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

[michaelrack]

The Federal government can't force docs to take patients via legislation (although Obama doesn't seem to be bothered that much by Consititutional prohibitions). State governments could (and will, if the feds make this a condition of continued medicaid funding, or otherwise threaten to withhold $).

If a state medical licensure board made taking a certain # of medicare or medicaid patients a condition of licensure, I think it would be considered constitutional.

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[michaelrack]

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 all doctors- just solo practitioners and small groups. The Obama plan is to force most docs to become employees of hospitals or large organizations such as Kaiser- these organizations will receive subsidees (not in current legislation, but it's coming)

 

[deleted87716]

If a state medical licensure board made taking a certain # of medicare or medicaid patients a condition of licensure, I think it would be considered constitutional.

The state medical boards are comprised primarily of doctors (politically well-connected doctors, in most cases). I don't think that's a very likely scenario, either.

 

[IDBasco]

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.

I'm glad you brought EMTALA up. I was thinking about it, but my last post was enough as is. If all this were to happen, it wouldn't be in one fell swoop. (welcome to progressive politics) It would be incremental, say via a move to single payer or something and with later further tightening of regulations until docs simply don't have a choice. Starve, change careers or take the gov. pts. There would likely not be a law that just outright ordered docs to accept medicare with no choice. They don't have to do that- 13th amendment avoided.

If docs did try to rise up, it would be their relatively small number vs. the not so relatively small group of recipients of gov. healthcare. Who do you think the politicians will pay more attention to? Not to mention the gov. would probably label it as some kind of anti-trust and further put the screws to the docs.

 

[deleted87716]

If all this were to happen, it wouldn't be in one fell swoop. ... It would be incremental, say via a move to single payer or something and with later further tightening of regulations...

A move to single-payer wouldn't exactly be "incremental..."

 

[MOHS_01]

Not all doctors- just solo practitioners and small groups. The Obama plan is to force most docs to become employees of hospitals or large organizations such as Kaiser- these organizations will receive subsidees (not in current legislation, but it's coming)

I'm not sure as this bill has had more iterations than the Bible, but at one point this was spelled out rather explicitly. There was something about ACO's or provider groups in excess of X providers being eligible for Y. It's easier to exercise control over a small number of suits as opposed to a host of independent minded practitioners.

 

[Slack3r]

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.

You must not peruse pre-allo. Kids on there are willing to give a kidney and/or testicle for the "dream" of medicine and will happily tell you they'll work for $30k as long as they can play doctor.

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.

Getting your reimbursements cut slightly less than everyone else hardly puts you in a "lot better position", especially since most of the primary care emphasis is empty promises and smoke up-the-ass at this point.

Also, when (I doubt this is an "if" scenario) Washington requires Medicare/govt insurance acceptance for medical licensure, all those for-cash panaceas will be in a worse situation that they are now.

 

[medicinesux]

And you thought Medicare rates were dismal, check out what medicaid is now paying!

http://community.nytimes.com/commen...0/03/16/health/policy/16medicaid.html#preview

OBGYN in Michigan gets payed $842 for delivering a Medicaid patient's baby via C-section! Is that worth the risk of getting whopped with a 50 million dollar lawsuit if baby don't come out perfect????

 

[deleted87716]

Getting your reimbursements cut slightly less than everyone else hardly puts you in a "lot better position", especially since most of the primary care emphasis is empty promises and smoke up-the-ass at this point.

I was referring to the option to drop out of the insurance game altogether.

Also, when (I doubt this is an "if" scenario) Washington requires Medicare/govt insurance acceptance for medical licensure, all those for-cash panaceas will be in a worse situation that they are now.

That's incredibly unlikely to happen. A bill that would bankrupt our healthcare infrastructure would be political suicide.

 

[Slack3r]

That's incredibly unlikely to happen. A bill that would bankrupt our healthcare infrastructure would be political suicide.

Similar to passing an unpopular healthcare bill through a controversial reconciliation process?

 

[deleted87716]

Similar to passing an unpopular healthcare bill through a controversial reconciliation process?

That would likely prove politically damaging for Democrats, but the real problem would be the almost certain end of any semblance of bipartisanship.

I should add that most physicians support the healthcare reform bill.

 

[ygree001]

I should add that most physicians support the healthcare reform bill.

Do you have a source for that?
I'm not attacking you, just curious. I know it's anecdotal and limited, but I haven't met one that does.

 

[deleted87716]

Do you have a source for that?
I'm not attacking you, just curious. I know it's anecdotal and limited, but I haven't met one that does.

Check the policy positions for most physician organizations.

 

[Sneezing]

Organizations are not physicians. Most are made up of only a handful of those they claim to represent. Go to a place like Sermo and you'll see a different picture.
http://www.sermo.com/reform/survey_results
92% surveyed there do not believe any proposed health reform will address the real issues.

There is a massive disjunct between societies and real physicians, residents, and students.

 

[deleted87716]

There is a massive disjunct between societies and real physicians, residents, and students.

Maybe. So, what are you doing about it? Whining on Sermo or SDN doesn't count.

 

[vhawk]

Maybe. So, what are you doing about it? Whining on Sermo or SDN doesn't count.

You cant say "maybe," you just said earlier in this thread that state licensing boards are made up of doctors and doctors would never do things like that. You cant now say that "maybe" there is some massive disconnect between the official policies and positions of organizations and actual doctors.

 

[deleted87716]

You cant say "maybe," you just said earlier in this thread that state licensing boards are made up of doctors and doctors would never do things like that. You cant now say that "maybe" there is some massive disconnect between the official policies and positions of organizations and actual doctors.

"Maybe" simply means "prove it." Sermo and SDN are basically web sites filled with anonymous whining. No political clout whatsoever.

The two posts you mentioned aren't related. The post where state medical boards came up had to do with a hypothetical government mandate to accept Medicare/Medicaid. It had nothing to do with physician support of the Obama healthcare bill.

 

[Siggy]

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

One of the professors at my school seriously recommended cash only practices during a lunch lecture. Let the patients fight with their insurance companies to cover the bill. Even to an OMS-1 like me, that seemed a little over optimistic.

 

[deleted87716]

One of the professors at my school seriously recommended cash only practices during a lunch lecture. Let the patients fight with their insurance companies to cover the bill. Even to an OMS-1 like me, that seemed a little over optimistic.

It's being done.

Right now, the market is relatively limited, as long as most doctors continue to accept insurance. That could change.

 

[willow18]

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

What do you base this on?


http://jama.ama-assn.org/cgi/content/abstract/303/8/747
Conclusion A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees. (not overall salary).

As for salaries, I believe they are still rising as well:
http://www.merritthawkins.com/pdf/mha2009incentivesurvey.pdf
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

 

[lipomas]

What do you base this on?


http://jama.ama-assn.org/cgi/content/abstract/303/8/747
Conclusion A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees. (not overall salary).

As for salaries, I believe they are still rising as well:
http://www.merritthawkins.com/pdf/mha2009incentivesurvey.pdf
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Hours worked does not mean doing an equal amount of work per hour for fewer hours. Most docs are cramming more into their schedules. They may work fewer hours because they take less call and have someone else cover their hospitalizations, but they are doing more. And lots of people are working part time now.

Salaries may be rising but not adjusted for inflation, for the most part. The salaries of those who manipulate the system to their advantage (often at the expense of other physicians or even patients) are rising, but those aren't real numbers that should be considered because many of these physicians are *******s who should not be emulated.

I believe that data you posted but I also defy you to find more than a handful of practicing physicians (non-academic) who think that their compensation is improving and their work hours are improving.

 

[bookfreak89]

You must not peruse pre-allo. Kids on there are willing to give a kidney and/or testicle for the "dream" of medicine and will happily tell you they'll work for $30k as long as they can play doctor.



Getting your reimbursements cut slightly less than everyone else hardly puts you in a "lot better position", especially since most of the primary care emphasis is empty promises and smoke up-the-ass at this point.

Also, when (I doubt this is an "if" scenario) Washington requires Medicare/govt insurance acceptance for medical licensure, all those for-cash panaceas will be in a worse situation that they are now.

This. The attitudes concerning issues like these are like day vs. night. Pre-allo vs. practicing attendings. Idealism vs. reality? Reading what actual attendings are going through makes me question some of the responses I read over at Pre-Allo. Just wanted to chime in.

-PreMed student.

 

[telenurse]

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.

No wonder the night float residents love coming to my floor's monthly/bimonthly potluck party....the nurse's on my floor FEED the residents!