Pay me like a French doctor. You know you want to.

[BobbyB]

Hahaha, ok probation. I'll try harder to read sweden's tax code and come up with a real number and not punt like you did for another 14% tax rate bump without any facts or an understanding of progressive tax rates. You do, however, seem to know what the tour guide said. Tour guides are generally experts on the tax code in each country, that's why they give tours for a living.

running the numbers

lets see how much someone earning $150,000 would pay in taxes under the swedish tax code

31% 0-88,180: 27335.80
56% 88,180-150,000: 34619.20
total income tax: 61,955

about 41% plus a 25% VAT on anything you buy holy crap

lets compare to the US:
10% 0-8,925: 892.50
15% 8,926-36,250: 4098.75
25% 36,251-87,500: 12812.50
28% 87,851-150,000: 17500
total income tax: 35,303.75

about 23.5% with no VAT

GOD BLESS MURICA!!! USA! USA! USA!

that is $26,651.25 saved every year

---

Members don't see this ad.

 

[PL198]

Wait, you guys do know that the French government is in terrible debt, they have a workforce retention crisis, a productivity crisis, are incredibly socialistic and socially conservative, have low wealth inequality, a smaller population, and less health disparities than in the US right?

Nah all is well over there. It's a better way of life. Health care is a human right. Everyone should be able to have the highest level of care, for free. Doctors are useless and crap. Insert Atlas Shrugged quote here. F*ck France. I hope they go bankrupt.

 

[WhippleWhileWeWork]

Nah all is well over there. It's a better way of life. Health care is a human right. Everyone should be able to have the highest level of care, for free. Doctors are useless and crap. Insert Atlas Shrugged quote here. F*ck France. I hope they go bankrupt.

But...wine, cheese, and baguettes.

 

[PL198]

But...wine, cheese, and baguettes.

Nearly every system with socialized health care is limping around on a peg leg, so I'm not really sure why the rest of the world continues to push towards it

 

[Lucca]

Nearly every system with socialized health care is limping around on a peg leg, so I'm not really sure why the rest of the world continues to push towards it

The (wealthy) countries with single-payer systems (I am reflexively opposed to saying 'socialized' because that's facetious and doesn't mean anything) and countries without them have many problems in common and different kinds of problems too. The only difference with single-payer countries is that healthcare spending isn't one of their problems.

 

[WhippleWhileWeWork]

Nearly every system with socialized health care is limping around on a peg leg, so I'm not really sure why the rest of the world continues to push towards it

Because one day someone will get the balance just right, every person or group that's been given the power to try, thinks it will be them or convinced others that it will be them.

 

[TheRobin]

Wait, you guys do know that the French government is in terrible debt, they have a workforce retention crisis, a productivity crisis, are incredibly socialistic and socially conservative, have low wealth inequality, a smaller population, and less health disparities than in the US right?

None of these really address why the cost of medical education (or even higher ed. in general) is higher in the U.S. than in France.

If I had to give an educated guess, I would say that the reason costs for U.S. med. schools have increased is because of the amount of federal financial aid available. It's a constant supply of money for the schools. Couple that with decreases in state funding, and you have increases in tuition and fees.

 

[DermViser]

Pretty sure anyone with an income knows how they are being taxed. Idiot. And someone above mentioned paying a type of social security tax. Wiki mentions it but says go to other site for details.

And if you look wiki it says > 90k pays 56% tax. So most of their income is being taxed that high.

Keep talking. You're making yourself sound dumber by the moment. You provide no support for your argument and then try to make up bs against mine. Are you 12 bra?

 

[DermViser]

None of these really address why the cost of medical education (or even higher ed. in general) is higher in the U.S. than in France.

If I had to give an educated guess, I would say that the reason costs for U.S. med. schools have increased is because of the amount of federal financial aid available. It's a constant supply of money for the schools. Couple that with decreases in state funding, and you have increases in tuition and fees.

Simple. Bc it's a seller's market. Right now, no matter how high the cost of tuition is, people are willing to still apply to medical school either willingly, or forced to by their parents. Even if loans stopped, there are enough physician families who will send their sons and daughters to med school which they will pay in full.

 

[Lucca]

None of these really address why the cost of medical education (or even higher ed. in general) is higher in the U.S. than in France.

If I had to give an educated guess, I would say that the reason costs for U.S. med. schools have increased is because of the amount of federal financial aid available. It's a constant supply of money for the schools. Couple that with decreases in state funding, and you have increases in tuition and fees.

I'm not trying to explain it away. Just puzzled at the false comparison by the traditionally conservative, traditionally highly wealth and independence preoccupied SDN allos.

 

[TheRobin]

there are enough physician families who will send their sons and daughters to med school which they will pay in full.

No wonder the published mean debt for med. school graduates seems low. Just out of curiosity, any idea what percentage of folks out there pay in full?

I'm not trying to explain it away. Just puzzled at the false comparison by the traditionally conservative, traditionally highly wealth and independence preoccupied SDN allos.

I misread what you were driving at in the original post.

 

[Nidor]

.

 

[Psai]

@DermViser fails to recognize that European doctors are paid much less than American ones and the income tax is much higher in Europe. Go talk to some Euro residents at US programs. They'll tell you they left Europe and aint goin' back because the salaries and income taxes suck. They'll also tell you Europe is more medically advanced since they don't have FDA regulation. The FDA is good for keeping out the bad, harmful practices but the good things still take 10 years to approve here while in Europe they instantly go on the market. Everything has pluses and minuses.

Yeah that's how thalidomide happened.

 

[Priapism4tooLong]

french country side, vineyard, beautiful cheataeu, wonderful wife, children playing, grow your own wine, don't do anything stressful like dermatology from 10-4 ahhhh the life.

 

[notbobtrustme]

sure, if I can't work more than 36 hours a week, have 8 weeks guaranteed vacation and 1 year of paternity leave, with no student loans, no healthcare costs out of pocket, I'll take a 95k salary.

And is that even a physician's salary or is that a resident's? Much of the world doesn't even give out MDs until you pass the equivalent of a fellowship; most doctors are actually MBBS's or w/e the equivalent in France is.

 

[dadaddadaBATMAN]

Pretty sure anyone with an income knows how they are being taxed. Idiot. And someone above mentioned paying a type of social security tax. Wiki mentions it but says go to other site for details.

And if you look wiki it says > 90k pays 56% tax. So most of their income is being taxed that high.

Keep talking. You're making yourself sound dumber by the moment. You provide no support for your argument and then try to make up bs against mine. Are you 12 bra?

Someone else already pointed this out, but I think you're missing a few things.

1. The pay may be around 100,000 dollars, as opposed to our 160-200,000 dollars, but they are also working around 2/3 of our hours. I have yet to meet a primary care physician working less than 50 hour weeks, and a lot of them seem to work closer to 60 hours.

2. I don't have the exact numbers, but estimates of French vacation time seem to run around 5 weeks. You won't find that in the USA. This also works into the number of hours worked per year.

3. Those high taxes you're citing aren't present in a vacuum: they pay for things. Like health insurance, longer maternity/paternity leave, college, and medical school. I'm not arguing this is the best way to do things, but the high taxes are partially offset by the returned benefits. You are strictly looking at after tax income, as though that is the holy grail, without considering the costs in the USA.

4. I already mentioned this in #3, but the cost of medical school is huge. If you have $300,000 in debt (not unlikely with interest and loans), and practice for 20 years, it's another $15,000/yr from your pay (I know this is an oversimplification with repayment plans, interest, time to pay back, etc., but I'm lazy).

So don't simply write off the other countries' model "because high taxes are bad." It might make sense for a foreign graduate, who has already benefited from a drastically reduced cost of education, to come here when they finish training. But that doesn't necessarily mean US MDs are better off.

 

[Microshaft]

Payez-moi comme un médecin français. Vous savez que vous voulez.

 

[deleted500612]

sure, if I can't work more than 36 hours a week, have 8 weeks guaranteed vacation and 1 year of paternity leave, with no student loans, no healthcare costs out of pocket, I'll take a 95k salary.

And is that even a physician's salary or is that a resident's? Much of the world doesn't even give out MDs until you pass the equivalent of a fellowship; most doctors are actually MBBS's or w/e the equivalent in France is.

Pretty sure that is a full doctor's salary. You raise good points though, that the work week over there is MUCH more humane and tailored for lifestyle, and they are given more holidays and paid sick leave days than you could even imagine. I bet if you look at the total hours worked in a year for a PCP doc in France vs one in America, they end up being paid pretty similar per hour, just that the American docs work many more hours.

 

[llort1337]

Someone else already pointed this out, but I think you're missing a few things.

1. The pay may be around 100,000 dollars, as opposed to our 160-200,000 dollars, but they are also working around 2/3 of our hours. I have yet to meet a primary care physician working less than 50 hour weeks, and a lot of them seem to work closer to 60 hours.

2. I don't have the exact numbers, but estimates of French vacation time seem to run around 5 weeks. You won't find that in the USA. This also works into the number of hours worked per year.

3. Those high taxes you're citing aren't present in a vacuum: they pay for things. Like health insurance, longer maternity/paternity leave, college, and medical school. I'm not arguing this is the best way to do things, but the high taxes are partially offset by the returned benefits. You are strictly looking at after tax income, as though that is the holy grail, without considering the costs in the USA.

4. I already mentioned this in #3, but the cost of medical school is huge. If you have $300,000 in debt (not unlikely with interest and loans), and practice for 20 years, it's another $15,000/yr from your pay (I know this is an oversimplification with repayment plans, interest, time to pay back, etc., but I'm lazy).

So don't simply write off the other countries' model "because high taxes are bad." It might make sense for a foreign graduate, who has already benefited from a drastically reduced cost of education, to come here when they finish training. But that doesn't necessarily mean US MDs are better off.

Exactly. High income tax because they are paying everything else that is free for everyone, such as healthcare, education, more vacation, etc. Socialized economies are probably the best for society since everyone is treated more equal and have more opportunities, but they're bad for the rich and ppl with high-paying jobs. That's what America is for. MURICA!!!

Also, I have no school debt from college or med school so I'll be rollin once I finish residency. Best of my both worlds. I have all the medical fields open to me since I'm an AMG, while I also have no debt like an FMG. Suck it.

 

[Perrotfish]

sure, if I can't work more than 36 hours a week, have 8 weeks guaranteed vacation and 1 year of paternity leave, with no student loans, no healthcare costs out of pocket, I'll take a 95k salary.

And is that even a physician's salary or is that a resident's? Much of the world doesn't even give out MDs until you pass the equivalent of a fellowship; most doctors are actually MBBS's or w/e the equivalent in France is.

As always if you want free school, a stable though modest salary, great benefits, no malpractice concerns, good hours, relatively little control over your life and career, and the government for a boss I can put you in contact with a military recruiter today. Granted we do not have 1 year of paternity but then again neither does France (they guarantee 2 weeks, which is actually the same policy as the US military). You'll also have a much better tax rate than the French, a higher average salary, lower living expenses, a shorter training pathway, the opportunity to jump to higher civilian salaries 4 years after you finish residency, regular opportunities for promotion, and the option to retire on half pay 20 years after you graduate from medical school if you stay in. So really its a better deal than the one your pining for.

These threads pop up over and over again. Everyone whines about how badly medicine is going in America and how much better it is in Europe and how medicine is terrible and how our salaries are going to collapse entirely in a year or two. If anyone believed that there would be a line around the block for the military scholarships. Instead the recruiters are lucky to have more than one applicant per slot. Which makes me strongly suspect that y'all don't really believe what you're saying.

 

[llort1337]

running the numbers

lets see how much someone earning $150,000 would pay in taxes under the swedish tax code

31% 0-88,180: 27335.80
56% 88,180-150,000: 34619.20
total income tax: 61,955

about 41% plus a 25% VAT on anything you buy holy crap

lets compare to the US:
10% 0-8,925: 892.50
15% 8,926-36,250: 4098.75
25% 36,251-87,500: 12812.50
28% 87,851-150,000: 17500
total income tax: 35,303.75

about 23.5% with no VAT

GOD BLESS MURICA!!! USA! USA! USA!

that is $26,651.25 saved every year

Exactly. Thanks for doing the numbers. So clearly I'm right and @WhippleWhileWeWork is wrong. And that's how you take out the trash.

 

[Mad Jack]

sure, if I can't work more than 36 hours a week, have 8 weeks guaranteed vacation and 1 year of paternity leave, with no student loans, no healthcare costs out of pocket, I'll take a 95k salary.

And is that even a physician's salary or is that a resident's? Much of the world doesn't even give out MDs until you pass the equivalent of a fellowship; most doctors are actually MBBS's or w/e the equivalent in France is.

MBBS=US MD. In MBBS countries, a MD is a research-based degree equivalent to a PhD in medical science you get after your MBBS. A European MD=US MD/PhD. It's really just a terminology thing.

The Eurozone workweek applies to employed physicians. So you can enjoy a maximum of 36 mandatory work hours, 12 weeks paid vacation, zero educational debt, a full pension, and free health care as a French doctor.

 

[WhippleWhileWeWork]

Exactly. Thanks for doing the numbers. So clearly I'm right and @WhippleWhileWeWork is wrong. And that's how you take out the trash.

Hahaha, I know who you are now. You're the credit card guy from that other thread who got all butt hurt there too.

Also, if you think that an effective income tax rate of 41% + a consumption tax of 25% = 70% effective income tax rate then you can win all day. Winning! Clearly.

 

[PL198]

Exactly. High income tax because they are paying everything else that is free for everyone, such as healthcare, education, more vacation, etc. Socialized economies are probably the best for society since everyone is treated more equal and have more opportunities, but they're bad for the rich and ppl with high-paying jobs. That's what America is for. MURICA!!!

Also, I have no school debt from college or med school so I'll be rollin once I finish residency. Best of my both worlds. I have all the medical fields open to me since I'm an AMG, while I also have no debt like an FMG. Suck it.

Said no one ever. Show me 1 that has prospered. OH WAIT . Keep dreaming chief. The reason America succeeded from the start and was once the premiere nation of the world, was because it tried to get as far as possible away from the BS you are talking about. Those that do not understand the course of history are bound to repeat it.

 

[DocVapor]

As always if you want free school, a stable though modest salary, great benefits, no malpractice concerns, good hours, relatively little control over your life and career, and the government for a boss I can put you in contact with a military recruiter today. Granted we do not have 1 year of paternity but then again neither does France (they guarantee 2 weeks, which is actually the same policy as the US military). You'll also have a much better tax rate than the French, a higher average salary, lower living expenses, a shorter training pathway, the opportunity to jump to higher civilian salaries 4 years after you finish residency, regular opportunities for promotion, and the option to retire on half pay 20 years after you graduate from medical school if you stay in. So really its a better deal than the one your pining for.

These threads pop up over and over again. Everyone whines about how badly medicine is going in America and how much better it is in Europe and how medicine is terrible and how our salaries are going to collapse entirely in a year or two. If anyone believed that there would be a line around the block for the military scholarships. Instead the recruiters are lucky to have more than one applicant per slot. Which makes me strongly suspect that y'all don't really believe what you're saying.

I think you left out that whole deal about the large probability of getting shipped all over the globe for long periods, and the slim chance of it being a war zone, and dying there.

Edit: Not to say it isn't an admirable path. If I was younger and unmarried I certainly would have strongly considered it.

 

[dadaddadaBATMAN]

."relatively little control over your life and career, and the government for a boss

I filtered your post down to the problem that everyone has with it. And it isn't just the government for a boss, it's the military.
I have enough family that has gone through that particular brand of bull**** to know better.

Yeah, the military has some cool benefits. That's pretty much where the similarities end though: the major difference isn't in the positives, it's in the negatives. In places like France/Eurozone, workers' rights are massive and employer's rights are comparatively fewer than the USA. Look up the policy on firing people in France if you don't believe me.

The military is the exact opposite: you essentially sign away every right you have. So no, it isn't even remotely reasonable to "strongly suspect that y'all don't really believe what you're saying."

I may have misinterpreted your intent, but if you're trying to convince me military practice is even remotely like European practice you are completely full of it.

 

[neusu]

"Yep. As a friend of mine from a very upper-class background once said to me "Doctors are the hired help." She was actually speaking of a mutual friend of ours who was a successful ophthalmologist; in her mind, he was a tradesman. I frequently tell my friends that I see myself as a skilled worker not unlike a plumber. The problem is that most doctors are too immersed for too long in the arduous training that it takes to become a doctor, and they don't have the social awareness or the time to notice nuances like these, or how their lives are being affected by them. Those who are savvy enough, are either going into, or planning to go into non-clinical fields."

I was having a similar discussion with a capitalist friend of mine. FWIW, he is a partner at a private equity firm in NY and formerly was an analyst at Goldman Sachs. In essence, the conversation went as such:

Me, "What it comes down to, in the future, instead of me being an independent business owner of my own practice, I will become labour."

Him, "Dude, you'll be a neurosurgeon, no one will ever think of you as labour."

Me, "The current practice environment is changing. Having an independent practice or a small group is going away. As soon as the MBAs get us under their purview, we become another equation of how much they can get us to work with how little they can pay us."

Him, "You have a point, but I can't fathom you, or the general public would stand for that."

Me, "It's already done.."

 

[WhippleWhileWeWork]

I was having a similar discussion with a capitalist friend of mine. FWIW, he is a partner at a private equity firm in NY and formerly was an analyst at Goldman Sachs. In essence, the conversation went as such:

Me, "What it comes down to, in the future, instead of me being an independent business owner of my own practice, I will become labour."

Him, "Dude, you'll be a neurosurgeon, no one will ever think of you as labour."

Me, "The current practice environment is changing. Having an independent practice or a small group is going away. As soon as the MBAs get us under their purview, we become another equation of how much they can get us to work with how little they can pay us."

Him, "You have a point, but I can't fathom you, or the general public would stand for that."

Me, "It's already done.."

Thanks, Obama ?

I'd hate to think that the solution is in fact, a form of class warfare, essentially a PR campaign to defend Physicians by going on the offense with the real numbers of who's making what in medicine but....

 

[llort1337]

Hahaha, I know who you are now. You're the credit card guy from that other thread who got all butt hurt there too.

Also, if you think that an effective income tax rate of 41% + a consumption tax of 25% = 70% effective income tax rate then you can win all day. Winning!

Don't know about another thread, but if you were dumb there also then I'm sure you deserved it.

And you get my point about the taxation. That's nearly 70% in taxes...66%. You were arguing that Europe is similar to the US. If you're seriously going to try to argue a moot point now, then you're just showing how ignorant you are. Classic move by a 12 year old who lost the argument but won't give up and just makes himself look more stupid.

Anyways, this should no longer even be debated now. I already showed I'm correct and now you're just arguing for the sake of arguing. Let's get back to the next topic on why their taxes are so high and comparing to military service.

 

[llort1337]

I filtered your post down to the problem that everyone has with it. And it isn't just the government for a boss, it's the military.
I have enough family that has gone through that particular brand of bullcrap to know better.

Yeah, the military has some cool benefits. That's pretty much where the similarities end though: the major difference isn't in the positives, it's in the negatives. In places like France/Eurozone, workers' rights are massive and employer's rights are comparatively fewer than the USA. Look up the policy on firing people in France if you don't believe me.

The military is the exact opposite: you essentially sign away every right you have. So no, it isn't even remotely reasonable to "strongly suspect that y'all don't really believe what you're saying."

I may have misinterpreted your intent, but if you're trying to convince me military practice is even remotely like European practice you are completely full of it.

Good points.

 

[WhippleWhileWeWork]

Don't know about another thread, but if you were dumb there also then I'm sure you deserved it.

And you get my point about the taxation. That's nearly 70% in taxes...66%. You were arguing that Europe is similar to the US. If you're seriously going to try to argue a moot point now, then you're just showing how ignorant you are. Classic move by a 12 year old who lost the argument but won't give up and just makes himself look more stupid.

Anyways, this should no longer even be debated now. I already showed I'm correct and now you're just arguing for the sake of arguing. Let's get back to the next topic on why their taxes are so high and comparing to military service.

Did you just add 41 + 25 and conclude that that's a 66% income tax rate? Do you understand what income tax is? Do you understand what a purchase tax is? Do you understand that they are not the same thing?

Also, no, I wasn't arguing anything except your 70% income tax rate. Attention to detail...

 

[WhippleWhileWeWork]

View attachment 181109

Haha, I feel like this is more about the Parisians than the french as a whole. But the french don't even like the Parisians.

 

[PL198]

Did you just add 41 + 25 and conclude that that's a 66% income tax rate? Do you understand what income tax is? Do you understand what a purchase tax is? Do you understand that they are not the same thing?

Also, no, I wasn't arguing anything except your 70% income tax rate. Attention to detail...

LOL at the store and everything is 50 percent off and I have a 25 % discount, 75 % DISCOUNT OMG. YAY ADDING

Oh wait. I sincerely hope that dude/dudette has a better grasp on math if he/she is a medical student.

I was having a similar discussion with a capitalist friend of mine. FWIW, he is a partner at a private equity firm in NY and formerly was an analyst at Goldman Sachs. In essence, the conversation went as such:

Me, "What it comes down to, in the future, instead of me being an independent business owner of my own practice, I will become labour."

Him, "Dude, you'll be a neurosurgeon, no one will ever think of you as labour."

Me, "The current practice environment is changing. Having an independent practice or a small group is going away. As soon as the MBAs get us under their purview, we become another equation of how much they can get us to work with how little they can pay us."

Him, "You have a point, but I can't fathom you, or the general public would stand for that."

Me, "It's already done.."

Absolutely. Physicians are vilified in the public's eyes. I honestly sort of hope it gets so bad for us that they overreach and a massive backlash happens. If they just slowly make it worse and worse, I doubt physicians will ever unite or care enough to do anything about it. It's got to get the point where people are ready to not practice anymore on a massive scale for any actual changes to be made. Docs have to button down. TBH I don't give a damn what the public thinks of doctors. It's like in Ender's game, " They don't have to like me, they just have to follow me." All the public needs to do is respect doctors.

also HUGE LOL @ tying medicaid patients reimbursement to satisfaction. that one truly cracks me up. Funny, we never ask poor people what they think about the state of the economy. Yet they are somehow qualified to evaluate the compensation their doctor receives.

 

[llort1337]

Did you just add 41 + 25 and conclude that that's a 66% income tax rate? Do you understand what income tax is? Do you understand what a purchase tax is? Do you understand that they are not the same thing?

Also, no, I wasn't arguing anything except your 70% income tax rate. Attention to detail...

Jesus, are you really that lazy to look it up yourself instead of arguing stupid stuff with no evidence?

From wiki for Sweden income tax:

Sweden has a progressive income tax, the rates for 2014 are as follows:

• 0% from 0 kr to 18,800 kr (~0 - 2,690 USD)
• Circa 31% (ca. 7% county and 24% municipality tax): From 18,800 kr to 433,900 kr (~2,690 - 62,140 USD)
• 31% + 20%: From 433,900 kr to 615,700 kr (~62,140 - 88,180 USD)
• 31% + 25%: Above 615,700 kr (88,180 USD and up) [4]

That's 56% everything above 88k. That's a lot more than the income tax here. For the love of god, look something up first before blabbering like always.

 

[neusu]

Thanks, Obama ?

I'd hate to think that the solution is in fact, a form of class warfare, essentially a PR campaign to defend Physicians by going on the offense with the real numbers of who's making what in medicine but....

Doctors have, historically, always been in the Bourgeois Class. This, again historically, includes bankers, traders, engineers, and merchants. The Bourgeois was the original middle class, essentially, the class between the aristocracy and the serfs. We have been called to our fiduciary duty of taking care of our patients and as such, been rewarded handsomely. The general public has never seemed to have an issue with this. We spend seemingly eons, comparatively, in school, in training, learning our art and our trade. While a plumber, mechanic, carpenter, or factory worker can earn an income, we pursue ours through a greater understanding of a multitude of sciences. A better comparison to the former would be an engineer.

Following the industrial revolution, we as a society, were able to create a more broad middle class. This new middle class was above the previous subsistence living wherein they previously resided. We as physicians also "moved up." While we still weren't aristocracy, we were well above them.

Any more, most physicians live an "upper middle class" living. Meaning, by gaining the average college education, you could gain the lifestyle of the average physician. That being said, our cohort group of bankers, merchants, and traders have escalated. Have you seen how much the average car dealer or grocery store owner is worth? How about the private factory owner? Capitalism is good, if you have capital. Unfortunately, the government limited our ability to pursue such ambitions with the Stark Law. We well may have ended up at the same end without it.

Nonetheless, the issue with Obamacare is that it, in it's end-run, at least in my anticipation of such, goal is that we are all federal employees (much as the OP indicated). At a minimum, physicians are capped by a federal single payer.

No one outside medicine seems to care about the slow creep of a federalization of a previous cottage industry. Does anyone else suspect if we decided to federalize lawyers there wouldn't be an issue? How about realtors? Travel agents?

Certainly, there are issues with the current patient: Doctor environment. The goal of putting all doctors on the federal pay scale is not a great solution.

Likewise, with that being the ultimate goal, as OP indicated, there needs to be some kind of federal loan forgiveness or debt relief. There simply is no way that anyone incurring a, now, $300,000 in debt can pay that off within their lifetime and pursue a satisfactory life.

EDIT: Paragraph 7 patientoctor changed to patient: Doctor

 

[PL198]

Doctors have, historically, always been in the Bourgeois Class. This, again historically, includes bankers, traders, engineers, and merchants. The Bourgeois was the original middle class, essentially, the class between the aristocracy and the serfs. We have been called to our fiduciary duty of taking care of our patients and as such, been rewarded handsomely. The general public has never seemed to have an issue with this. We spend seemingly eons, comparatively, in school, in training, learning our art and our trade. While a plumber, mechanic, carpenter, or factory worker can earn an income, we pursue ours through a greater understanding of a multitude of sciences. A better comparison to the former would be an engineer.

Following the industrial revolution, we as a society, were able to create a more broad middle class. This new middle class was above the previous subsistence living wherein they previously resided. We as physicians also "moved up." While we still weren't aristocracy, we were well above them.

Any more, most physicians live an "upper middle class" living. Meaning, by gaining the average college education, you could gain the lifestyle of the average physician. That being said, our cohort group of bankers, merchants, and traders have escalated. Have you seen how much the average car dealer or grocery store owner is worth? How about the private factory owner? Capitalism is good, if you have capital. Unfortunately, the government limited our ability to pursue such ambitions with the Stark Law. We well may have ended up at the same end without it.

Nonetheless, the issue with Obamacare is that it, in it's end-run, at least in my anticipation of such, goal is that we are all federal employees (much as the OP indicated). At a minimum, physicians are capped by a federal single payer.

No one outside medicine seems to care about the slow creep of a federalization of a previous cottage industry. Does anyone else suspect if we decided to federalize lawyers there wouldn't be an issue? How about realtors? Travel agents?

Certainly, there are issues with the current patientoctor environment. The goal of putting all doctors on the federal pay scale is not a great solution.

Likewise, with that being the ultimate goal, as OP indicated, there needs to be some kind of federal loan forgiveness or debt relief. There simply is no way that anyone incurring a, now, $300,000 in debt can pay that off within their lifetime and pursue a satisfactory life.

Only problem I have is your middle comparison about car dealers and etc is comparing private business to someone that is employed by someone else. I know people that own a single grocery store that make 2-3x what the average physician makes. IMO if the government wants primary care and the whole preventative thing to work, they'd make private practice a more realistic option. I would definitely be interested in the private practice primary care of the past. It's possible to make boatloads if you can pull it off, it's just that they are making it harder and harder.

 

[notbobtrustme]

Nonetheless, the issue with Obamacare is that it, in it's end-run, at least in my anticipation of such, goal is that we are all federal employees (much as the OP indicated). At a minimum, physicians are capped by a federal single payer.

only in america is the biggest private expansion of medicine equated to everyone being federal employees.

The ACA entrenches the employer-insurance model. It does nothing to move us towards government takeover. If anything, it takes us further away from a single-payer until the system catastrophically collapses.

 

[circulus vitios]

I was having a similar discussion with a capitalist friend of mine. FWIW, he is a partner at a private equity firm in NY and formerly was an analyst at Goldman Sachs. In essence, the conversation went as such:

Me, "What it comes down to, in the future, instead of me being an independent business owner of my own practice, I will become labour."

Him, "Dude, you'll be a neurosurgeon, no one will ever think of you as labour."

Me, "The current practice environment is changing. Having an independent practice or a small group is going away. As soon as the MBAs get us under their purview, we become another equation of how much they can get us to work with how little they can pay us."

Him, "You have a point, but I can't fathom you, or the general public would stand for that."

Me, "It's already done.."

How exactly are MBAs preventing you from starting your own practice?

 

[neusu]

How exactly are MBAs preventing you from starting your own practice?

They certainly aren't.

The opportunity cost of starting a solo practice, to keep in line with the current requirements with respect to EMR and billing are too much for a solo practice to be viable. Thus, because of that requirement, it forces doctors in to a group practice, or a hospital owned practice. Instead of being physican owned and run, because of the Stark Act, it is corporate or hospital owned, and has administration (e.g. MBAs) with whom the physicians are responsible to.

 

[llort1337]

Likewise, with that being the ultimate goal, as OP indicated, there needs to be some kind of federal loan forgiveness or debt relief. There simply is no way that anyone incurring a, now, $300,000 in debt can pay that off within their lifetime and pursue a satisfactory life.

Interesting read, but the conclusion is wrong. The average PCP makes 200k and Obamacare is only increasing their pay. You do a 25-year loan repayment plan paying $1700/month. A salary of 200k, 140k after taxes can afford $20k taken off and still easily pursue a satisfactory life during those 25 years. It sucks but can be done. Sure there are many others jobs out there that can pay similarly, but there's more to being a physician than money. Engineers and pharmacists may have similar pay, but they are not doctors. Yes their training and education is much easier than a doctors, but if you really want to be a doctor you'll do it anyway.

Don't get me wrong here. I agree you though that we should be paid more for the extra training. But I'm just arguing your lifestyle is not as **** as you exaggerated.

 

[Psai]

Interesting read, but the conclusion is wrong. The average PCP makes 200k and Obamacare is only increasing their pay. You do a 25-year loan repayment plan paying $1700/month. A salary of 200k, 140k after taxes can afford $20k taken off and still easily pursue a satisfactory life during those 25 years. It sucks but can be done. Sure there are many others jobs out there that can pay similarly, but there's more to being a physician than money. Engineers and pharmacists may have similar pay, but they are not doctors. Yes their training and education is much easier than a doctors, but if you really want to be a doctor you'll do it anyway.

Don't get me wrong here. I agree you though that we should be paid more for the extra training. But I'm just arguing your lifestyle is not as **** as you exaggerated.

Smells like a premed.

 

[llort1337]

They certainly aren't.

The opportunity cost of starting a solo practice, to keep in line with the current requirements with respect to EMR and billing are too much for a solo practice to be viable. Thus, because of that requirement, it forces doctors in to a group practice, or a hospital owned practice. Instead of being physican owned and run, because of the Stark Act, it is corporate or hospital owned, and has administration (e.g. MBAs) with whom the physicians are responsible to.

Depends on the specialty. Some specialties are only outpatient and hospitals have no interest in buying these practices. Those few specialties will be more impervious to the ACO wave than the rest.

 

[llort1337]

Smells like a premed.

Smells like a resident actually. I'm all for us making more money. But even if we made the same as say pharmacists in the future, I would still do it. If you actually love medicine, you'd still do it. Talk to the Europeans.

 

[deleted128562]

Also, I have no school debt from college or med school so I'll be rollin once I finish residency. Best of my both worlds. I have all the medical fields open to me since I'm an AMG, while I also have no debt like an FMG. Suck it.

Let me guess. You have no debt because mommy and daddy paid for everything? I knew a few arrogant pricks like you in med school, and they invariably had mommy and daddy paying for school, drove around in daddy's BWM, and went home to mommy every day at lunchtime to nurse.

 

[circulus vitios]

They certainly aren't.

The opportunity cost of starting a solo practice, to keep in line with the current requirements with respect to EMR and billing are too much for a solo practice to be viable. Thus, because of that requirement, it forces doctors in to a group practice, or a hospital owned practice. Instead of being physican owned and run, because of the Stark Act, it is corporate or hospital owned, and has administration (e.g. MBAs) with whom the physicians are responsible to.

I'm not an expert on EMR but it doesn't look that expensive in the grand scheme of things.

http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me

It seems most of the complaints are about productivity. No surprise that physicians in their 50s are struggling to figure out computers.

http://medicaleconomics.modernmedic...lth-information-technol?contextCategoryId=146

I don't know what kind of practice you want to build, but if you can perform your procedures in an ASC then you can absolutely refer your patients to a self-owned ASC, provided that you follow the rules. http://www.bricker.com/services/resource-details.aspx?resourceid=452

 

[PL198]

Interesting read, but the conclusion is wrong. The average PCP makes 200k and Obamacare is only increasing their pay. You do a 25-year loan repayment plan paying $1700/month. A salary of 200k, 140k after taxes can afford $20k taken off and still easily pursue a satisfactory life during those 25 years. It sucks but can be done. Sure there are many others jobs out there that can pay similarly, but there's more to being a physician than money. Engineers and pharmacists may have similar pay, but they are not doctors. Yes their training and education is much easier than a doctors, but if you really want to be a doctor you'll do it anyway.

Don't get me wrong here. I agree you though that we should be paid more for the extra training. But I'm just arguing your lifestyle is not as **** as you exaggerated.

If someone takes 25 years to pay of their school loans, thats a major problem. Most people pay off their first house before that. Good luck trying to pay off 2 then in that time(house + school). 1700/month is a HUGE payment. Also good luck paying 1700/month as a resident.

 

[PL198]

I don't think you have any concept of how money works. So if you end up being a PCP, what do you think happens to that principal while you are in residency making pennies on the dollar? Hint: It doesn't get smaller.

 

[Lucca]

Said no one ever. Show me 1 that has prospered. OH WAIT . Keep dreaming chief. The reason America succeeded from the start and was once the premiere nation of the world, was because it tried to get as far as possible away from the BS you are talking about. Those that do not understand the course of history are bound to repeat it.

Way to know nothing.

 

[circulus vitios]

Likewise, with that being the ultimate goal, as OP indicated, there needs to be some kind of federal loan forgiveness or debt relief. There simply is no way that anyone incurring a, now, $300,000 in debt can pay that off within their lifetime and pursue a satisfactory life.

I'll have $400k in student loans after I complete residency. I estimate that I'll be able to pay them all off within 4 years of getting my first real job, assuming I specialize and receive a starting salary that is inline with the averages.

 

[llort1337]

If someone takes 25 years to pay of their school loans, thats a major problem. Most people pay off their first house before that. Good luck trying to pay off 2 then in that time(house + school). 1700/month is a HUGE payment. Also good luck paying 1700/month as a resident.

I don't think you have any concept of how money works. So if you end up being a PCP, what do you think happens to that principal while you are in residency making pennies on the dollar? Hint: It doesn't get smaller.

Hey guys I didn't say I liked the system. I just said it's doable lol.