| In the midst of an exploding national
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| | drugs in this country cost patients
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| healthcare crisis, there's much talk
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| | between thirty and fifty percent more
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| about slashing drug prices and cutting
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| | than in Europe is an issue warranting
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| health insurance company profits. While
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| | attention, the equally important fact
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| these are valid debates, many physicians
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| | that doctors' pay is also dramatically
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| are actually offering an equally
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| | inflating healthcare costs is rarely
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| controversial solution: cut their pay.
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| | discussed. American physicians make
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| Hearing a physician suggest a pay cut for
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| | between two and three times more than
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| him or herself is a bit like witnessing a
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| | their counterparts in other
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| politician opting out of a kickback.
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| | industrialized nations. The average
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| Sure, it happens but most of us will
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| | doctor here earns between $200,000 and
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| never see it, and tend to believe such a
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| | $300,00 a year. Primary care physicians
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| thing a dangling, idealistic myth too
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| | earn less -- usually between $125,000 and
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| elusive to pull down into reality. Many
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| | $200,000 annually -- and specialists earn
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| healthcare economists and physicians,
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| | more. Making $400,000 a year and above is
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| however, are suggesting just that. Dr.
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| | not unheard of for radiologists and other
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| Alan Garber, a practicing internist and
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| | doctors with additional years of
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| director of the Center For Health Policy
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| | training.
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| at Stanford University, thinks offering
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| | No one is debating the respect doctors
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| medical doctors a lower, fixed salary,
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| | should be given for their years of
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| accompanied by bonuses for healthy
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| | intensive education and, in most cases,
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| patients, may be a crucial step to
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| | enormous talent. Medical schools run
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| working out of the crisis.
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| | around $30,000 a year now, putting most
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| "The problem is the way (physicians) earn
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| | graduating medical students in
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| their money. They have to do stuff. They
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| | considerable debt. They should be
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| have to do procedures," said Dr. Peter
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| | compensated, and allowed to earn what is
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| Bach, pulmonary physician at Memorial
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| | necessary to lead comfortable lives and
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| Sloan-Kettering Cancer Center in New York
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| | clear their credit reports. But European
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| City and former senior advisor to
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| | doctors only earned $60,000 to $120,000 a
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| Medicare and Medicaid. In other words,
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| | year in 2002, according to a survey
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| doctors are paid by the procedure, not by
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| | sponsored by the British government.
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| whether the procedures go well, if their
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| | This, in turn, means much lower medical
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| patients actually need them, or if their
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| | costs are transferred to the public.
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| health improves.
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| | Europeans pay less, overall, for their
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| In contrast, doctors are not financially
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| | healthcare partly because they pay their
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| rewarded for routine exams or "cognitive
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| | doctors a comfortable, but far lower,
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| services," such as researching different
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| | salary. The discrepancy between nurses'
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| treatment options, or giving patients
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| | and doctors' pay, as well, is simply
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| advice on how to improve their health
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| | unacceptable to many when nurses often
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| without medical visits, tests, or
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| | work just as many hours, and provide just
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| prescription drugs. This, despite the
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| | as intensive -- albeit different -- care
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| fact that healthy eating, exercise, and
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| | as physicians.
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| the end of tobacco use would
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| | The idea of paying doctors a fixed
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| "significantly" cut cancer deaths,
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| | salary, possibly with bonuses for healthy
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| according to the American Cancer Society
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| | patients, is not without its problems,
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| -- up to 66%. Primary care physicians and
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| | however. Such a system may encourage
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| pediatricians provide more of this
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| | physicians to only see those patients
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| routine care and rarely perform
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| | they believe can be easily treated, for
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| complicated procedures, so, in general,
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| | example. It may also do the opposite of
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| they're paid a lot less.
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| | encouraging rigorous and thorough
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| The pay-by-procedure method, which offers
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| | testing, as doctors would theoretically
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| little financial incentive to enter
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| | be paid the same for twenty minutes of
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| family practices or pediatrics, is
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| | evaluation as for twenty hours.
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| fostering a shortage of qualified
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| | The additional pressure to meet the
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| physicians. Twenty percent of people in
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| | demanding needs of a growing population
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| the U.S. have "inadequate or no access to
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| | during a time when physicians are in
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| primary care physicians" because of this
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| | short supply may further increase this
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| shortage, according to reports released
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| | tendency. It's clear, however, that
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| in March. In 2004, 75% of counties in
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| | something has to be done. As usual, most
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| Texas lacked an adequate number of
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| | of the solutions will be hashed out in
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| primary care physicians to meet their
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| | Congress and through the media, but it's
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| needs. Twenty-four counties didn't have
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| | up to those of us actually receiving the
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| one at all. For cities like Dallas,
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| | care that may, or may not, save our lives
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| Houston, and Austin -- which handle an
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| | to push for those decisions.
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| almost unimaginable caseload and are
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| | Being aware of issues affecting the
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| already experiencing deficiencies in the
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| | accessibility and quality of healthcare
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| number of most types of healthcare
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| | is an important part of minding your
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| providers -- any further deficiencies
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| | health. How you take care of yourself
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| could cause serious problems.
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| | will certainly affect you as you age, and
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| And while the fact that prescription
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| | eventually your wallet, as well.
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