Would you or I still want to be(come) a physician in the US if socialized medicine was employed?

[Kurk]

Specifically a single-payer system.

I know there are threads on this but I'm asking again because of recent political events (Comrade Sanders).

Let's say the average pay for primary care physicians was cut down to $80,000 (this is about the median salary in Europe for PCPs).

Despite what the math says, a certain politician ensures that you graduate from public undergrad college debt free. You still have approximately $175,000 give or take in debt from med school at graduation.

You still have to go through residency with meager pay.

You have the increased complications of a single-payer system (e.g less one-on-one time with patients, flooded with many more patients, resulting stress, etc).

You're still working 70+ hours the majority of your career for significantly less pay per hour.

You're still sacrificing your youthful twenties and possibly your health later down the road.

Expect the price of living to increase as it does with most socialized countries.


Would you still do it?
I personally wouldn't. This is very close to exploitation in my eyes.

I would very much become a physician under these circumstances if I was working 40 hours a week with not nearly as much debt (LOL right?).

Unfortunately the physician shortage isn't going away anytime soon in the states and I can only imagine cutting physician pay wouldn't help that problem. Despite what many people seem to think, there aren't enough completely selfless people on this planet to fulfill the demand for doctors—that is unless you make getting into med-school so easy that you can have complete idiots in charge of the most valuable attribute you have.

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[Law2Doc]

1. There is no physician shortage. There is a distribution issue with two few doctors in some parts of the country and gluts in the big popular cities.
2. Foreign countries with socialized medicine salaries, as you mentioned, have shorter schooling, less school debt and work shorter hours. Nobody is offering any of this. So nobody would ever for instance become a surgeon training 6 years in residency and working 100 hour weeks to never move out of that studio apartment. So this is all fiction and what if. Nobody is going to get rid of tuition debt (schools and lenders are a big national industry), and we would actually have the doctor shortage you are talking about if hours drop to 40, so this is all fantasy.

So it's a moot question. Market forces have already dictated what doctors need to earn to get some of the best and brightest go through all the required training, and we are in fact finding that it's probably actually not enough to get people to move to certain underserved parts of the country as is.

 

[Mad Jack]

No, I would leave on principle.

And 80k is less than I made with my Associate's degree- why the hell would I have cost myself one million dollars in tuition and opportunity cost to make the same amount after 8 years of hell?

 

[kcehreuhcs]

That's the problem with politicians that desperately try to adapt systems of any sort that work well in other countries, but probably won't in their own. I'm a huge supporter of sozialiced medicine, because it works astonishingly well in my home country, but as you already stated: In the U.S., there's a lot of changes needed in a lot of different areas for this to actually work. I believe most of the changes that would be necessary to make something like socialized medicine work in the U.S. aren't very popular among most Americans.

 

[Law2Doc]

I would also point out that while doctors are easy targets, they actually aren't really the biggest ticket items in healthcare costs. We could all earn minimum wage and our healthcare costs would still be much higher than in other countries. We aren't the problem, just the ones painted as villains by much more powerful lobbying interests.

Doctors are also an easy target for politicians because by and large the public has no sense of the schooling and training involved and just sees this guy in a white coat earning a couple hundred thousand dollars a year for writing a few prescriptions for zpacks after a nurse takes your history and vitals. And that's assuming they don't think our life is a giant romp in the on call room like on Greys Anatomy.

The probable future is that NPs will take over a lot of primary care functions, because it's cheaper to throw someone with a lot less training out there. But I'm not sure it's the better result for patients.

 

[DoctorSynthesis]

Specifically a single-payer system.

I know there are threads on this but I'm asking again because of recent political events (Comrade Sanders).

Let's say the average pay for primary care physicians was cut down to $80,000 (this is about the median salary in Europe for PCPs).

Despite what the math says, a certain politician ensures that you graduate from public undergrad college debt free. You still have approximately $175,000 give or take in debt from med school at graduation.

You still have to go through residency with meager pay.

You have the increased complications of a single-payer system (e.g less one-on-one time with patients, flooded with many more patients, resulting stress, etc).

You're still working 70+ hours the majority of your career for significantly less pay per hour.

You're still sacrificing your youthful twenties and possibly your health later down the road.

Expect the price of living to increase as it does with most socialized countries.


Would you still do it?
I personally wouldn't. This is very close to exploitation in my eyes.

I would very much become a physician under these circumstances if I was working 40 hours a week with not nearly as much debt (LOL right?).

Unfortunately the physician shortage isn't going away anytime soon in the states and I can only imagine cutting physician pay wouldn't help that problem. Despite what many people seem to think, there aren't enough completely selfless people on this planet to fulfill the demand for doctors—that is unless you make getting into med-school so easy that you can have complete idiots in charge of the most valuable attribute you have.

If you wouldn't become a physician if the healthcare system changed, don't become a physician with the current system. Become a doctor if this is what you want to do.

 

[Mad Jack]

If you wouldn't become a physician if the healthcare system changed, don't become a physician with the current system. Become a doctor if this is what you want to do.

That's a rather shortsighted thing to say. People should do what fits the three big vectors in regard to employment- what gets them the best balance of what they can stand or enjoy doing, what they're good at, and what makes them enough money to suit their needs.

I mean, if physician pay were to theoretically decline to 80k, I'd be making 50k post-tax. Professional dues eat up another 3k/year. My minimum loan payments are $31,608/year (unless I go with IBR, in which case I'll have a multi-million dollar tax bomb at the end which will wipe out my life's savings right before retirement). That leaves me with just over 15k a year post-tax to live on- I wouldn't do ANY job for that low of pay, let alone one that involves the stress, training time, and liability of being a physician. Wanting to take care of others doesn't mean one should be willing to financially ruin themselves for the rest of their lives to do so.

 

[DoctorSynthesis]

That's a rather shortsighted thing to say. People should do what fits the three big vectors in regard to employment- what gets them the best balance of what they can stand or enjoy doing, what they're good at, and what makes them enough money to suit their needs.

I mean, if physician pay were to theoretically decline to 80k, I'd be making 50k post-tax. Professional dues eat up another 3k/year. My minimum loan payments are $31,608/year (unless I go with IBR, in which case I'll have a multi-million dollar tax bomb at the end which will wipe out my life's savings right before retirement). That leaves me with just over 15k a year post-tax to live on- I wouldn't do ANY job for that low of pay, let alone one that involves the stress, training time, and liability of being a physician. Wanting to take care of others doesn't mean one should be willing to financially ruin themselves for the rest of their lives to do so.

I'm not making the argument that potential income shouldn't be a factor, i'm making the argument that the system shouldn't dictate whether you will become a physician or not. There is no system (that will be put in place, even if sanders is president) where potential income is low enough that becoming a doctor isn't feasible. In eery "first world" country doctors are paid well. The ones where they are paid less education is free. If you are truly in it soley for the money, medicine will suck for you. This can't be what is driving your decision, and something that people become overly worried about. You have to actually like the job at the end of the day.

GP's pretty much make 100K or more in all countries, even those with socialized medicine. Exception being France but they have no educational costs. They still make 95K and they also don't have malpractice cost.

 

[KinesiologyNerd]

If you wouldn't become a physician if the healthcare system changed, don't become a physician with the current system. Become a doctor if this is what you want to do.

That's cute

 

[DubVille]

I'm not making the argument that potential income shouldn't be a factor, i'm making the argument that the system shouldn't dictate whether you will become a physician or not. There is no system (that will be put in place, even if sanders is president) where potential income is low enough that becoming a doctor isn't feasible. In eery "first world" country doctors are paid well. The ones where they are paid less education is free. If you are truly in it soley for the money, medicine will suck for you. This can't be what is driving your decision, and something that people become overly worried about. You have to actually like the job at the end of the day.

GP's pretty much make 100K or more in all countries, even those with socialized medicine. Exception being France but they have no educational costs. They still make 95K and they also don't have malpractice cost.

Sure if that is solely the only reason you choose medicine it may suck. However if you are only doing it to "help people" your job will suck too. It is unwise to not consider income when choosing a job. Also, if the system is bad enough the inefficiency, oversight, and paternalism from admin/regulating bodies/etc can absolutely make it not worth continuing.

 

[Law2Doc]

I'm not making the argument that potential income shouldn't be a factor, i'm making the argument that the system shouldn't dictate whether you will become a physician or not. There is no system (that will be put in place, even if sanders is president) where potential income is low enough that becoming a doctor isn't feasible. In eery "first world" country doctors are paid well. The ones where they are paid less education is free. If you are truly in it soley for the money, medicine will suck for you. This can't be what is driving your decision, and something that people become overly worried about. You have to actually like the job at the end of the day.

GP's pretty much make 100K or more in all countries, even those with socialized medicine. Exception being France but they have no educational costs. They still make 95K and they also don't have malpractice cost.

Our system is a bit more complex than you are allowing. We are part socialized (in that many patients bills are being paid for by the government under Medicare/Medicaid) and part not. Tuition and educational lenders are big business with big lobbies so education will never be free and student debt isn't going away. And we have politicians, mostly lawyers with relatively short professional schooling and no lengthy training, who through reimbursements are deciding how much is enough for doctors to earn per patient visit. As a result every year doctors see reimbursements slashed and have to see more patients a day just to earn the same amount as last year. Right now most doctors see more patients per hour and work more hours a day to have the same kind of income doctors earned 20 years ago. And student tuition and loans have only gone up in this interval. And we have a medical malpractice set up that's different than most other countries which creates a big fixed cost and is actually exacerbated if you see more patients faster. All this is initially fine if your premise is that doctors earned a lot to start with, but if you follow this course there will eventually be a breaking point.

So IMHO it's a bit naive to just say "doctors do well even in socialized countries". They don't have the political set up we have, don't have the student loan and schooling industries we have, don't have the malpractice system we have, and so in our system if we keep going the way we are going, we can definitely get to a point where it's simply not financially feasible to incur the expenses to become a doctor. My bet, as I said above, is that we will eventually concede the issue and a lot of primary care functions will just be handled by undertrained, cheaper NPs in a generation or two.

 

[grapp]

Specifically a single-payer system.

I know there are threads on this but I'm asking again because of recent political events (Comrade Sanders).

Let's say the average pay for primary care physicians was cut down to $80,000 (this is about the median salary in Europe for PCPs).

Despite what the math says, a certain politician ensures that you graduate from public undergrad college debt free. You still have approximately $175,000 give or take in debt from med school at graduation.

You still have to go through residency with meager pay.

You have the increased complications of a single-payer system (e.g less one-on-one time with patients, flooded with many more patients, resulting stress, etc).

You're still working 70+ hours the majority of your career for significantly less pay per hour.

You're still sacrificing your youthful twenties and possibly your health later down the road.

Expect the price of living to increase as it does with most socialized countries.


Would you still do it?
I personally wouldn't. This is very close to exploitation in my eyes.

I would very much become a physician under these circumstances if I was working 40 hours a week with not nearly as much debt (LOL right?).

Unfortunately the physician shortage isn't going away anytime soon in the states and I can only imagine cutting physician pay wouldn't help that problem. Despite what many people seem to think, there aren't enough completely selfless people on this planet to fulfill the demand for doctors—that is unless you make getting into med-school so easy that you can have complete idiots in charge of the most valuable attribute you have.

I'd be a paramedic instead, still a possibility of becoming a doctor. But, with that said, I'd choose a paramedic. Why? Because when I shadow a doctor, I enjoy lots of patient contact and there is a lot is paperwork already to begin with. Less patient contact? No thanks, I'll be a paramedic.

 

[DoctorSynthesis]

Our system is a bit more complex than you are allowing. We are part socialized (in that many patients bills are being paid for by the government under Medicare/Medicaid) and part not. Tuition and educational lenders are big business with big lobbies so education will never be free and student debt isn't going away. And we have politicians, mostly lawyers with relatively short professional schooling and no lengthy training, who through reimbursements are deciding how much is enough for doctors to earn per patient visit. As a result every year doctors see reimbursements slashed and have to see more patients a day just to earn the same amount as last year. Right now most doctors see more patients per hour and work more hours a day to have the same kind of income doctors earned 20 years ago. And student tuition and loans have only gone up in this interval. And we have a medical malpractice set up that's different than most other countries which creates a big fixed cost and is actually exacerbated if you see more patients faster. All this is initially fine if your premise is that doctors earned a lot to start with, but if you follow this course there will eventually be a breaking point.

So IMHO it's a bit naive to just say "doctors do well even in socialized countries". They don't have the political set up we have, don't have the student loan and schooling industries we have, don't have the malpractice system we have, and so in our system if we keep going the way we are going, we can definitely get to a point where it's simply not financially feasible to incur the expenses to become a doctor. My bet, as I said above, is that we will eventually concede the issue and a lot of primary care functions will just be handled by undertrained, cheaper NPs in a generation or two.

Doc, I agree with your analysis, however, I think your getting a bit too "doomsday" with your conclusion.

 

[sonofva]

No, I would leave on principle.

And 80k is less than I made with my Associate's degree- why the hell would I have cost myself one million dollars in tuition and opportunity cost to make the same amount after 8 years of hell?

I didn't make 80k when I was an LPN, but the benefit:BS ratio was way better then....


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[Mad Jack]

I'm not making the argument that potential income shouldn't be a factor, i'm making the argument that the system shouldn't dictate whether you will become a physician or not. There is no system (that will be put in place, even if sanders is president) where potential income is low enough that becoming a doctor isn't feasible. In eery "first world" country doctors are paid well. The ones where they are paid less education is free. If you are truly in it soley for the money, medicine will suck for you. This can't be what is driving your decision, and something that people become overly worried about. You have to actually like the job at the end of the day.

GP's pretty much make 100K or more in all countries, even those with socialized medicine. Exception being France but they have no educational costs. They still make 95K and they also don't have malpractice cost.

Even 100k would still leave me at net poverty wages after my loans were factored in lol.