicians and Surgeons, All Other $173,860.

What do doctors in other countries make? Times Article

Source: Congressional Research Service analysis; see notes in table below

In response to Uwe Reinhardt’s recent post on “rationing” doctors’ salaries, a number of readers wrote in asking about physician compensation in other countries.

Doing a direct comparison of remuneration across different countries is tricky because the same salary may allow for different standards of living in different places.

But here are two possible ways to think about these comparisons, taken from a 2007 Congressional Research Service report entitled “U.S. Health Care Spending: Comparison with Other OECD Countries.”

One way to compare cross-country data is to adjust the salaries for purchasing-power parity — that is, adjusting the numbers so that $1,000 of salary buys the same amount of goods and services in every country, providing a general sense of a physician’s standard of living in each nation.

These numbers are in the second, fourth and sixth columns of the chart below.

They show that American general practitioners and nurses earn more than their counterparts in other developed countries, and American specialists (insert plastic surgeons & dermatologists) are close to the top of the pack.

Source: Congressional Research Service (CRS) analysis of Remuneration of Health Professions, OECD Health Data 2006 (October 2006), available at [http://www.ecosante. f /OCDEENG/70.html]. Sorted by specialists’ compensation. Amounts are adjusted using U.S. dollar purchasing power parities. Amounts from previous years are trended up to 2004 dollars using the annualized Bureau of Labor Statistics Employment Cost Index for wages and salaries of health services workers in private industry. It is not known whether wage growth in health professions in other countries was similar to that in the United States. Amounts are from previous years for 10 countries: data for Australia, Canada, Denmark (for specialists and nurses), Finland (for nurses), and the Netherlands are from 2003; data for Belgium (for specialists), Denmark (for general practitioners), New Zealand (for nurses), and Sweden are from 2002; data for Switzerland and the United States (for specialists and general practitioners) are from 2001; and data for Belgium (for general practitioners) and the United States (for nurses) are from 2000. Ratios of salaries to GDP per capita reflect the year the data was collected and are not adjusted for inflation. For countries that have both self-employed and salaried professionals in a given field, the amount presented here is the higher of the two salaries. Four countries have both salaried and self-employed specialists: the Czech Republic (where compensation is $29,484 for salaried and $34,852 for self-employed specialists), Greece ($67,119 and $64,782), the Netherlands ($130,911 and $252,727), and the United States ($170,300 and $229,500). One country has both salaried and self-employed general practitioners: in the United States, salaried general practitioners earn $134,600, compared with $154,200 if self-employed. All nurses are salaried among this data.

Another way is look at how a doctor’s salary compares to the average national income in that doctor’s country — that is, gross domestic product per capita. These numbers are in the third column, fifth and seventh columns of the chart.

As a country’s wealth rises, so should doctors’ pay. But even accounting for this trend, the United States pays doctors more than its wealth would predict:

Source: Congressional Research Service (CRS) analysis of Remuneration of Health Professions, OECD Health Data 2006 (October 2006), available at [http://www.ecosante.fr/OCDEENG/70.html].

According to this model, the 2007 report says, “The U.S. position above the trendline indicates that specialists are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more.”

But it’s important to keep in mind, the report notes, that health care professionals in other O.E.C.D. countries pay much less (if anything) for their medical educations than do their American counterparts. In other words, doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.

I would also hazzard a guess that malpractice insurance for physicians in the US is multiples of what physicians in other countries need to shoulder.

If anyone has more current stats for physician income in the US I'd love it if you'd leave a link in the comments of this post.

Real Estate Investing For Physicians: Part 1

Real estate investing for physicians; The worst of times... The best of times.

With apologies to Charles Dickens and A Tale of Two Cities, when it comes to real estate investing, this is truly the worst of times and the best of times. I’m sure you’ve heard the adage of real estate investing – “location, location, location.” Well I’m here to say that just as important is “timing, timing, timing!”

To explain, let me wind the clock back to the wild and wooly 1980’s. That is when I made my first foray into real estate investing. At the time, I was the director of multiple hospital emergency departments and was flush with the success of our multi-site outpatient urgent care/occupational medicine/multi-specialty centers. With the hubris that only a physician can muster, I assumed that my successes with medical entrepreneurship would easily translate into other business ventures.

So I started investing in real estate. 

One of the first markets we entered was a wine-growing, newly burgeoning bedroom community about an hour from the Orange County/Los Angeles hub of Southern California – Temecula. The area was red-hot! – land values were skyrocketing, businesses were flocking to the area, and the rental market was alive and well. As my wife and I were driving to Temecula, we saw a mile-long line of traffic backed up on to the highway, waiting to exit to the downtown area.  I excitedly commented, “Look honey, there’s so many people wanting to live and work here, they can’t even get off the freeway!” My wife just said, “Hmm, that could be a problem.”  But I pushed ahead and quickly purchased over a million dollars worth of vacant land parcels, a small rental house and a five acre mini-estate home.

Now, let’s fast forward two years. The red hot market continued to appreciate, then topped and quickly became an ice age of falling house and land values coupled with an oversaturated rental market. Opportunities to sell the properties at top dollar evaporated, refinancing dried up and it was a challenge to keep rentals occupied.

So what did I learn from this humbling experience? First, listen to my wife. Second, my previous medical business triumphs did not automatically endow me with the abilities to succeed in other arenas – I needed mentoring, more education and a lot more research. Third, timing was everything – the backed up freeway exit should have told me that the town had not created a sufficient infra-structure to handle the population growth.

So let’s come back to the present day. Over the past two to three years, real estate investing has gone from the darling of cocktail party banter to the subject of head-shaking and hand-wringing.  In many ways, this is the worst of times. Values continue to drop, rental rates are staggering, and the lending environment is stifling –sound familiar?

But it’s also the best of times. Properties can be purchased at very low percentages of true market value, credit is available if you know where to look, and if structured correctly re-sales can be expedited to willing buyers.

The current trend becomes easier to understand if you step back and look at real estate as a cyclical phenomenon – typically repeating five discrete stages: flat market, initial appreciation, accelerating appreciation, topping, and depreciation. We are obviously currently in the final stage – depreciation, i.e. decreasing house and land values.

So in this scariest of times, what can you do? Learn the lesson of timing and put your money to work in the one property type that is working well now – foreclosures.  A lot more on that in my next post.

Read Part 2: Real Estate Investing For Physicians - Real Estate Auctions >

Thankful Children Are More Successful

Recent research indicates that children who are thankful grow up to be healthier, happier, more successful adults. Seeing the glass half full, a sense of optimism,and avoiding people who are negative are important leadership and entrepreneurial traits. What's more, even if you are a grumpy, negative or annoying, behavioralists and experts in emotional intelligence tell us you can change your behavior.

If you find you are in a negative spiral, try some of these things starting today:

1. Make a list of three things that you appreciate and for which you are thankful. Being a doctor in the US is not so bad after all.
2. Follow the no asshole rule. Whenever possible, stay away from bosses , workmates and acquaintances who are negative, grumpy, cynical, crass, fowl and just plan mean.
3. Do your good deed for the day. Give some something that they would value...a smile, a nice word, a piece of information, a contact on Linkedin.
4. Say please and thank you. Your grandmother was very smart and there is a reason she taught you that.
5. Don't curse.

Take this opportunity to be positive in the midst of all the changes in our lives. Your spouse, your kids and your dog will really appreciate it.

Happy Thanksgiving.

TV News Report on the Expedition Medicine National Conference

The Expedition Medicine National Conference

For those who might be interested in seeing one of our CME conferences in action, I've posted this television news report that was done on our Expedition Medicine National Conference in 2007.  The news station is Fox 5 WNYW out of New York City.

Even though the report was a couple of years ago, most of the information is still current.

Dr. Arlen D. Meyers, Founder Of The Society Of Physician Entrepreneurs, Joins Freelance MD

Freelance MD today announced the addition of Dr. Arlen D. Meyers as a contributing physician writer.

Arlen D. Meyers, MD MBA is the cofounder, and Chief Medical Officer of MedVoy, a medical tourism company. He is also a Professor of Otolaryngology, Dentistry and Engineering at the University of Colorado at Denver and Health Sciences Center. He teaches at the Bard Center for Entrepreneurship at the University of Colorado Denver and the Daniels School of Business at the University of Denver and is a consultant to several biotech, medical device and bioscience investment firms.

"We're very excited that Dr. Meyers has joined us," said Jeff Barson, Freelance MD's Founder. "Dr. Meyers background with technoloy and life-science startups gives him a unique understanding of many of the areas that physicians want and need more information."

Dr. Meyers is the author of over 300 articles and book chapters and is Editor-in Chief of eMedicine.com: Otolaryngology-Facial Plastic Surgery. He is the cofounder of two medical biophotonics companies and is a consultant to several other bioscience investment and medical device and biotech companies.

He presently serves on the Executive Committee of the University of Colorado Bioengineering Center and is a member of the executive committee of the Colorado Advanced Photonics Technology Center at the University of Colorado-Denver. He is Vice-President of the Biomedical Division of VentureQuest, a technology development consulting company, President and CEO of Oncolux, a biophotonics company, and former founder of Oncolight.Dr. Meyers was a member of the Colorado Governor's Commission on Science and Technology, a member of the Colorado Nanotechnology Task Force and was formerly the Executive Director of the Colorado Alliance for Bioengineering. In addition, he is cofounder and former director of the University of Colorado MD/MBA program and former director of the Bard Center Bioscience Entrepreneurship Program.

Dr. Meyers was named as a member of the Denver Business Journal’s 2004 Who’s Who in Healthcare and has received multiple awards for teaching, clinical care and research. He is on the Fulbright Senior Scholars Roster. Dr. Meyers serves on the editorial boards of The Archives of Facial Plastic Surgery, Biotechnology Healthcare, The Journal of Comparative Technology Transfer and Society and the Journal of Commercial Biotechnology.

About Arlen D. Meyers MD, MBA
Dr. Meyers received his B.S. degree from Dickinson College, his M. D. from Jefferson Medical College and did his residency in Otolaryngology-Head and Neck Surgery at the University of Pennsylvania. His received his MBA from the University of Colorado and is a former Harvard-Macy fellow.

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.