"I'm a Medicare Doc- Here's what I Make"

[medicinesux]

Must watch the video- "300 surgeries just to break even!" "reimbursed only a little over 1K for an invasive neurosurgical procedure"

http://money.cnn.com/2010/03/04/news/economy/medicare_doctor_costs/

I am outright frightened to see what the landscape is going to look like in just ten more years.

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[Sneezing]

Why are you frightened? This is exactly the first step that is needed to improve healthcare and right many of the wrongs you voice concern about. This is the type of change Obama and all physicians should be advocating for. Just let medicare die.

 

[jp104]

Doctors are screwed if the user comments to the article are any indication. Some guy was saying that construction workers have a harder job? Really?

 

[ChiDO]

Doctors are screwed if the user comments to the article are any indication. Some guy was saying that construction workers have a harder job? Really?

The public really has no idea what it takes to go through medical school, residency, and beyond. They get their knowledge from Grey's Anatomy on Thursday nights. Doctors just run around the hospital all day being inolved in drama and make millions each year, drive fancy cars, and take long vacations.

Most don't realize that they have $200k+ in debt to repay on top of everything else in life.

 

[Bobblehead]

If you read through the comments from the CNN link you'll come to realize that no matter how healthcare reform happens, physicians will end up on the losing side of the table. The politicians know they can stick it to physicians because no one's going to feel sorry for the poor doctor who no longer can make $100,000 a year. The public who is flailing in massive amounts of consumer debt, are upside down on their house and had their insurance premiums skyrocket won't have much sympathy left either. The insurance companies will just follow the government's lead, lower reimbursements and say "hey that's just the way it goes, you need to be more efficient". If you're employed your boss will tell you to bill more. If you're working for yourself you'll need to cut someone's salary, benefit or eliminate people to make the new math work.

I don't have a good solution. But saving a high percentage of your income and leaving yourself financially flexible may allow you to get out before things become too painful.

 

[medicinesux]

I don't have a good solution. But saving a high percentage of your income and leaving yourself financially flexible may allow you to get out before things become too painful.

My thoughts exactly. It is FAR from getting better and I now realize this more than ever. I am hoarding money that would make Uncle Scrooge look like King Midas. Eating mac and cheese while I hear gunshots off in the distance from my TINY ghetto apt is WELL WORTH IT when I realize that I can get out of this nightmare that much faster. Can't wait to get out. Can't wait! If people at my hospital only knew that I lived in a neighborhood full of crack dealers, gang bangers, hookers, and child molestors. Needless to say the annual resident welcoming party will not be happening at my place this year! LOL. Come to think of it, I should throw up a clock under my screen name counting down to the day I have my freedom back where I get to celebrate my extreme early retirement. What a most glorious day that will be.

 

[dynx]

I'll do my part. Medicare? no f*cking way. You better have private insurance and if you dont...well I'll take the same mastercard you used for those designer jeans and throwback jersey fat-ass.

 

[xanthines]

I'd rather have cold, hard cash, thank you.

http://www.walletpop.com/blog/2010/...d-chargeback-even-once-can-lead-to-blacklist/

-X

...well I'll take the same mastercard you used for those designer jeans and throwback jersey fat-ass.

 

[indo]

If the financial reward becomes too much less than the effort put in there will be a "brain drain" in medicine. Eventually, only desperate foreign medical graduates will be filling our residencies and subsequently our hospitals.

In the mean time, I'm sure the hell not going in to primary care.

 

[deleted87716]

In the mean time, I'm sure the hell not going in to primary care.

Why not? We're going to be in a lot better position than most specialists to be able to respond to whatever healthcare reform dishes out.

We could all go cash-only and still keep our waiting rooms filled.

Maybe we should.

 

[docB]

If the financial reward becomes too much less than the effort put in there will be a "brain drain" in medicine. Eventually, only desperate foreign medical graduates will be filling our residencies and subsequently our hospitals.

In the mean time, I'm sure the hell not going in to primary care.

Sure there will be a brain drain but no one on the paying end will care. Patients can't tell the difference. That's been proven. So smarter people shy away from medicine. The med schools will have to admit someone. They'll just lower their standards. At the end those guys will be presented to the public with a degree and a white coat. Position filled. All the public wants is any "doctor" who works cheap. They can't tell if they're quality or not.

 

[scut25]

maybe we should go on strike.

 

[Sneezing]

Why not? We're going to be in a lot better position than most specialists to be able to respond to whatever healthcare reform dishes out.

We could all go cash-only and still keep our waiting rooms filled.

Maybe we should.

There is no need to go on strike people. This is all you have to do. We want to be paid and not have to deal with excess crap. You do this and you reduce the crap and get paid. It is equivalent to striking. Use your feet. In the coming healthcare bubble crunch primary care will be the best off of any specialty. I sometimes wish I wanted to do primary care more than psych.

 

[indo]

Why not? We're going to be in a lot better position than most specialists to be able to respond to whatever healthcare reform dishes out.

We could all go cash-only and still keep our waiting rooms filled.
Maybe we should.

Wouldn't an all cash option be limited to practices in places where people are capable of actually paying for their health care?

 

[lipomas]

I keep wondering where the breaking point is. Healthcare has a few things currently trending which are not compatible

1) Physician salaries decreasing and physicians doing increased work to compensate and make up for loss income
2) Med school (and undergrad) tuition skyrocketing
3) Reimbursement declining
4) Health insurance costs rising, forcing people out
5) For profit healthcare proliferating, with exploding numbers of administrators and construction projects to make the administrators happy
6) Increasing entitlement from patients and refusal to treat health care spending as anything less than a God given free right.
7) Decreasing desire to pay higher taxes or premiums for anything
8) Increasing complexity of medical care and consequent costs.

Any of these individually are problematic but can be dealt with. All of them together is not pretty. But because most of the strings are being pulled by for-profit healthcare (including for-profit hospitals, drug companies, and for-profit insurance companies) and the senior lobby (keep the government out of my medicare, etc) things are not going to get better very quickly. And doctors will suffer and continue to work harder and continue to fight against each other for scraps from the table instead of fighting the admininstrators and policy makers like they should be.

 

[Long Dong]

Doesn't relate to Gen Res, becareful the powers that be will move/edit/delete.

 

[lipomas]

Doesn't relate to Gen Res, becareful the powers that be will move/edit/delete.

Boy people really have a paranoia on these forums that the moderators are for some reason out to get them. Who cares? If it gets moved go post where it gets moved. Cripes, people are children on this site.

 

[Long Dong]

Boy people really have a paranoia on these forums that the moderators are for some reason out to get them. Who cares? If it gets moved go post where it gets moved. Cripes, people are children on this site.

 

[lipomas]

Why me so serious? Why you so serious! I was trying to hint that this is just a website and where a thread is or is not moved to is a trivial concern. Hence, I am trying to make fun of those like you who think thread moving is such a serious issue. But people continue to get their panties in a bunch over whether threads are moved, and how there must be some sort of conspiracy against people speaking the truth. I know you didn't go that far, but others have. It just gets annoying, that's all. Personally I don't give two ****s about whether a thread is moved or not.

 

[Long Dong]

Why me so serious? Why you so serious! I was trying to hint that this is just a website and where a thread is or is not moved to is a trivial concern. Hence, I am trying to make fun of those like you who think thread moving is such a serious issue. But people continue to get their panties in a bunch over whether threads are moved, and how there must be some sort of conspiracy against people speaking the truth. I know you didn't go that far, but others have. It just gets annoying, that's all. Personally I don't give two ****s about whether a thread is moved or not.

Sorry didn't use my sarcasim font in my ealier post.

 

[BlondeDocteur]

Sure there will be a brain drain but no one on the paying end will care. Patients can't tell the difference. That's been proven. So smarter people shy away from medicine. The med schools will have to admit someone. They'll just lower their standards. At the end those guys will be presented to the public with a degree and a white coat. Position filled. All the public wants is any "doctor" who works cheap. They can't tell if they're quality or not.

Really? I'd love to read that ("that" being whatever proves pts can't tell the difference between a smart doc and a dumb one). Srsly.

 

[docB]

Really? I'd love to read that ("that" being whatever proves pts can't tell the difference between a smart doc and a dumb one). Srsly.

Here are a few articles that discuss the fact that patients either weight elements of physician interactions that have nothing to do with technical competence such as appearance or that patient satisfaction has little to do with actual quality of care delivered.

Patient’s perceptions of the quality of their hypertension care does not correlate with the quality as judged by reviewing the record.
http://www.bmj.com/cgi/content/abstract/333/7557/19

Patients were unable to accurately rate their quality of care
http://www.annals.org/content/144/9/665.abstract?sid=96a0838c-dc16-4a61-bd78-0ec7af80d492

Patient satisfaction does not equate to quality of care in MI
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.108.792713v1

AAFP review article that notes that patients heavily weight non technical physician qualities such as communication, appearance, time spent and “willingness to listen” more than compentency.
http://www.aafp.org/fpm/2007/0100/p33.html


I just sat through 2 days of Studer Group material so these were the ones fresh in my mind.

There have been others that show patients rate foreign doctors delivering correct care worse than American doctors delivering bad care and so on. Patients don’t have a clue. They base their likes and dislikes on stuff that has nothing to do with correct care and certainly nothing to do with their doctor’s intelligence.

After the brain drain any doctor that is marginally competent but a snappy dresser and a charming conversationalist will be just fine.

 

[docB]

I wish I had time and a Facebook page because many of the comments on that page are ******ed.



Morbidity and mortality will increase if or when this happens.

Compared to what? In the future it will be really difficult to prove that M&M got worse due to physician quality issues rather than any number of confounders. More importantly what difference would it make? Patients won't be able to time travel to a time when doctors were smarter.

 

[gutonc]

Here are a few articles that discuss the fact that patients either weight elements of physician interactions that have nothing to do with technical competence such as appearance or that patient satisfaction has little to do with actual quality of care delivered.

Patient’s perceptions of the quality of their hypertension care does not correlate with the quality as judged by reviewing the record.
http://www.bmj.com/cgi/content/abstract/333/7557/19

Patients were unable to accurately rate their quality of care
http://www.annals.org/content/144/9/665.abstract?sid=96a0838c-dc16-4a61-bd78-0ec7af80d492

Patient satisfaction does not equate to quality of care in MI
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.108.792713v1

AAFP review article that notes that patients heavily weight non technical physician qualities such as communication, appearance, time spent and “willingness to listen” more than compentency.
http://www.aafp.org/fpm/2007/0100/p33.html


I just sat through 2 days of Studer Group material so these were the ones fresh in my mind.

There have been others that show patients rate foreign doctors delivering correct care worse than American doctors delivering bad care and so on. Patients don’t have a clue. They base their likes and dislikes on stuff that has nothing to do with correct care and certainly nothing to do with their doctor’s intelligence.

After the brain drain any doctor that is marginally competent but a snappy dresser and a charming conversationalist will be just fine.

Thanks for all the links and actual data. Of course, this can be boiled down to the following: "people are stupid."

 

[Long Dong]

Thanks for all the links and actual data. Of course, this can be boiled down to the following: "people are stupid."

That means job security for docs because their is no cure for stupidity.

 

[deleted87716]

After the brain drain any doctor that is marginally competent but a snappy dresser and a charming conversationalist will be just fine.

Whew.

 

[deleted87716]

Wouldn't an all cash option be limited to practices in places where people are capable of actually paying for their health care?

Primary care is cheap, relatively speaking.

 

[Winged Scapula]

Whew.

I was thinking the same thing...thank goodness for the Jimmy Choos the patients always comment on.

 

[SouthernSurgeon]

If the financial reward becomes too much less than the effort put in there will be a "brain drain" in medicine. Eventually, only desperate foreign medical graduates will be filling our residencies and subsequently our hospitals.

In the mean time, I'm sure the hell not going in to primary care.

Sidestepping the argument about whether patients would care/notice...

I think it is unrealistic to think there will be any appreciable "brain drain" for quite some time. You already have a decades worth of physicians "in the pipeline" if you go from current senior residents to 1st year med students. That's not even counting the premeds (and if you read the threads on this stuff in pre-allo you'll see that it's not dissuading any of them).

If there were to be any notable brain drain, it would come far too late to do us any good.

 

[MOHS_01]

Why not? We're going to be in a lot better position than most specialists to be able to respond to whatever healthcare reform dishes out.

We could all go cash-only and still keep our waiting rooms filled.

Maybe we should.

First part is true enough -- the higher the episode of care costs the less protected in the current (future) environment.

I still call on the second part, though. If most PCP's went to a cash only model, in the absence of widespread abandonment of the traditional copay insurance model, there will not be enough patients willing to pay cash to keep a full book. I believe that you give the public a little too much credit... they'll just find some half trained provider who takes their insurance to fill the void.

 

[deleted87716]

If most PCP's went to a cash only model, in the absence of widespread abandonment of the traditional copay insurance model, there will not be enough patients willing to pay cash to keep a full book.

If most primary care physicians went cash-only, they wouldn't have much choice. The remaining doctors who accepted insurance wouldn't be able to handle the workload.

You might have a two-tiered system, but then...we pretty much do already.

 

[Dr Oops]

Sidestepping the argument about whether patients would care/notice...

I think it is unrealistic to think there will be any appreciable "brain drain" for quite some time. You already have a decades worth of physicians "in the pipeline" if you go from current senior residents to 1st year med students. That's not even counting the premeds (and if you read the threads on this stuff in pre-allo you'll see that it's not dissuading any of them).

If there were to be any notable brain drain, it would come far too late to do us any good.

its already happening in primary care.

 

[fab4fan]

Whew.

Like you needed to worry.

 

[deleted87716]

From the blogosphere:

New primary care doctors are going cash only

Medicare cuts will strengthen doctors’ negotiating position

 

[IDBasco]

From the blogosphere:

New primary care doctors are going cash only

Medicare cuts will strengthen doctors’ negotiating position

I would like to believe the premise of the second article BUT as it mentions, the gov can simply force docs to take their patients via legislation. I don't think most Americans would shed a tear for the docs in that circumstance.

 

[Pembleton]

jokeu

 

[deleted87716]

the gov can simply force docs to take their patients via legislation

They'd have to repeal the 13th Amendment first.

 

[IDBasco]

They'd have to repeal the 13th Amendment first.

Bah. That won't stop a determined bureaucrat. You have way more faith in the government than I do- especially the current administration. Like Clinton said, it depends on the what the meaning of the word is, is.

 

[deleted87716]

Bah. That won't stop a determined bureaucrat. You have way more faith in the government than I do.

No, but I've read the Constitution. So have they. So have their lawyers. So have pretty much everyone's lawyers.

 

[IDBasco]

No, but I've read the Constitution. So have they. So have their lawyers. So have pretty much everyone's lawyers.

Ever heard of the draft? A different situation, sure, but shouldn't the 13th amendment prevent it? The supreme court decided it didn't apply to military, jury duty, etc. In short, it came down to interpretation or "intent" of the amendment. Well, nothing prevents that from happening again.

Butler v Perry (240 US 328 [1916]), the Supreme Court wrote:

[The 13th Amendment] introduced no novel doctrine with respect of services always treated as exceptional, and certainly was not intended to interdict enforcement of those duties which individuals owe to the state, such as services in the army, militia, on the jury, etc. The great purpose in view was liberty under the protection of effective government, not the destruction of the latter by depriving it of essential powers.

Is the war and military different from healthcare? Yup. But there will always be room for interpretation of "intent", and that is exactly why I don't have the same faith you do. Believe whatever you choose.

 

[deleted87716]

Ever heard of the draft? ... Is the war and military different from healthcare? Yup.

Need I say more?

 

[MOHS_01]

Blue, I wish that I had your optimism/blind faith/whatever it is.... they trample on the Constitution with great regularity. I really don't see how this would be any different -- if they were faced with the prospect of not having enough providers to pass out the bread and man the circus. Of course they could always open the FMG floodgates........ or give full scope / run to DNPs, PAs, NPs.....

 

[Sneezing]

Blue, I wish that I had your optimism/blind faith/whatever it is.... they trample on the Constitution with great regularity. I really don't see how this would be any different -- if they were faced with the prospect of not having enough providers to pass out the bread and man the circus. Of course they could always open the FMG floodgates........ or give full scope / run to DNPs, PAs, NPs.....

If this happens it just means physicians will not leave the government care to these lesser trained "providers". Physicians will still service the population who values knowledge, skill, and hardwork of a physician.

 

[deleted87716]

Blue, I wish that I had your optimism/blind faith/whatever it is...

Lack of frank paranoia?

 

[lipomas]

Physicians will still service the population who values knowledge, skill, and hardwork of a physician.

LOL. That leaves about 100 people around the country. Most of those still think they should get all their care for free! Or they are broke and can't pay anyway.

Since when do people value knowledge and skill anymore? People only value hard work when it is their own hard work and they are getting paid for it. Or they value someone else's hard work if it saves THEM money. People mostly only value knowledge and skill when it doesn't cost any more than less knowledge and skill. Some people tend to value knowledge that validates their opinions and biases, but that usually involves talk radio or magazines or corrupt politicians, not their medical care (unless they are suing someone).

 

[MOHS_01]

Lack of frank paranoia?

I bet you're one of those who would have been totally shocked and taken aback when the feds outlawed the ownership of gold, confiscated it, paid it out at "market value" -- which was a farce in and of itself, but that's another story for another time -- and proceeded to immediately devalue your savings by the order of 45%, give or take.

 

[Sneezing]

Or they value someone else's hard work if it saves THEM money.

Good point. You advertise how saving money is equal to improving their health. It really is a simple marketing scheme, actually truth really.

 

[docB]

I would like to believe the premise of the second article BUT as it mentions, the gov can simply force docs to take their patients via legislation. I don't think most Americans would shed a tear for the docs in that circumstance.

They'd have to repeal the 13th Amendment first.

When I first read IDBasco's comment I had the same reaction. But as I thought about it I realized that's what they did to emergency docs with EMTALA (the law that says patients must be treated in EDs without regard to ability to pay). There are some differences of course. EMTALA applies to anyone who takes Medicare (which is all ER docs) and you're talking about bailing on Medicare altogether.


So I disagree with Blue Dog on this (which is unusual). I can envision a situation where the govt. created a statutory obligation for docs. They could attach it to med school loans, licensure, etc. I think that if doc really left the CMS programs en masse it's a possibility.

 

[dragonfly99]

Is that what other countries do? (force docs to take/accept all comers into their practices)

I'd expect that in countries with truly socialized medicine (i.e. gov't is a single payer and all docs are gov't employees).

 

[deleted87716]

I can envision a situation where the govt. created a statutory obligation for docs. They could attach it to med school loans, licensure, etc. I think that if doc really left the CMS programs en masse it's a possibility.

If the government forced doctors to accept Medicare at a rate of reimbursement that essentially made it impossible for them to stay in business (which is pretty much what we have today - the only way any of us keep our doors open is by cost-shifting from better-paying commercial contracts) they would FORCE ALL OF THE DOCTORS OUT OF BUSINESS.

Not a particularly smart political move, IMO.