President Bernie Sanders

[BLADEMDA]

Have any of you Democrats/Liberals/Bernie Bros considered the implication of electing Sanders as President? Do you know what he will do to this specialty?

Before any of you post ridiculous comments about how the world comes first or "greater good" theory the vast majority of unions and Democrats decide to vote for candidates that help their cause, keep their jobs and pass laws helping them. This is true for auto workers, culinary workers in Vegas, coal miners, fishermen, etc.

This specialty isn't much different than the coal miners in that the liberal left wants us out of a job in favor of other, cheaper anesthesia providers.

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[BLADEMDA]

This is graph showing that salaries in Anesthesiology will plummet by 50-60% if Bernie Sanders becomes President and passes his signature proposal of Medicare for All. The graph shows average private reimbursement for specialties vs Medicare:

 

[BLADEMDA]

The odds heavily favor Bernie Sanders getting the nomination at this time and running against Trump. Even if you hate Trump electing Bernie is far worse than Hillary Clinton and his presidency may destroy this field.

 

[ChocoE21]

so then why don't we unionize and bargain for better medicare reimbursement rates? If even a quarter of all anesthesiologist say we won't bill for the hospitals for a day that could have multi billion dollar effects. Or do some other form of labor organization to bargain for better wages more equitable with others in our profession (physicians). Either way, bernie sanders or not, I'm curious why you think physicians never want to stand up for themselves and their wages.

 

[bronx43]

Wait why should anesthesiology get 344% Medicare rates when I, as a medicine sub specialist, can’t even get 150%?

 

[IkeBoy18]

Wait why should anesthesiology get 344% Medicare rates when I, as a medicine sub specialist, can’t even get 150%?

Medicare reimburses pennies for anesthesia. 344% of very little is still usually very little.

 

[bronx43]

Medicare reimburses pennies for anesthesia. 344% of very little is still usually very little.

It’s all relative. For outpatient e&m, level 4 return visits only pay $107 and can take 40 min of your time. I’m not sure you’ll get sympathy from most other specialties.

 

[dangEras]

It’s all relative. For outpatient e&m, level 4 return visits only pay $107 and can take 40 min of your time. I’m not sure you’ll get sympathy from most other specialties.

If medicare values putting someone under and actively monitoring them for an hour at say at $100/hr, I'd say one can easily make the case for making level 4 clinic visit be worth ~$30 in said environment.

 

[bronx43]

If medicare values putting someone under and actively monitoring them for an hour at say at $100/hr, I'd say one can easily make the case for making level 4 clinic visit be worth ~$30 in said environment.

Outpatient physicians would disagree. And alas there is no such objective metric - merely opinions. And as I said, most physicians would give you no sympathy for losing 344% of Medicare rates. If the gravy train ends for you all, then live with it.

 

[Guillemot]

My job wouldn't be worth it for that kind of pay cut. I guess I'd consider it for no nights, weekends, holidays.


I guess if Bernie wins I could just go back to school and study something else for free.

 

[Beeftenderloin]

If he forgives my wife and I’s student loan debt as promised, It makes the potential pay cut far more palatable.

 

[nimbus]

Outpatient physicians would disagree. And alas there is no such objective metric - merely opinions. And as I said, most physicians would give you no sympathy for losing 344% of Medicare rates. If the gravy train ends for you all, then live with it.

I don’t know what the hourly wages are for your specialty. Medicare rates for anesthesia works out to about $80-100/hr gross before any expenses are taken out. Good luck finding anybody to do it for that pay.

 

[Southpaw]

Outpatient physicians would disagree. And alas there is no such objective metric - merely opinions. And as I said, most physicians would give you no sympathy for losing 344% of Medicare rates. If the gravy train ends for you all, then live with it.

You’re looking at this wrong, but it doesn’t make your entire argument wrong. You’re assuming that Medicare values all specialties equally, and therefore getting 344% of Medicare is wrong. Why can’t you start from a position of Medicare valuing us worse than you, relatively speaking? I imagine we both know that answer.

not that you, or Medicare, care, but if tomorrow I wake up and I’m earning 1/3 of my income due to ‘Medicare for all’ I’ll simply go do something else. And, like you, I’m fine with that. Outpatient medicine will suddenly become even more attractive. No anesthesia concerns over sick patients, no CRNAs, and most importantly no nurse managers or hospital administrators telling me how to do my job.

 

[bronx43]

I don’t know what the hourly wages are for your specialty. Medicare rates for anesthesia works out to about $80-100/hr gross before any expenses are taken out. Good luck finding anybody to do it for that pay.

How does that math work? Is Blade off on the 50-60% drop in salary? The numbers you’re throwing out are significantly more than a 50% cut.

 

[bronx43]

You’re looking at this wrong, but it doesn’t make your entire argument wrong. You’re assuming that Medicare values all specialties equally, and therefore getting 344% of Medicare is wrong. Why can’t you start from a position of Medicare valuing us worse than you, relatively speaking? I imagine we both know that answer.

not that you, or Medicare, care, but if tomorrow I wake up and I’m earning 1/3 of my income due to ‘Medicare for all’ I’ll simply go do something else. And, like you, I’m fine with that. Outpatient medicine will suddenly become even more attractive. No anesthesia concerns over sick patients, no CRNAs, and most importantly no nurse managers or hospital administrators telling me how to do my job.

Medicare is obviously banking on the fact that docs won’t go out and do something else, because most of us can’t find something as stable and lucrative, even with a hefty cut.

Mgma median in 2018 for anesthesiology was $460k. You’re saying most anesthesiologists would leave a job that pays them half that?

 

[nimbus]

How does that math work? Is Blade off on the 50-60% drop in salary? The numbers you’re throwing out are significantly more than a 50% cut.

Medicare reimbursement for anesthesia is about $22/unit. Anesthesia is billed based on base units+time unit. 15min=1 time unit. Base units for each case varies from 3(knee scope) to 30(liver transplant) based on complexity.

Most commercial insurance pay 3-4x medicare.

 

[Southpaw]

Medicare is obviously banking on the fact that docs won’t go out and do something else, because most of us can’t find something as stable and lucrative, even with a hefty cut.

Mgma median in 2018 for anesthesiology was $460k. You’re saying most anesthesiologists would leave a job that pays them half that?

I take call, sleep in the hospital and care for all comers at all hours of the night. OB, trauma, vascular, and anything else that may show up. No 8-4 for me with half day on Friday. Under MFA I’d make 1/3 of my current income based on my understanding of Medicare vs private payor rates.

I don’t care what other anesthesiologists would do. But I’d certainly, without hesitation, go do something else if forced to get that haircut.

 

[nimbus]

Link partly explains how we ended up with sh*tty medicare reimbursement.

https://www.csahq.org/docs/default-source/news-and-events-docs/csa-bulletin-docs/spring-2006/rbrvs_p4p.pdf?sfvrsn=d69ec646_2

http://www.csahq.org/docs/default-source/history-of-anesthesia-articles/history-articles/pauker-a-history-of-rbrvs-part2-2006.pdf?sfvrsn=d864c146_2

 

[bronx43]

I take call, sleep in the hospital and care for all comers at all hours of the night. OB, trauma, vascular, and anything else that may show up. No 8-4 for me with half day on Friday. Under MFA I’d make 1/3 of my current income based on my understanding of Medicare vs private payor rates.

I don’t care what other anesthesiologists would do. But I’d certainly, without hesitation, go do something else if forced to get that haircut.

But go do what? I think I would do the same until I try to actively come up with what I would do to pay my bills and mortgage. Medicare for all wouldn’t magically make my bank forgive 50% of my mortgage.

Maybe you have a special skill to leverage that most other docs don’t. Medicare knows this, and they could care less about whether or not a small percentage of doctors would leave the profession.

 

[Southpaw]

But go do what? I think I would do the same until I try to actively come up with what I would do to pay my bills and mortgage. Medicare for all wouldn’t magically make my bank forgive 50% of my mortgage.

Well I’ve honestly considered the options. My FIL makes a little more than 50% of my salary in primary care for clinic hours and 1/2 day on Friday. No nights. No weekends. No sleeping in the hospital. I’d go do that even if required to train for another two years. I also have outside interests that I’d consider pursuing. And they wouldn’t pay me nearly what I currently make but they also would not require the sacrifices that I have made and continue to make to be an anesthesiologist.

 

[Southpaw]

But go do what? I think I would do the same until I try to actively come up with what I would do to pay my bills and mortgage. Medicare for all wouldn’t magically make my bank forgive 50% of my mortgage.

Maybe you have a special skill to leverage that most other docs don’t. Medicare knows this, and they could care less about whether or not a small percentage of doctors would leave the profession.

What kind of paycut would medical sub specialists take under MFA?

 

[bronx43]

What kind of paycut would medical sub specialists take under MFA?

Depends what field. There are so many moving parts to Medicare for all that it’s not predictable in the least. If we simply assume that the only difference will be changing all rates to Medicare rates, then I would guess paycut would be around 20-30%. Most medicine specialists are already heavy in Medicare.

 

[chocomorsel]

But go do what? I think I would do the same until I try to actively come up with what I would do to pay my bills and mortgage. Medicare for all wouldn’t magically make my bank forgive 50% of my mortgage.

Maybe you have a special skill to leverage that most other docs don’t. Medicare knows this, and they could care less about whether or not a small percentage of doctors would leave the profession.

Sell your house and get a smaller more manageable mortgage. If you can’t make your mortgage payments off 250k, then I don’t know what to tell you.
Get out of NY for one if that’s where you are.
That being said, I hate Trump, but not necessarily leaning towards Sanders. Don’t know where I am yet.

 

[Wkrdoc]

ANYONE (especially physicians) who votes for this guys a F******* idiot. End of story

 

[Wkrdoc]

Sell your house and get a smaller more manageable mortgage. If you can’t make your mortgage payments off 250k, then I don’t know what to tell you.
Get out of NY for one if that’s where you are.
That being said, I hate Trump, but not necessarily leaning towards Sanders. Don’t know where I am yet.

The stock market would plummet if sanders won. I’m pretty damn happy with what trump has done for me financially. Don’t be an IDIOT. Vote for what benefits you as a physician

I hated what obama stood for, but I did well with him so he got my vote.

 

[Planktonmd]

This whole argument is not worth anyone's time... So far it looks like this country is going to have 4 more years of good old Trump. None of the democratic candidates is able to appeal to the moderate democrats or convert even one of those MAGA guys. So why waste time arguing something that's never going to happen?

 

[chocomorsel]

The stock market would plummet if sanders won. I’m pretty damn happy with what trump has done for me financially. Don’t be an IDIOT. Vote for what benefits you as a physician

If I want to be an idiot, that’s my prerogative. It’s a free country. I vote for who I want.
Can you read? Are you slow?

 

[Wkrdoc]

If I want to be an idiot, that’s my prerogative. It’s a free country.
Can you read? Are you slow?

Sounds good stupid. Have fun

 

[chocomorsel]

[deleted]

 

[Wkrdoc]

[deleted]

 

[chocomorsel]

Somebody please close this dumpster of a thread. We already got dinguses that clearly lack comprehension skills calling people names. Political and gun threads really need to have their own sub forums.

 

[nimbus]

Even if Bernie wins, M4A is not a done deal. Overall he represents my views more than Trump so I have no problem voting for him if he’s the nominee.

 

[kidthor]

Bernie 2020 baby. Getting loans cancelled and if you don't like it, sorry

Not for you - you're a "rich doctor". Pay your fair share.

 

[PharmLover234]

Not for you - you're a "rich doctor". Pay your fair share.

 

[Zekchar]

But go do what? I think I would do the same until I try to actively come up with what I would do to pay my bills and mortgage. Medicare for all wouldn’t magically make my bank forgive 50% of my mortgage.

Maybe you have a special skill to leverage that most other docs don’t. Medicare knows this, and they could care less about whether or not a small percentage of doctors would leave the profession.

Medicare for all would be fought tooth and nail. It would take a while to get in passed through a republican congress. I'm 5 years out and already 1/3 the way to FIRE. I think that if things change in that way then Private Hospitals would spring up. You'd have the option to go to the public hospital and be seen by endless nurses, PAs, and NPs or go to the private hospital and be seen exclusively by doctors. Anybody with any money or concern for the well-being of their significant others would go to the 2nd option. Basically, similar to what the British model is.

Alternatively, If things got really bad I would go back and do a psychiatry residency and start seeing private patients only while being my own boss.

 

[Wkrdoc]

Even if Bernie wins, M4A is not a done deal. Overall he represents my views more than Trump so I have no problem voting for him if he’s the nominee.

Have fun with those new tax brackets lol

It’s astonishing a physician would vote for someone trying to wreck their industry and lower their take home salary with insane tax brackets. Yet jump on board bc he’s pro life or an environmentalist.

I don’t need a president to be a “good guy”. He can be a complete dingus. Hell, I don’t even need to like him as a person. But if he does the job well then I’m all for it.

 

[nimbus]

Have fun with those new tax brackets lol

It’s astonishing a physician would vote for someone trying to wreck their industry and lower their take home salary with insane tax brackets. Yet jump on board bc he’s pro life or an environmentalist.

I don’t need a president to be a “good guy”. He can be a complete dingus. Hell, I don’t even need to like him as a person. But if he does the job well then I’m all for it.

For the record, I’m not pro life. That’s one of my many major objections to Trump. I will be more than fine regardless of who is president.

 

[Wkrdoc]

For the record, I’m not pro life. That’s one of my many major objections to Trump. I will be more than fine regardless of who is president.

Sorry Pro choice. Clearly you know what I meant. So you’d vote for someone based on something that’s never really going to change (Ie gun laws) that has zero effect on you personally?

Meanwhile, it may have a legit possibility of impacting your future regarding industry and take home salary?

Blows my mind

 

[nimbus]

Sorry Pro choice. Clearly you know what I meant. So you’d vote for someone based on something that’s never really going to change (Ie gun laws) that has zero effect on you personally?

Meanwhile, it may have a legit possibility of impacting your future regarding industry and take home salary?

Blows my mind

I live on 30-35% of my take home so yeah.

 

[Wkrdoc]

I live on 30-35% of my take home so yeah.

Oh so you’re cool handing the rest over to the gov?

Unbelievable, your party is nominating a full blown socialist and you guys aren’t skipping a beat.

 

[cowbydoc]

My take home from this is that some sort of governmental insurance is gaining steam. Get your ducks in a row, your debts in control because things will most likely change in the next decade or so.

 

[pgg]

Somebody please close this dumpster of a thread. We already got dinguses that clearly lack comprehension skills calling people names. Political and gun threads really need to have their own sub forums.

Sounds good stupid. Have fun

All - keep it civil. We're going to experiment with threadbanning people who can't keep the spittle in their own mouths.

 

[pgg]

2016 shook my faith in being able to predict anything about elections any more, but ...


It's looking like Bernie Sanders will be the nominee. I suppose it's possible the DNC will sabotage him again, but it's hard for me to see how any of the others overtake him.

He would be an enormous downballot drag on most of the House seats the Democrats flipped in 2018 (which are by definition in moderate/swing districts). If he's the guy for the Democrats this year, Trump has to be loving his chances ... he may even get a Republican Senate and House until the midterms.

Even if Bernie Sanders did win, without Senate and House supermajorities he'll never get student loan forgiveness, M4A, or any of the other things he's campaigning on passed. For that reason alone, I'm not clutching my pearls about how a Sanders win might affect my tax bill or income.

Going to be an interesting year.

 

[deleted941485]

Have any of you Democrats/Liberals/Bernie Bros considered the implication of electing Sanders as President? Do you know what he will do to this specialty?

Before any of you post ridiculous comments about how the world comes first or "greater good" theory the vast majority of unions and Democrats decide to vote for candidates that help their cause, keep their jobs and pass laws helping them. This is true for auto workers, culinary workers in Vegas, coal miners, fishermen, etc.

This specialty isn't much different than the coal miners in that the liberal left wants us out of a job in favor of other, cheaper anesthesia providers.

Finally somebody posts about this. Been waiting all month for somebody to make a thread and now it’s here.

Bernie looks pretty untouchable. He will have Nevada by the end of the night. And honestly if he moderates can’t coalesce behind anyone then guess what he will get the nomination.

While conservatives I’ve talked to say that seems fine and dandy with them, I think they are playing with fire and seriously misjudging the electorate in general.

His M4A plans will be disastrous for any specialty really. It’s really been an all out assault this year on medicine.

 

[deleted941485]

Outpatient physicians would disagree. And alas there is no such objective metric - merely opinions. And as I said, most physicians would give you no sympathy for losing 344% of Medicare rates. If the gravy train ends for you all, then live with it.

The whole percentage thing is relative anyway. You could sit in a 4 hour train wreck case and walk away with 300 dollars for the day if that patient is on Medicaid. Seems totally fair.

 

[deleted941485]

Medicare is obviously banking on the fact that docs won’t go out and do something else, because most of us can’t find something as stable and lucrative, even with a hefty cut.

Mgma median in 2018 for anesthesiology was $460k. You’re saying most anesthesiologists would leave a job that pays them half that?

They’ll stay for a while but honestly they probably won’t work the hours they used to, train residents, and start to take on side gigs and looks for new opportunities.

You’re right physicians wont leave outright because they can’t but I don’t expect them to really putting nearly as much effort into the day to day.

In Bernie world, you’d be faced with a significant pay cut and higher probably signifantly higher tax rates. A real double whammy.

 

[deleted941485]

2016 shook my faith in being able to predict anything about elections any more, but ...


It's looking like Bernie Sanders will be the nominee. I suppose it's possible the DNC will sabotage him again, but it's hard for me to see how any of the others overtake him.

He would be an enormous downballot drag on most of the House seats the Democrats flipped in 2018 (which are by definition in moderate/swing districts). If he's the guy for the Democrats this year, Trump has to be loving his chances ... he may even get a Republican Senate and House until the midterms.

Even if Bernie Sanders did win, without Senate and House supermajorities he'll never get student loan forgiveness, M4A, or any of the other things he's campaigning on passed. For that reason alone, I'm not clutching my pearls about how a Sanders win might affect my tax bill or income.

Going to be an interesting year.

The dems currently in Congress will fall in line. If Bernie wins the nom, they will sing his tune as well.

 

[BLADEMDA]

Outpatient physicians would disagree. And alas there is no such objective metric - merely opinions. And as I said, most physicians would give you no sympathy for losing 344% of Medicare rates. If the gravy train ends for you all, then live with it.

You have no idea the inherent risks of "going under" general anesthesia or receiving a peripheral nerve block/neuraxial anesthesia. Medicare reimburses me at a rate of a plumber or electrician for my services. I suspect many will simply retire rather than accept reimbursement rates far below the risks assumed by Physician Anesthesiologists.

 

[Consigliere]

Trump will be re-elected. Guaranteed. I have a 100% accuracy rate in picking every president since Carter. This time will be no different.

 

[thinkorswim]

This whole argument is not worth anyone's time... So far it looks like this country is going to have 4 more years of good old Trump. None of the democratic candidates is able to appeal to the moderate democrats or convert even one of those MAGA guys. So why waste time arguing something that's never going to happen?

I’m pretty sure this was the exact sentiment when Trump became the GOP nominee. It’s been a few hours since I’ve been outside, but the last time I checked, the world still hasn’t come to an end.

I for one think we could survive a Bernie presidency (and probably need it for our own sanity). Sure you guys might have a few liberal policies shoved down your throats, but nothing huge will change in your day-to-day life, as it probably hasn’t since Trump was elected either.