Physician Salaries - below 100K

[MedChic]

With the potential salary drop in physician salaries how low are they predicted to go?


Possibly under $100 K post residency?

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[OnDemond]

With the potential salary drop in physician salaries how low are they predicted to go?


Possibly under $100 K post residency?

Who knows? Hopefully FM/GP docs won't make any less than they are already, but I don't think any of us posting on the medical student thread have a clue...It all depends on how many patients, location, years experience, etc. as well.

 

[MedChic]

Who knows? Hopefully FM/GP docs won't make any less than they are already, but I don't think any of us posting on the medical student thread have a clue...It all depends on how many patients, location, years experience, etc. as well.

That's scary. No I am not in it purely for the money, but it definitely was a big motivator, not to mention that my mounting debt will continue to grow.

My school tution for the coming year is about 50K....that is pure tuition....w/living expenses, fees etc. I will be taking out about 70K in loans for the year.

I think I've blindly jumped down the rabbit hole and will be enslaved by our govt in a few short yrs. I don't know...I had doubts; maybe they were there for a reason. WARNING: if you have doubts SERIOUSLY consider them

 

[McPoyle]

I think the debt we are incurring would prevent salaries from dropping too low. However "too low" is obviously open to interpretation.

Personally, I think we will see a narrowing of the spread so to speak. The FM guys will potentially make slightly more however some other fields/specialists will make significantly less. It seems the days of 500k+ private practice salaries are limited in favor of a lower ceiling (maybe 300k?).

I think if salaries were to decrease to below where one could repay loans we would see one of two things:
1) A reduction in the number future physicians as their business acumen, correctly, tells them that this is a lose-lose proposition.
2) A sharp increase in the number of people defaulting on their loans, taking the hit either leaving medicine or leaving the country to practice elsewhere.

What is frightening to me is that this seems like it will be an insidious change over the next 10-20 years where the populous is slowly moved over to the "public option". This is frightening to me because unlike most professions where the pay may increase as experience increases we will potentially see the exact opposite. As we get older, having children/families, our expenses go up. However, as we move into a single payor/medicare system our reimbursement will be decreasing each year. I have a good feeling that this may be the only highly educated, professional, group where this is allowed to happen. Unless that is, we start taking action now.

 

[Doublecortin]

I think the debt we are incurring would prevent salaries from dropping too low. However "too low" is obviously open to interpretation.

Personally, I think we will see a narrowing of the spread so to speak. The FM guys will potentially make slightly more however some other fields/specialists will make significantly less. It seems the days of 500k+ private practice salaries are limited in favor of a lower ceiling (maybe 300k?).

I think if salaries were to decrease to below where one could repay loans we would see one of two things:
1) A reduction in the number future physicians as their business acumen, correctly, tells them that this is a lose-lose proposition.
2) A sharp increase in the number of people defaulting on their loans, taking the hit either leaving medicine or leaving the country to practice elsewhere.

What is frightening to me is that this seems like it will be an insidious change over the next 10-20 years where the populous is slowly moved over to the "public option". This is frightening to me because unlike most professions where the pay may increase as experience increases we will potentially see the exact opposite. As we get older, having children/families, our expenses go up. However, as we move into a single payor/medicare system our reimbursement will be decreasing each year. I have a good feeling that this may be the only highly educated, professional, group where this is allowed to happen. Unless that is, we start taking action now.

really???? says who?!? The dumb ignorant public thinks doctors are making waay more money then they deserve. They obviously know nothing about the insane amount of time, effort, and money it takes to get to the point where you can earn a decent salary as an attending.

But this ignorance by the general public is helping politicians in their drive to cut reimbursements to the bone

 

[MossPoh]

If it dropped below 100k they can be prepared for a lot of physicians dumping the job and finding something else. I'd either move to another country, or take one of the jobs for much less stress with much greater income potential.

 

[turkeyjerky]

Okay idiots, can we please agree to talk out of our mouths, not our asses.

There is nothing in the proposed health care bills to suggest that physicians, as a whole, are going to see a large reduction in income. In fact, it finally gets rid of the medicare payment reduction formula that causes us all headaches every year (at a cost of 239 Billion dollars).

There is a budget neutral proposal that would increase payments to PCPs at the cost of proceduralists, but every expert (yes, physicians) agrees that this change has been needed for a long time (think about it--why should a doctor get reimbursed more for suturing than for working up abdominal pain).

So, if anything, the reforms are a net plus for physicians. No, that doesn't mean it's perfect, and there are a great number of problems with it. But the status quo is both unacceptable and unsustainable.

 

[turkeyjerky]

For my part, this is what I see happening. Generalists will make a little more than they do now while specialists will make less (think in the 200-300k range). Nurse practitioners and physicians' associates (won't be called assistants anymore) will gradually take over more and more of primary care. Primary care docs will supervise midlevels and take care of the more complicated patients or become hospitalists. Because of this, more and more med students will choose to specialize (despite the diminished returns, but no one wants to compete w/ nurses).

Eventually, primary care physicians will become a thing of the past, and primary care will transition to a "gate-keeper" model, where patients are directed to the relevant specialist by a noctor* with an alphabet soup after his or her name.

Not exactly a rosy scenario, but not the end of the world either.

 

[astrocreep96]

Okay idiots, can we please agree to talk out of our mouths, not our asses.

There is nothing in the proposed health care bills to suggest that physicians, as a whole, are going to see a large reduction in income. In fact, it finally gets rid of the medicare payment reduction formula that causes us all headaches every year (at a cost of 239 Billion dollars).

Ha! The graduated reduction formula may be eliminated, but there is nothing about salary caps or straight reductions in payments in times of financial shortfall. Get ready for the same budget cuts that public universities see when state funds get low. You will be a government employee, and your ability to keep your job will be determined by the genius bean counters in D.C.

There is a budget neutral proposal that would increase payments to PCPs at the cost of proceduralists, but every expert (yes, physicians) agrees that this change has been needed for a long time (think about it--why should a doctor get reimbursed more for suturing than for working up abdominal pain).

The budget neutral idea does not work at current reimbursement rates. The CBO projects ~$250 billion shortfall at current rates. One of Obama's advisors recently spoke on CNN (or MSNBC, can't remember which) and stated something to the effect of "...well yeah, the CBO estimate states the budget shortfall only because they have made those projections with current reimbursement rates."

A ~$250 billion budget deficit doesn't disappear by increasing payments.

So, if anything, the reforms are a net plus for physicians. No, that doesn't mean it's perfect, and there are a great number of problems with it. But the status quo is both unacceptable and unsustainable.

Yes, a plus if you consider no provisions made in the health care bill for capping malpractice payouts thus limiting malpractice insurance rates. A plus if you consider Medicare's current huge deficit. A plus if you consider Massachusette's and California's current budget crisis partly due to out of control costs in healthcare.

I agree that the status quo is unacceptable and unsustainable. I don't see that as justification for making it worse.

 

[cgscribe]

It's safe to say that primary care doctors will see a general increase in their salaries, and sub-specialists and procedural-fields will see a drop in their numbers- for better or worse. A lot of professional organizations, including the ACP, have been fighting to limit/stop the idea that primary care fields should receive higher reimbursement at the expense of specialists. But, public opinion will probably win out- hard to convince people that inordinate years of training, expensive malpractice, and school debt are reason for docs to make more than 300-400k.

 

[cgscribe]

Good post astrocreep. I think almost all medical students would agree that status quo is unacceptable and that something needs to be done. At the same time, the current political arena, on both sides, is just laughable.

 

[turkeyjerky]

Ha! The graduated reduction formula may be eliminated, but there is nothing about salary caps or straight reductions in payments in times of financial shortfall. Get ready for the same budget cuts that public universities see when state funds get low. You will be a government employee, and your ability to keep your job will be determined by the genius bean counters in D.C.



The budget neutral idea does not work at current reimbursement rates. The CBO projects ~$250 billion shortfall at current rates. One of Obama's advisors recently spoke on CNN (or MSNBC, can't remember which) and stated something to the effect of "...well yeah, the CBO estimate states the budget shortfall only because they have made those projections with current reimbursement rates."

A ~$250 billion budget deficit doesn't disappear by increasing payments.



Yes, a plus if you consider no provisions made in the health care bill for capping malpractice payouts thus limiting malpractice insurance rates. A plus if you consider Medicare's current huge deficit. A plus if you consider Massachusette's and California's current budget crisis partly due to out of control costs in healthcare.

I agree that the status quo is unacceptable and unsustainable. I don't see that as justification for making it worse.

I'm talking about the budget neutral (with respect to the budget of medicare) changes in medicare reimbursment rates that reduce payments to specialists and increase (slightly) payments to pcps.

"A ~$250 billion budget deficit doesn't disappear by increasing payments." He was talking about removing the scheduled decreases in payments. Most people assume that that would happen anyway, but it's still a huge (239 billion dollar) pain in the ass that this bill finally solves.

 

[astrocreep96]

Good post astrocreep. I think almost all medical students would agree that status quo is unacceptable and that something needs to be done. At the same time, the current political arena, on both sides, is just laughable.

I was just in SF last week. Cool King Tut exhibit at the de Young museum you have going.

 

[cgscribe]

Hahaha, well now this is just us complimenting each other's posts and cities. I've heard it was a little overrated for the price- as they didn't have the REAL sarcaphogus (spelling?).

For other's interested in a GREAT discourse on public-healthcare-options, I suggest watching CNBC's "Meeting of the Minds: Future of Healthcare." It's on hulu for free. Had a pretty esteemed panel, lots of civil debate about the good/bad. Just made me sad that doctors like them and the other panelists aren't the ones making decisions.

 

[astrocreep96]

Hahaha, well now this is just us complimenting each other's posts and cities. I've heard it was a little overrated for the price- as they didn't have the REAL sarcaphogus (spelling?).

For other's interested in a GREAT discourse on public-healthcare-options, I suggest watching CNBC's "Meeting of the Minds: Future of Healthcare." It's on hulu for free. Had a pretty esteemed panel, lots of civil debate about the good/bad. Just made me sad that doctors like them and the other panelists aren't the ones making decisions.

Yeah, little sidetracked. Oh well. Tut's sarcaphagus wasn't there, but they did have one from a mistress from his harem. All was not lost.

I'm talking about the budget neutral (with respect to the budget of medicare) changes in medicare reimbursment rates that reduce payments to specialists and increase (slightly) payments to pcps.

I was under the impression that the CBO's estimates showing a budget deficit was in consideration of the current bill, which had already accounted for the adjustment in reimbursement, meaning that to be budget neutral would require a reduction across the field.

He was talking about removing the scheduled decreases in payments. Most people assume that that would happen anyway, but it's still a huge (239 billion dollar) pain in the ass that this bill finally solves.

I think it is great they handled that issue. I also applaud the issues of insurance portability and denial of coverage. These are some of the key general issues that AMA considered when they voted in support of the bill (notwithstanding the fact that many of the specifics likely would fall short of the AMA's desires or aims).

However, the bill falls short on a number of other issues. Again I point to the examples of California's economy. In fact, take a look at July 11th edition of The Economist if you can get your hand on it. That issue discusses Texas and contrasts it to California (it's closest major economic neighbor). I don't consider myself too conservative in many issues, but I have to admit the issue of how Texas handles its economy and healthcare is in stark contrast (and much more successful) in comparison to California's. This is nicely demonstrated by Texas' budget surplus (not to mention their rainy-day fund) in the face of the entire nation's economic crisis, and the fact that people are streaming out of California into Texas by the tens of thousands.

Unfortunately, as cgscribe suggested above, it is not doctors making the decisions here (which would make sense). It is effectively the people that run the DMV and the Social Security office.

 

[Cerberus]

There is a budget neutral proposal that would increase payments to PCPs at the cost of proceduralists, but every expert (yes, physicians) agrees that this change has been needed for a long time (think about it--why should a doctor get reimbursed more for suturing than for working up abdominal pain).

Most of your post is idiotic but I just want to focus on this part of it. People love to bitch about how much more specialists make than PCPs but seem to ignore the fact that specialists have to undergo training in a fellowship, which takes several more years than a general practitioner. A GI trained physician has spent an additional 3 years of their life busting their ass for resident pay and accruing interest on their student loans. If we want to start increasing the pay of PCPs at the expense of specialists, be prepared to see a LOT of people deciding it just isn't worth it to do a fellowship.

 

[turkeyjerky]

I was under the impression that the CBO's estimates showing a budget deficit was in consideration of the current bill, which had already accounted for the adjustment in reimbursement, meaning that to be budget neutral would require a reduction across the field.

Yes, you are correct about that. But we're talking about different things. What I said (or meant to say) above was in reference to the proposed changes in medicare reimbursments (basically cutting payments for specialists--particularly imaging by 20% or so, in order to increase payments to primary care by about 6-8%).

 

[FractureFixer]

So how much do you think Orthopedics will be making?? (ie. are they a procedural specialty)

 

[The Angriest Bird]

Here's my question. With a gazillion problems to deal with in the current healthcare system, does the government really want to deal with one more - a bunch of pissed off doctors because of decreased salaries?

 

[Random Anesthesiologist]

I took a cursory look through your post history, and everything you've ever written is idiotic. It seems you spend most of your time trolling in the lounge posting **** straight from the lunatic fringe. I suggest you go back there, jackass.

Cerb has been around this place many years (under this and other names, as many of us have) and has tons of quality posts. It's a shame when you click on his posts it only goes back 400 posts.

The lounge is a completely different animal. It's looney on purpose, not just because.

 

[a winner is you]

There's nothing to suggest physician pay will ever drop below 100k.

 

[MedChic]

Here's my question. With a gazillion problems to deal with in the current healthcare system, does the government really want to deal with one more - a bunch of pissed off doctors because of decreased salaries?

I don't know. Honestly, sometimes I get the feeling docs are treated like the flies on govt. radar and gluttonous stepchildren by the patient population.

I'm sorry. I don't get it. Doctors are the ones with the knowledge base and the education. Doctors are the ones with the licenses. Doctors are the ones who go through extensive training to perfrom procedures, who diagnose, treat, and notice the clinical issues that start the ball rolling in the direction of necessary new research and technology.

Why is it ok for star football players and members of Congress to rake in trillions of dollars, while we can't even control our own fate despite all the **** we go through in training and the debt we incur to HELP PEOPLE instead of throwing a pigskin or BS rhetoric around?!

We as future docs HAVE TO take control of where our future is going to go. I wonder how significant all these players in the healthcare game would feel if docs just dropped their scalpels and refused to put up with crap. The problem is that compassion is often taken for granted.

 

[TopSecret]

Should doctors go on strike?

 

[OPPforlife]

For other's interested in a GREAT discourse on public-healthcare-options, I suggest watching CNBC's "Meeting of the Minds: Future of Healthcare." It's on hulu for free. Had a pretty esteemed panel, lots of civil debate about the good/bad. Just made me sad that doctors like them and the other panelists aren't the ones making decisions.

So I just finished watching this, and you were right, it was actually pretty interesting and the level of bias was fairly low.
However, watching the discussion made me think about some thing. Did you catch the part where they talk about the possibility of a shift of incentive from procedures provided to the "actual" quality of health provided? One of the panelist's suggests that for example if a certain doctor's patient lowers his cholesterol level the doctor should be compensated for that.
I mean I really thought about this, and it really does seem like an OK idea. What am I missing here though? because it really just seems too good to be true.

 

[masterofmonkeys]

Did you catch the part where they talk about the possibility of a shift of incentive from procedures provided to the "actual" quality of health provided? One of the panelist's suggests that for example if a certain doctor's patient lowers his cholesterol level the doctor should be compensated for that.
I mean I really thought about this, and it really does seem like an OK idea. What am I missing here though? because it really just seems too good to be true.

First, lowering cholesterol outside of actual CHD patients doesn't lower all-cause mortality, and has unproven benefit in women of any age, and men over 50. And indeed, lower cholesterol correlates with higher mortality later in life.

Second, as an example, my mom just got dinged on a 'performance measure' because she won't treat an 88 year old patient's HTN with HCTZ. He's orthostatic as it is, and even 12.5mg QD is enough to exacerbate the problem to the point that if he takes it, he needs assistance just to stand up. If he doesn't take it, he doesn't.

As another example, my poor doctor will probably get dinged (or at least not rewarded) for not doing anything about my weight. Because at 30.5 BMI I am obese (oh noes! me and my 32" waist are going to fall over dead any minute now!!!).

That's the problem. How do we design performance measures that make sense? How do we allow for exceptions? How do we account for docs who have sicker patients?

 

[masterofmonkeys]

Okay idiots, can we please agree to talk out of our mouths, not our asses.

There is nothing in the proposed health care bills to suggest that physicians, as a whole, are going to see a large reduction in income. In fact, it finally gets rid of the medicare payment reduction formula that causes us all headaches every year (at a cost of 239 Billion dollars).

There is a budget neutral proposal that would increase payments to PCPs at the cost of proceduralists, but every expert (yes, physicians) agrees that this change has been needed for a long time (think about it--why should a doctor get reimbursed more for suturing than for working up abdominal pain).

So, if anything, the reforms are a net plus for physicians. No, that doesn't mean it's perfect, and there are a great number of problems with it. But the status quo is both unacceptable and unsustainable.

'budget neutral' proposal also includes wanting to set the government option at medicare/medicaid rates. Which are pitiful. Incentive will be to shift more and more people to the public option as, with lower payouts as well as tax subsidy, it will have lower premiums. More people being seen at a lower rate IS A DROP IN INCOME.

You are aware of how many docs simply can't afford to see medicare patients anymore right? Because of just how pitiful payments are?

Also take into account that our taxes will almost definitely go up. WHICH IS ANOTHER DROP IN INCOME!!!

There aren't many people who would disagree with status quo being unsustainable. But I don't think the solution is to allow govt to ration care and treat us like slaves. We get enough of that in residency.

What we haven't seen is a lot of sense. Lets take a look at some of the hundreds of state and national mandates that drive up health insurance costs. How about high deductible catastrophic care plans? Why are normal events in life like routine vaginal deliveries covered by 'health insurance'. Why do we force EVERYONE (in many states) who wants comprehensive health insurance to be insured against infertility. Or have chiropractice/acupuncture/aromatherapy covered? That doesn't even make sense.

 

[Evergrey]

Should doctors go on strike?

Interesting idea, I'm just curious -- how would a doctor strike exactly pan out? Would people just stop treating anyone (wouldn't people die then)?

 

[masterofmonkeys]

Interesting idea, I'm just curious -- how would a doctor strike exactly pan out? Would people just stop treating anyone (wouldn't people die then)?

They already are going against strike against medicare/medicaid. Fewer and fewer will see these patients.

 

[MedChic]

So I just finished watching this, and you were right, it was actually pretty interesting and the level of bias was fairly low.
However, watching the discussion made me think about some thing. Did you catch the part where they talk about the possibility of a shift of incentive from procedures provided to the "actual" quality of health provided? One of the panelist's suggests that for example if a certain doctor's patient lowers his cholesterol level the doctor should be compensated for that.
I mean I really thought about this, and it really does seem like an OK idea. What am I missing here though? because it really just seems too good to be true.

The catch is that over 50% of patients don't follow medical advice, stop taking medications too soon or take them inconsistently, and live an unhealthy lifestyle. Basically docs would be penalized for their patients' decisions and stupidity over which they really have no control.

 

[astrocreep96]

Should doctors go on strike?

My understanding is that, with the exception of a few states, physicians do not enjoy exemptions from federal antitrust laws, meaning a strike may be effectively illegal.

I would think that compensation would never have dropped to as low as it has if physicians had past opportunities to organize on a grand scale against insurance and the government.

 

[MossPoh]

Interesting idea, I'm just curious -- how would a doctor strike exactly pan out? Would people just stop treating anyone (wouldn't people die then)?

http://nejm.highwire.org/cgi/reprint/355/15/1520.pdf

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1410875

http://www.wsws.org/articles/2006/mar2006/doct-m18.shtml

All about the same thing, but you get the idea.

You treat the critically ill and true emergencies but leave all else hanging there. While something may not kill you, it can be very painful or intolerable. A strike isn't something out of the blue, it results from the voices of many being ignored. We provide a service that requires a tremendous amount of time and sacrifice on our lives and the lives of our loved ones. Using our compassion and will to help against us to cut costs is a horrendous way to do things. There are so many other areas that can be more efficient and reduce overhead. I don't feel like I "deserve" some ridiculously high salary but I feel at the end of my long road and all the sacrifices I've made, I have, at the very least, earned the chance to receive comparable payment for my efforts invested. While one shouldn't do this for the money, I'd certainly like to make more than I was offered by companies out of college and within a few years of working there.

 

[turkeyjerky]

'budget neutral' proposal also includes wanting to set the government option at medicare/medicaid rates. Which are pitiful. Incentive will be to shift more and more people to the public option as, with lower payouts as well as tax subsidy, it will have lower premiums. More people being seen at a lower rate IS A DROP IN INCOME.

You are aware of how many docs simply can't afford to see medicare patients anymore right? Because of just how pitiful payments are?

Also take into account that our taxes will almost definitely go up. WHICH IS ANOTHER DROP IN INCOME!!!

There aren't many people who would disagree with status quo being unsustainable. But I don't think the solution is to allow govt to ration care and treat us like slaves. We get enough of that in residency.

What we haven't seen is a lot of sense. Lets take a look at some of the hundreds of state and national mandates that drive up health insurance costs. How about high deductible catastrophic care plans? Why are normal events in life like routine vaginal deliveries covered by 'health insurance'. Why do we force EVERYONE (in many states) who wants comprehensive health insurance to be insured against infertility. Or have chiropractice/acupuncture/aromatherapy covered? That doesn't even make sense.

I think you're the first person I've ever heard suggest that "routine" vaginal deliveries shouldn't be covered by health insurance.

You seem enamored with "consumer-driven health care". You really think advocates of this approach have your interests at heart? You really thing Regina "The B!tch" Herzlinger cares about you?

You should read this book by Tim StoltzfusJost/URL]. It'll give you a different view of that whole movement.

 

[Parts Unknown]

Most of your post is idiotic but I just want to focus on this part of it. People love to bitch about how much more specialists make than PCPs but seem to ignore the fact that specialists have to undergo training in a fellowship, which takes several more years than a general practitioner. A GI trained physician has spent an additional 3 years of their life busting their ass for resident pay and accruing interest on their student loans. If we want to start increasing the pay of PCPs at the expense of specialists, be prepared to see a LOT of people deciding it just isn't worth it to do a fellowship.

I haven't seen anything so extreme as to suggest completely closing the gap between primary and specialist reimbursement. Specialists will always make more for their trouble, the question is whether the current wide variance in pay is truly justifiable or even in the best long-term interest of our profession. It seems odd for us to bemoan the encroachment of midlevels, while at the same time not lifting a finger to defend better compensation for primary care services.

 

[cgscribe]

So I just finished watching this, and you were right, it was actually pretty interesting and the level of bias was fairly low.
However, watching the discussion made me think about some thing. Did you catch the part where they talk about the possibility of a shift of incentive from procedures provided to the "actual" quality of health provided? One of the panelist's suggests that for example if a certain doctor's patient lowers his cholesterol level the doctor should be compensated for that.
I mean I really thought about this, and it really does seem like an OK idea. What am I missing here though? because it really just seems too good to be true.

It's an "OK" idea, as you said, but of course there's lots more to it. It's tough to ding docs for giving good advice, good recommendations, but their cohort just happens to make bad personal choices. There's no way to control for personal choice in these incentives. This would be even more complicated by Obama's push for NP's in primary care (I could go on and on about this one): I think it's fair to say these NP's would carry much healthier cohorts than primary-care-MD's, so would have lower cholesterols, BP's, etc. Is it fair for them to receive more reward than MD's who choose to treat sicker patients?

--Even so though, my beef isn't with the idea of adding incentives for PCP's to increase their income. It's the idea being espoused that we should be making those incentives at the expense of surgeons and cardiologists and GI's, etc. who have trained for more years, carry much higher malpractice, work worse hours (save for OB's) and accrue more debt.

 

[mjl1717]

There's nothing to suggest physician pay will ever drop below 100k.

I agree... Remember your so called "friends" will more often then not increase your anxiety NOT decrease it!!

1)Ive heard of residents doing 3 years of residency in internal medicine in New York and struggling to make 80k per year...

2)Also Ive said this 9 zillion times '"As Barbara Fadem said- you dont go into this field to make money but if you happen to make some along the way its ok..

 

[ChemEngSoonMD]

I better not be making 100k out of med school. I am making 80k right now as an engineer.

 

[Parts Unknown]

It's an "OK" idea, as you said, but of course there's lots more to it. It's tough to ding docs for giving good advice, good recommendations, but their cohort just happens to make bad personal choices. There's no way to control for personal choice in these incentives. This would be even more complicated by Obama's push for NP's in primary care (I could go on and on about this one): I think it's fair to say these NP's would carry much healthier cohorts than primary-care-MD's, so would have lower cholesterols, BP's, etc. Is it fair for them to receive more reward than MD's who choose to treat sicker patients?

This is why implementation of pay-for-performance has been largely dead in the water. Prospective payment systems adjusted for a patient population's risk profile is more likely, IMHO.

--Even so though, my beef isn't with the idea of adding incentives for PCP's to increase their income. It's the idea being espoused that we should be making those incentives at the expense of surgeons and cardiologists and GI's, etc. who have trained for more years, carry much higher malpractice, work worse hours (save for OB's) and accrue more debt.

As a specialist in training, I'm not sure this argument has legs. The disparity in compensation derives less from the extra training, liability, and debt, and more from historic artifact. Show your average person one of the many online salary surveys and it may raise an eyebrow:

Internal medicine (3 yrs) $176,000
Infectious disease (6 yrs) $178,000
Gastroenterology (6 yrs) $349,000

Working worse hours isn't necessarily true, either. I can think of a number of colleagues who put in extra years so they could do high paying procedures in an 8-5 outpatient setting with minimal call.

Throw in all the recent hubub about overutilization, geographic disparities in Medicare spending, comparative effectiveness research, and the shortage of primary care doctors, an we've got a Grade-A mess on our hands.

In the face of all this, IMHO the best option would be to selectively decrease the number of specialist training positions in order to defang overutilization arguments and maintain market power.

 

[masterofmonkeys]

I think you're the first person I've ever heard suggest that "routine" vaginal deliveries shouldn't be covered by health insurance.

Well, I'm glad I'm unique. I don't understand how a routine delivery really qualifies as a risk though. To me this is the equivalent of including the cost of tire replacement in your car insurance.

You seem enamored with "consumer-driven health care". You really think advocates of this approach have your interests at heart? You really thing Regina "The B!tch" Herzlinger cares about you?

Actually as an evolutionary biologist, I understand self-interest a good deal better than most, and it informs my views of politics and economics to a considerable degree. For one, it's why I'm not a market anarchist, because i understand the limits of rationality and some of the various factors that play into it. For another, it's why I'm not a flaming socialist, because I understand the nature of the commons and the anti-commons.

I do have nerve damage, and consequent to that a lot of spinal issues, that perhaps make me a MORE vociferous opponent of government-run healthcare, rather than less. Because I spend about 1/10 as much on healthcare as your average 'back pain' (stupid diagnosis) patient despite more severe disease than avg by radiograpy and exam. And because when i give up and need back surgery due to gross anatomic compromise of spinal and radicular structures, I am going to need it. Not 6 months from then, but right then.

Because I hate the thought of paying TONS of tax money into government healthcare, or a lot of excess money into comprehensive health insurance for coverage I don't need or want, only to have to deal with limits, red tape, denials of coverage, and wait lists.

 

[OPPforlife]

I better not be making 100k out of med school. I am making 80k right now as an engineer.

stick to engineering man, unless you have a full ride through medical school, taking a 150k+ debt (or spending the equivalent through savings) ....well is stupid.

 

[atomi]

I better not be making 100k out of med school. I am making 80k right now as an engineer.

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[atomi]

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[OPPforlife]

I'm spending all my savings with no loans and am having major doubts after writing the first tuition check. I miss my 30 hour work weeks and normal relationships already.

wow you must really want to be a doctor. Well look at it this way, your young, so maybe going to medical school is NOT that bad of a risk. If you end up loving medicine as a career, I am sure you will not regret a penny you spent. If not....oh well.

 

[atomi]

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[OPPforlife]

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Is it bad that the previous post got me really worried? I mean I really love medicine guys...but I would hate financial insecurity. Financial security is some thing I also want!

 

[The Angriest Bird]

Should doctors go on strike?

If you think this is out of the realm of possibility, ask Germany.

 

[cgscribe]

This is why implementation of pay-for-performance has been largely dead in the water. Prospective payment systems adjusted for a patient population's risk profile is more likely, IMHO.

--Awesome, I hadn't heard of these policies, that would be amazing if realistic.

As a specialist in training, I'm not sure this argument has legs. The disparity in compensation derives less from the extra training, liability, and debt, and more from historic artifact. Show your average person one of the many online salary surveys and it may raise an eyebrow:

Internal medicine (3 yrs) $176,000
Infectious disease (6 yrs) $178,000
Gastroenterology (6 yrs) $349,000

Working worse hours isn't necessarily true, either. I can think of a number of colleagues who put in extra years so they could do high paying procedures in an 8-5 outpatient setting with minimal call.

Throw in all the recent hubub about overutilization, geographic disparities in Medicare spending, comparative effectiveness research, and the shortage of primary care doctors, an we've got a Grade-A mess on our hands.

In the face of all this, IMHO the best option would be to selectively decrease the number of specialist training positions in order to defang overutilization arguments and maintain market power.

--Yeah, I have no beef with any of this info (although I daresay a GI/cards/surgeon has more liability/malpractice versus ID or heme, etc.). I agree that non-procedural specialists have consistently gotten the short end of the stick with current policies. Decreasing specialist training positions- I think that's a good idea. At the same time, my main point was that high-income specialists shouldn't see their hardwork diminished either- this zero-sum argument being espoused is just troubling to me (this isn't you, it's more the pundits).

 

[ChemEngSoonMD]

stick to engineering man, unless you have a full ride through medical school, taking a 150k+ debt (or spending the equivalent through savings) ....well is stupid.

Stay an engineer. The money difference is not worth it unless you do something procedural based, in which case the time isn't worth it, and procedural reimbursements will get whacked by the govt.

Like i said in my previous posts. Its not about the money its about having a bigger epeen than my phD dad.

 

[The Angriest Bird]

Is it just me, or all the published physician salary surveys seem ridiculously unreal and inaccurate?

 

[Sol Rosenberg]

stick to engineering man, unless you have a full ride through medical school, taking a 150k+ debt (or spending the equivalent through savings) ....well is stupid.

Engineering isn't all roses either. Your chances of making 0/yr rise quickly after the age of 40 in engineering, whereas medicine generally rewards/values experience. So if, in your calculations comparing engineering to medicine, you assume $80k/yr (plus some standard raise per year) for an engineering career I would argue that your calculations are flat-out wrong. Put another way: How many "old" (> 40-45 or so) engineers do you know?

That's not to say that once you turn 40 as an engineer, you have unemployment to look forward to. Most engineers transition to management or embark on a new career (business, patent law, get a PhD and join academia) anyway, so, as a former engineer myself, I see my transition to medicine as doing what I WANT to do, on my own terms, before I am forced to make a transition anyway.

Put yet another way: Society DOES value doctors highly. If we get to a point where doctors' salaries are too low to sustain a living, other professions will have taken a much bigger hit and will have their professionals living in the poor house....at which time, the whole country will be f*****, and you will have bigger things to worry about than whether your salary is competitive to that of lawyers or some other professional.

 

[OPPforlife]

Like i said in my previous posts. Its not about the money its about having a bigger epeen than my phD dad.

not worth it in my opinion.