what I do for thirty seven dollars and five cents

The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, recent cholesterol levels, fasting glucose and urine protein. We discussed screening for bowel cancer with “the poo test” versus colonoscopy, with reference to his family history. We talked in detail about prostate cancer testing and I offered to provide written information as we were out of time. As I signed his script for the blood pressure medication he winked at me.

“That was easy money for you, wasn’t it?” he said as he walked out.

Thirty-seven dollars and five cents is the value this government places on up to twenty minutes of my time. This figure, the amount a practice receives from Medicare for a standard consultation, has not changed in four years, and under the current arrangement, will not change for another three. I myself receive sixty five percent of that. But are the pennies well spent? Let’s see.

Tuesday.

0830
Nineteen year old homeless girl slouches angrily in chair while I explain why she needs the daily medication that keeps her alive and out of hospital. After about nine minutes her body language changes.
“Oh,” she says, “If someone had just told me that I would’ve taken it. Can I get a chlamydia check while I’m here?”
0846
Eleven minutes assessing a toddler with fever. Are you dying of meningococcal septicaemia, or do you have a cold? Repeat this consultation six times today.
0901
Stoic man, whose wife of forty years is in hospital again, vaguely says he wants a “check up.” That’s not like him.  After ten minutes of probing chat, he mumbles something about a funny feeling in his shoulder, but it’s probably nothing. Ask the nurse to do an ECG. Thank God the nurse is here today.
0914
Talk for fifteen minutes to a young man who just lost his leg. Together make a list of the things he will think about when he can’t take his mind off the gun in his uncle’s garage.
(0932. Check Stoic Man’s ECG and send him in an ambulance to base hospital. Three hours later he is flying to Sydney for heart surgery. Lives to fight many more days and continues to care for his wife at home.)
0940
Spend three minutes in silence with a woman with finger marks on her neck to see if today is the day she wants to talk. Nope. Talk about her migraine management plan instead. Maybe next week.
0953
Insert contraceptive implant into giggling, chaotic eighteen year-old, saving everyone three years worth of unplanned pregnancies.
1004
Attend to eighteen year old who has now fainted. Answer phone call from nursing home – three new urinary tract infections, someone is delirious and Bert’s family are here from Perth and would like to talk to me about that magnesium. Can I come by at lunch?
1010
Determine whether eighty nine year old is fit to drive, waving the lives of the public around in my hand.
1027
Explain to young man that, contrary to what Dad tells him, men as well as women can carry sexually transmitted infections, and that discharge should be tested and treated. Screen him for depression. He’s not depressed, yet, but he is injecting testosterone into his butt and has a secret abscess he’ll let me see.
1045
Explain to woman with nine years of abdominal pain unresponsive to dry needling, pyrrole supplementation, crystal healing and zinc replacement that her basic bloods show she probably has coeliac disease.
1056
Reassure first-time mum with post-natal depression that she is not evil. Organise support.
1115
Shout at ninety two year old that she has gained four kilograms of fluid, and her medications need jiggling or she will end up in hospital again. Receive beatific smile and cheek pat in return. Jiggle medications. Stop the four least useful of her fifteen medications. Arrange to review tomorrow for more jiggling.
1132
Repeat child with fever consultation.
1148
Repeat child with fever consultation. Notice child has stopped growing. Rebook to investigate.
1203
Advise local butcher that she should invest in Hepatitis A vaccine prior to Thailand trip, for all our sakes.
1212
Take phone call from lab – this blood count from yesterday’s man with the night sweats looks weird. It looks like cancer. Call haematologist. He’s busy.
1218
Repeat child with fever consultation.
1230
Notice suspicious looking lesion on bricklayer’s forearm while taking blood pressure. A notorious no show, I probably won’t see him for six months. Biopsy today.
1254
Lunch! Call the haematologist again. Call the patient with the weird blood to request he come in this afternoon. Do some quick reading to brush up on weird blood. Paperwork. Go to the nursing home.

General practice costs 7% of Medicare’s budget (1). Seven percent. The frontline of medical care, the majority of doctors and the whipping boy for most governments, is consistently under attack, and the latest genius conclusion, that we can build a tower to Mars with the money we will save by starving the frontline further, is madness. Keep two patients per week out of intensive care, ten patients per week out of hospital, rather than skimming the top off the rebates so that GPs see eight patients per hour to make their practices viable, rather than five. But don’t tell me that general practice is not worth investment. Of course, in addition to the big stuff, I see my share of coughs, colds and medical certificates demanded by, ironically, mostly government employers. But I also start a dialogue, about malaria prevention on the trip to Africa, about those amphetamines, that sedentary job, this obesity.  These are the things making a lot of us unwell, not a shortage of three-hundred-dollars-a-bottle lolly water from the natural therapist with the most Swedish furnishings in their Surry Hills space. We talk about the free stuff, the bang for your buck stuff that changes lives and saves money – fibre, exercise, alcohol reduction, community involvement instead of long work hours.
I invest time in saving Medicare money. I do this by listening to the actual problem, examining the patient and explaining why most often a blood test or CT scan isn’t going to change what we know or what we do. The more I get squeezed, the less time I will spend. A study in 2014 showed that doctors are more likely to prescribe antibiotics at the end of the day(2). Obviously. It’s much more draining to examine the patient, explain a viral versus bacterial infection and reassure the sullen face of the millennial accustomed to instant gratification that antibiotics are not the right treatment, than it is to just print a quick script for Amoxyl and get them out the door. It saves me money, time and energy to just shut up and order the test or prescribe the drug. That way Medicare or the Pharmaceutical Benefits Scheme (i.e. the taxpayer) pays, not me. But I spend the time because I believe 1) in universal health care remaining sustainable and 2) that I’ve invested eleven years and over a hundred thousand dollars in my own eyes and ears and mind, and utilising these tools before a multinational pharmaceutical and/or pathology company seems both wise and cost-effective. Also, I would like antibiotics to still work when my children have children, and my colleagues in Infectious Diseases tell me that at this rate, they won’t.

One of the most important ways that GPs save Medicare money is by keeping people out of that economic sinkhole, The Hospital. I spend eleven minutes each assessing at least three to four infants per day who don’t need a bed in the emergency department, and I send the quietly declining asthmatic that does. I jiggle cardiac medications to take the load off failing hearts. Last month I saw a socially isolated man who had decided to quit the cannabis that was destroying his life. I saw him every second day for a fortnight for four to seventeen minutes, encouraging him through withdrawal, using medication judiciously and making plans for how and why to stay off it. I can only imagine what an admission to the local Mental Health Unit for a drug induced psychosis costs, but it’s probably more than $185.25.

Here’s thirty seven dollars and five cents well spent – talking to people about end of life care. Then if the last illness comes on in a nursing home we know what the person’s wishes are – far and away most commonly to stay in the nursing home. That $37.05 will save Medicare $500 on an ambulance, a six hour spell on an emergency bed involving probably four nurses, two to three doctors, a cleaner, wards-person, clerk, three or four lab technicians, one radiographer to take an x-ray, a radiologist to interpret it, a kitchen hand to bring a tray of food which will be thrown out, and buckets of equipment for drips, antibiotics, catheters, oxygen tubing, sheets (let’s not even get started on the environmental impact). If they make it out of emergency to the ward while the hospital tries to contact their interstate children, the price tag will skyrocket. With any luck you’ll snag an ICU stay at $1500 per day, before everyone agrees that this eighty nine year old woman with advanced dementia has been trying to die for months. If we’d talked about it, it would have cost a GP visit to the nursing home, a couple of vials of morphine, a subcutaneous needle, and the comforting presence of a familiar carer. Rather than strangling the greedy GPs further, how about a campaign encouraging people to sit down with their GP and talk about what they want as their health begins to decline? If they want to be actively treated in hospital, let’s do it, no worries. But if they don’t (as the vast majority of ninety year olds don’t), let’s not send them kicking and screaming and then sedated, in a freezing ambulance, because no one knows their wishes or is confident enough in the inexorability of death to let it happen. That could save some money.

1430 Repeat child with fever consultation. Notice he is quiet, not the good quiet. Something’s not right. Send this one to hospital.

My paediatric friends tell me there’s pretty much nothing more depressing than seeing parents rocking up to emergency departments with kids with snotty noses or an eighteen month history of picky eating. This stuff just doesn’t need to be jamming up emergency, consuming huge amounts of resources, slowing down the care of the truly unwell. Lowly GP though I am, I can recognise a dangerously sick kid. Not the good quiet. Send them to the GPs and we will part them like wheat from chaff, at a fraction of the cost. It’s also a good way to keep the snotty kids away from the immunosuppressed kids with cancer.

The consumer has one of the most important roles in valuing and preserving Medicare. The other day someone asked me to order an x-ray for a sore foot. It would have taken me a minute to order it, but I took seven minutes to examine her, explain why it wouldn’t be helpful, describe the problem and explain that she needed supportive footwear.

“The x-ray’s free isn’t it?” she asked.
“Well, Medicare pays.”
“I may as well get it then, if I don’t have to pay.”
“Face-palm.”

It never ceases to amaze me what people will not pay for. A woman recently asked me about the cervical cancer vaccine for her teenaged daughter. I explained the benefits and cost, and she looked at me in dismay when I explained that it would not be provided under Medicare. Despite having a family history of cervical cancer, seeing a close family member die of the disease, and having the opportunity to drastically reduce her daughter’s risk, the woman was visibly offended at the prospect of paying and told me she’d think about it when they returned from their trip to Europe.

In the end, the government doesn’t want to pay me and neither do the people. The government froze indexation on Medicare rebates three years ago (though they do kindly continue to index my HECS-HELP debt each year). So while rent, fees, insurance and the cost of living goes up, my income doesn’t. I also receive no superannuation, maternity, holiday or sick leave. Can we all stop looking surprised when we have to pay to see a GP? Each fortnight I look at my bank account and decide to start doing Botox injections so I can get a car made after 1995. Last week I told a chiropractor what I get paid and she gasped and laughed.

1410    Have a very unpleasant conversation with a man about weird blood.

So why do I bulk bill? Because I believe people should be able to see a doctor, regardless of income, and we are all better off if this is the case. I do it because I want to help catch the people wandering near the cracks, like the chaotic teenager and the octogenarian with seven chronic diseases. However, a purely bulk billing practice will inevitably also attract people who can pay, but don’t want to – those who will spend money on cigarettes, eyebrow waxes, alcohol, smashed avo, private school fees or gentrified suburban rent, but not on healthcare. When someone in a Saba jacket complains to me that “the last crap doctor” didn’t explain anything, I inwardly reflect that it’s like whinging that eating McDonald’s gave you reflux. It’s one or the other – a gap payment, or eight patients an hour. I give good care, but I haven’t burnt out yet. Soon I’ll have to start either charging a gap, doing that Botox of an evening or, more likely, becoming a “crap doctor.” If you want better care, either pay a gap, or write a letter to your member of parliament. Preferably both. You get what you pay for, because your government won’t.

1740 Prescribe some antibiotics for a viral infection.

If I had billed the building contractor the private fee of $70.00, $37.05 would be refunded directly into his bank account by Medicare. Of that $70.00, thirty-five per cent goes to the practice for rent, insurance, the receptionist and nurse, software, electricity and equipment. Of my $45.50 I would pay around 37% tax plus the Medicare levy (total $17.75), and 7% for my HECS-HELP debt ($3.19). So for eighteen minutes of my time I would take home $24.56.
I bulk billed him, and therefore made $13.01 after tax. That dizzying sum has to cover sick leave, holiday and maternity leave, superannuation, and around $8,000 per year in registration fees, indemnity insurance and continuing professional development.

So no, it wasn’t easy money.

  1. Health Expenditure Australia 2013-14: analysis by sector. AIHW. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129553773
  2. Linder JA, Doctor JN, Friedberg MW, et al., Time of day and the decision to prescribe antibiotics. JAMA Internal Medicine. Published online 6 October 2014. doi:10.1001/jamainternmed.2014.5225

110 comments

  1. Most of our patients value our service to them but we are the political football and being referred to as “greedy GPs” creates the desired community attitudes. Value ourselves and be respected. Bulk bill those in need and charge privately to those who can afford to pay and you will practice quality medicine. GPs should not be the poor stressed relatives of the medical profession.

    Liked by 2 people

  2. Well written. A copy in every doctors waiting room `might` help change attitudes. Attitudes change governments or at least help change government decisions.

    Liked by 1 person

  3. I have some sympathy for GPs given the rebate freeze must make business planning hard and make you feel under attack. Sadly GPs seem to also have a blind spot to where their annul income sits in relation to our overall society. You are sitting pretty compared to most people working In health; including all those nurses, admin, social workers, AOD workers, Dietitians etc.
    It’s against your old friends from medical school; the plainyl greedy neurosurgeons, cardiologists etc all sitting in the top ten wage earners in Australia. It’s a relative confirmation biase problem, worsened by so many doctors living in the expensive postcodes.

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    1. Yes, medical professionals make a good living. Never mind that:
      – They spend up to eight years at uni.
      – Most people who get into medicine could have chosen far more lucrative paths.
      – The top-ten wage earners didn’t include executives who get bonuses, salespeople who get commission etc. I know a bunch of tradies and car salespeople who make much more than I do (as a doctor in training).
      – The social cost of years of 60-hour weeks is significant. During training (between five and twelve years) we spend approx 3-6 months of the year at hospitals away from home with no additional financial reward (sorry, ‘free’ accommodation if you’re still paying rent at home and one return flight home per three months).
      – We study between 10-30 additional unpaid hours per week to achieve training goals.
      – The ‘greedy’ neurosurgeon spent at least ten years being one-in-three on-call while earning registrar wages, moving city/state every year or two, has most likely had a divorce/relationship breakdown and may have missed out on having a family at all. They make a lot of money (if they get to the end) but it’s hard to imagine a tougher job or a more gruelling training period.
      – The responsibility, training time and cost and level of expected knowledge of doctors is in a completely different ballgame to that of our excellent nursing and allied health colleagues. We are team comprised of many adjacent smaller and discrete teams. It’s not a hierarchy and the pay discrepancies reflect that.
      – The cost of ongoing training is huge – between further study, mandatory courses, college fees, exams, insurance – I’ve spent at least $40,000 so far on making myself better equipped to work in the public system. In the next five years I expect that figure to triple. I’m entering a specialty that is almost entirely the domain of the public hospital system, so while my $250,000 a year (before tax) peak earnings (if there are any jobs around in another five years) sounds fabulous to the uneducated, it’s pretty hard-won.

      Liked by 3 people

    2. You’re right Alex, medical Doctors study hard and long, and I think I over cooked the egg this morning posting my comments. I should not have called anyone greedy, apologies to neurosurgeons.
      I still contend that most Doctors, GPs included, have a clouded understanding of where they sit income wise. It reminds me of my mtb riding friend who is an Exec at a telco, as is his wife, but he couldn’t believe they would reach the top 20% of household income. Of course they actually sit well above that.
      The main point is really that the well off socialise with other well off people, and end up with a completely distorted view of the world.

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    3. Your point that doctors are well off compared to the rest of society is not a valid point or argument.

      Yes, doctors are still paid more than most of society. However, that isnt an apples to apples comparison. How is it fair to compare a full time medical practitioners wage to that of a part time worker in another industry, or even another health provider such as a nurse/physio? They perform different jobs so of course they should be paid differently. The real question is are GPs being paid the amount proportionate to their job and the benefit they bring to society. Clearly a lot of(read, almost all) GPs feel that they arent.

      Secondly, your point that GPs have a distorted view of the world is egregious and pretty insulting – and is based more on idle opinion than any fact, statistics or logic.

      Thank you for your incredible insight into the GPs mind, clearly theyre all just suffering from relative confirmation bias, maybe we should change the laws so GPs get paid the same as the rest of society, that’ll teach them.

      Like

  4. Mostly really good stuff but I stopped when you had a go at millenials which followed a go at government workers – other than the fact they’re both stereotypes and not based on fact (ie govt workers don’t take more sick days than others and no way in hell are millenials responsible for the misconceptions about anti-biotics) – don’t sh!t on others to make your point.

    Liked by 1 person

    1. Hi Yasmin – The comment about government workers was saying that the government organisations (employers) require certificates to be given – not that government workers take more sick leave.

      Liked by 1 person

  5. You still get more for a consult that a foster parent will get for 24 hours caring for a traumatised child. Not taking away from the fabulous work you do, but hopefully helpful for some comparison to other important and difficult jobs that are underpaid…

    Liked by 1 person

  6. Great read, however the doctor in that story makes 65% of that amount personally.

    In reality, the ATO says that General Practice (on average) costs 40% to run, 45% to run in a rural area. And even this is based on numbers from 10 years ago.

    Wages have increased, rent, phone, cost of supplies has increased. In many areas the cost electricity has doubled in price in that same ten years.

    In real terms today’s practices are required to do more, accreditation is more complex, technology leaps and bounds ahead, the government wastes more money on programs that don’t / can’t work in current form like eHealth records, that practices have to be able to comply with to get any money…

    I’d guess that the cost of running a rural GP practice is significantly more than half of the earnings of the practice, particularly for a solo GP. In truth the Rural GP earns way less than the 65% reported in that article.

    What does the ‘building contractor’ charge for a call-out on Saturday morning?

    Liked by 2 people

    1. And many doctors make less – I turned down a practice offering me 45%, I currently work for 55% with no holiday or sick pay. The last few years, college, training, insurance etc have topped $8000 annually.

      I qualified as a GP in the UK in 2001. In August I will return to a full time hospital job because I simply do not want to make the financial sacrifice of being in GP. There’s about $1000/week difference between the two jobs – and I am not a hospital consultant and I do no private work. I also work in the state with the lowest pay for hospital doctors.

      But that $1000 is the money that pays my mortgage. It enables me to make charitable donations. It means I do not have to stress over unexpected bills. It frees me to focus on doing a good job. And so I have decided that GP is not for me.

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  7. Don’t bulk bill people who should pay. People do not appreciate what they perceive to be free. Medicare freeze has at least given you a push to consider that the socialist utopia of universal health care is an unsustainable myth.

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    1. Exactly wrong. Maybe in Norway where they have a small, compact population & massive sovereign assets due to oil reserves. In Australia, which used to be one of the most efficient heath systems in the world, the cost of health care far exceeds the ability to pay for the level of care we demand. The medicare levy is totally inadequate in covering the nation’s health bill – the money has to come from somewhere. Maybe from the rich dickheads who pay 48c in the dollar tax!

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  8. Oh Yasmin have a whinge. I’m a millennial and she didn’t “have a go” at us, she said we’re accustomed to instant gratification – which the majority of us are, and it’s incredibly annoying.

    She also didn’t “have a go” at government workers – having her salary paid by the government via Medicare, she IS a government worker herself.

    More annoying than the entitlement/instant gratification of millennials, is the speed at which some of our generation race to be offended by something, usually (as beautifully demonstrated by yourself) without having read/listened properly to the thing they’re outraged about.

    Liked by 1 person

  9. Informative on an issue I knew practically nothing about. Am now reading other articles and information pieces, and letting people know. Thanks for raising the awareness.

    Liked by 1 person

  10. Yasmin, I think rather than trying to ‘sh!t’ on other people, the author was pointing to the irony of government workers nearly always being required to provide a sick certificate for days off sick, however as should be common sense sick people (for example with colds or gastro or other short self-limiting diseases) would be better off staying at home and away from the general public (not in the doctors waiting room) for a piece of paper. And the government not valuing the other work that GPS do, but also insisting that their employees visit one for something like a sick certificate!

    Liked by 1 person

  11. Awesome article! Doctors deserve every cent they earn, especially after the years of study (that is lifelong) and the many sacrifices they would have made along the way and continue to make in order to maintain knowledge & be there for their patients after hours.
    Medicare rebates should be increased, but I do feel patients (if they are able) should be prepared to pay for the expert opinion and time of a qualified professional, just like any other (accountant, lawyer, tradesperson etc). That $37 gap is less than a nice dinner out or a weekend away, and certainly much less than seeing a tradesperson, for example.
    Let’s not forget the time GPs also spend following up our results, doing admin, reading hospital discharge summaries for their patients & making phone calls- all done in time that they do not get paid for!
    I am always happy to pay to see my GP, as I value my health- something I see as my responsibility, not theirs. Let’s not forget that blood tests, Pap smears, X-rays/scans, and medications are either fully or at least partially covered by Medicare.
    Definitely not easy money for GPs! I think most people are appreciative, but nonetheless, I want to say thank you for serving the community!

    Liked by 1 person

  12. Greetings from across the Pacific! Your essay definitely resonated with me. As a family doctor in Canada, I started out reading and wondering where you were getting paid $37 for each consultation (and hoping it wasn’t too far away)! Where I practice, consultation fees are almost 20% lower than your $37 and the government has forbidden us from balance billing patients.

    I have now all but stopped my clinical practice and will be moving to another country that actually values (relatively speaking) those in primary care who practice good medicine. It was either that, try to retrain in another specialty (nearly impossible in this part of the world), or leave medical practice altogether. I love the work we do, but given our stagnant pay schedules, growing expectations, and repeated blatant disrespect/animosity doles out by the government and their appointed administrators, I was in the early stages of burnout. The scary part is that I have only been in practice for a couple years. I see my colleagues here migrating towards low acuity walk-in clinics without any continuity of care because you can earn more in fewer hours than you would practicing “real” medicine. If this keeps up, there soon won’t be any true “family doctors” left.

    Liked by 1 person

  13. I feel exhausted just reading about your day. I will never complain about paying the gap again! I just wish that the government would increase the medicare rebate to doctors while increasing the medicare levy paid by all Australians. It is shameful that it hasn’t happened already.

    Like

  14. GPs have a rewarding career and are able to make a comfortable income. However, within the GP population there is a wide variation in income. The ‘six minute medicine’ doctor may make very good money seeing the ‘easy’ patients. However, those of us who want to practice the sort of medicine that we were trained for are in quite a different position. When I go to work, the longer I spend with a patient, assessing them properly and doing my best to ensure that they feel they are being listened to, the less money I make (especially when working with disadvantaged patients). It’s just about a straight line graph…so that’s why those of us who are trying to do the right thing feel a bit sensitive about this. If you factor in hours worked, as well as recreation leave, super, and all the other things I have to self-fund, my income is about the same as a senior registered nurse. So while I am not complaining about life, I would like to point out that there is a diminishing group of GPs willing to practice this way. If the system isn’t changed to reward good practice, the next generation will be less inclined to be community minded and health care as a whole will suffer.

    Liked by 2 people

  15. Lol at Greetings and the Original Posting doctor. So 37.50 per 10 min increments is not enough? That’s $1,800.00 per day or $9,000.00 per week. Greedy Much? Sometimes you save lives, I’ll give you that, other times it takes you 2 minutes to write a repeat script. You still have it better than most Australians, probably the reason most doctors drive BMW’s or other expensive European cars. There are people out there who have studied harder and longer than you have who’s daily jobs might not entail serving individuals but serving an entire nation who don’t earn as much as you do. I’m not complaining, I earn a ridiculous amount of money. Not as much as you and your poor doctor friends but enough to know when it’s not appropriate to complain. Maybe you could write yourself a prescription for Valium or something to calm yourself down. At the end of the day your not that important.

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  16. Thank you for this honest & insightful post. I have a GP like you & I am so fortunate. My eyes are opened into the reality of medical practice told as is. Of course there are others where it is not as you describe & not a great deal of interest is taken in the patient other than “time in & out” & chat or quick exam. You are to be commended for your work & I hope more appreciate what you & others like my GP contribute.

    Like

  17. @ abramelin you are obviously not paid a ridiculous amount of money for reading (37$ for 20 not 10 minutes), maths (*.65*24 = $570 per day not $1800) or grammar (it’s you’re not your.) Aside from getting everything wrong it’s possible you might have made some good points. Maybe stick to the area you are paid ridiculously well in. Presumably you know something about that. The Medicare freeze is pretty rough. What business wouldn’t struggle with frozen revenue and rising costs? It was misleading of the government to say it’s a 50 c cut. That might be true for one year but compounding over 7 years it’s a big deal. The rebate freeze doesn’t equate to frozen income- that dives if your expenses rise for 7 years due to inflation whilst business turnover stays the same. Doctors will have to charge the public more- they are forced to.

    Liked by 1 person

  18. @Abramelin your assumption is unfortunately one shared by many people. However, it is incorrect because it is based on incomplete and misleading information. One result of this is that there are proportionately fewer “real” family doctors than there used to be.

    The notion that consistently limiting visits to 10 minutes and seeing six people per hour (excluding documentation) is absurd. I don’t know the basis of your assumption that we take home $1800/day, but I assure you that it is not accurate. It looks like you are using the Australian payment of $37, somehow magically making that pay out every 10 minutes, and multiplying that by 49 visits/day. Aside from being a generally ridiculous assumption on its own, these dollar figures are NOT take-home physician pay. These are gross income figures for the practice. That means that from that money, all overhead expenses have to be paid: rent, utilities, equipment, everyone else’s salaries, and so on. Even granting your above inaccurate assumption, after overhead, you would be looking at *perhaps* $1080/day for seeing a ridiculous number of patients that physicians like the author and the others who have posted here would never be able to see…exactly because it takes time to provide proper care to people. That also assumes that insurance pays the consultation fee; I don’t know how it is in Australia, but having worked in multiple developed Western countries, I have discovered that getting paid for work you have done is not a guaranteed thing. Again, that’s assuming getting paid at a rate roughly double what insurance actually pays.

    Your use of an example of a 2-minute prescription refill also suggests that you did not read the article; that’s exactly the kind of medicine the author and many of us do NOT practice because we don’t consider that to be practicing medicine. Even in such a situation that you think would be a quick prescription are a lot of decisions and factors being processed in the background. These things depend on your individual personal and family history, current status, symptoms, physical (and sometimes psychiatric) exam, vital signs, other medications, and recent changes. If your doctor makes that look easy, I’m happy for you. If your doctor isn’t gathering pertinent information, then you’re seeing a symptom of the underlying problem – that is, the theme of the article. At the end of the day, regardless who you are or what you do, no one likes to be told that they and the work they do are not valued.

    I drive a European car, yes. However, there is a 90% chance that you, like most of my patients, drive a care that is much more expensive and newer than I (unless yours is also > 10 years old and would sell for less than $5k). From your humblebrag about earning a “ridiculous amount of money,” it’s almost certain that you do. So, rejoice in knowing that yours is bigger than mine, though I’m not sure what kind of alternate fact you would present to make it serve your point.

    Most of us don’t go into this for prestige or importance or to make a “ridiculous amount of money” and with all the garbage being spewed about and changes in the air, young people would be daft to do it for the money. If you want to take care of people that are sick and try to keep them healthy and at home with their families, good luck telling them that “sorry, your 10 minutes is up. Bye!” The best advice I can give you is: waterproof your shoes ASAP, wash your hands often, and burn your clothes frequently. Oh, and ignore holier than thou armchair quarterback internet trolls. The last tip is particularly important, though it’s a work in progress for me.

    Liked by 1 person

  19. @Perkins Sadly, those comments are testament to how good of a job government and insurance PR teams have done in spreading the “by default, doctors are greedy and overpaid.” Comparing my own income to many truck drivers, for example, I would be better off financially driving a truck than practicing medicine – that’s not even considering that I would also get benefits and more time off as a truck driver!

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  20. As a former blogger myself, let me congratulate you for a very well-written and to-the-point account of an Australian GP’s day and some of the tribulations that go along with it.

    As someone who does General Practice himself, I share most, if not all, of your sentiments. A great portion of the public and the government have no idea how hard it is to do a (good) GP’s work each and every day. As doctors, there are a lot of other jobs or positions we can do that are much better-earning than doing GP work, but the (good) GP does it because he/she really cares. Unfortunately this is not realized at all by most, not even by our own colleagues, and sometimes your reward would be an insensitive comment similar to that provided by your building contractor.

    Hopefully this blog reaches further into the public eye and opens the eyes of eveyone. Please allow me to share it to my corner of cyberspace.

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  21. Hold on a second, you make 65% of $37.05 and see on average 4 patients per hour.

    That’s $722 per day or $158k p.a. (and yes I have subtracted 4 weeks annual leave and 9.5% super).

    If you think $158k p.a. isn’t enough for a GP (DOUBLE the average wage), you are kidding yourself. If you wanted to be rich you should have gone into private enterprise. As a doctor, you receive immense respect in the community and get to help people all day every day.

    (Also note after tax figures are misleading – everyone pays HECS and tax).

    From the figures you’ve provided, you’ve proven that we have the balance right.

    Liked by 1 person

    1. The respect we receive nowadays are little and far between. $158k is nothing compared to my finance friends. Why are you comparing a trained professional who spent years, hours and ten’s of thousands of dollars of training to a waiter? How much is your HECs? Mine is $60k for 7 years of uni. Please shoosh when you know nothing. I am already put off from doctoring and will be looking at other ventures.

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    2. I didn’t say anything about waiters, why would I? They’re lucky to be on $50k – nowhere near the average. And $60k is nothing out of the ordinary for HECS, after all Commerce (2nd most popular degree after arts) is in the same contribution band as medicine.

      So I stand by my point, to be on double the average wage is not something to be claimed about – regardless of how hard you work.

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    3. Commerce is a 3 year degree mate. Same contribution bad but the years required is much lower. Which again showcases your ignorance.

      And my very average commerce friends make $120k+ a year with bonuses and other benefits which we do not have. And they don’t require study outside of work which we as doctors do not get paid for.

      Also why do you think many “smart” doctors do not pursue a career in general practice. The monetary incentive is to keep talent and if it isn’t there people will move into more lucrative fields. There may be many factors contributing to crap GPs but this may be one of them. I saw a patient who was seen by 3 experienced GPs who told the patient he had kidney problems his rash was obviously from scabies (I was only a 2nd yr doctor). Many practices are now corporate entities which force GPs to churn out patients otherwise they will be fired. This lack of time to able to properly assess the patient may also be contributing to the issue.

      Good luck on finding a good GP because chances are if you aren’t in the medical field you wont’ know whether your GP is good or bad.

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    4. They’re just GPs, not even real doctors. They are just a middleman in the system, whether it’s to get a script or to get a letter to see a real doctor.

      Like

    5. As a “real” doctor, I can tell you now that GPs are far more real than you realise. You’ve clearly missed the point of this whole article.

      Liked by 1 person

  22. The respect we receive nowadays are little and far between. $158k is nothing compared to my finance friends. Why are you comparing a trained professional who spent years, hours and ten’s of thousands of dollars of training to a waiter? How much is your HECs? Mine is $60k for 7 years of uni. Please shoosh when you know nothing. I am already put off from doctoring and will be looking at other ventures.

    Liked by 1 person

  23. Of course, if the fees are raised (but not Medicare), you’re probably still going to see the office worker with the cold who just needs a medical certificate. You probably won’t see the sore foot (they’ve gone into the local Emergency Department when it starts aching on a cold night, adding to the full waiting room). And you won’t see the mother with the child who is the wrong “quiet” because that extra $25 is the difference between her other child getting the new pair of school shoes they desperately need, or not. And Mother decides to give the young one another dose of child-paracetamol, then starts to panic later and again ends up in Emergency.

    *sigh*

    It’s not easy. And the Government won’t help, alas. Bother them. Hang in there.

    Although, might I suggest that there’s a new sort of drug on the market, that’s actually just paracetamol or ibuprofen in a fancy bottle, clearly marked as such but just different-looking from the normal stuff, that you can prescribe for patients that need fluids, the tablets and rest and NOT antibiotics? Just the different bottle would make them feel better, I’m sure.

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  24. I think there are two main points here:
    1. Our job is hard but mostly rewarding and mostly interesting
    2. The public perception is that we make a good wage. Our perception is that we are routinely and repeatedly undervalued by the government, by other health providers, and occasionally by our patients.

    I always think with regards to the freeze and the broken promise to index the rebates to inflation – what worker in Australia would put up with an effective pay cut every year for the last 20+ years? I feel the other newer item numbers must be why there hasn’t been widespread revolt amongst GPs but it could equally be the nature of the people usually drawn to being a GP. I couldn’t for the life of me (disclaimer: 20 minutes of googling) find any information on historical average pays for GPs – anyone know where to find this information?

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  25. Needs to be read by every pollie in the country! And our commnities who have the good fortune to be able to access a GP.

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  26. A very good article. GPs are frontline and extremely cost effective. I firmly believe in universal health but think it is being quietly eroded.
    Regarding Drs fees. It is the usual thing. Governments spending money at the wrong end. Ok to fund hospitals but not ok to spend money keeping people out of hospital by encouraging and funding GPs. To freeze Medicare rebates is extremely irresponsible. GPs necessarily need to increase fees so patients instead go to ED rather than pay the gap. Who wins here. Not the tax payer, not the patient and not the GP. When will governments look ahead and plan for long term solutions for health expenditure.
    Frontline services from GPs are a cost effective long term solution. They should and must be funded properly. A GP’s job is not an easy one. We should and must support them.

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  27. There is no doubt in my mind that you care for the patients that you treat and that you are providing value to the government and that you should be appropriately remunerated. I also believe that in the longer term,bulk billing will not be sustainable shown by the repeated freezing of rebates. With the government consistently cutting costs to the Healthcare, it is unlikely that the government will remove the freeze on Bulk billing

    At the end of the day any free to the consumer service is more likely to be over used. This concept is called the ”Zero price effect” . I personally believe that an extra nominal fee of a few dollars (2 or 3),capped at 5 visits per annum per family to be charged regardless of whether the patient is bulk billed or not (therefore the most a family will ever be charged is $10) . This will reduce the cases of non-essential visits to the doctor and instil some extra value to the service. Of course this proposal was rejected when Tony Abbot proposed it and it will unlikely be raised any time soon.

    I would also like to point out that worldwide, Australia is ranked 2nd in the highest paid countries to practice medicine: https://medicfootprints.org/10-highest-paid-countries-world-doctors/ . Therefore, to me it seems that the government has no incentives to raise Bulk Billing rates as Australia remains competitive on an international scale, despite the rate freezes

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    1. @bob – The article you linked to – in support of your comment that Australia is ranked the #2 place in the world to practice – says the average GP salary in Australia is $91,000. Apart from that, the difference in utilization between something “free” and something with even a small per-use charge differs greatly and that is a well established concept. As someone that works in another country where physicians are not allowed to charge patients for anything covered by insurance (almost every visit), I see this firsthand. Interestingly, for some, naturopaths and chiropractors are allowed to both bill insurance AND balance bill patients.

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  28. Some interesting comments and a great article bringing a perspective we don’t see on an issue that we don’t hear enough about. Firstly, I feel similar issues show up somewhere is most industries, although the specifics of this issue mean that you have better reason to be concerned.

    I was going to write something about how even though I too aspire to help people through working in my industry as a helicopter pilot (helicopter emergency medical service) and have spent well over $100k in training/education, I only get paid my industry award of 53k before tax (and I’m fortunate for that). However, I realise that as others have pointed out, we would be comparing apples and oranges. I would never devalue your job, as I wouldn’t be interested or able to do what you do. It sounds completely draining! But I’m sure that you’re wages allow you to live comfortably (as mine do) and I’m sure that your job is rewarding (as mine is), so just as a matter of perspective, maybe things aren’t so bad.

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  29. @ $37.05 for 20 minutes equates to $115.15 an hour x 8 hour day = $921.20 x 20 working days = $18424 per month x 12 months = $221088 per annum at a very conservative and simple calculation. How many people ever earn that “small” pay even in this present day? Please stop the whinging !!!!!! Look around your neighbourhood and count how many people are earning this amount !!!

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    1. Um… read again. The GP in this article only receives a percentage of that amount, so your maths is very wrong. She also doesn’t have sick leave, super (though how that’s legal, I have no idea since you are supposed to be getting super if you earn over $400 a month) and no annual leave.

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  30. You gotta remember, you guys are just GPs, not some highly talented specialists who perform life changing surgeries or save lives from serious diseases like cancers and heart problems.
    You’re just middlemen who we need for scripts (between us and pharmacies), medical certificates (between us and work or school or daycare), or referral letters (between us and real doctors). Whatever you do, we can look up on Google but just don’t have the right licenses to carry out the treatment.
    Don’t big yourselves up to be some great doctors or anything. Not even worth the $158K quoted above. You’re just GPs. i.e. you’re just middleman clerks.
    This article and the comments from other GPs just highlight what a greedy bunch you are. Not in the profession to help people as you would have said in your medical interviews. You’re really out there for money you don’t deserve.

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    1. Just GPs? Jesus have you tried being one? General Practice IS a specialty mate.

      Now some of you incredibly disrespectful bias is of course justified. Medicine does need reform and needs to be shifting some of the first line triage onto nurses, away form GPs, but the education and currency you need to maintain a general practice is not trivial and GPs suffer burnout pretty fast.

      And no, I am not a GP.

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  31. The sad sad thing in this world is that such realities and such experiences will in all likelihood never reach the eyes of enough decision makers in government to wake up and basically fund and subsidize the front line to the hilt as the primary downstream cost saver we have. It will alas, only be read by the already converted further saddening them on account of the lame trends our governments drive, in attacking the funding on this front line. It’s a sad sad world indeed, in decline.

    But there is hope. And the main hope is not in technological revolution (which is happening but not making these things better) but in the rising tide of discontent and push for political and electoral reform. With enough of it, we might some day see more representative governance. But it is a long way away as I suspect until we have fundamental electoral reform it won’t be within reach.

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    1. Of what conceivable relevance is that?

      The front line is force to churn patients over in increasing ridiculous short intervals, burning out GPS, running increasing queues as they run behind schedule using the time needed for a consultation, and medicare is covering half what most seem to need to charge to stay in business meaning all those folk you want to be screening for early detection of everything, are suddenly $35 out of pocket to go see a GP which is hardly an added incentive to go, which is what we need and you’re wondering what I want to earn? What do you want to earn? And who actually gives a hoot?

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    2. Mate if you are complaining about being inadequately remunerated, we can’t sympathise with your pleas unless you state what you desire to earn. Otherwise, you just appear greedy and unsympathetic towards the Australian public.

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    3. I’m not. If you read a complaint about remuneration in my words I apologize, but ask you kindly to reread with a little less bias. I have an issue with government funding medical services not to the point of deliver by half way, which creates a society in which the rich have better health outcomes than the poor.

      I am not pleading anything, I require none of your sympathy, and I have made no mention of the Australian Public beyond my desire to see them adequately provisioned with health care. Which means the freedom to see a front line GP or triage nurse at least as often as they can be encouraged to in order to catch anything and everything as early as possible, which as it happens we know is the greatest way to save on net medical costs in the long run.

      In short, as the article itself makes clear, underfunding the front line is shooting ourselves in the foot. We end up paying more on later care and treatment than we saved on underfunding the front line.

      Like

  32. @Dave I wish math in the real world was as generous as it is in your post. Alas, it is not. More accurate math based on real-world numbers have been posted.

    @Ron – It’s unfortunate that that’s been your experience in healthcare, though that should not be the norm. However, it is a symptom or adaptation of exactly what the author (and many posters) described. On the other hand, if you are genuinely being maleficent, you truly deserve to see those “walk-in docs” that you describe. I am curious about how much your lawyer charges for their time and work and why it’s acceptable for a lawyer to charge a certain amount, but not people in other professions. Over here, $250/hour is the lower end of the spectrum and a quick search turns up $300/hour as a common base rate for a solicitor at a small (read: cheaper) firm in Australia. $!20/hour seems to be a common base rate for a law clerk (typically new graduates, who are not practicing lawyers) at a small firm. At larger firms, rates are often double those of small firms. Personally, I would be quite pleased if all the unpaid hours required for charting, following up investigation results, phone calls, and other paperwork/forms/documentation suddenly qualified as “billable hours.”

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    1. @ Greetings! (February 9, 2017 at 2:52 pm)
      I must admit I don’t have the talent to come up with decent defences and arguments like lawyers, nor would I trust myself to look up the law. Yes, lawyers are expensive, but they offer a service that I don’t feel I can do myself.
      I do feel comfortable researching something on the internet (e.g. webmd.com) and wish I had the authority to order my own bloods, get my own medications etc. but now, we need you middlemen GPs.

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  33. @Ron Why should any job exist? I’m perfectly capable of putting bricks in a line with some mortar, who needs a builder? How hard can it be to make a 5 star meal. I’ve watched YouTube videos about it so I guess we don’t need chefs. Don’t even get me started on engineering. Even 5 year olds can design and build with Lego sets. Look at the end of the day everyone is allowed their own opinions. It’s just a shame that yours is so horribly wrong.

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    1. Av, the question isn’t about whether a GP job should exist or not..it’s about the remuneration they’re whinging about for what they do.
      But in response to your question about why jobs exist – they exist to convenience others in terms of time or service, or offer something they can’t do themselves. For instance, if someone had a brain tumor, they’d go to a neurosurgeon because they’ve got the appropriate skill to offer something that others can’t. How much skill is required in being a middleman to write out scripts, referral letters, blood forms, medical certificates.
      And you wonder why GPs are able to do 5min “consults”.
      GP: “Got a cold? Need some time off? Here ya go mate…that’ll be $37.05” (nah that’ll be $80 thanks). Get real.

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  34. Have to agree with Daves comment above….
    Lots of whinging about wages and lots of self praise for how much study you do / how hard your training is / how unsocialable the hours are….
    Here are some facts:

    You are well paid….yes…you are well paid…despite your whinging about the rebate freeze an average BB GP working Monday to Friday will easily clear 200k, worth their salt easily 300k….so you are in the top 5% of income earners in the country……so next time you whinge about your wage…suck it up you fuckwit.
    You are a public servant: yes you are…you may work in a private clinic with a private business owner but you are paid the majority of your money by the federal government hence making you one of the highest earning public servants in the country.
    Every job is difficult….yes you trained long, and yes life long learning self directed learning blah blah blah…every profession is always learning, always adjusting…you are not alone, so stop stuffing your years of training down our throats.
    Your job involves one on one contact with patients, which is very difficult, and demanding, and exhausting…so what, suck it up, do your job.

    The original article was very well written and a good insight into the day of a GP…but I am just over this culture of taking amongst medicos…it’s time we recognised just how fortunate we are.

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    1. “Every job is difficult” – You can’t possibly be so naive as to believe that, surely!

      “suck it up, do your job.” – did you actually read the core issue? Recurrent funding cuts mean to cover costs a whole pile of service delivery compromises are on the table. From patients paying more (increasing society of healthy rich and sick poor as a consequence) to a lower doctor to patient ratio even after patient drop off due to higher costs, which squeezes consultation times and quality of service.

      “culture of taking” – Where does such dross come from? Seriously. Currently almost any general practice I know charges about twice what medicare delivers and none bulk bill. Except for kids and pensioners and health care card holders and even then sometimes only for already registered patients not taking new ones on bulk billing. Underfunding the damned front line of health provision has everything to do with making these services available to all not just those with money and delivering quality service. If practices are routinely having to charge $70 for a consultation then that’s what it costs and what medicare should cover for crying out loud to encourage early detection and screening of a shite load of conditions that cost us buckets more downstream for failure to do so, which is rising in likelihood as funding id increasingly attacked.

      Study, become a GP then get all laissez fair about the crap situation we’re building.

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  35. @David

    Yeah ‘David’ I’m sure you just ‘have to’ agree with ‘Daves’ comment from above. I’m so glad that I’ve finally found someone else who loves facts!

    Here are some more just for your reading pleasure.

    The number of physicians per 1000 people in Kenya is .2 (compared with 3.3 in Australia) that is physicians not just GPs but it’s a good first degree of approximation.

    The maternal deaths rate in Kenya is 500/100,000 live births (it’s 6.8 in Australia)

    The amount back bencher politicians are paid in Australia is 198k a year. I’m sure they do the same amount of work as your standard bulk billing GP. In fact I would trust the politicians with my life.

    Yes every job requires professional training, that was very fact-sy of you! But what other job holds the lives (literally) of your mother, father, brother, sister, daughter, that neighbour you hate, in their hands?

    It’s so easy to sit back and comment on things you have absolutely no understanding about. I mean you’re clearly doing it (fuckwit) but where I do agree with you is where you said ‘its time we recognized just how fortunate we are.’ You’re absolutely correct. You don’t know just how good you have it.

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  36. Well… $24 after tax for 18 minutes is way better than me… I get $22 before tax for 1 hour!!! I would say I’m just as stressed as you if not more stressed. Btw I’m an accountant~ I’m a little bit of a junior though, so perhaps that’s why. 😦

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  37. Thanks Av for the update re Kenya and physician numbers / maternity mortality rates….not sure how that fits into my criticism but interesting none the less.

    Don’t know why you’re making the point about backbenchers mate theyre politicians…they are well paid for a difficult challenging job..go walk in their shoes for a day and appreciate the unique difficulties of being an MP.

    My criticism is not of the blog, nor of the hard work or dedication of any doctor or professional across Australia.

    My intense criticism is saved for those who are ignorant of just how fortunate we, as medicos are.
    I use the term fuckwit, to describe those in medicine who deem that their wages of $100k, $200k, $300k is insignificant and does not recognise their worth.
    I am critical of those who do not recognise that fee for service is broken and without a long term fix, it will break our healthcare budget irreparably within years.
    I am critical of medicos who arrogantly assume that they are the only profession who continue to learn or study or have challenging difficult jobs.

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  38. Ok whoever Ron is is a freaking moron.

    Ron let me be very clear. You are exceptionally deluded if you thin for a second you are capable of diagnosing and self treating on your own with the internet. Delusional. You are either a supremely arrogant individual or just monumentally stupid. You haven’t a clue the detail and number of clinical training that go into the medical care decisions I and other doctors make each day.

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    1. Dipshit Steve it doesn’t take a genius to figure out that the internet is a library full of resources – you just have to find the right sources and medical e-books. How to you think GPs got where they are? By studying those same books. They regurgitate what you can read, dummy. Keep wasting your money on those middleman plebs.
      You don’t seem particularly bright if you didn’t know that the only reason they go through individual steps to keep up to date or complete training, is because they need to tick the boxes that bureaucracy has set up.
      Surgeons at least do things computers and clerks can’t. They don’t just sit there printing off papers to get you to another party.
      You really are the classic brainwashed goof who reckons GPs save lives, confusing them emergency physicians and surgeons and cardiologists and intensivists and what not.

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