Erin H, MD

Northeast transplant loving life in OK! Wife. Mom of boys. Physician Anesthesiologist.

[Erin H, MD @DrErinH]

@JahangirAsgha10 👏👏👏👏👏👏

[John Asghar @JahangirAsgha10]

The physician shortage isn’t just about how many doctors we have.
It’s about how much time we are forced to waste.

Physicians in the U.S. spend an average of 16 hours per week on administrative tasks.
Not optional work. Not inefficiency.
But time we are required to spend—by payers, regulators, and federal programs—on prior authorizations, coding justification, compliance reporting, and EHR documentation.

That’s two full days per week stripped away from patient care.
Across the workforce, this removes 20–25% of total clinical capacity—not because physicians aren’t available, but because they are redirected away from the bedside by policy.

And this is not the global norm.

U.S. physicians spend four times more on billing and insurance-related tasks than their Canadian counterparts (Health Affairs, 2020).
In most European systems, administrative overhead is under 30 minutes per day.
In the U.S., it regularly exceeds 3–4 hours per day.

This administrative load is not the byproduct of better outcomes or safety.
It is the result of flawed, government-driven agendas that prioritize data collection, billing audits, and metric compliance over clinical judgment and time with patients.

Programs like MIPS, MACRA, “value-based” reporting frameworks, and EHR certification requirements were designed around bureaucratic performance indicators—not patient outcomes, not physician capacity, and certainly not operational efficiency.

They have created a system where physicians are penalized for focusing on care, and rewarded for satisfying administrative benchmarks.

This is not a staffing issue.
It is a structural policy failure.

Until the system stops forcing physicians to waste time proving their value on paper, we will never reclaim the capacity we already have.

[Congressman Greg Murphy, M.D. @RepGregMurphy]

The greatest threat to American healthcare is the insurance company industry. They abuse the honor of helping patients and use it to siphon off money and deny care. It is past time Washington DC fixes the problem. The insurance industry has shown no remorse.

[Noah Kaufman, MD @noahkaufmanmd]

I recommend to all young bright people to not go into medicine.

Do something else with your life. You will be much much happier.

Plus, physicians are being compensated less and less every year. Soon we will be overworked middle class slaves.

By the way, our suicide rates are twice the general population.

Have a nice day.

[Robert Oubre, MD | The Doctor of Documentation @Dr_Oubre]

In case you needed the reminder, CMS is yet again reducing the physician conversion factor: $33.29 in 2024 to $32.35 in 2025.

It was #36.68 in 1998.

If it kept up with inflation, it would have been $68.58 in 2023.

If you're not sure what the conversion factor means for physicians, I discussed it in a previous newsletter here: https://t.co/q3g4yEAeC5

Happy 2025.

[Marilyn Heine @MarilynHeineMD]

🚨1/ Congress fails to include Medicare payment relief in final government funding bill.

❗️Drops provisions agreed to on a bipartisan basis to mitigate the Medicare cut.

❗️January 1, Medicare payments to physician practices will ⬇️ 2.83%. As costs to keep the lights on ⬆️ 3.5%.

[Erin H, MD @DrErinH]

@kryscorbett @amyfaithho Physician fees account for around 8% of total healthcare costs in this country. Physician cost is not the driving force in cost.

[Erin H, MD @DrErinH]

@NFinTX @BrentAWilliams2 Those are all facility and hospital issues. Agree they are too much. He’s referring only to actual rates physicians receive for care they provide. Those are undervalued by MCR across the board.

[Erin H, MD @DrErinH]

@DorisKoest85554 @BrentAWilliams2 On average for most physicians MCR pays 70% of private, anesthesiologists it’s only about 27% of private. But MCR has essentially kept physician rates flat for 20+ years while consistently increasing hospital rates. No inflation adjustment for docs. But hospitals get it.

[Erin H, MD @DrErinH]

@cashptfuture @BrentAWilliams2 Medicare has increased rates for outpatient and inpatient hospitals consistently since 2000. What they have kept the same is physician rates. No inflation adjustment in 20+ years. The ones providing care get screwed. Rates for docs need to be increased.

[Roger Seheult, MD @RogerSeheult]

Math question: Which line(s) are not responsible for increasing costs in healthcare.

Hint: I took old math.

[Noah Kaufman, MD @noahkaufmanmd]

This is a tough one in medicine.

As an Emergency Medicine Physician (EMP) I am not only beholden to EMTALA laws to provide ALL patients a Medical Screening Exam (MSE) regardless of their ability to pay, I am ethically forced to do so also. What am I going to do? Not treat someone?

Obvi that’s a non-starter. I will treat you if you come in and can’t pay.

As such, over HALF my patients that come to the ER CANNOT PAY. I am doing a TON of free health care on these individuals. Because it’s right (whether or not it’s THEIR right)…

But come tax time, I cannot write-off all that free time. Additionally, because taxes are so high—over 50% in California and a few other places—we docs often work until June or July FOR FREE (to pay the government our tax share). Ironically, then our TAXES go to pay for the care of many of the people we saw those first six months who are on social support structures like Medicare or -caid or other state-run programs.

On top of this, medical education puts us badly in debt and we don’t finish the grueling training until we are 30 yrs old. 🤯

I just spoke to two young engaged new attendings who just got done with training and have over $900,000 in debt at over 7% interest. That’s nuts!

So it forces many of us into specialties where we can earn more money.

On top of that, it’s a thankless job; patients are upset because it is bankrupting them (and being sick sucks and our society is sicker than ever). So they write complaints. Non-physician administrators then lecture physicians about the “service” side of medicine and keeping patients happy. Even more insane, reimbursement (getting paid) is often dependent on patient satisfaction!!! WHAT!?

Because of how broken the system is, I would never recommend Medicine as a career for our best and brightest. And since it is a skill based profession, more of you will die or stay sicker in the hands of less qualified, less trained and lower compensated providers.

THIS IS WHY DOCTORS FEEL LIKE SLAVES.

THIS IS WHY WE HAVE A SHORTAGE OF DOCTORS.

THIS IS WHY US DOCTORS ARE LEAVING IN DROVES.

DO YOU UNDERSTAND?

HELP!

[Artificial Opticality @A_Opticality]

@Third_i_Prophet Yup, and this one shows it too. Bottom two lines nursing and physician compensation. Top line admin compensation.

[Third_Eye_Prophet @Third_i_Prophet]

A media blitz has been going on to demonize Doctor salaries. It's obviously funded by the Healthcare-Pharma Complex, to deflect blame onto Doctors for high Healthcare costs.

It is the worst kind of gaslighting against doctors, because the exact opposite situation is true.

First, doctor pay is 6-9% of all Healthcare costs, so even if they worked for free, it would hardly put a dent in Healthcare spending.

Second, many young doctors may not realize this, but Congress froze Medicare payments to doctors in 1997, and real salary adjusted for inflation decreased 80% since then!

Medicare work-RVU payment-
2000: $36.69
2024: $33.29
Inflation since 2000: 70%

Meanwhile, hospital payments and insurance premiums have OUTPACED INFLATION since 2000. That is where the problem lies.

People will argue that doctors are paid more in the US, but so is every other profession- law, finance, tech, nursing, etc.

Average nurse salary-
USA: $82,750
Germany: $33,000

Also, the US has fewer doctors per capita than Europe, resulting in more office visits and procedures per doctor.

And US doctors have on average $227,000 in debt compared to none in Europe. If you just invested that money in the S&P at it's historical return of 10.26% for 45 years, adjusting for inflation, you get $22.97 Million. That is the opportunity cost of becoming a doctor in America.

Anyone blaming doctor pay, which is down 80% the past 25 years, for our high healthcare costs, needs to read this thread and face the facts.

[Real Doc Speaks @realdocspeaks]

OMG! Look at the admin cost! No more moaning about physicians' salaries until the admin cost is brought down to the average in the US!!! @DutchRojas @mass_marion @noahkaufmanmd @anish_koka

[Erin H, MD @DrErinH]

@Noahpinion Fun fact. As an anesthesiologist I have zero control over what rate I bill an insured patient. It’s all set by the insurance company. Tell me who has control in this system again???

[Erin H, MD @DrErinH]

@DoctorAspen @anish_koka Like this chart, except why are anesthesiologists not in the physician category ? 🤔🤔🤔

[Erin H, MD @DrErinH]

@RichardAFerraro Negative to the tune of a few hundred thousand. All of this anger at physicians is misdirected.

[Erin H, MD @DrErinH]

@Lexvevindi @independentMDs Physician reimbursement by Medicare is effectively less now than 20 years ago. Have never had an inflationary adjustment and we are subject to several % cuts every year. You use Medicare as the “gold standard” and independent practices go under.

[Erin H, MD @DrErinH]

@mahesh_shenai @udaya_bhaskar49 They may collect data on it, but CMS does not pay for modifiers. And now some private entities are following suit in some states.