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  1. #1
    DoctorJ is offline Junior Member
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    Primary Care MD Salary?

    How much money does an internist or a family doc make in primary care? Relatively speaking?

    I'm interested in getting a N.D. (doctor of naturalpathic medicine) degree after my residency. These schools will take me into their program with advance standing if I hold a license to practice allopathic medicine.

    N.Ds from 5-6 schools are eligibe to practice in California after passing the board exam and they make $200/HR and see avg. 10 pts per day.

    I'm wondering if say setting up a shop in a nice place (Beverly Hills/Boca Raton) and accept only cash from wealthy people.

    Not a lof of overheads too coz you prob don't need assistants. And I guess you can incorporate allopathic medicine for acute cases by prescribing drugs...etc.

    What do you guys think?

  2. #21
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    you are not listening

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    I never commented on the stats being high, low etc. So there are a lot of deaths each year cause by doctors. I would like to know what consitutes a death caused by a doctor. how many people would dies each year if there were no doctors? Also, that stat has to do with non-error related adverse effects. These include things impossible to predict like anesthesia reactions, anaphylaxis from antibiotics, cardiac arrythmias from certain drugs. Thes are not healthy robust football players dying here either, these are old sick aften debilitated people that have lived far longer than they would have had it not been for modern medicine. If a guy with and ejection fration of 15% who has an AICD that fires twice a week comes in and I start flecanide which leads to a fatal arrythmia, that is a non-error, medication related death. 10-15 years ago he would have been dead a long time ago. Everytime his AICD fired, modern medicine converted him from a potentially fatal ventricular arrhythmia back to whatever he called a "normal" rhythm.

    The reason that I don't like herbal medicine is the same reason you think it is so good. many of the herbs have the same chemicals as the drugs that I use. They are not standardized, or purified. You don't know what they are adulterated with. I have said time and again that I am against it because they ARE drugs. You just don't know how much. What I Rx doesn't say "somewhere between 10 and 75mg/dose" on it. There is a dose-response curve to most medications. If you don't know the dose, how can you know the response. That stuff was great 2,000 years ago, but we have come a long way since then. Wake up, come out of the stone age.

    DoctorJ, I'm not sure how much a "part" of medicine Naturopathy is. I think that more research needs to be done into what the remedies that are used are, isolate and purify the active ingredient, and use it that way. There is also a lot of liability involved if you are an M.D., N.D. practicing both. If one of your unresearched treatments kills someone...and since they are drugs, and we have established in this thread that drugs kill >100,000 people per year, then that is going to affect your M.D. licensure. Evidence, as in scientific journals, hold up in court. What Confucious say...doesn't

    As for ephedra, they should have banned it. It is dangerous and too many of the wrong people were using it. Would ephedrine be over the counter if there were legitimate medical uses for it?? Nope. Again, it worked well for asthma before albuterol, and salmeterol, and fluticasone, but now that we have things better and safer should we still use the old remedy??? Should we go back to ether instead of halothane, foxglove instead of digoxin (a very toxic drug), eccinachea (spelled way wrong) instead of amantadine for flu prophylaxis. While we're on that topic, in 1918 the flu killed 18 million people. How many people did the flu vaccine save in just the past year??? Incalculable. I'm sure it killed some people, too. Medicine is by no means perfect. We strive for perfection, but the laws of probabilities indicate we will never reach a therapeutic nirvana.

    Since this is a stupid topic we are on now, I will refrain from desecrating this dead horse any further. I trust my opinion. G
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  3. #22
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    response

    Quote Originally Posted by prsch132
    Actually, the article is not anti-medicine, It was written by a MD and was taken from the Journal of the American Medical Assiciation (JAMA). It was written by an MD, for MDs....but it makes sense that you all would say.......it was a bunch of crap from a anti-medicine web page........none of the "elite" would write like that....
    yes and the statistic kept by the WHO on infant mortality is flawed.

    the majority of deaths in infant mortality occur in infants with birthweights less than 1500 grams.
    In America infants at the limit of viability are resuscitated, and these patients have a higher mortality rate. In places like Cuba , these patients are not resuscitated and frequently not counted as live births.

    Therefore, when people say that infant mortality rates are higher in the United States than Cuba, they are correct but it is an error to inter quality of healthcare based on this statistic.

    and the reason that people die from "side effects" from drugs is that just about anything with a strong effect, can also have a side effect.

    the bogus homeopathic garbage prescribed by ND's is basically inert, and of course you can't have a side effect when your only effect is placebo effect.

    tell me, do these "practitioners" do a wallet biopsy to determine how much 60X platypus scrotum extract their patients will need to recharge their vital force?
    ( or is it life FARCE?)

  4. #23
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    hmm

    Quote Originally Posted by jim
    ? I am already getting recruited for hospitalist jobs, as well as practices in some rural areas(only 6 months out of med school, not bad, hope the offers are still there in 2 1?2 years!)
    Jim,
    I am basically a hospitalist, since I take in-house call ( you can tell when I am on a 24 hr call because I post a lot here )

    I like the fact that when I am off, I am off. If I am not on the schedule to work for 6 or 7 days, then good luck finding me.
    I flew over 80,000 miles this year going places on the holes in the schedule ( and in the end, wound up with 2 weeks unused vacation time at the end of the year that I never had to use)

    Still, it is like being a resident on call forever. you have to like weekends and nights in the company of nurses, covering on the occasional holiday ( or a lot of holidays depending on how many aprtners are in your group...we have 5 not too many for me )

    Sometimes I do miss the office lifestyle, but not that much when I see my friends from residency getting up early 5 days a week.

    This month ( January ) I am working every monday night, and this wednesday night and that's it! 5PM to 8 AM is a piece of cake for those of us that grew up in the land before time ( 80 hr work week limit )

    So I am going to go to Vegas for a few days, and maybe to Los Angeles ....aah life is rough

    Granted, I think our call schedule is pretty fabulous and some months I am working a lot more days or nights than this month, but there are so many jobs that you can be more flexible in the type of lifestyle that you may choose.
    Of course to each his own. I know Teratos will rave about his position, and rightly so because I know that he loves it. That's the beauty of medicine as a career. You have a lot of choices and there is no excuse for not being happy.

  5. #24
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    well...

    Quote Originally Posted by prsch132
    . That is people who might have not died otherwise if they stepped into the hospital. .
    yes, let's all avoid hospitals completely and watch the death rates !
    ( no cheating now when you get diaphoretic and pain in your left shoulder and shortness of breath )


    this ignorant statement, standing alone , qualifies you as an ND. Skip the school dude, you have the mind-set down pat!

  6. #25
    Rogers is offline Junior Member
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    Primary Care MD Salary?

    Quote Originally Posted by FLK
    Quote Originally Posted by DoctorJ
    What do you guys think?
    well I think ND's do not practice evidence based " medicine"

    a fairly biased view of the topic can be found at http://www.quackwatch.org/01Quackery...turopathy.html

    [10]
    DrJ, I think you probably are well aware that Fam practice and Int Med docs are making 80K - 120K, base before possible bonuses. I mean if you are a med student I am sure you are aware of that.

    Your idea is a sound one. Health care is like a puzzle - the job of a doctor is to find out what is missing - rarely is it too little valium. It can also be viewed as a tool box - the more tools you can use the better.

    I was reading a professional pediatric magazine the other day and it mentioned spinal (cervical) manipulation for reducing ear infections and allowing the internal ear to drain, quoting studies done at an osteopathic school in Oklahoma. I don't have the article in front of me - but spinal manipulation was quackery 10 years ago, now mainstream pediatric (medial) journals are publishing about it.

    More and more MD's are becoming viewed as technicians - patients often come in, tell the doctor whats wrong and what to prescribe. The doctor merely is paid to put the pen to the paper.

    I know of a naturopath out here that grosses close to a million a year.Its ALL cash. Not one penney from insurance. His overhead is faily high since he uses ALOT of vitamin supplementation, and he does alot of lab work and also performs alot of technical testing like EKG's , Doppler etc. But I know he just bought this huge *** house with an area of the house that he had built so the roof can be retracted with a motor on good days so there is no roof - just open sky. Its pretty cool. His results with diabetes and circulation are documented and impressive.

    Quackwatch is run by Stephen Barrett MD I think. If memory serves me right, he has had his share of lawsuits, and has been barred from giving "expert" testimony in certain court cases. I think even many MD's feel his credibility is lacking, and his jedgement skewed.

    More and more lifestyle - such as diet and exercise, such as ND's prescribe - are recognized as the foundations of health. Medicine of course fills the gap for certain infectious disease and traumatic accidents - and some conditions like Type 1 diabetes. However you will find MD's who made fun of vitamins etc 10 years ago now taking their daily omega 3 fish oil capsules, along with Co-Q-10 and glucosamine sulfate. These things all have substantial bodies of evidence behind them. That is why baby formula is now fortified with essential fatty acids as well. That is why vitamin B3 is noted in medical pharmacology books as being one of the strongest things known to lower cholesterol and raise HDL.

    Since the oath of a medical doctor is "Above all else do no harm". You will be living this more than 99% of all other MD's. As an example, you will be a much more honest MD by trying a regimine of exercise, chromium, etc BEFORE prescribing a glitazone for a type 2 diabetic. If that fails (which it probably won't if they comply) in a short period, then you can start pharmacotherapy. You will have that to fall back on - since it would then be harmful to the patient to let their hyperglycemia continue untreated. But you will at least be starting with the safer therapies first. You will no doubt rub many MD's the wrong way - as well as making them mad as they get audited by an HMO they whore for while you make direct cash deposits.

    I think your idea is sound financially and medically. Lots of research backing naturopathic ideas. Exercise has been shown to reduce insulin resistence tremendously. Certainly alot more sound then treating every child with a 1st time sore throat simply by giving them antibiotics. As well 2 studies published in JAMA show that more money is spent every year on alternative therapies than on traditional medical PCP care - and almost all of it out of pocket. Medicine could not compete at all if they were not government subsidized as well as subsidized by the pharmaceutical industry let alone insurance companies.

  7. #26
    Rogers is offline Junior Member
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    well...

    [quote="FLK"]
    Quote Originally Posted by prsch132
    . That is people who might have not died otherwise if they stepped into the hospital. .
    yes, let's all avoid hospitals completely and watch the death rates ! quote]

    I would have to look for the studies, but I believe there has been 3 times doctors have gone on strike (once I think was in Orange County) and the death rate went down all 3 times

  8. #27
    heart1st is offline Member
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    ummmm....and that proves?

    Death rate went down...for a period of time.

    What happens when docs go on strike? Do they shove critically ill pts out the door? Do they stop caring for someone with an acute MI? No...

    What they stop is: elective surgery. A known risk.

    Then, should we stop elective surgery? Well, it all depends upon what basket the various surgeries which are called elective fall. I'm not sure whether my radical hysterectomy was considered elective or not. Certainly, I could have delayed it, with uncertain results. (I had the hysterectomy because of pre-cancerous condition--hyperplasia with atypia). If I were a patient whose surgery were delayed, that doesn't mean that that was the best thing for me...because, had my condition been cancerous...well, you get the picture.

    That's one thought.

    The other thought is...were these teaching hospitals, which were running residents around at 100+ hr/week--and now people were being treated by physicians with sufficient rest?

    Ya just can't take statistics at face value--or any other headline that you hear (for instance, about how much the lady who scalded herself on MacDonald's coffee got.).

    That said, there is something to be said for some forms of "complementary" medicine. I don't discount all non-allopathic medicine. Just non-evidenced based medicine. I mean, hey, my Mom bought my warts from me when I was a kid--and they went away. There are certain phenomena that we just don't know about for sure. I mean, probably one of the best health assets you can have is a strong support system.

    It sounds to me like your interest is in making a lot of money. I suggest a different career than health care. Try investment banking.

    BTW -- have you ever considered whether you'd even be able to get malpractice insurance for your allopathic practice if you are including naturopathic treatments? (That's probably why your ND friend is doing so well--less insurance paperwork, less government regulation, probably less malpractice insurance. Hey, where's the case law, right?)

    heart

    (Who takes eyedrops, with some scientific evidence, for her cataract, and hopes to avoid cataract surgery.....)
    There were over 80 million reports of food poisoning last year...more involving fruits and vegetables than involving beef...


    Coming soon:

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  9. #28
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    well...

    [quote="Rogers"]
    Quote Originally Posted by FLK
    Quote Originally Posted by prsch132
    . That is people who might have not died otherwise if they stepped into the hospital. .
    yes, let's all avoid hospitals completely and watch the death rates ! quote]

    I would have to look for the studies, but I believe there has been 3 times doctors have gone on strike (once I think was in Orange County) and the death rate went down all 3 times
    .garbage research. flawed data, flawed conclusion.
    If this was evidence based, then third party payors would stop all reimbursement and close hospitals in a SAFETY MEASURE
    Doctors would be banned.
    taking care of a trauma patient would become illegal.
    doing a c-section would be assault
    doing a breast biopsy or god forbid removing a tumor, well this is an unnecessary risk that I certainly would not authorize



    how about some more anecdotal garbage research : I played Russian Roulette last week and put 5 bullets in the cylinder. I didn't blow my brains out, and my sore ankle felt better > I conclude that Russian Roulette is a safe AND effective treatment for a sore ankle

    I am not a diabetic, but I am taking insulin. my ND says that he can give me an all natural islet cell supporter, and that I should stop my insulin.
    Guess what, I no longer get hypoglycemic.

    I went to my ND and complained of unintentional weight loss, and new onset constipation . He prescribed this really cool minced thyroid extract, and "vital force magnets" and guess what, I'm going to die in 6 months of colon cancer !

    WHEEEE this is fun making rediculous statements !

  10. #29
    teratos's Avatar
    teratos is offline Jedi Moderator 658 points
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    well...

    I know I said I ws going to stay out of it, but you guys are getting too silly

    Quote Originally Posted by Rogers
    I would have to look for the studies, but I believe there has been 3 times doctors have gone on strike (once I think was in Orange County) and the death rate went down all 3 times
    You need to review articles a bit more critically. Think of confounds. If the doctors in Orange county went on strike, where would the sick people go?? They would leave Orange county for medical care. So...what happened to the death rates in surrounding counties?

    People who are in the hospital these days are very, very, sick. If you are only very sick, you get sent home. It is amazing that the death rate is as low as it is.

    For the comment on docs going right to glitizones for diabetes:

    Oh, BTW, if you read the ACP guidelines on diabetes treatment, lifestyle modifications are first line treatment for diabetes. That is a diabetic within a given HbA1C range. If you have a pt with an A1C of 16%, then a little excercise won't cut it. Most people won't exercise anyway.
    What do you know about glitizones?? Did you know they often promote weight loss?? Did you know they have a favorable effect on triglycerides?? Did you know it is theorized that they PROMOTE beta-cell regrowth and prevent beta-cell apoptosis, thereby prolonging the period of time before people need insulin??
    What about ACE inhibitors in diet controlled diabetes?? Reduce the incidence of renal insufficiency, and in the case of Ramipril, prevent CAD (coronary aretery disease). Got a leaf for that? G
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  11. #30
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    teratos is offline Jedi Moderator 658 points
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    Wow

    Actually, i did a little reading on Naturopathy. They are referred to as "drugless doctors", and most seem to stay away from herbs and stuff. They believe in the bodies ability to heal itself. I do that, too. I am an antibiotic Nazi, and try to shy away from giving drugs when drugs aren't needed. Unfortunately, they still need to come out of the stone age. There are lots of drugs that can improve survival.

    As for a Naturopath making $1 million per year. I believe it, but that is really sad. If they work a 40 hour week, then they average $502/hr. wow. Talk about your wallet biopsy. G
    AUC Class of '99
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    DISCLAIMER: I have no financial stake in ValueMD, or any medical school.

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