Am I missing something about US salaries here?

[Krayvon2]

I work in the UK, colleague works in the US for the same company.

We do a very similar job - Colleague earns around $158k per year. My salary is in £ and still a very good one but considerably less if you look at the exchange rate (probably half of US salary). However, this is a common trend with US vs UK employees in our company due to job market differences, experience etc (the sector we work in commands more of a premium over there).

With my UK salary I still manage to save a decent amount each month and pay all bills and mortgage etc.

Talking to US colleague about how in the UK we get paid on one set day every month (over there salary is paid in two installments each month) and they asked me how on earth I managed to make the money last all month.

They seemed to find it hard to believe it was possible to make a salary last 30 days and implied they struggled to make what they earn last over a couple of weeks! They've also made comments in the past about struggling with a surprise bill or having to put off a purchase.

I know lifestyles are more expensive over there but they spoke as if they earned peanuts so I'm wondering if I'm wrong to think that's a good salary? They get health cover through the company too so that's not an issue. Is there some other tax or something that I'm missing here? They are East Coast but not in most expensive area (not New York or Boston)

amp.theguardian.com/society/2021/oct/18/nhs-england-hospitals-having-to-rely-on-obsolete-imaging-equipment

Not funny.

This is the standard "but it's all about the Benjamins!" argument, and it's rarely that simple--in this case, the neurologists themselves don't make money from extra scans. (Radiology does.)

It's more complicated than that. When technology is available to use, there's a tendency to use it, for good or bad. (Bad would be overuse of DaVinci robotic surgery, but that's another essay.) Once you have paid for the CT scanner and the technician, the cost of each scan actually drops, because those costs are fixed.

I don't have current stats on availability of CT scans on the NHS, but in the 2000s, which is when that AAN recommendation came out (2007, to be precise) not all NHS hospitals had CT available at all times. The American system, again in both good and bad ways, effectively encourages hospitals to invest in expensive technology to "compete" with other facilities. So what often happens is that a hospital has whatever new tech is available and the staff responds to that availability and uses it more.

You can calculate how many scans you need to do to find a problem (aka Number Needed To Treat, or NNT) and work out, financially, the cost per problem found and decide if it's "worth it"; this is what NICE does when it develops guidelines. American medical groups tend to downplay cost over safety when they develop guidelines. This doesn't mean they are directly profiting from it, or even that they're helping colleagues profit. They downplay resource scarcity in ways that other systems do not. They are trained to assume that CT scans are easily available and not in need of rationing or prioritizing. It's also partly a response to the medico-legal climate and the fear of the risk, or perceived risk, of being sued. You will be sued for not doing a CT. You won't be sued for doing one, especially if the procedure was in line with accepted practice. You can argue that this leads to unnecessary scans, and sometimes it does, but there's a great deal of grey area and it's not always clear cut. At some point, the question is going to be risk tolerance and that cannot be perfectly quantified.

Now, there is also a lot of interesting research on how clinicians respond to the availability of new and more expensive technology and subconscious bias, but most of it isn't direct. This is yet another reason cost control needs to be top down and coordinated.

So @Krayvon2 did you get your answer? Lol

Posts about the US just descend into a shit show in MN.

Posts about the US just descend into a shit show in MN.

You said it, sister.

When my child was struggling with a chronic illness and we had to call an ambulance and ended up in A&E we were seen immediately with the ambulance sending DC's number ahead to hospital so their file had already been reviewed by the time we had got there and a doctor was ready and waiting to treat on arrival without us having to explain the illness. Amazing service and this with an NHS style model. This would NEVER happen in the US, healthcare is very fragmented (another issue)!!

That's actually also how it happens where I live in the US. We arrive at Maine Med or one of the other hospitals in Maine that are part of MaineHealth, they open up MyChart, they see our records. MaineHealth treats 1.1 million of Maine's 1.3 million residents BTW.

Yes, when I first arrived I was very confused by the fact that Maine brands both Medicare and Medicaid as Mainecare.

Any medical system under the hospital system can "talk" to each other. Need an Xray? Go get it and the doctor can pull it up from his office. Need a mammogram? Need to go-to the ER? Doc can see any medical records from within that system.

The problem arises when the hospital systems don't talk to each other.

As for expenses in the US, my car payment is $800 a month, mortgage is $1900. We are comfortable. Have retirement and savings. That is with 25 years experience and multiple moves around the country early on. But I recognize that not everyone has the same opportunities we have. I live in a high cost of living area.

@drspouse

How would the doctor have known the seizure wasn't caused by a brain injury without the CT scan?

It's possible to have epilepsy and also sustain a brain injury from some other cause.

It's like that where I live too.

That was probably true 20 years ago, but not now. The ACA funded the creation of regional health data exchanges. Any hospital my family or I might go to has electronic access to our medical records.

www.nyehealth.org/

In addition, I have access to all my medical records. If I get a mammogram in the morning, the result is online by the afternoon. I know when I had my last gyn exam. It's all at my fingertips. I can schedule any kind of medical appointment through the same app.

I have access to all my medical records.

Same here. And I get an email alert every time something is added to the record.

I love being able to see my records. Had a mammo last month and they sent me the images. I cant make heads or tails of it obviously, but I am a nerd when it comes to seeing those things.

I had surgery on my wrist once and was just under twilight sleep. I asked the doctor to show me the incision because I wanted to see how it all works. 😆

I could write huge amounts on here about how the NHS is failing my family, but it’s all very personal so I won’t.

I can say my parents have given up and now just pay privately for all their treatment - they do have some health insurance but it doesn’t cover what they need, and now they have pre-existing conditions so they’re not sure they can get those covered if they buy new insurance.

MIL ditto.

Sister and BIL cannot afford that so they are stuck in years of limbo trying to get care, which is ironic as they work for the NHS.

I understand the US systems has all sorts of failings, but right now I’d stay here rather than risk entrusting my family’s health to the NHS.

@mathanxiety no it was a Pepperidge Farm sliced wholemeal loaf in Stop and shop. Connecticut is expensive. Have defected to Aldi.....

ooh, yes, Stop & Shop (Giant here) is pricey in general. That said Pepperidge Farm is considered a "premium" brand. It costs $1-2 more than store brand everywhere. (But their sandwich sliced white is one of the few with a good firm texture instead of being too soft and cottony, though it's on the sweet side like all American white bread.)

Pepperidge Farm is a higher priced brand of bread everywhere.

Their Toasting white bread is quite dense, sliced a little thicker, and does make fabulous toast.

I would definitely say that a downside of living in the US is that pre-packaged bread is generally overpriced and not great. We buy bread from the bakery section, or make our own. If we're buying white bread we often buy Italian from the bakery.

For years I really missed Hovis bread, but I actually prefer Hannaford's 9 Grain Bread now - I don't know if Stop & Shop has the same (I think they're the same chain?). It's expensive but good. Mind you, we eat it so slowly we have to keep it in the fridge otherwise it goes off.

I love Pepperidge farms thin sliced bread. My grandmother always used it for sandwiches. Their products are more expensive but worth it.

We don’t eat very much bread but like @ZZTopGuitarSolo I usually either make it, get it from the grocery bakery section or from an Italian bakery. Occasionally I’ll by a more expensive 7 grain bread, whichever brand looks good that day. And our grocery Rye bread is great/stays fresh longer.

We buy Pepperidge Farm bread as well, but for me the best bread available anywhere in the US is Cuban bread, but the authentic stuff is hard to get outside Florida (mainly Tampa).

I've never bought Pepperidge Farm bread after experimenting with it a few times. I prefer supermarket bakery bread, and there are some great Italian and East European bakeries nearby offering good quality baked goods.

We have Dave’s Killer breads, or Trader Joe’s sourdough which has only flour, salt yeast and water in it. Dave’s filled in the gap left by the Vermont Creamery people. It’s super $$$ but the only sliced and bagged loaf that doesn’t have rubbish (including sugar) in it.

@Partyandbullshit I was just coming on to suggest Dave's Killer! I think it's the best of the pre-sliced big brands available, their various seed options are nice and their floury white buns make for a mean bacon buttie😂

If you are in the Boston area, any of Iggy's breads, though in particular the whole wheat sourdough baguette, are amazing.