Friday, March 13, 2009

Blogger Don Surber asks, "Ok, what if doctors decide to go John Galt?" in a post today. He is referring to doctors in Britain who are being forced to cut their hours. This is not the same as "going Galt" where people do it purposely to reduce the tax burden, of course, but it should give us an example of what is to come should doctors and other professionals decide to "go Galt."

I have talked with people who say that some emergency room doctors are thinking of reducing their hours should taxes be raised and deductions reduced. One remarked, "Let some other sucker out there take over." I even heard one doctor looking forward to nationalized healthcare so he could work less. We should look to Britain to see how well a reduction of doctor's hours will go over for their health care system. Not well, I expect.

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35 Comments:

Blogger Alex said...

No doubt liberals would force doctors to work X number of hours "for the good of the society". Slavery is back baby!

2:37 PM, March 13, 2009  
Blogger Alex said...

BTW, slavery was the order of the day in the Soviet Union. Everyone had an assigned job and woe to you if you didn't show up.

2:38 PM, March 13, 2009  
Blogger steve said...

'reducing your tax burden' is "Going Galt" about as much as letting your schnauzer on your rowboat is "Going Noah". Have you read the book? Galt took drastic measures. He didn't shave a few office hours next month. Comparing that to Galt's actions is ridiculous.

I think you guys are defining success downward so you can declare victory without fundamentally changing much about your lives.

3:51 PM, March 13, 2009  
Blogger steve said...

Oh wait...I just realized that we've missed the Going Galt story for several years!!

Since you've all read the book, I'm sure you recall that Francisco plotted with Ragnar to sink his own ships in order to destroy his own company, D'Anconia Copper.

Don't you see? AIG...Bear Sterns...Citibank...Lehman Brothers...Chrysler...

They've been Going Galt for several years now and we were oblivious!

4:02 PM, March 13, 2009  
Blogger Major-General said...

Steve:

Chrysler was killed by the Germans, who used a strong dollar to shore up their balance sheets with Chrysler's record profits in the late 90's early 2000's

4:10 PM, March 13, 2009  
Blogger nathan said...

Hate to burst your romantic bubble but there will be many many doctors here and elsewhere who will love what theuy do and feel an obligation to continue to give help to those in need, even if--lord forbid--they p[ay the taxes that were in place before Bush reduced them.

Besides: fewer doctors, or doctors with fewer hours will create opening for more newly minted doctors...will create job market.

But tell us: will you go on record with your family as cutting back on all things to get under 250,000 per year income? Yes or No?

4:25 PM, March 13, 2009  
Blogger steve said...

Sure...Just like D'Anconia's ships were sunk by a Dane...

4:25 PM, March 13, 2009  
Blogger TMink said...

I work with doctors and my father was a doctor. The doctors I know are much more concerned about the so-called Freedom Of Choice Act that would require all hospitals and all hospital personnel to perform abortions at any time before "viability."

42 states have laws protecting physicians and other health care workers from violating their Hippocratic oath by being forced against their will to murder. All parental notification laws would be made null and void as well. No state law would be honored at all. Those would vanish and an iron clad "right" to abortion would be federalized.

Even my friends who are a Pediatrician and a Urologist are quite concerned as the handwriting on the wall is large and conspicuous. Our President has said that he would sign FOCA the day it hits his desk.

My father, who was an OB/GYN would have just quit rather than murder. Honestly, he would probably quit rather than have some bureaucrat dictate his practice in a lesser matter. That is one of the reasons I admire and respect him, he tried to live out his convictions.

Trey

4:56 PM, March 13, 2009  
Blogger orthodoc said...

Nathan, speaking as a physician, I gotta tell you...no one works for free. It's not only the physician - it's the nurses, the techs, the support staff. If the money's not coming in, no one will be in the office. My obligation, as you put it, does not extend to performing mandatory charity.
Sorry about that. Not clear why physicians would be immune to the idea of being rewarded for effort.

As for your comment "fewer doctors, or doctors with fewer hours will create opening for more newly minted doctors...will create job market" - you do understand what a physician's training involves, right? The four years of university (paid out of pocket), the four years of med school (paid out of pocket), the three to seven years of residency (now you get paid - about $40-50k/year)? You do understand that the number of residency positions is set by CMS? Just saying that we should have more "newly minted doctors" has all the force of a note passed in study hall. And even if the Big Owe decided today that what this country really needs is more doctors, not one will be in practice for at least eight years.

So, although you probably won't see physicians cutting back on all things to get under 250k, you will see a decided lack of interest in performing extra work that isn't rewarded. Whether that level is 250k, 350k, or (since these arbitrary numbers have a way of drifting down) 100k will be up to each individual. The result: you'll wait longer, get less attention, your paperwork and forms will be done late in the day or not at all, and so on.

5:28 PM, March 13, 2009  
Blogger Alex said...

orthodoc - the big O will decree "freshly minted" doctors within 18 months.

5:33 PM, March 13, 2009  
Blogger orthodoc said...

I bet they'll be "barefoot doctors"...

5:55 PM, March 13, 2009  
Blogger RR Ryan said...

I have no idea whether it's true in general(I suspect it isn't) but most of my parent's friends who were doctors came from rich families. When malpractice insurance hit 100k per year(in the '70's) a couple of them did actually retire. Policy matters; limiting hours or salaries would have the same effect now.

6:06 PM, March 13, 2009  
Blogger MarkyMark said...

Doc,

Here's what we CAN look forward to when we nationalize health care: ambulances WAITING IN LINE to discharge their passengers at the emergency room! That's no joke; in the UK, ambulances have to wait in line before they can pull up to the emergency room door...

MarkyMark

6:14 PM, March 13, 2009  
Blogger Alex said...

MarkyMark - stop it with the scare mongering about UK hospitals. We know you're lying. Unless you can show video proof of a 1000 times it happened!

6:17 PM, March 13, 2009  
Blogger steve said...

You guys are kooks. I'm going back to the moderate blogs. Have fun pretending to be John Galt while not actually doing anything of consequence.

6:31 PM, March 13, 2009  
Blogger Alex said...

steve - don't let the door hit your ass on the way out!

6:39 PM, March 13, 2009  
Blogger orthodoc said...

Here you go, Alex.

Council sorry for three-hour ambulance wait
news.scotsman.com/edinburgh/Council-sorry-for-threehour-ambulance.5028084.jp

The human cost of forcing ambulances to wait
http://www.guardian.co.uk/society/2008/feb/17/health.nhs

Woman's 42-minute ambulance wait rapped by Healthcare Commission
http://www.mirror.co.uk/news/top-stories/2008/08/21/woman-s-42-minute-ambulance-wait-rapped-by-healthcare-commission-115875-20705677/

Nurse died after two hour wait for ambulance
http://www.telegraph.co.uk/news/uknews/2596383/Nurse-died-after-two-hour-wait-for-ambulance.html

Four-hour wait for a lifesaving ambulance trip
http://www.dailymail.co.uk/health/article-1112207/Four-hour-wait-lifesaving-ambulance-trip.html

"There was massive variation across the country in the slowest response time for a category-A case. In the North West it was just 38 minutes, but in the East Midlands, the longest response took two hours and 34 minutes, and in Wales, three hours 47 minutes - the suspected poisoning case.

"Critics blamed the failures on Labour's strict four-hour maximum waiting time for hospital accident and emergency units.

"As this is only counted from when the patient steps through the casualty department doors, ambulances often queue outside hospitals, dropping off patients only when they are certain to be seen within the allotted time."

Admittedly, the waits are the result of the British government telling ERs that they have to get their patients out within 4 hours or else, but iif nothing else, this demonstrates pretty clearly that people respond to incentives, both positive and perverse.

Steve, if you can't understand that people change their behavior because of rewards or lack thereof, then go ahead and snicker. Have fun.

6:52 PM, March 13, 2009  
Blogger Alex said...

orthodoc - you will need 993 more examples to fill your 1000 quota before you can convince one liberal troll.

6:56 PM, March 13, 2009  
Blogger Pete said...


But tell us: will you go on record with your family as cutting back on all things to get under 250,000 per year income? Yes or No?


Already did. Sold my business last year which employed 9 full time people and 7 contract employees. I paid six figures in personal taxes this year - after my (legal) sheltering of funds, and will get a tax refund for 2009.

Of the sixteen people which worked there last spring, when I sold all, only five still have jobs.

I have mine, though, so I don't give a damn. I have what is called "Fuck you" money. I could retire if doing nothing wouldn't drive me barking mad, so I am doing a 9 - 5 job solely to keep busy. Own my home, and have things arranged so I really want for nothing.

You and your president have fun with your recession. Let me know how it works out. Like I said, I have mine, and ya'll can sod the fuck off.

7:23 PM, March 13, 2009  
Blogger Mary said...

Perhaps it's because I never use the ER, but honestly, my first thought in reading, "Let some other sucker out there take over." is that doctor should step aside immediately, regardless of his tax burden or not.

See: when you come to hate your job, and those feelings transfer into the care of your patients, it's time to have the courage to step aside.

I've remarked here before: plenty of unhappy professionals -- psychologists, doctors, attorneys -- were expressing unhappiness with their chosen professions well before the Obama budget was revealed.

Why not forget about a fictional book character, and if you hate your job (hence the "sucker" remark) and you obviously are no longer doing it out of love, pride in your work, or for the prime motivator of money... for everyone's sake, just retire early and figure out what it is you DO want to do.

Because the truth is, if you really feel that way and stay, it's you who is the "sucker" and I'd venture to guess that your patients are paying for you hatred of being there in that role.

"Mamas, don't let your babies grow up to be psychologists ... or ER doctors ... or corporate attorneys." Something about money not buying happiness, or something like that. (Remember: the world could always use a few good Zamboni drivers!! :-)

7:31 PM, March 13, 2009  
Blogger Mary said...

And amen to Trey on the importance of FOCA and the very little media coverage this issue is getting...

7:32 PM, March 13, 2009  
Blogger Pete said...

Mary the day you love your job enough to do it for free - better yet, at a net cost to you - you let us know. Then your comments will have some weight.

I'm just sick of working hard to support parasites. That is what sucks the joy out of it for me.

I cut back when I had my mortgages, I budgeted, didn't go in over my head, paid them on time and for what? To be taxed at unconscionable rates to pay the mortgages off for human debris who didn't bother to do any of that?

While I built my business I ate frugally, and what do I see? A bunch of ignorant white trash welfare queens with cartloads of junk and a pack of inbred ill-behavd children paying for it with a food card?

Fuck that. You libs work hard and support the human ticks you made with your own work. I'm done with it.

9:37 PM, March 13, 2009  
Blogger aspie6073 said...

Dr. Smith

How come you have not answered my questions? I can only think of these reasons.

1. I offended you somehow but alas I do not know how I offended you.

2. You're not able to answer my questions.

3. You're in the process of answering my questions.

The truth is modern society is too complex for me. It's too variable and there is no pattern to it.

Dr. Helen Smith, the violent kids say and I quote "there are too many damn rules."

I have my response to these kids. I say there are too few rules. I say there are not enough rules and the rules are vague and ambigious.

I have tried to go to my autism center here for help but I have yet to receive the paperwork. In fact, I was promised to be in a social group. They have yet to deliever on this promise.

Before any of you tell me to take responsiblity I will say I have already tried. Before you say, I am whining, then please help me out. Before you say, you're not entitled to anything I say you are all correct and I am not. I'm asking and begging society for help. I'm not demanding it. Dr Smith, if you, anyone else, or the rest of you cannot help me and others like me than that is fine. I will not harbor any ill will towards the majority of society.

On 3-28-2009, my parents, my fiance, my family will never see me again because I am withdrawing from society permenantly. I do not know how I will do this yet but I do have my options open. I do not want to be a burden on anyone and I am sorry if I was offensive to anyone in my entire life.

I will be back here 3-28-2009 and I will email you my math proof in which you can do x/0 where x <> 0. This means I can divide by 0.

I feel like I am about to approach a nervous breakdown and the more I approach it the only thing I can concentrate more on is numbers.

Everyday that I drive on the express I am compelled to add the numbers together on license plates, on exit signs and everywhere I see numbers. I keep wanting to determine if they are the even numbers that I can divide by 2 to get the odd numbers.

Maybe I will go to a monastery or a buddist temple. Who knows what I'll do but I got to get out of American society completely. It is mentally and emotionally killing me. Good bye until 3-28-2009.

Again, Dr. Smith I am sorry I offended you if I did.

10:37 PM, March 13, 2009  
Blogger Christopher said...

As mentioned in another post; just do it.

Go "John Galt" already, but don't half-step it either. Completely leave the country and build a utopia of the "type-A me-firsters".

Dr. Helen, I highly doubt you talked to a decently sized cross-section of the medical community. Most medical professionals don't do it for the money and the nominal increase in taxes wouldn't nearly take away from their desire to help the people who need it most.

11:41 PM, March 13, 2009  
Blogger Pete said...

Go "John Galt" already, but don't half-step it either. Completely leave the country and build a utopia of the "type-A me-firsters".

You leave if you don't like it.

Neither you, nor anyone else, nor this country as an entity is entitled to my productivity.

7:26 AM, March 14, 2009  
Blogger Bill said...

I talked to a record store owner the other day. He told me that he used to own two stores, open seven days a week, with four employees. He closed one store, let all four employees go, is now closed on Sunday, and reduced his hours to boot.

Result? Not much net drop in income, but a significant drop in his blood pressure.

I feel fairly certain that this fellow had never heard of John Galt. His employees were probably paid minimum wage, and I doubt if their being let go made the newspapers. But, I suspect this is just one of many, many smaller examples of people responding rationally to the the stresses (including financial stresses) of running a small business today.

You don't have to make a grand gesture to go John Galt.

The liberals just don't seem to understand, or want to understand, that people respond to incentives, both positive and negative.

10:10 AM, March 14, 2009  
Blogger TMink said...

"Mamas, don't let your babies grow up to be psychologists"

Ahhh, that is good! Thanks for the smile Mary! It made my day a little happier. I have to show my wife that one.

Trey

11:17 AM, March 14, 2009  
Blogger Oligonicella said...

Christopher --

"Most medical professionals don't do it for the money..."

That is profoundly naive.

Nominal is in the mind of the beholder. It's also a term used by the incrementalist to disguise the actual target amount.

11:35 AM, March 14, 2009  
Blogger FrederickJohnson said...

Christopher is damn right. Out here in Sparatanburg, SC where I live, most of today's doctors are not only the uber-rich ones but very arrogant and misleading. My wife came across a foreign doctor who wasn't so filthy rich a couple of years ago and after her treatment, she thanked her from the bottom of her heart and even told me that she reminds me of the good old doctors who used to be not so money-minded 20 years ago. I even found out that the only doctors pushing for the so-called "tort reform" are the rich weasels who had very bad records. The not-so rich doctors are always the ones under the knives of Big Insurance, Big Pharma, various trial lawyers, etc ... Taxes are just potatoes in pale comparison. Sure, I'd love some real tort reform on this issue and will even take single payer since it reinforces personal responsibility and cuts down on them frivolous lawsuits conservatives keep complaining about. Besides, most doctors I've come across have nowhere the luxury Dr Helen. Maybe it's high time we quit accepting sellout policies of privatization of everything and give quality care a real chance after 28 years.

1:58 PM, March 14, 2009  
Blogger Micha Elyi said...

Lemmee get what FrederickJohnson is claiming: Michelle Obama's whining about the burdens of her girls' private school tuition, and the payments on her cut-rate (thanks to her hubby's buddy Rezko) mansion on her six-figure income was ok by FJ, but if a doctor who does real work for a hospital decides the increased hassle of doing that work (thanks to Michelle's hubby) means its time to hang it all up, well then FJ goes into denial. Ha ha.

If FJ insists on a round of duelling anecdotes, well I've plenty of anecdotes from real doctors that they can satisfy their desire to do charity work by working for free -- in other countries where the patients are even more grateful.

1:01 AM, March 15, 2009  
Blogger cubanbob said...

Again the fools commenting here that doctors don't work for the money as if they themselves work for love and the fellowship of man.

Hate to bust your bubble but most doctors do work for the money, they have huge educational debts to pay off. a far shorter working life to pay it off (just think of how many years an orthopedic surgeon for example has reduced from his working years from the first day of undergraduate school until the last day of his board accredited training, 14 years?) and that is before he or she actually earns a significant income. That is probably another 3 to 5 years. 17 to 20 years before the big money earned by working killer days. Tell me again they do it only for the love.

Canada which is often touted as the example for the US, doctors routinely go 'Galt' every year. The government has in essence created one single HMO and that is the state. They set the fees and the maximum the doctors can earn so once they hit the pay cap, they go on vacation since they being greedy bastards do not want to work for free. Come to think of it, who is the greedy bastard, the clown who expects them to work for free so they don't have to pay or the person who refuses to be a slave to someone else by working for free?

And Micha Elyi is spot on when he said the doctors who are willing to work for free tend to do so other countries. There they really do treat for love for a few weeks a year truly impoverished and sick people who are truly grateful and not self entitled parasites who could earn more and pay their way in life if the would simply not make a wrong choice every time they have a choice and get rid of the attitude the world owes them a living.

2:00 AM, March 15, 2009  
Blogger Dave Cornutt said...

My dentist has already done this; two years ago, she cut back her hours, dropped a number of patients, and laid off two employees. She told me that she was working too hard for too little additional effect; it was effecting her health, and she wasn't enjoying it. It wasn't just taxes, but the cost and time of regulatory compliance; she said that too much of her work time was tied up in things other than actual dentistry. Now she works four days a week, only takes patients that interst her, and she has an office manager and one assistant. And she says that she has a lot more free time, and her bank account has sufferent not a whit.

12:08 PM, March 16, 2009  
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5:52 PM, March 17, 2009  
Blogger peter.w said...

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10:26 AM, May 01, 2009  
Blogger 9988 said...

smiling,face.Not,only,can,answer,good,intentions,by,form.Can,also,shorten,distance,between,human,relationses!Happiness-not-is-getting-much.And-is-accounting-less~wish-happy-delectation....

8:56 AM, May 05, 2009  

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