By Jeff Brown, MD
By Jeff Brown, MD
Jeff Brown, MD, is a Board Certified Family Practitioner, currently specializing in geriatrics as a Medical Director, and is also a consultant for the California Medical Board .

Food For Thought

I've been told that the classic journalism story is a dog bite piece. So did you realize that dog bites are responsible for 1/3 of the liability freight on your homeowner policy? Yep, and the average cost is $24,840. If you keep Fido fenced or leashed you could help save a bundle.

Last year, for the first time, more money went through debit cards than credit cards. Maybe it's a small silver lining of controlled spending in the cloud of the debt recession.

And did I tell you that in 2009 more docs took salaried jobs than went into private practice, for the first time ever? Average student debt of over $150 K, the recent difficulty in getting loans as well as a new generation of young professionals with a different idea of how to live their lives may have had more to do with this momentous change than just a slumping economy, however.

"Money doesn't guarantee success, but it certainly beautifies failure." Words to live by, for some. To paraphrase Billy Crystal's "Fernando" character on "Saturday Night LIve," "Darling, it's better to look good than to feel good and you look maaarvelous."

A recent review claimed that 1 in 5 medical claims are processed incorrectly. Any doc could have told them that, and added that they forgot to include processed slowly or not at all....

In our professional and personal rush to learn, we sometimes forget that knowledge can change behavior for the worse, as well. Didn't we learn in medical school that a little knowledge is a dangerous thing? Remember, that applies to money matters, too. It helps to look a bit further into things financial than just first pass.

Robert Frost wasn't thinking of medicine, or finances especially, when he said "All thought is a feat of association."

60% of older MDs have been sued at least once, ranging from 40% in primary care to almost 70% in ob-gyn. Interestingly, only 22% of psychiatrists have been sued. Underscores what we have been told about the value of empathy in the doctor-patient relationship to keep things amicable, perhaps.

"Those who understand interest earn it; those who don't, pay it."

I've mentioned before that it can be helpful to realize that the term "tax break" is but a euphemism for spending. Let me give you a few examples. We have some that work at cross purposes, such as $3.1 billion annually going for employee parking and $0.5 billion going for employee mass transit subsidies. Or how about special interest exceptions to the tax code such as the one that Blue Cross/Shield get to the tune of $.7 billion?

Of course many tax breaks serve a social purpose, such as $4.4 billion for veterans' benefits exclusions, the elderly $2.6 billions and childcare $2.2 billion. Before you start to get a warm glow, however,keep in mind we are spending over $1 billion per day, that's per day, not per year as the others are, on making war.

Over the last 50 years, the number of households with some form of life insurance has dropped from over 80% to 70%. That's in spite of much lower rates, tax subsidies and the applied effort of a legion of salesmen. In part, it certainly shows the impact of the recession on even potentially important financial planning tools, such as life insurance.

Last year there were about 350 million acute care visits. Amazingly,1/4 were to the ER, 1/4 to specialists and, surprisingly, only 1/4 to primary care docs.

To help understand why, consider that doctor search firms tell us that the average starting salary for primary care docs is about $160 K and for specialists about $230 K. Now personal medical interests aside, if you had a $150 K debt, 10 years of pent-up deferred needs and the usual dose of human nature, which way would you choose to go?

If our profession and society deems that we need to importantly reduce costs and to have more primary care docs to see the millions of baby boomers and newly insured from the health care bill, shouldn't we just change the financial incentives and let nature take its course?

Medicare, for better or worse, controls the national fee structure and is in a position to increase primary care reimbursements, probably at the specialists' expense, to maintain current budget neutrality, which all the other paying entities will follow. Put this idea into priority debate and let the games begin.

Financial planning is essential, but no original game plan survives the opening kick-off. You know, "Man plans and God laughs." For instance, only about 1/2 of people actually end up retiring somewhere around their original plan for age and income level. Life just has too many interesting curves and dips including the Wild Card, health.

So we save, we plan, we exercise, we eat our veggies and we stay nimble.