Medicare Plans to Cut Specialists' Payments

[Hernandez]

That is a very real reality. Why work yourself to the bone 70-90 hours/week and make the same as someone who works 9-5 for 3 years of residency?

God I can't believe the stereotypes that persist about physician specialties even with groups of physicians......

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[Pir8DeacDoc]

I've been to medical school. I've spent 3 months of my rotations doing family medicine. They are GREAT people and make for a great medical "home" for patients. But let's not kid ourselves into thinking they put in a ton of hours during residency.


For the record I went to a good primary care medical school (at least so sayeth the rankings)

 

[Hernandez]

I've been to medical school. I've spent 3 months of my rotations doing family medicine. They are GREAT people and make for a great medical "home" for patients. But let's not kid ourselves into thinking they put in a ton of hours during residency.

For the record I went to a good primary care medical school (at least so sayeth the rankings)

I know just as many FM residencies that are run like IM residencies as I do the ones who take home call and don't step foot in the hospital after their intern year.

 

[dynx]

I know just as many FM residencies that are run like IM residencies as I do the ones who take home call and don't step foot in the hospital after their intern year.

all respect when I say...bitch please! C'mon....we all went to medical school. We all rotated through the services with the FP residents. It's cake. Its the puffball of residency training. We all know it. You aren't fooling anyone. Go preach to the pre-meds if you're trying to fool people.

There are a couple hard core FP residency programs out there, I don't deny that, but they are the exception.

 

[spyyder]

That is a very real reality. Why work yourself to the bone 70-90 hours/week and make the same as someone who works 9-5 for 3 years of residency?

You should be going into a field because you enjoy it, not because of the number of years of training or expected salary. This will allow people that ACTUALLY want to go into a certain field an equal opportunity. You think half the people that apply to derm give a crap about the field?

 

[Pir8DeacDoc]

You should be going into a field because you enjoy it, not because of the number of years of training or expected salary. This will allow people that ACTUALLY want to go into a certain field an equal opportunity. You think half the people that apply to derm give a crap about the field?

I agree with this completely. Honestly I'd be doing ENT either way. But it's a tough pill to swallow that half my class from med school is already done with residency and starting practice (i.e paying off school loans). I'll be able to make up the difference eventually but if people are going to dedicate such a huge chunk of their lives to training (i.e missing every social event and family gathering), I think there should be some financial pay out for that.

 

[Winged Scapula]

I agree with this completely. Honestly I'd be doing ENT either way. But it's a tough pill to swallow that half my class from med school is already done with residency and starting practice (i.e paying off school loans). I'll be able to make up the difference eventually but if people are going to dedicate such a huge chunk of their lives to training (i.e missing every social event and family gathering), I think there should be some financial pay out for that.

This is the problem I have with the "redistribution of wealth." I chose surgery because I enjoyed it but the training is miserable as is the lifestyle. I'll be damned if I don't think that that deserves more pay than other fields with less hours, shorter training and less liability.

 

[efex101]

What really gets me is that *****Obama thinks that by increasing pay to PC it will make for medical students going into field en masse wTF? they also talk about forgiving students loans blah blah blah like that is not already available. Nobody is going into PC "not" just because the $$$ but because it is insane to do so and practice good medicine. Seeing all the patients with 20 problem list and 40 medications in the alloted time is plain nuts. Most of the patients nowadays are ****ing train wrecks and living until freaking 90+. Who in their right mind wants to take care of this folks?

 

[DrFraud]

I have trouble believing that reducing payments to specialists will somehow be enough to allow for a significant increase in pay to primary care docs. I think the decision to propose a redistribution of payments is related to the desire to pit doctors against each other and thus prevent a unified medical position by physicians on the changes proposed.

By bickering about who works harder or who deserves more money, it just increases the likelihood that the proposals will go through without appropriate scrutiny by physicians, something in my opinion is in the interest of those who are writing this proposal and who are very much against discussing issues that could negatively affect the salaries of lawyers and the vast expense of time and money expended out of fear of lawsuits.

 

[asmallchild]

I have trouble believing that reducing payments to specialists will somehow be enough to allow for a significant increase in pay to primary care docs. I think the decision to propose a redistribution of payments is related to the desire to pit doctors against each other and thus prevent a unified medical position by physicians on the changes proposed.

By bickering about who works harder or who deserves more money, it just increases the likelihood that the proposals will go through without appropriate scrutiny by physicians, something in my opinion is in the interest of those who are writing this proposal and who are very much against discussing issues that could negatively affect the salaries of lawyers and the vast expense of time and money expended out of fear of lawsuits.

Excellent argument

 

[Taurus]

I have trouble believing that reducing payments to specialists will somehow be enough to allow for a significant increase in pay to primary care docs.

The cuts to specialists accomplish two things

1) increase primary care pay
2) increase the number of primary care residencies (the word on the street is 15%)

It doesn't matter frankly if US grads don't go for the bait and enter primary care. There's a huge number of FMG's who would love to get one instead. Remember that a large percentage of FM and IM slots go to FMG's already. However, there will be 30% increase in med grads from 2004 levels over the next few years. So many US grads will be forced to go into primary care whether they want it or not.

 

[DrFraud]

The cuts to specialists accomplish two things

1) increase primary care pay
2) increase the number of primary care residencies (the word on the street is 15%)

You're forgetting part II of the cuts my young grasshopper. Fast forward 3 years from now, when a new set of cuts are made, this time to primary care after a new wave of primary care docs finish residency, likely in the order of 10-15%.

At this point, the specialists won't care because the primary care docs didn't stand up for them, and now everyone will end up with smaller pieces of a smaller pie.

Instead of bickering as to who deserves more and who should profit at whose expence, we all should be defending cuts against any area as if it were against the area of practice that we as individuals are in. The alternative will be cuts to everyone on the installment plan.

 

[frank51]

I also believe that this redistribution will not persuade anyone to go into PC if they weren't interested in the first place, more importantly does anyone know what the likelihood is of these cuts actually becoming reality?

 

[DrFraud]

I also believe that this redistribution will not persuade anyone to go into PC if they weren't interested in the first place, more importantly does anyone know what the likelihood is of these cuts actually becoming reality?

Well, i think one advantage the lawers have is they always stick together, whether in congress, in the white house, or in practice. We as doctors are getting caught up in a foolish argument around who deserves more and at whose expence it should come at.

I think this quote during the revolutionary war is very apropos

"We must, indeed, all hang together, or most assuredly we shall all hang separately"

Unlike the lawyers, doctors are not forming a unified front. Instead of arguing for reductions in costs by advocating tort reform, finding cases where tort reform improved care and reduced surplerfluous and costly procedures, and advocating for electronic records and improvents to technology infrastructure, as well as trying to lower the expence/tuition for educating doctors, and many other areas of health care reform that can try and find ways to reduce beaurocratic red tape and time that doctors have to waste arguing with insurance companies.

Just as an example, we need to explain to people and continue to hammer away how lawsuits against OB/GYN doctors by 16 year old patients (years after their birth) negatively affects care by reducing the number of OB/GYN docs who are willing to deliver babies and increases the cost for everyone instead of getting stuck on whether primary care doctors should get raises at the expence of specialists.

We all should be against this, otherwise, we will all eventually get screwed.

 

[Taurus]

Instead of bickering as to who deserves more and who should profit at whose expence, we all should be defending cuts against any area as if it were against the area of practice that we as individuals are in. The alternative will be cuts to everyone on the installment plan.

Before entering medicine, I knew full well that we were at the mercy of CMS and that cuts were inevitable with Medicare and Soc Security going broke. If anything this country will need to cut total healthcare spending. I did my homework before I went to medical school. Did you? Yes, this is just the start of cuts. Nobody is forcing anybody to stay in this field. If you want to make money, medicine is not the place for it.

So I chose a specialty where even if they cut my pay by 50% I would be fine with it. I won't be rounding all day and writing stupid H&P notes. I won't be standing in the OR for 10 hours either.

 

[DrFraud]

Before entering medicine, I knew full well that we were at the mercy of CMS and that cuts were inevitable with Medicare and Soc Security going broke. If anything this country will need to cut total healthcare spending. I did my homework before I went to medical school. Did you? Yes, this is just the start of cuts. Nobody is forcing anybody to stay in this field. If you want to make money, medicine is not the place for it.

So I chose a specialty where even if they cut my pay by 50% I would be fine with it. I won't be rounding all day and writing stupid H&P notes. I won't be standing in the OR for 10 hours either.

yes i did. My primary concern is not that cuts are impending. It's how it is happening and the affect it is having on docs in different areas. We should not be fighting with each other about this, the more we fight, the less unified and the more likely the interests of patients will be secondary to the interests of businesses, politicians, and lawyers.

 

[sirus_virus]

I also believe that this redistribution will not persuade anyone to go into PC if they weren't interested in the first place, more importantly does anyone know what the likelihood is of these cuts actually becoming reality?

I slightly disagree with this point; as much as we like to pretend money does not drive specialty interest , you just need to look at the rank of competitiveness of different specialties and you will see it follows strictly by pay (except PM&R of course).
If you close the pay gap between PCPs and specialists even without raising PCP pay, you will see an increased migration in that direction. Throw in a pay raise for PCPs and more robust loan forgiveness as this administration has proposed, then you might actually see Primary care becoming somewhat competitive to get into. This is the case presently in some European countries as we speak.

 

[Taurus]

We should not be fighting with each other about this, the more we fight, the less unified and the more likely the interests of patients will be secondary to the interests of businesses, politicians, and lawyers.

The lobbyists for each specialty will duke it out in Washington along with lobbyists from every other interest group out there. Do I hope that the cuts to my specialty is less? Sure, but there's not much I can do to influence the final outcome. It is what it is. I will accept and live with the outcome.

Bottom line is be very careful what specialty you go into. Are you gonna regret going into something like so many attendings I know? I for one would shoot myself if I had to see patients, round, and write H&P notes all day or stand for 10 hours for surgery. Money is important but ask yourself if you would still do it if your salary was cut by 50%.

 

[Taurus]

This is the case presently in some European countries as we speak.

This is true. The most competitive field to get into in England is General Practice. In fact, you get a lower salary if you specialize.

 

[medsRus]

This is true. The most competitive field to get into in England is General Practice. In fact, you get a lower salary if you specialize.

Wow, I never knew this. What are the salary differences out there?

 

[GassiusClay]

that is insane.

changing the malpractice milleu would do a lot to help. doctors are doing the best they can under stressful circumstances...surgical/medical specialists moreso than PCP's. You shouldn't have to walk on eggshells to do your job. They need to fix that. Obama has been a complete wimp on this issue.

Wimp or weasel? I think more so the latter. I couldn't believe that everybody acted like snobs toward McCain and then basically rimjob this weasel. He's a lawyer first and pathetic nanny-state loving Democrat second. I'm not saying that Republicans are perfect, but some of their propositions invite responsibility versus should be someone else's burden mentality.

Malpractice is here to stay. I say current doctors be brutally honest to those deciding to enter medicine. Something like the "Stay Away Campaign."

 

[Disciple]

I slightly disagree with this point; as much as we like to pretend money does not drive specialty interest , you just need to look at the rank of competitiveness of different specialties and you will see it follows strictly by pay (except PM&R of course).

So, are you saying that PM&R specialists make more than they should given the level of competitiveness, or that the level of competitiveness is lower than it should be, given the average compensation for PM&R specialists.

 

[frank51]

I slightly disagree with this point; as much as we like to pretend money does not drive specialty interest , you just need to look at the rank of competitiveness of different specialties and you will see it follows strictly by pay (except PM&R of course).
If you close the pay gap between PCPs and specialists even without raising PCP pay, you will see an increased migration in that direction. Throw in a pay raise for PCPs and more robust loan forgiveness as this administration has proposed, then you might actually see Primary care becoming somewhat competitive to get into. This is the case presently in some European countries as we speak.

Generally, the more competitive a specialty, the higher the salary, I completely agree. In order to persuade people to go to PC, the cuts have to be much more extreme, and if that happens, a lot of people will not put the time and effort to specialize, theoretically we would then face a shortage of specialists, but who knows, the reality may be very different.

 

[sirus_virus]

So, are you saying that PM&R specialists make more than they should given the level of competitiveness, or that the level of competitiveness is lower than it should be, given the average compensation for PM&R specialists.

Yes, but that is because a lot of students have not even heard of it let alone consider it as a specialty. BTW, I am against any type of pay cut even under the guise of narrowing the salary gap.

I know I have been flamed a lot of times on SDN for advocating physician unions and strikes, but it is not hard to see the powerlessness of the physician workforce manifesting itself. Specialists were complacent when the notion was that it was the PCPs losing money; but after that long meeting between insurance execs and Obama, where they agreed to focus on primary care and "reduce fragmented payments for fragmented care" AKA slash specialist pay, specialist are now officially on the chopping blocks too. This is not going to be a gradual process either, don't be surprised if the percentage cuts from private insurance companies exceeds that of Medicare in the next few years. For one thing, who is going to stop them?

 

[Disciple]

So, in other words, PM&R would be more competitive if more medical students knew about it.

For clarification, there are generally 2 main types of physiatrists. Inpatient based (averages a little higher than primary care) and outpt EMG/interventional pain management/Occ Med/Sports Med based (averages closer to Anesthesiology pain management).



Physicians are not going to band together.

I'm reminded of this every time I get into an argument over the phone on a insurance utilization review call with a physican in my same specialty, in my state.




Don't be the last rat on a sinking ship.

 

[platon20]

If I am a better surgeon than you, and more people come to me because I am better, and thus I do more Total Knees/radical mastectomies/whatever than you bet I should be paid more than you. I don't see why that is hard to understand, maybe I'm missing something.

Wrong. If you are better than everybody else, then those patients will recognize that and pay you out of pocket for whatever you want to do to them. That way you can charge $10,000 dollars and live like a king because everybody loves you. If people want to pay for your services, let them pay out of pocket, not use taxpayer dollars.

 

[platon20]

This is the problem I have with the "redistribution of wealth." I chose surgery because I enjoyed it but the training is miserable as is the lifestyle. I'll be damned if I don't think that that deserves more pay than other fields with less hours, shorter training and less liability.

Nobody's saying that specialists should get paid the same as PCPs. Were simply stating that the pay differential should be at most, double, not 5 times or 10 times what a PCP makes.

 

[Winged Scapula]

Nobody's saying that specialists should get paid the same as PCPs. Were simply stating that the pay differential should be at most, double, not 5 times or 10 times what a PCP makes.

And I agree with you: some specialists make ridiculous amts of money. But for those of us who already don't make double what a PCP makes (which is most junior general surgeons) I fail to see how the cuts for us and increased reimbursement for PC is going to do anything but bring our salaries much closer.

 

[Flopotomist]

I can't believe this thread made it to page two with nobody pointing out that one of the "primary care" specialties getting a raise after all this is done is chiropractics. Seems like with an ever shrinking pie, maybe we should start to be more selective about who gets pieces instead of quibbling over how big the pieces are.

 

[psychforme]

why does the gov pay for chiropractics at all?

 

[medsRus]

why does the gov pay for chiropractics at all?

Because they can. JK...

Many studies demonstrate the clinical efficacy and cost-effectiveness of chiropractors, for example, in managing chronic lower back pain. That's way they get govt reimbursement. Now, this makes sense...

 

[mercaptovizadeh]

This whole primary care vs. specialists "debate" is covering up the reality of what goes under the two. An infectious disease doctor has 5 years of training, but his salary is not much greater than general IM. Likewise the endocrinologist, rheumatologist, and nephrologist. Coincidentally, these subspecialties are not the competitive subspecialties of IM. Cards, GI, heme/onc, and allergy/immuno are. In contrast, rad onc, rads, ophtho, and derm, have 5 or 4 year residencies, and the risk and knowledge base is frankly not much greater than in the above-mentioned specialties (OK, ophtho has some surgery involved, and improperly applied radiotherapy can be a problem) but the pay is not uncommonly 3X that of the low-procedure IM subspecialties. With pediatric subspecialties with 5 or even 6 years of training, the discrepancy is even more egregious.

We are not saying IM/peds/FP should be paid like neurosurgery, general surgery, orthopedic surgery, anesthesia, etc. Critically ill patients, rigorous/hellish training over longer years, technical procedures, higher legal liability, etc. OF COURSE surgeons of all types should be paid 2-3X what IM/peds and their subspecialties make. But to group surgery with many "fluffier" specialties with no where near the same risk or technicality is disingenuous. And many IM/peds residencies are no joke, either.

 

[medsRus]

OF COURSE surgeons of all types should be paid 2-3X what IM/peds and their subspecialties make.

I will not accept this statement as such and without further analysis. I don't envision an ideal system where pays are this discrepant.

 

[mercaptovizadeh]

I will not accept this statement as such and without further analysis. I don't envision an ideal system where pays are this discrepant.

So you don't think the neurosurgeon should be earning 3x or more what the general IM or pediatrician does?

 

[mercaptovizadeh]

Before you go and call a specialty fluffier and say that the risk and knowledge base is not much greater you should look into these specialties. I myself can only speak for radiation oncology and can say without a doubt that the fund of knowledge is signficantly greater. With clinical knowledge, physics, and biology required as part of the curriculum and board examiations in each I don't think that you can say that this is on par with an IM or FP or Peds fund of knowledge the basics of which are learned in medical school and internship. Further, depending on where you train in rad onc you can have a significant amount of surgical work in the form of brachytherapy.

If you read my post carefully, you would see that I was not comparing rad onc, etc. with IM/peds alone. I was comparing it to IM/peds + 2 year fellowship, i.e. the same number of years of training. It seems, however, that you want to claim that the rad onc fund of knowledge is significantly greater than the nephrologist, ID, endocrinologist, etc. fund of knowledge in their respective fields, and that that that merits a 2-3x greater salary. Perhaps the fund of knowledge really is 2-3x greater.

 

[Acherona]

The other reason why salaries should be more equal across specialties is that it will probably save the health care system money in the long-term by discouraging the over-use of procedures and encouraging a primary care/preventative strategy. As long as procedures receive disproportionate reimbursements, we will continue to see an overuse of non-indicated interventions.

 

[asmallchild]

In contrast, rad onc, rads, ophtho, and derm, have 5 or 4 year residencies, and the risk and knowledge base is frankly not much greater than in the above-mentioned specialties

A statement that is worthless unless its coming from someone who has been through both one of these "fluffy" residencies and a "real" residency.

We can all make assumptions from the outside. Unless we're actually doing it, that's exactly what they are. Assumptions.

 

[mercaptovizadeh]

A statement that is worthless unless its coming from someone who has been through both one of these "fluffy" residencies and a "real" residency.

We can all make assumptions from the outside. Unless we're actually doing it, that's exactly what they are. Assumptions.

While the term "fluffy" is insulting, it is in reference to how these specialties compare in rigor to surgery. Grouping them with surgery and surgical specialties when trying to contrast with primary care is disingenuous. They are much more similar to primary care in terms of risk and rigor (i.e. hours, call, etc.) than they are to surgery.

Care to explain why neurology, a four year residency, should be reimbursed so much less than derm, also a four year residency?

It makes no sense. I, and most other people, accept the discrepancy between surgical/highly procedural specialties and the more diagnostic specialties, and we accept a large different in pay. But please do not try to sell me this BS of how derm/radiology/ophtho is so much more rigorous/intellectually tough than neuro/rheum/ID/endocrine/etc. specialties, which do the same/similar years of training, face similar risks and in many cases greater hours and more critically ill patients, and are thus deserving of 2-3x greater pay. That is a joke.

 

[MOHS_01]

I absolutely hate these pissing matches based upon "I think this" or "I think that" or "I think it is not fair".... it becomes patently clear in short order that ignorance of the medical reimbursement construct runs deep and wide throughout the ranks.

For about the 10,000th time -- we should not be speaking of physician income as if we are all salaried employees of some grand corporation. The compensation distribution varies almost as greatly within specialties as it does between specialties. Some of the discrepancy between specialties can be traced back to the individuals self-selected for the specialty in the first place. Some of it has to do with the FFS pay construct. Some of it has to do with disease prevalence, demographics, and trends. Much of it has to do with the individual practitioner.

People do not recognize the "difficulty" of any given specialty unless they have an in-depth knowledge of that discipline. Perhaps it would interest some of you to research the number of diagnoses / entities / disorders covered and tested on the respective board exams for the various specialties, as that is one of the most objective methods for measuring scope or breadth of knowledge base required..........

 

[asmallchild]

I absolutely hate these pissing matches based upon "I think this" or "I think that" or "I think it is not fair".... it becomes patently clear in short order that ignorance of the medical reimbursement construct runs deep and wide throughout the ranks.

For about the 10,000th time -- we should not be speaking of physician income as if we are all salaried employees of some grand corporation. The compensation distribution varies almost as greatly within specialties as it does between specialties. Some of the discrepancy between specialties can be traced back to the individuals self-selected for the specialty in the first place. Some of it has to do with the FFS pay construct. Some of it has to do with disease prevalence, demographics, and trends. Much of it has to do with the individual practitioner.

People do not recognize the "difficulty" of any given specialty unless they have an in-depth knowledge of that discipline. Perhaps it would interest some of you to research the number of diagnoses / entities / disorders covered and tested on the respective board exams for the various specialties, as that is one of the most objective methods for measuring scope or breadth of knowledge base required..........

 

[radslooking]

Before you go and call a specialty fluffier and say that the risk and knowledge base is not much greater you should look into these specialties. I myself can only speak for radiation oncology and can say without a doubt that the fund of knowledge is signficantly greater. With clinical knowledge, physics, and biology required as part of the curriculum and board examiations in each I don't think that you can say that this is on par with an IM or FP or Peds fund of knowledge the basics of which are learned in medical school and internship. Further, depending on where you train in rad onc you can have a significant amount of surgical work in the form of brachytherapy.

Honestly, you've got a pretty myopic view of this whole thing. I really don't think the fund of knowledge is really that incredibly different. Moreover, you have forgotten much of the knowledge that you would need to function on a daily basis as an FP/Peds/IM MD. Moreover, you could make the argument that some specialists should be paid less because they deal with "less crap". Calls, pain meds, paperwork etc etc. I've frequently heard this used as a reason why people would never do a PCP's job, but then it's conveniently left out when talking about compensation and 'how easy' it is. I think you could make a strong argument for the amount of baloney PCP's deal with, they should be making much better salaries.

 

[medsRus]

I've seen how much radiation oncologist work compared to primary medicine doctors, and it is not certainly not more. Also, I doubt that they are any different in terms of amount of training compared to any fellowship trained physician.

 

[mercaptovizadeh]

Let's compare:

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Specialty | Median | Starting

5 year surgical residencies:

General Surgery $337,595 $222,950

Orthopedic Surgery $450,000 $312,208

5 year non/minimal procedural residencies (+/- fellowships):

Diagnostic Radiology - Non-Interventional $420,858 $330,000

Radiation Therapy (M.D. only) $395,166 $295,200

Endocrinology $205,497 $160,000

Hypertension & Nephrology $246,646 $176,960

Infectious Disease $220,601 $154,900

Rheumatologic Disease $217,010 $160,000

Pediatric Infectious Disease $174,154 ****

Pediatric Neurology $204,540 ****

Pediatric Nephrology $192,958 ****

Pediatric Endocrinology $187,693 ****

Let me just toss in a few 6 year training programs, for comparison:

Pediatric Gastroenterology $218,032 ****

Pediatric Cardiology $234,613 ****

Pediatric Hematology / Oncology $205,567 ****

4 year residencies:

Ophthalmology $305,301 $211,000

Dermatology $344,847 $230,000

Ob/Gyn $283,110 $197,000

Neurology $229,119 $180,000

I find it disturbing that a pediatric hematologist/oncologist, who has 6 years of training and works a job that is very emotionally trying, with sick and dying children, and encounters numerous critical complications arising from cancer and its treatments, earns less than half what a diagnostic radiologist (5 years of training) earns.

Something is very rotten with the compensation.

 

[Taurus]

I find it disturbing that a pediatric hematologist/oncologist, who has 6 years of training and works a job that is very emotionally trying, with sick and dying children, and encounters numerous critical complications arising from cancer and its treatments, earns less than half what a diagnostic radiologist (5 years of training) earns.

Something is very rotten with the compensation.

Oh go cry me a river.

Is it fair that some investment bankers made $50 million and up (as much as billions) per year?

This is the United States of America. We live in a free market society. There will always be disparities in pay for many different reasons in every industry. That's life and deal with it.

That's why the best and brightest naturally go where there is money and lifestyle. That's why investment banking is very difficult to break into. That's why derm, plastics, rad, rad onc are very difficult to get into. Obama wants to change the pay structure and incentives to promote more primary care. If he succeeds into making primary care a money/lifestyle field, then there will be more competition to get into it. That's why in many European countries like England primary care is the most competitive field to get into.

 

[psychforme]

Oh go cry me a river.

Is it fair that some investment bankers made $50 million and up (as much as billions) per year?

This is the United States of America. We live in a free market society. There will always be disparities in pay for many different reasons in every industry. That's life and deal with it.

That's why the best and brightest naturally go where there is money and lifestyle. That's why investment banking is very difficult to break into. That's why derm, plastics, rad, rad onc are very difficult to get into. Obama wants to change the pay structure and incentives to promote more primary care. If he succeeds into making primary care a money/lifestyle field, then there will be more competition to get into it. That's why in many European countries like England primary care is the most competitive field to get into.

Well go cry a river now that someone with a spine cuts these ridiculous reimbursements.

 

[radslooking]

I understand its a free society and all that. I dont expect or want people to be made equal. My problem is compensation isn't based on any objective measures. There should generally be a risk/reward relationship with pay. Longer residency, more pay. Longer hours, more pay. More crap to deal with more pay. More prestige....actually can actually be a negative influence on pay sometimes because it can attract in ways other than compensation.

My point is there is usually a risk/reward in most things, and in our situation, it is lacking.

 

[DrFraud]

I understand its a free society and all that. I dont expect or want people to be made equal. My problem is compensation isn't based on any objective measures. There should generally be a risk/reward relationship with pay. Longer residency, more pay. Longer hours, more pay. More crap to deal with more pay. More prestige....actually can actually be a negative influence on pay sometimes because it can attract in ways other than compensation.

My point is there is usually a risk/reward in most things, and in our situation, it is lacking.

errrrrrrrrrr, how about supply and demand too. Adam Smith is turning in his grave somewhere.........

 

[mercaptovizadeh]

Oh go cry me a river.

Is it fair that some investment bankers made $50 million and up (as much as billions) per year?

This is the United States of America. We live in a free market society. There will always be disparities in pay for many different reasons in every industry. That's life and deal with it.

That's why the best and brightest naturally go where there is money and lifestyle. That's why investment banking is very difficult to break into. That's why derm, plastics, rad, rad onc are very difficult to get into. Obama wants to change the pay structure and incentives to promote more primary care. If he succeeds into making primary care a money/lifestyle field, then there will be more competition to get into it. That's why in many European countries like England primary care is the most competitive field to get into.

What a joke. Medicine in the US is competitive how? If it was truly competitive, then whoever wanted to could practice medicine and charge whatever rates he/she wanted that patients were willing to pay. Medicine is a highly regulated profession and has nothing to with the free market. You need to complete medical school, then you need to complete a residency program, and the slots are determined in a noncompetitive manner. We need a lot more dermatologists for all the demand. We squeeze the spots so the number of dermatologists stays low, and so that dermatologists never run out of patients and so they can demand high rates. Compensation is largely determined by the state via Medicare (noncompetitive), and then the insurance companies follow suit (therefore, also noncompetitive since all can fall back to the lowest common denominator set by the state). There's nothing free market about this at all.

 

[radslooking]

errrrrrrrrrr, how about supply and demand too. Adam Smith is turning in his grave somewhere.........

of course, that goes without saying. i was hoping my audience could assume certain things

 

[DrFraud]

of course, that goes without saying. i was hoping my audience could assume certain things

Given the arguments used to justify salery in this thread, one has to wonder if this assumption is valid.....