They won't be able to even reach that earning potential until they are at least in their mid-30's (and even later for the highly-specialized positions). We are already slowly starting to see doctor shortages.

But they'll still make way more over their lifetime than non-college grads. Over the life of the loan college grads get thousands of dollars of tax breaks that non-college grads don't get.

There are a number of offerings that tie Electronic Health Records and E-Prescribing together. The infrastructure is there now. With E-prescribing, there is a national network where a doctor can see what insurance program(s) a patient belongs to, along with what medications that insurance program covers/doesn't cover/prefers. The formulary information available varies, but can be as detailed as the physician seeing what copay a patient will have to pay at the pharmacy. Along with this the physician can see the prescription history of the patient. There is a company, RxHub, that has built this infrastructure. Payers submit their eligibility and formulary information daily, and the prescription history is a real time query. All through very well defined electronic standards.

Software vendors seeking the physician(for e-prescribing) and Hospitals(for Electronic Medical Records) are leveraging this infrstructure or attempting to add to it.

The downside. Insurers with 200 Million lives support e-prescribing, as in their technical infrastructure is in place and functioning. Physicians aren't adopting the technology. Something like 200,000 prescriptions have flowed through the e-prescribing infrastructure, and that is a pretty abysmal percentage of total prescription volume. Why? One...Physicians aren't using e-prescribing. My personal opinion is that they can't or don't want to be bothered with the change. Two... Pharmacies, essentially the independent Mom and Pop pharmacies, aren't buying into the infrastructure...along with a healthy dose of the chain pharmacies trying to keep them out. Three... Confusion abounds. An example, CMS has required that Medicare-D payers/insurers support E-prescribing by this April. No one knows exactly what "support" means. I mean No one.

Medicare is pushing E-prescribing. This year, or next, physicians are starting to be incentivized for utilizing the process. In a few years, they will start to be penalized for not participating.

I'm an E-prescribing skeptic, yet I believe the single fastest way to an electronic medical record will be to utilize and expand the existing infrastructure the pharmacy payers/insurers have built and utilized over the years. Pharmacy claim payment/processing is decades ahead of medical. You probably know this intuitively, as when your pharmacist submits a claim for payment, he has a response in under five seconds. That is the speed of light compared to a medical claim of similar complexity.

Great post. I would just add two huge reasons why physicians haven't flocked to e-prescribing en masse.

First, the DEA has yet to allow the prescribing of Schedule II medications via e-Rx. These include some of the most commonly prescribed drugs in the nation and are, without a doubt, the most likely to be involved in diversion or fraud.

Second, unless Congress makes a change to the Sustainable Growth Formula (or some other act is passed), physicians face a 21% cut in Medicare payments which goes into effect on January 1, 2010. This is a cut that was supposed to have happened in 2008, but was postponed. It's already become apparent through an AMA survey of physicians done prior to the original deadline that, as a whole, docs would be less willing to take on the care of Medicare beneficiaries or adopt changes to their practice which might be time-consuming (and, therefore, costly).

I was reading an article in Forbes on the highly expensive proton-beam treatment centers.

The $150 Million Zapper - Forbes.com

A few things stuck out:

"Winifred Hayes, a nurse whose research and consulting firm evaluates medical technologies for insurers and hospitals, says the proton-beam construction boom is driven more by a technology arms race among hospitals than by compelling medical evidence. "At a price tag of $150 million, the public deserves to have this question answered," she says. X-ray radiation therapy machines cost $3 million each; a big clinic would have several.

But patients are used to getting what they want, especially in cancer care, where any chance at living longer with fewer side effects is worth trying, especially if someone else is picking up the tab. Schoolteacher Mark Chalupsky of Carver, Minn. feared that prostate cancer surgery would render him incontinent, so he went to Florida last summer to get protons instead. "I had no side effects," he says. "I would play golf and go to the beach" after treatments. Medicare pays twice as much for a round of protons as for X-rays: $34,000 for eight weeks of therapy versus $16,000. Private insurers also cover protons, though they often require preapproval.

Zietman of Mass General worries that older prostate patients who don't even need treatment at all will, once excited by Internet tips, rush off to get proton therapy."


Is this a big part of why costs are skyrocketing? Aside from the politics and investment-side of things, are patients just as greedy? Should doctors and nurses have the right to reject treatment if they don't see that it is worth the cost in terms of benefits and alternative treatments? Should taxpayers (through Medicare) pay more money and should insurance patients pay higher premiums for those who get the treatment? We all want the best treatment, doctors, and facilities, and we invest in that (which I think gets often overlooked when comparing our costs with other countries), but we want to pay those costs.