Thinking about dropping out of medical school now....

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Originally Posted by Kevin Baker

I wouldn't worry. We're getting 30 mln + new paying customers, are facing an aging population with a lot of docs retiring, and students have an average debt load close to $200k. I only see physician salaries going up.

You're more optimistic than I am. I only see nurses and PAs doing more primary care for less $.

Originally Posted by KinasePro

This is debatable, though. The policy wonks say it won't lead to significant savings but this guy and a handful of EM physicians I've spoken with estimate that >50% of the tests they order are defensive medicine. The truth is probably somewhere in-between, but I'd bet that the wonks are underestimating.

You can just look at states that DO have tort reform - in those places fewer tests are NOT ordered - the wonks have already been proven right.

Again you should argue that tort reform is good because it is fair while the current system is unfair. You won't get tort reform passed through legislatures on promises of it saving substantial amount of money because there will be experts testifying against you with actual hard data who will disprove your claims.

Showing cases of unfairness and proposing a more just system is a much better idea, in my opinion anyway.

Originally Posted by Lokhtar

You can just look at states that DO have tort reform - in those places fewer tests are NOT ordered - the wonks have already been proven right.

What states have true tort reform? If you talking about states like MD, where "tort reform" caps plaintiff payout to $30 mil, it's no wonder medicine hasn't become less defensive in those states.

Originally Posted by KinasePro

What states have true tort reform? If you talking about states like MD, where "tort reform" caps plaintiff payout to $30 mil, it's no wonder medicine hasn't become less defensive in those states.

Texas has implemented several measures in the area of tort reform, like requiring the losing party to pay the opposing party's court costs and capping non-economic damages, to name just two. Because of this, I think Texas has become arguably the most physician-friendly state in the country. How this impacts the practice of defensive medicine, I'm not exactly sure, although most studies I've seen seem to indicate it has failed in reducing health care costs in the state.

Originally Posted by JABWS

Texas has implement several measures in the area of tort reform, like requiring the losing party to pay the opposing party's court costs and capping non-economic damages, to name just two. Because of this, I think Texas has become arguably the most physician-friendly state in the country. How this impacts the practice of defensive medicine, I'm not exactly sure, although most studies I've seen seem to indicate it failed in reducing health care costs in the state.

Interesting, I didn't know this. Although the question remains: how much reform is enough to actually prevent defensive medicine? While there's clear legal benefits to practicing in texas based on this reform, perhaps it's not enough to change physician behavior.

Originally Posted by auburnO5

I won't be happy with anything less than $200k, MAYBE I could settle for $150k.

And the way I see it, by the time I'm through with residency, regardless of what field I go into (not interested in surgery) that I will be making less than $150k thanks to our glorious presidente. I'm over halfway done but at this point I think it makes the most sense for me to go ahead and quit.

Me too.

Originally Posted by Kevin Baker

I wouldn't worry. We're getting 30 mln + new paying customers, are facing an aging population with a lot of docs retiring, and students have an average debt load close to $200k. I only see physician salaries going up.

Three words prove you wrong: Medicaid Fee Schedule.

So you guys are excited about being able to see more Medicaid patients? Got it.

Y'all getting trolled by a barner

If you want to make over 200k a year, play QB for Auburn.

Originally Posted by Dave89

You're more optimistic than I am. I only see nurses and PAs doing more primary care for less $.

They see themselves doing it too - and they're lobbying for it. No one can predict the future but I wouldn't go into primary care right now even with the promise of incomes increasing. Increased reimbursements only work if patients are seeing you instead of the APN.

Originally Posted by KinasePro

Interesting, I didn't know this. Although the question remains: how much reform is enough to actually prevent defensive medicine? While there's clear legal benefits to practicing in texas based on this reform, perhaps it's not enough to change physician behavior.

Well, there is zero chance whatsoever that there's going to be any tort reform that's stronger than what Texas has now. Non-economic cap of $250k, etc etc. It's an extremely strong law for physicians. So if that's not good enough, then it's not an argument you can make because no law will be better for physicians unless you make it that patients can't sue at all.

As I said, the best (and IMO, the true) argument for malpractice reform is that it's immoral and unfair. Other legislatures have seen what happens in the malpractice reform states - the cost of malpractice insurance may go down, but the cost of healthcare doesn't. So for most states taking the issue under advisement, they're not going to believe the people claiming that costs will go down - because they will have hard data against unsubstantiated claims. Not that I am naive enough to believe legislation is based on hard data, but you have hard data plus a powerful lobby group like the trial lawyers association and....good luck fighting that.

Originally Posted by Lokhtar

Well, there is zero chance whatsoever that there's going to be any tort reform that's stronger than what Texas has now. Non-economic cap of $250k, etc etc. It's an extremely strong law for physicians. So if that's not good enough, then it's not an argument you can make because no law will be better for physicians unless you make it that patients can't sue at all.

As I said, the best (and IMO, the true) argument for malpractice reform is that it's immoral and unfair. Other legislatures have seen what happens in the malpractice reform states - the cost of malpractice insurance may go down, but the cost of healthcare doesn't. So for most states taking the issue under advisement, they're not going to believe the people claiming that costs will go down - because they will have hard data against unsubstantiated claims. Not that I am naive enough to believe legislation is based on hard data, but you have hard data plus a powerful lobby group like the trial lawyers association and....good luck fighting that.

I know I'm probably in the minority on this one, but regardless of my ambivalence towards tort reform (I would hate to be on the wrong side of a suit), the idea of suppressing civil liberties in an attempt to insulate health care professionals from liability is one that makes me very uneasy. Not only has malpractice reform proven to be ineffective in curbing healthcare costs, but tort cases in general have been grossly misrepresented by the media and party leaders seeking political gain. I'm probably barking up the wrong tree with this one, as it seems that everyone knows someone who has been negatively affected by this kind of litigation, but there are real victims on the other side of the coin too. And politicians do these people a major injustice by characterizing the majority of malpractice suits as frivolous and increasingly onerous for physicians.

I am not advocating that physicians be impossible to sue - the problem is that the cases are too complex to sufficiently explain to juries and sometimes that means physicians get off easy and other times, it means there are awards that are way over-sized compared to the issue at hand. I think we can come up with a fairer system that allows patients to bring complaints and be compensated while not allowing the crazy unfair verdicts. The vast majority of cases get settled anyway, but it's the ridiculously large payouts that drive the cost of insurance up. We could surely come up with panels of educated citizens, composed of both healthcare professionals and non-healthcare people, that would decide the case on the merits and not be swayed by emotion and/or be confused by complexity of the case. Is that the best way to do it? Probably not, I'm sure other people can come up with other ideas. I just think that the current system isn't fair.

Good luck trying to make 200k reliably in any non-medicine field. Not going to happen.

If you like medicine then stick with it. Medicine is a fairly broad field and it's very difficult to not find a field you have interest in (if you initially had some interest in medicine). Regardless of what happens with compensation, you will live comfortably. We may not be happy with what's happening, but we don't have much control or say. If you are not interested in medicine and solely in the salary, then you likely will not be happy in medicine. The money is not worth it if you have no love for what you're doing. There are one or two people I work with who absolutely hate their job lol. Crazy how someone can go through 4 years undergrad, 4 years med school, and 7 years residency for a job that they know they hate just for the money. It's not worth it.

Originally Posted by YH5

If you want to make over 200k a year, play QB for Auburn.

I'm guessing you're not an Alabama fan then, either.

Originally Posted by 2324tigers

I'm guessing you're not an Alabama fan then, either.

Even though your next national championship is probably another 60 years away, I'm sure you'll be fine waiting - plenty to do in auburn

Originally Posted by loveoforganic

Even though your next national championship is probably another 60 years away, I'm sure you'll be fine waiting - plenty to do in auburn

Right, because Tuscaloosa is a booming metropolis.

We have electricity and running water at least! Small steps

Originally Posted by auburnO5

So you guys are excited about being able to see more Medicaid patients? Got it.

You don't have to take them and those people were effectively zero'ed out under the old system, so it's no net gain/loss for a physician who doesn't take Medicaid. The big draw is that a ton of insurance shenanigans have been curtailed (eg recission, lifetime caps, preexisting condition exclusion), so these insurers will have to compensate provider services vs in today's system when insurance companies can basically say "nope, don't want to."

Originally Posted by notbobtrustme

You don't have to take them and those people were effectively zero'ed out under the old system, so it's no net gain/loss for a physician who doesn't take Medicaid. The big draw is that a ton of insurance shenanigans have been curtailed (eg recission, lifetime caps, preexisting condition exclusion), so these insurers will have to compensate provider services vs in today's system when insurance companies can basically say "nope, don't want to."

Yeah, I keep telling people that one of the main problems in today's system is that so many hospitals end up losing money by not being able to collect on patients who don't have insurance. At least this will help curtail some of that.

Originally Posted by loveoforganic

We have electricity and running water at least! Small steps

Who are you kidding? Tuscaloosa is the gem of southwest Alabama. Don't be modest.

Originally Posted by notbobtrustme

You don't have to take them and those people were effectively zero'ed out under the old system, so it's no net gain/loss for a physician who doesn't take Medicaid. The big draw is that a ton of insurance shenanigans have been curtailed (eg recission, lifetime caps, preexisting condition exclusion), so these insurers will have to compensate provider services vs in today's system when insurance companies can basically say "nope, don't want to."

You won't "have" to take them, kind of like states don't "have" to comply with certain federal mandates...but lose highway/transportation funding by doing so.

Originally Posted by SoulinNeed

Yeah, I keep telling people that one of the main problems in today's system is that so many hospitals end up losing money by not being able to collect on patients who don't have insurance. At least this will help curtail some of that.

Yeah, they'll just take it from you. But hey, medicine isn't about giving the best care to individual patients anymore; it's about giving care to the largest number of people.

Originally Posted by 2324tigers

You won't "have" to take them, kind of like states don't "have" to comply with certain federal mandates...but lose highway/transportation funding by doing so.

No, that's not how it works. Unless legislation changes, physicians can choose to see patients with medicaid/medicare. Here in IL, something like 60% of all physicians do not accept Medicaid as a form of payment.

Originally Posted by 2324tigers

Who are you kidding? Tuscaloosa is the gem of southwest Alabama. Don't be modest.

I'm glad we're on the same page

For all of you saying physician salaries will rise, take a look at any country that has socialized its healthcare.

Originally Posted by bocanutz

For all of you saying physician salaries will rise, take a look at any country that has socialized its healthcare.

The ACA is about as far from socialized medicine as you can get. Plus, those countries also heavily subsidize medical education. Finally, many of those countries also cap the number of hours you can work. So, in short, almost nothing from those countries actually translates over to the United States.

Originally Posted by notbobtrustme

The ACA is about as far from socialized medicine as you can get. Plus, those countries also heavily subsidize medical education. Finally, many of those countries also cap the number of hours you can work. So, in short, almost nothing from those countries actually translates over to the United States.

More legislation will be coming on the heels of this. If the government takes control of what is essentially 20% of our GDP, don't you think it will inevitably empower the government to engulf a progressively larger portion?

Why stop here? There's no good reason for the government to stop expanding with the ACA.

Originally Posted by auburnO5

So you guys are excited about being able to see more Medicaid patients? Got it.

So, should we only take care of the patients that pay us well?

Originally Posted by JackShephard MD

So, should we only take care of the patients that pay us well?

aside from policy... do you have a legitimate reason not to? hypothetically speaking....

Originally Posted by SpecterGT260

aside from policy... do you have a legitimate reason not to? hypothetically speaking....

Sure. Doing unto others as you would have them do unto you.

Originally Posted by JackShephard MD

Sure. Doing unto others as you would have them do unto you.

That's one opinion..... and you're perfectly welcome to abide by it. However it is missing a certain "universal truthiness" if you ask me

On a very basic level there is no better reason for your doctor to provide his services for free than there is for the guy who rotates your tires.

Originally Posted by SpecterGT260

That's one opinion..... and you're perfectly welcome to abide by it. However it is missing a certain "universal truthiness" if you ask me

On a very basic level there is no better reason for your doctor to provide his services for free than there is for the guy who rotates your tires.

That's aside from the fact that if there is a certain number of patients you are able to treat, you might as well treat those who can pay you. Is a Medicaid patient's life or well-being worth any more than a cash-paying one?

Originally Posted by SpecterGT260

aside from policy... do you have a legitimate reason not to? hypothetically speaking....

Healing the sick is a fundamental tenet of our profession, not healing the sick*. All those rights and all the status and prestige we enjoy? Yeah, that doesn't come free.

*Pending approved credit

I am mindful of my bottom line, but I accept that a certain percentage of the cases I read will go uncompensated. You can liken that to auto service, but frankly I don't care if the 27 year old women in the ED with possible acute leukemia has insurance or not. That person needs help, and I can help her. For me that's pretty much the end of the story.

Originally Posted by SpecterGT260

That's one opinion..... and you're perfectly welcome to abide by it. However it is missing a certain "universal truthiness" if you ask me

On a very basic level there is no better reason for your doctor to provide his services for free than there is for the guy who rotates your tires.

It's one opinion and I think it's the best. As was said above, I see our profession differently than a profitable service enterprise. Taking care of for "free" and being paid *less* are two different things, first off. If your brother or mother was on medicaid and needed serious medical attention in a different state, how would you feel if every doctor denied them service? If you had a daughter and then you died, leaving her to grow up alone and on medicaid, would you want her to get care?

Well, I don't want to get paid less $ like many others on this thread. But I'm going to operate based upon the principle I mentioned above even if it costs 20% of my income. I believe you would want others to care for your family members instead of showing them the door.

Originally Posted by Gut Shot

Healing the sick is a fundamental tenet of our profession, not healing the sick*. All those rights and all the status and prestige we enjoy? Yeah, that doesn't come free.

*Pending approved credit

I am mindful of my bottom line, but I accept that a certain percentage of the cases I read will go uncompensated. You can liken that to auto service, but frankly I don't care if the 27 year old women in the ED with possible acute leukemia has insurance or not. That person needs help, and I can help her. For me that's pretty much the end of the story.

Originally Posted by JackShephard MD

It's one opinion and I think it's the best. As was said above, I see our profession differently than a profitable service enterprise. Taking care of for "free" and being paid *less* are two different things, first off. If your brother or mother was on medicaid and needed serious medical attention in a different state, how would you feel if every doctor denied them service? If you had a daughter and then you died, leaving her to grow up alone and on medicaid, would you want her to get care?

Well, I don't want to get paid less $ like many others on this thread. But I'm going to operate based upon the principle I mentioned above even if it costs 20% of my income. I believe you would want others to care for your family members instead of showing them the door.

I'm not arguing with you. I was only pointing out that issues of morals are not the same for everyone so while you can apply your morals as you see fit this in no way means you have the "right answer". You're employing subjective reasoning to get there. I'm not saying you're wrong. But not being wrong doesn't equal being right.
What I want for my family is irrelevant. I also want free tire service. Does that mean I should also get that. Health (or death) is a very recognizable line at which we can say "well its different" but it is important to remember that the line is arbitrary.


I also take issue with quantifying or establishing value with personal relation. What I want for my family and what they deserve are two different things.

Originally Posted by Gut Shot

Healing the sick is a fundamental tenet of our profession, not healing the sick*. All those rights and all the status and prestige we enjoy? Yeah, that doesn't come free.

*Pending approved credit

I am mindful of my bottom line, but I accept that a certain percentage of the cases I read will go uncompensated. You can liken that to auto service, but frankly I don't care if the 27 year old women in the ED with possible acute leukemia has insurance or not. That person needs help, and I can help her. For me that's pretty much the end of the story.

That's fine. I am only trying to point out this is nothing beyond personal opinion. Lets pretend that tomorrow we were plunged into some Road Warrior style apocalypse (wanted to use Fallout but saw that you're an attending and figured Mad Max may be more time appropriate ) would you dole your skills out for those in need while your family starved or would you hold.out until you could receive compensation? My only point is that healthcare isn't a right and that we tend to the poor now because we can afford to. I would also like to note that nothing I've said here actually betrays my own opinion on the matter.

Originally Posted by 2324tigers

More legislation will be coming on the heels of this. If the government takes control of what is essentially 20% of our GDP, don't you think it will inevitably empower the government to engulf a progressively larger portion?

Why stop here? There's no good reason for the government to stop expanding with the ACA.

That's a lot of ifs with no backup. Congress might outlaw medicine altogether and go back to leeches and powdered tiger penis. You can't bank on what ifs and maybes. For now, physician salaries look to be intact with the ACA. As others have said, they may actually rise with universal coverage and an increased workload.

xxx

Originally Posted by SpecterGT260

I'm not arguing with you. I was only pointing out that issues of morals are not the same for everyone so while you can apply your morals as you see fit this in no way means you have the "right answer". You're employing subjective reasoning to get there. I'm not saying you're wrong. But not being wrong doesn't equal being right.
What I want for my family is irrelevant. I also want free tire service. Does that mean I should also get that. Health (or death) is a very recognizable line at which we can say "well its different" but it is important to remember that the line is arbitrary.


I also take issue with quantifying or establishing value with personal relation. What I want for my family and what they deserve are two different things.

So should we only give to those who deserve? Who should we be generous to?

Btw, all these arguments are subjective. Please re-read anything I've said, I never claimed to "be right" as opposed to being subjective.

Check out the last line of my last post

Originally Posted by 2324tigers

More legislation will be coming on the heels of this. If the government takes control of what is essentially 20% of our GDP, don't you think it will inevitably empower the government to engulf a progressively larger portion?

Why stop here? There's no good reason for the government to stop expanding with the ACA.

LOL I wish they had completely taken over 20% of our GDP, but they didn't. Unfortunately.

Find out your Canadian tax info here. Plug in your salary. I pay more taxes here in Oregon that I did when I lived in British Columbia. Made more money there too. Canadian dollar is basically at par now, btw.

http://www.ey.com/CA/en/Services/Tax...2-Personal-Tax

Some real info for you.

Here is some 2009 Physician Billing information for the Province of British Columbia. Names and salaries:
http://www.health.gov.bc.ca/msp/legi...9_complete.pdf

To find out what each physician specializes in, just search their name here: https://www.cpsbc.ca/node/264

My old family doc is on that list, and billed about $450k. Working in downtown Vancouver.

Income tax calculator here as well: http://www.ey.com/CA/en/Services/Tax...2-Personal-Tax

http://www.xe.com/ <-- currency exchange

A Canadian Cardiac Surgeon I worked with used to tell me stories about how he loved shocking is US colleagues at conferences by telling them how much money he makes.

Originally Posted by Shnurek

That link does not include the 4.95% CPP and 1.78% EI but yes I also used that link. I just didn't post it because it wasn't sufficient enough.

So 4.95% + 1.78% = 6.73% and 6.73% of $190,000 is $12,787.

Therefore.... your final take home pay will be $116,000 - $12,787 = $103,213 in the worst case scenario. Hmmm that seems awfully like my original figure of $100,000 but thanks for your pompous tone.

Some real info for you.

Here is some 2009 Physician Billing information for the Province of British Columbia. Names and salaries:
http://www.health.gov.bc.ca/msp/legi...9_complete.pdf

To find out what each physician specializes in, just search their name here: https://www.cpsbc.ca/node/264

My old family doc is on that list, and billed about $450k. Working in downtown Vancouver.

Income tax calculator here as well: http://www.ey.com/CA/en/Services/Tax...2-Personal-Tax

http://www.xe.com/ <-- currency exchange

A Canadian Cardiac Surgeon I worked with used to tell me stories about how he loved shocking is US colleagues at conferences by telling them how much money he makes.

Canadian Resident Salary Info here as well:

http://www.carms.ca/eng/r1_program_salaries_e.shtml

Salary of $75,000 pays an average tax rate of 22% in British Columbia
http://www.ey.com/CA/en/Services/Tax...2-Personal-Tax

Found the 2011 British Columbia billings: http://www.health.gov.bc.ca/msp/legi...uebook2011.pdf

search the names here to find out which specialties they go with: https://www.cpsbc.ca/node/264

My old family doc billed $454,809.82 His practice is in downtown Vancouver.

I chose some doctors that I know from the list. All work at the same Vancouver hospital.

Cardiac Anesthesiologist at my old hospital: $561,692.79

OB who delivered my best friend's baby: $634,236.47

Cardiologist (electrophysiology specialist): $703,938.32

Cardiologist (heart failure specialist): $690,000.54

Cardiac Surgeon: $550,852.16

I asked an anesthesiologist how much he pays in malpractice insurance a year once. His answer. $1000.

Universal health care sounds terrible.

Originally Posted by jayceee

My old family doc billed $454,809.82 His practice is in downtown Vancouver.

OK we get it. You don't have to repeat this anecdotal evidence three times.