So, bottom line... what is the future of anesthesiology for MDs?

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Blade, you make a convincing argument and I follow what you are saying but it is based entirely on the ABSOLUTE worst case scenario. All I'm saying is a one payer system or even Obamacare for that matter is not a foregone conclusion... YET (http://washingtonexaminer.com/rep.-...epeal-obamacare-with-51-votes/article/2501153). Same fears/arguments about socialized medicine were made back in the 60's when Medicare was created. That was half a century ago. No one has a crystal ball...

My practice has a comparatively low medicare/medicaid population. I understand you are in Florida so you are probably on the other end of the spectrum and more sensitive to reimbursement inequalities. My guess most of America is somewhere in between.

Your prediction of a one payer system is assuming COMPLETE obliteration of a multi-billion dollar insurance industry. I don't see that happening overnight. The battle is lost but the war has just begun. Obama has pissed off the entire financial and healthcare industry. Lots of powerful, wealthy, influential people are not just gonna roll over. I will reserve my pessimism until after the Nov elections.

BTW, I saw your blurb regarding Vermont but where is the mention of the 15 states that want to opt out of the additional Medicaid option??

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This isn't a difficult question. A Single Payer system would likely increase primary care income SLIGHTLY higher compared to 2012. So. all one needs to do is get the MGMA data for a close estimate.

For most other specilaties a 20% reduction would be reasonable but I expect Ortho, Optho and Radiology to do worse (?30% reduction) as the govt. LIMITS elective procedures (or MRI scans for Rads). Ortho will take a hit as the govt. puts rules in place for elective joint replacement, etc.

Pain Medicine will likely take a hit of 25% (more if doing a lot of implants) because of IPAB.

Of all the actual Anesthesia OR subspecialties I would expect Peds to do the best under Medicare Plus as the govt. may include a Peds. Anesthesiologist incentive in the payment.

General and Cardiac Anesthesia will take a hit of 50% compared to today's MGMA data.

CRITICAL CARE Anesthesia should do well as this specialty becomes the gatekeeper for keeping health care expenses down in the last 90 days of life.

I saw the 2010 MGMA data listed on SDN, do the 2012 data exist for free somewhere so I don't have to pay the 625.00$ non-member fee that I see on the website? Or maybe I'm looking in the wrong place...

Anyway, Blade, thanks for that info, so, I see you note Neurosurgery as a specialty that will hold its own. What is IPAB? And why would implants be limited? Just more and more control of what gets approved in the future? Also, do you have any reason to think Peds incentives will happen? And to clarify, CCM, would do okay because, (is this the logic) that, well, someone has to take care of the people who are in their last days? to be blunt, will nurses encroach in this area as well?

As a side question to this thread, the pathway to CCM, aside from 4 anesthesia + CCM, is there another pathway? I thought Pulm was a pathway. Would that be IM+Pulm+CCM? (that's a long road...ha).

you mentioned neurosurgery (in another post) remaining 100% paid by Medicare. Are there any other subspecialties that will benefit like neurosurgery? why are hearts not treated the same way.

I ask these because, while I'm planning on staying with writing for now, if a show or two sells in next 12-24 months, I may still be able to make medicine happen, and yes, that's what I want. but without a show sale, and writing a check for med school for 250K, I'm not sure I can make much sense of this, financially.

D712
 
I totally agree with you, just not so sure the Canadian way is really that bad, once society has decided it wants universal free healthcare. We could do worse than Canada.

And there's different degrees of rationing. I'd have less heartburn over rationing / delaying elective inguinal hernia repairs than I would over rationing / delaying colectomies for cancer.

I'm NOT making a Judgment over which system is better although I prefer the Ryan plan. The Canadian System is far superior to ObamaCare and my bet is Hillary Clinton knows this and will advocate such a system in her 2016 Presidential campaign.
 
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Blade, you make a convincing argument and I follow what you are saying but it is based entirely on the ABSOLUTE worst case scenario. All I'm saying is a one payer system or even Obamacare for that matter is not a foregone conclusion... YET (http://washingtonexaminer.com/rep.-...epeal-obamacare-with-51-votes/article/2501153). Same fears/arguments about socialized medicine were made back in the 60's when Medicare was created. That was half a century ago. No one has a crystal ball...

My practice has a comparatively low medicare/medicaid population. I understand you are in Florida so you are probably on the other end of the spectrum and more sensitive to reimbursement inequalities. My guess most of America is somewhere in between.

Your prediction of a one payer system is assuming COMPLETE obliteration of a multi-billion dollar insurance industry. I don't see that happening overnight. The battle is lost but the war has just begun. Obama has pissed off the entire financial and healthcare industry. Lots of powerful, wealthy, influential people are not just gonna roll over. I will reserve my pessimism until after the Nov elections.

BTW, I saw your blurb regarding Vermont but where is the mention of the 15 states that want to opt out of the additional Medicaid option??

I live in JUST SUCH A STATE that wants to opt out of the Medicaid expansion. Still, ObamaCare is the LAW OF THE LAND and unless the GOP sweeps the White House and the Senate the Unaffordable Patient Health Care Law will begin to irreversibly alter the practice of medicine.

You think Socialists care about Billion dollar industries? If ObamaCare stands "as is" the Health Insurance industry is toast. History. Obliviated. The only Payer left standing will be govt. run health care via the Federal or State govts. This is exactly what Obama and the Liberals wanted in the first place but they needed a Trojan Horse to get there.

By the way your practice will be FEDERALIZED along with mine. There won't be any large private payers left as "not for profit" government health care drives them out of business. The few smaller insurers left standing will end up in Court over the "right" to sell Private health care policies to individuals outside the exchanges. If I were you I wouldn't count on SCOTUS to help you here any more than they did with Obamacare.
 
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I saw the 2010 MGMA data listed on SDN, do the 2012 data exist for free somewhere so I don't have to pay the 625.00$ non-member fee that I see on the website? Or maybe I'm looking in the wrong place...

Anyway, Blade, thanks for that info, so, I see you note Neurosurgery as a specialty that will hold its own. What is IPAB? And why would implants be limited? Just more and more control of what gets approved in the future? Also, do you have any reason to think Peds incentives will happen? And to clarify, CCM, would do okay because, (is this the logic) that, well, someone has to take care of the people who are in their last days? to be blunt, will nurses encroach in this area as well?

As a side question to this thread, the pathway to CCM, aside from 4 anesthesia + CCM, is there another pathway? I thought Pulm was a pathway. Would that be IM+Pulm+CCM? (that's a long road...ha).

you mentioned neurosurgery (in another post) remaining 100% paid by Medicare. Are there any other subspecialties that will benefit like neurosurgery? why are hearts not treated the same way.

I ask these because, while I'm planning on staying with writing for now, if a show or two sells in next 12-24 months, I may still be able to make medicine happen, and yes, that's what I want. but without a show sale, and writing a check for med school for 250K, I'm not sure I can make much sense of this, financially.

D712

I'm HOPING none of my posts on this thread become reality. I'm hoping Obama loses reelection and the GOP wins control of the Senate. Then, the GOP decimates Obamacare in 2013, adopts Simpson-Bowles, Passes Ryan Health Care reform and the DOW hits 20,000 by 2015.

But, HOPE isn't reality and right now the reality of 2012 is Obamacare.

Would you choose Anesthesiology for $200K a year over another Specialty earning $450? If so, then by all means don't think twice and join the Club. But, if you want a lucrative career without Advanced Nurses claiming Equivalence look elsewhere.

Enough Medical Students will ignore my advice, never believe my posts or simply hope things work out and enter this field anyway. God Bless them all.
 
I totally hear you about the reality and your predictions, and let's hope something else comes to pass. Having said that, Blade, could you address my questions in the post specifically if at all possible?

thanks much!!!!!! : )

for me, as you know a non-trad, with MUCHHHHH LESS earning time than someone 15 years ahead of me, I don't know if I can AFFORD to do anesthesia at 200K a year. I really don't. i could probably squeak by, especially if i bang out a script or two a year, but let's be honest, through the thick of it (M1-4 ----> PGY4) i'm not going to be banging out much of anything. maybe M4.... so, questions from above stand.

you know how much i love anesthesia and my experiences there, and i've made my way publishing already, so i could try and leverage that in the future. having said that, if i have to move over to anesthesia/CCM to make a LIVING during obama care, i'd do it. that's why your forthcoming opinions are as important as ever...

thanks dude,

D712
 
Can-a-mood-ring-predict-the-future-290x276.jpg


My Crystal Ball can't handle more than a few questions at a time so can you be more specific? Is there a particular specialty you would like to know about?
 
Haha, I'll number the questions so as to focus your crystal ball. I've narrowed down to the most important questions...

1.) I see you note Neurosurgery as a specialty that will hold its own. What is IPAB?

2) Do you have any reason to think Peds incentives will happen?

3) Why do you think CCM will thrive ($) under Maobama? Or single payer system. Can you be specific yet lay-talk for the non-doc billing side of my brain...

4) CCM. There are many pathways that I have read about: anesthesia (I imagine the most popular pathway on this thread), plum, IM, EM, Neuro etc. Is there a pathway that you think a) makes you the best CCM doc for PP or Academia (clinical v research) and b) might be the most lucrative avenue? Years in training vs. MICU/SICU work pp/academic compensation (if they differ)...

5) Any other specific specialities, that you think will thrive, financially (not a popular subject, I get it, but let's put "do what you'd be happy doing aside for the moment) under Maobama, or Single Payer System? I mean is Neonatology going to be the place to be because we're all having kids and they are not on medicare and bla bla bla...?

6) If you HAD TO GO TO MED SCHOOL TODAY, I mean, .357 :) pointed at your head, and you could not do General Anesthesia, and wanted to a) make a decent living in the face of MobamaCare and b) enjoy the HELL out of what you were doing day in and out, what would you choose? Or suggest for another person who loves procedures, fun, excitement, research and benjamins?

7) Thank you.

8) D712

9) To Darby's comment below, Pain vs CCM. Please explain why Pain is so protected vs. something like CCM or even GI. I mean, aren't many of the pain patients on medicare, and
thus getting 15$ office visits in clinic during 1/2 your week. And when you do procedures on them, say an epidural for back or leg pain, are those procedures going to be covered the same
way under Maobama? Why does that pay so well, when it's medicare money, vs. doing kids ear tubes and hearts all day long, don't they usually have private insurance covered by working parents who present with something like Blue Cross?

9a) Just saw a bill for family members' colonoscopy. 4000$. Procedure took doc 30 mins. Maybe he did 5-10 that day. Let's say 8. X 4000 = 32000. What does he pay the surgicenter for space? And if he does that 2 days during the week = 64,000 a week plus clinic. x 52 weeks. Why doesn't this GI make 3.3 million? (the math.) Or let's say HALF that many colonoscopies a year, why doesn't he make 1.65million. I mean, I'm sure he doesn't. So when you see the 4K bill, does the doc not get that in a check? Does the Anesthesiologist who I see got 2K for a friends' epidural not get that 2K?
Doctoring and money 101. Please clarify for the med students and future docs out there. I know docs who literally have 2 days a week of Pain procedures, full days of 10-12 fluro guided blocks from 9am-5.
Say 10 blocks. 20K x 52= over a million. Doctor makes about 1/2 of that. Why?
 
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i just cant understand why one would get into ccm when, we do VERY LITTLE CCM out in the real world. Plain and simple. 2) CCM is HOSPITAL BASED. You would further entrench and enslave yourself in and to the hospital.3) its generally lower paying than doing anesthesia. So whats the up side. i dont get it. Pain I can see. There are many areas you can get into with pain especially if you really like it. Pain can be purely outpatient and thats what you want. you dont wanna be involved with the hospital because they are going to have more and more and more power and will dictate how much you make and how much you work to make it in the future thats for sure
 
Darby11: the gift that keeps on giving.

Blade, edited above to add 9 and 9a. I promise that's it!

D712
 
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So I really want to switch into anesthesia from the specialty I am in and the only thing stopping me has been the future of anesthesia and I have been doing a lot of research and what I have read and taken from people i have talked to ( SDN, AANA, ASAHQ, heal care reform laws) is that anesthesia is in a unique situation being the lowest paid out through medicare approx 1/3 of what the tab is. So this disgusting reimbursement is going to be cut even lower after obamacare takes off. the head HHS is in favor of allowing all states to opt out of physician run anesthesia and letting crnas run wild... even though it will be more dangerous for patients it will be the cheaper option and like everything in life you get what you pay for. BC anesthesia groups are selling out to hospitals the anesthesiologist is now at the mercy of a hospital CEO in regards to work schedule/paycheck/job description. BC the hospital ceo can higher crnas at a cheaper price they will. There will be more need for anesthesiologist in 2020 bc of the huge baby boomer effect but by this time obamacare will have sucked out so much financial resources out of an already hurting system the single payer system will take over. dropping pay scales even lower at around the same time this DNAP CRNA BS is ready to debut. Now the crna's have earned a doctorate in nursing (whatever the hell that means) further reducing the need of anesthesiologists and thus lowering there pay even more. So to sum up it seems like increased titles for crna's, less utilization for MDA, constant lowering paychecks , reduced private group practices's , hospital ceo trying to figure out how to get rid of you to save money and the real kicker is inflation to worry about .... and don't forget your student loans.

I still really want to make the switch to gas but with all this up ahead how can anyone walk into this storm.
 
So I really want to switch into anesthesia from the specialty I am in and the only thing stopping me has been the future of anesthesia and I have been doing a lot of research and what I have read and taken from people i have talked to ( SDN, AANA, ASAHQ, heal care reform laws) is that anesthesia is in a unique situation being the lowest paid out through medicare approx 1/3 of what the tab is. So this disgusting reimbursement is going to be cut even lower after obamacare takes off. the head HHS is in favor of allowing all states to opt out of physician run anesthesia and letting crnas run wild... even though it will be more dangerous for patients it will be the cheaper option and like everything in life you get what you pay for. BC anesthesia groups are selling out to hospitals the anesthesiologist is now at the mercy of a hospital CEO in regards to work schedule/paycheck/job description. BC the hospital ceo can higher crnas at a cheaper price they will. There will be more need for anesthesiologist in 2020 bc of the huge baby boomer effect but by this time obamacare will have sucked out so much financial resources out of an already hurting system the single payer system will take over. dropping pay scales even lower at around the same time this DNAP CRNA BS is ready to debut. Now the crna's have earned a doctorate in nursing (whatever the hell that means) further reducing the need of anesthesiologists and thus lowering there pay even more. So to sum up it seems like increased titles for crna's, less utilization for MDA, constant lowering paychecks , reduced private group practices's , hospital ceo trying to figure out how to get rid of you to save money and the real kicker is inflation to worry about .... and don't forget your student loans.

I still really want to make the switch to gas but with all this up ahead how can anyone walk into this storm.

I think you pretty much got it down pat. There are a lot of issues coming our way in the next ten years. That's why the sunny weather outside right now is less relevant than the obvious thunderstorm on the radar screen coming you way.
 
Haha, I'll number the questions so as to focus your crystal ball. I've narrowed down to the most important questions...

1.) I see you note Neurosurgery as a specialty that will hold its own. What is IPAB?

2) Do you have any reason to think Peds incentives will happen?

3) Why do you think CCM will thrive ($) under Maobama? Or single payer system. Can you be specific yet lay-talk for the non-doc billing side of my brain...

4) CCM. There are many pathways that I have read about: anesthesia (I imagine the most popular pathway on this thread), plum, IM, EM, Neuro etc. Is there a pathway that you think a) makes you the best CCM doc for PP or Academia (clinical v research) and b) might be the most lucrative avenue? Years in training vs. MICU/SICU work pp/academic compensation (if they differ)...

5) Any other specific specialities, that you think will thrive, financially (not a popular subject, I get it, but let's put "do what you'd be happy doing aside for the moment) under Maobama, or Single Payer System? I mean is Neonatology going to be the place to be because we're all having kids and they are not on medicare and bla bla bla...?

6) If you HAD TO GO TO MED SCHOOL TODAY, I mean, .357 :) pointed at your head, and you could not do General Anesthesia, and wanted to a) make a decent living in the face of MobamaCare and b) enjoy the HELL out of what you were doing day in and out, what would you choose? Or suggest for another person who loves procedures, fun, excitement, research and benjamins?

7) Thank you.

8) D712

9) To Darby's comment below, Pain vs CCM. Please explain why Pain is so protected vs. something like CCM or even GI. I mean, aren't many of the pain patients on medicare, and
thus getting 15$ office visits in clinic during 1/2 your week. And when you do procedures on them, say an epidural for back or leg pain, are those procedures going to be covered the same
way under Maobama? Why does that pay so well, when it's medicare money, vs. doing kids ear tubes and hearts all day long, don't they usually have private insurance covered by working parents who present with something like Blue Cross?

9a) Just saw a bill for family members' colonoscopy. 4000$. Procedure took doc 30 mins. Maybe he did 5-10 that day. Let's say 8. X 4000 = 32000. What does he pay the surgicenter for space? And if he does that 2 days during the week = 64,000 a week plus clinic. x 52 weeks. Why doesn't this GI make 3.3 million? (the math.) Or let's say HALF that many colonoscopies a year, why doesn't he make 1.65million. I mean, I'm sure he doesn't. So when you see the 4K bill, does the doc not get that in a check? Does the Anesthesiologist who I see got 2K for a friends' epidural not get that 2K?
Doctoring and money 101. Please clarify for the med students and future docs out there. I know docs who literally have 2 days a week of Pain procedures, full days of 10-12 fluro guided blocks from 9am-5.
Say 10 blocks. 20K x 52= over a million. Doctor makes about 1/2 of that. Why?

1. IPAB- Obamacare's "Independent Payment Advisory Board" which will have the power to set reimbursement rates and the rules for getting paid.

2. Peds- This is a Critical area which CRNAs do not or can not practice solo. The need for Pediatric Anesthesiologists will force hospitals to pay a subsidy or ask IPAB for an Peds Adjustment. Militant CRNAS rarely venture into Peds Anesthesia Solo.

3. CCM- is valuable to IPAB. There is a national shortage of intensivists to care for an aging population. They will be viewed as essential gatekeepers in the last few months of life. Hospitals will pay for CCM plus Anesthesia Supervision. The Hoard of Solo CRNAs can do the cases while the CCM Anesthesiologists handles all their mishaps, complications and PACU consults. In addition, the CCM can cover the ICUs. In a Socialized Model CCM is very valuable.

4. Anesthesia is the best path for CCM; if you hate Anesthesia then Pulmonary Med.
Nobody is better at doing procedures than Anesthesiology in the ICU.

5. Medicare- Look for specialties that get reimbursed fairly well under Medicare. Neurosurgery is just one example and there are others like ENT, Interventional Radiology, EP Cardiology, etc.

6. ENT, Neurosurgery, Interventional Radiology or Invasive Cards (We will need more of these guys and not less). Ortho will drop from $700K to $500K but they won't starve.

7. You are Welcome

8. ?

9. Pain- IPAB will DENY many of those so called "necessary Procedures" and order MSO4 or Fentanyl Patches. But, Pain may turn into Orthodontics in that it becomes a cash business. Fewer patients getting treatment but those that do pay cash upfront.
Pain does get reimbursed 80% of the usual HMO fees by Medicare right now. Thus, Pain is viewed differently by Medicare in terms of work value than regular anesthesia (1/3 of usual fee).

10. Gi- A solid choice right now but non invasive testing may make these guys far less needed in the future. Yes, they commonly earn $600K to $900K in a busy Gi practice. Even an idiot can earn $400K doing Gi in PP right now. But, due to overhead costs only a select few are taking home more than $1.5 million annually (and those guys usually own the center).
 
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D712 your numbers for procedures are really low for what a typical guy does in a day, unless they are lazy or set up really inefficiently.
Our slow GI guys do ~20 colons a day, we used to have one who would do 30 to 35.
Pain procedures take very little time for guys that are good. Very common to have 15 min slots...

All that said, I would not advise anyone to go into anesthesia or even medicine in general from college right now, unless you truly feel you will LOVE the work. I feel the 8-10 year lag time gets you to a point where reimbursement makes very little sense. My personal guess is that anesthesiologists will be ~250 if they work moderately hard at that point, but we will see. Still good money compared to many jobs, but that makes it tough for me to justify the finances and lifestyle expenses going along with medical school.

Depending on specialty desires, PA school is a much better option for many people, especially those in your situation that are late starters. You can bypass 2 years of the negative income during school and be at a minimum double the residency salary for the next 4 years, putting you roughly 400 ahead (not counting tuition differences) by the time a MD would get out. I know multiple PAs making anywhere from 80-500 for full time work. A friend was offered ~120 for 2 days a week in derm with no cosmetics. I guess AA school would be our equivalent, and spots are increasing, but you are not able to jump specialties like a PA can.

This is a recent study from yale about the PA-MD salary difference over a career (although it was in primary care fields).
http://faculty.som.yale.edu/keithchen/papers/GenderNPV_WorkingPaper.pdf
 
D712 your numbers for procedures are really low for what a typical guy does in a day, unless they are lazy or set up really inefficiently.
Our slow GI guys do ~20 colons a day, we used to have one who would do 30 to 35.
Pain procedures take very little time for guys that are good. Very common to have 15 min slots...

All that said, I would not advise anyone to go into anesthesia or even medicine in general from college right now, unless you truly feel you will LOVE the work. I feel the 8-10 year lag time gets you to a point where reimbursement makes very little sense. My personal guess is that anesthesiologists will be ~250 if they work moderately hard at that point, but we will see. Still good money compared to many jobs, but that makes it tough for me to justify the finances and lifestyle expenses going along with medical school.

Depending on specialty desires, PA school is a much better option for many people, especially those in your situation that are late starters. You can bypass 2 years of the negative income during school and be at a minimum double the residency salary for the next 4 years, putting you roughly 400 ahead (not counting tuition differences) by the time a MD would get out. I know multiple PAs making anywhere from 80-500 for full time work. A friend was offered ~120 for 2 days a week in derm with no cosmetics. I guess AA school would be our equivalent, and spots are increasing, but you are not able to jump specialties like a PA can.

This is a recent study from yale about the PA-MD salary difference over a career (although it was in primary care fields).
http://faculty.som.yale.edu/keithchen/papers/GenderNPV_WorkingPaper.pdf

D712, the post above is saying "CRNA School Dude" then make money. You can bridge to a BSN in 12 months while writing all those plays. Then, You only need 12 months of ICU or PACU and you are in CRNA school. Have you thought about it?

Or, just jump right into AA School at Nova. You would make a great AA.
 
D712 your numbers for procedures are really low for what a typical guy does in a day, unless they are lazy or set up really inefficiently.
Our slow GI guys do ~20 colons a day, we used to have one who would do 30 to 35.
Pain procedures take very little time for guys that are good. Very common to have 15 min slots...

All that said, I would not advise anyone to go into anesthesia or even medicine in general from college right now, unless you truly feel you will LOVE the work. I feel the 8-10 year lag time gets you to a point where reimbursement makes very little sense. My personal guess is that anesthesiologists will be ~250 if they work moderately hard at that point, but we will see. Still good money compared to many jobs, but that makes it tough for me to justify the finances and lifestyle expenses going along with medical school.

Depending on specialty desires, PA school is a much better option for many people, especially those in your situation that are late starters. You can bypass 2 years of the negative income during school and be at a minimum double the residency salary for the next 4 years, putting you roughly 400 ahead (not counting tuition differences) by the time a MD would get out. I know multiple PAs making anywhere from 80-500 for full time work. A friend was offered ~120 for 2 days a week in derm with no cosmetics. I guess AA school would be our equivalent, and spots are increasing, but you are not able to jump specialties like a PA can.

This is a recent study from yale about the PA-MD salary difference over a career (although it was in primary care fields).
http://faculty.som.yale.edu/keithchen/papers/GenderNPV_WorkingPaper.pdf

Thanks PjL I really appreciate the insight. It's an uphill battle (significant) for someone my age. Lots to debate. But I proceed with writing business as usual. Actually procrastinating a little right now as I have an outline due today...

D712
 
D712, the post above is saying "CRNA School Dude" then make money. You can bridge to a BSN in 12 months while writing all those plays. Then, You only need 12 months of ICU or PACU and you are in CRNA school. Have you thought about it?

Or, just jump right into AA School at Nova. You would make a great AA.

I appreciate that Blade. For me, the bottom line is, I am WELL aware that there really is absolutely, positively NO way to have the numbers make sense. I mean, If I came out at 48 and worked for 20 years in a 75%+ practice, transitioning to administration in a community oriented med school, MAYBE. I mean, the stars would have to align in more than one galaxy to have the numbers make sense.

Versus writing, the upside is that one never knows how long you can ride the writing train. I could be the hottest 50 year old writer in town working on Newsroom (killer writing and show for anyone who is looking for a new Sunday night show - and oh yeah, Breaking Bad is back tonight!) but I digress. OR, I could be searching for absolute CRAP work when I'm 50 and wondering how the hell I'm going to make it to 90.

With medicine, as a CCM doc told me last week, "At least if you have the MD, you're going to fail upward." I think what he meant was what someone else said last night to me, "I'm not starving for food." An academic in a really cush town and locale with numerous college-aged kids. Granted the academic deal includes college tuition. Anyway.

As I said, the numbers are REALLY hard to justify, but a) i love medicine more than writing. and b) with medicine I will ALWAYS be employable, certainly for a nice 25 year career. I can gainfully get work. Writing has NO guarantees. I think as an MD, at least I can expect the guarantee of work. If not, we're all F-ed.

As for CRNA school, working even 12-24 months toward a CRNA is really not in the cards. I don't want to be a giver of medicine. I want to make decisions, lead the discussion, think critically, research, publish, be part of hospital boards and admin teams, and not be part of the problem, I mean that. I have never strived for mid-level in anything I do, and I'm really not going to start now. Not a bash against CRNA's, and I think the same goes for being an AA. I want to create the anesthetic plan, not simply fulfill it, I want to partake in discussions that further the field, attend and present at conferences. What's the cost to me between AA and MD school? 2 years at schooling level, and 3-4 at med level. 5 years of salary. Will those 5 years guarantee me a job when I'm 60? If so, fine. That's also how I justify it.

Also, frankly, I know many writers who get their MD and years later use it to work on medical shows, I cannot do that with an AA or CRNA and I would be a prime candidate to do all that.

Lastly, as much as I love anesthesia, there is always the possibility that I would goto med school and discover another field that gives me more security, professional fulfillment and happiness than Anesthesia. And that only comes with med school. So, bottom line is, I'm going full steam ahead with writing. If one or two of my pilots sell in next 1-2 pilot seasons, I'll, perhaps, write the check for med school and come out debt free. If not, I may just stay with writing.

Thanks for the advice and guidance BLADE AND PJL.

T-2 weeks to the big move!

D712

p.s. edit: I may get somewhat flamed for my AA and CRNA thought processes about why those spots aren't for me, but I can take it and, ultimately, those are the reasons that I feel, so that's what I wanted to convey. No point in sugar coating and respect to the AA's and NON MILITANT CRNA's out there.
 
Hey Doctor 712.

Have looked into one of the three LECOM (DO) schools? All tuition and fees will run you 28k/yr or 112k+interest for the full four years. If you have a wife that works and maybe has a decent income you can live on the cheap and have her pay your interest as it accumulates and not have to take out a loan for living expenses. I think the key for you will be minimizing debt and time in training while maximizing income.

If you've saved money in a 401k/rIRA even better. You've delayed medical school but there is a huge value for establishing some retirement savings as a young kid rather than being in medical school.

So you have your 112k medical education then look into one of the more lucrative specialties and knock out those loans through working hard your first few years while livin' the dream. If you can do this I think it could work out financially for you - especially when you consider the alternatives which typically pay a lower amount than medicine and don't have the same autonomy.

This is anecdotal but let me share with you what someone told me at a Trauma M&M lecture:

An older gentleman (who was running the show) was telling all us guests, who were paramedics, that he got his start as a paramedic. It wasn't until 32 that he was able to go to medical school. Then he blew us away by saying that today he was the Chief of Trauma Surgery and to never let a late start stop you from going into medicine if you realize, like he did, that it was what he wanted to do. I did not get the impression he regretted his decision!

EDIT: Just for full-disclosure I am pre-health. Not a physician.
 
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Yappy

Yeah, I've priced out most medical schools both IS/OOS in the US. Ha. LECOM is a fine price, but I'm leaving the state in two weeks. My new home state has 2 medical schools. 1DO and 1MD. So, I'll have options, but nothing like I have down here in FL where I also worked at 1MD school very closely with people who are more than happy to help me.
I should price out my new 2 state schools.

D712
 
D712, I hear you about the MD versus AA/CRNA thing. That being said, it sounds like you've completed all/most (through prior threads and your history on this forum) of the prerequisites for medical school, correct?

If so, then AA school (especially with your freedom of travel/ ability to live in AA states) is a very viable option. As a mid-level, you'll still very much have an important role, and say (depending on your relationship with the attendings) in how things go in the OR.

AA would afford you a steady income without the super-responsibility (clearly you are not one to skirt that, just saying), and TIME, of becoming an anesthesiologist.

You just may be able to get the best of both worlds. An interesting, cool career, with good pay, AND some regular hours (or the ability to work part time) in order to advance/focus on your writing as and when you see fit.

Just some ideas.

I've always said that medicine is an "extreme" in many ways. Length of years and cost are serious variables as you well know.
 
D712, I hear you about the MD versus AA/CRNA thing. That being said, it sounds like you've completed all/most (through prior threads and your history on this forum) of the prerequisites for medical school, correct?

If so, then AA school (especially with your freedom of travel/ ability to live in AA states) is a very viable option. As a mid-level, you'll still very much have an important role, and say (depending on your relationship with the attendings) in how things go in the OR.

AA would afford you a steady income without the super-responsibility (clearly you are not one to skirt that, just saying), and TIME, of becoming an anesthesiologist.

You just may be able to get the best of both worlds. An interesting, cool career, with good pay, AND some regular hours (or the ability to work part time) in order to advance/focus on your writing as and when you see fit.

Just some ideas.


I do appreciate the thoughts and advice. It's all food for thought! :thumbup::thumb up:

As for my new state schools, CO, the DO school is 44K a year. Thank you very much CO. And the MD school is (resident) 32K a year + (sit down peeps) $25K a YEAR in FEES. That's $58K per year IN STATE. Unless I read it wrong. OOS tuition: flat $83K a year.

1) I am NOT moving again, to goto med school. Unless I hate my new town, which I don't think I will.

2) There is always financial aid, and self pay. Bla bla bla.

3) But those tuitions are UN. FRIGGING. BELIEVABLE. You want socialized care Obama? U gotta cover Doctors' med school costs, otherwise it aint socialized medicine like other countries.

Shame.

D712
 
I do appreciate the thoughts and advice. It's all food for thought! :thumbup::thumb up:

As for my new state schools, CO, the DO school is 44K a year. Thank you very much CO. And the MD school is (resident) 32K a year + (sit down peeps) $25K a YEAR in FEES. That's $58K per year IN STATE. Unless I read it wrong. OOS tuition: flat $83K a year.

1) I am NOT moving again, to goto med school. Unless I hate my new town, which I don't think I will.

2) There is always financial aid, and self pay. Bla bla bla.

3) But those tuitions are UN. FRIGGING. BELIEVABLE. You want socialized care Obama? U gotta cover Doctors' med school costs, otherwise it aint socialized medicine like other countries.

Shame.

D712

Seriously. It's getting out of friggin control. 100% agreed on all points. This is getting to be borderline silly.

What, 10 long years ago, loan rates for professionals was something like 2.8%? Now, subsidized loans are 6.8%!

Topping it all off, you USED to be able to defer payments (if needed) until after residency (i.e. when you can actually afford it). NOW?? Interest accrues right after med school.

The common theme here, and I hate to sound like a little b.tch, is that it's open season on the "little guy". That much has been clear to me for a long time. We're going to see the largest disparity between the haves and have-not's that this country has seen in probably 60 years. And wer'e ALREADY the leader in wealth gaps amongst "industrialized" (actually we're becoming DEindustrialized) nations. Unbelievable.

O.k. I feel better now. Sort of....
 
Then you will graduate residency, and not only pay the highest percentage of income tax, but not get tax breaks that other middle class people have had for years such as writing off the interest on your home, STUDENT LOANS, kids etc. You're "rich" now.

It's BS.

Seriously. It's getting out of friggin control. 100% agreed on all points. This is getting to be borderline silly.

What, 10 long years ago, loan rates for professionals was something like 2.8%? Now, subsidized loans are 6.8%!

Topping it all off, you USED to be able to defer payments (if needed) until after residency (i.e. when you can actually afford it). NOW?? Interest accrues right after med school.

The common theme here, and I hate to sound like a little b.tch, is that it's open season on the "little guy". That much has been clear to me for a long time. We're going to see the largest disparity between the haves and have-not's that this country has seen in probably 60 years. And wer'e ALREADY the leader in wealth gaps amongst "industrialized" (actually we're becoming DEindustrialized) nations. Unbelievable.

O.k. I feel better now. Sort of....
 
gasattack3 said:
We're going to see the largest disparity between the haves and have-not's that this country has seen in probably 60 years. And wer'e ALREADY the leader in wealth gaps amongst "industrialized" (actually we're becoming DEindustrialized) nations. Unbelievable.

The wealth disparity is just one of many unsustainable trends.

To an extent, the abuse we're taking and about to take as rich doctors is just a reflection of the hardship most Americans are facing and are about to face.

What we're living through is the beginning of a significant and permanent recalibration of the western standard of living. Most of the assumptions and circumstances that fueled the last ~50 years of mostly uninterrupted prosperity and growth are coming apart. There is no simple, practical, politically tenable solution. The next 20 or 30 years will be nothing like the 80s, 90s, and early 00s. I don't believe for an instant that we're in any kind of recovery.

I think the super-rich have seen this coming for some time now. I also think much of the ongoing financial sector abuses of the last couple years represent them making final efforts to get theirs while the getting is good. Perhaps they were as blindsided as the rest of us by the 2008 shenanigans ... but now they see the writing on the wall.

If you're waiting for that gap to narrow, don't hold your breath.
 
I don't know.. I have friends who are in their 20's making good money doing jobs that would have paid less than or equal to analogous careers in the 80's 90's 00's. For example: One works for a major cable company installing cable making 70k w/ benfits, another makes 150k in corp sales, and another told me he makes 34/hr as a UPS driver. Two of them dont even have college degrees yet they're making good money and bought some 2000+ sq ft homes and will have no problem paying them off.

All I hear from people from my parents generation is how hard it was starting out when they were younger. My father worked hard without an education ~50+ hrs per wk and as a family we struggled to live in a 1400 sq ft home. I live in the same area I grew up in - my friends have it way better today than they would have 30 years ago in terms of standard of living.

I think that physicians are being uniquely screwed.

The wealth disparity is just one of many unsustainable trends.

To an extent, the abuse we're taking and about to take as rich doctors is just a reflection of the hardship most Americans are facing and are about to face.

What we're living through is the beginning of a significant and permanent recalibration of the western standard of living. Most of the assumptions and circumstances that fueled the last ~50 years of mostly uninterrupted prosperity and growth are coming apart. There is no simple, practical, politically tenable solution. The next 20 or 30 years will be nothing like the 80s, 90s, and early 00s. I don't believe for an instant that we're in any kind of recovery.

I think the super-rich have seen this coming for some time now. I also think much of the ongoing financial sector abuses of the last couple years represent them making final efforts to get theirs while the getting is good. Perhaps they were as blindsided as the rest of us by the 2008 shenanigans ... but now they see the writing on the wall.

If you're waiting for that gap to narrow, don't hold your breath.
 
10. Gi- A solid choice right now but non invasive testing may make these guys far less needed in the future. Yes, they commonly earn $600K to $900K in a busy Gi practice. Even an idiot can earn $400K doing Gi in PP right now. But, due to overhead costs only a select few are taking home more than $1.5 million annually (and those guys usually own the center).


Agree with most of it, but from what I understand virtual colonoscopies aren't really a threat, if it finds something or if the patient is high risk (strong family hx, IBD, etc.) then they have to be scoped anyway. Also from the patient stand point the worst part of the colonoscopy is the prep which patients who are getting a virtual colonoscopy also have to go through in addition to being awake during air insufflation. The diagnostic GI stuff not withstanding, there is tons of therapeutic modalities in the GI world. I would say Cards is also good, but doing a interventional fellowship is a must.
 
The wealth disparity is just one of many unsustainable trends.

To an extent, the abuse we're taking and about to take as rich doctors is just a reflection of the hardship most Americans are facing and are about to face.

What we're living through is the beginning of a significant and permanent recalibration of the western standard of living. Most of the assumptions and circumstances that fueled the last ~50 years of mostly uninterrupted prosperity and growth are coming apart. There is no simple, practical, politically tenable solution. The next 20 or 30 years will be nothing like the 80s, 90s, and early 00s. I don't believe for an instant that we're in any kind of recovery.

I think the super-rich have seen this coming for some time now. I also think much of the ongoing financial sector abuses of the last couple years represent them making final efforts to get theirs while the getting is good. Perhaps they were as blindsided as the rest of us by the 2008 shenanigans ... but now they see the writing on the wall.

If you're waiting for that gap to narrow, don't hold your breath.

Oh no. Not holding my breath. I totally agree, and very well stated.
 
I don't know.. I have friends who are in their 20's making good money doing jobs that would have paid less than or equal to analogous careers in the 80's 90's 00's. For example: One works for a major cable company installing cable making 70k w/ benfits, another makes 150k in corp sales, and another told me he makes 34/hr as a UPS driver. Two of them dont even have college degrees yet they're making good money and bought some 2000+ sq ft homes and will have no problem paying them off.

All I hear from people from my parents generation is how hard it was starting out when they were younger. My father worked hard without an education ~50+ hrs per wk and as a family we struggled to live in a 1400 sq ft home. I live in the same area I grew up in - my friends have it way better today than they would have 30 years ago in terms of standard of living.

I think that physicians are being uniquely screwed.

I think, however, that the accelerated pace at which our middle class is being eaten alive is what gets people's attention. I too have many friends in "service" industries doing pretty well for themselves. But, I don't think that stuff generates the real wealth that separates successful nations from where I think we're headed. Just look at our trade deficits to see that we're losing badly, albeit with numerous sectors (and companies) thriving.

We simply can't get into all of the reasons why we're screwed (overall as a nation), but suffice it to say there are many.
 
Agree with most of it, but from what I understand virtual colonoscopies aren't really a threat, if it finds something or if the patient is high risk (strong family hx, IBD, etc.) then they have to be scoped anyway. Also from the patient stand point the worst part of the colonoscopy is the prep which patients who are getting a virtual colonoscopy also have to go through in addition to being awake during air insufflation. The diagnostic GI stuff not withstanding, there is tons of therapeutic modalities in the GI world. I would say Cards is also good, but doing a interventional fellowship is a must.

Gi needs the routine, healthy Colonoscopy to make big money. Any Virtual test or CT scan which allows the healthy patient to skip the colonoscopy means lost revenue.

I do agree that Gi should keep "scoping for dollars" for the next 10 plus years.
 
Who cares how the wealth is created? If we've moved from relatively inefficient, costly manufacturing that dominated the past to cheap, cost effective manufacturing in developing nations I see that as a good thing. More wealth for the developed countries because new markets & cheap goods help the developing country & our middle class obtain technologies and goods [further expanding the market] they could never afford otherwise. The only thing that has changed is that you cannot expect to simply graduate HS, not develop any skills, and land some sort of American-life-style J-O-B for life with a pension. Or sit on a house and have it appreciate 20% every year earning equity just by virtue of "owning" a home.

The deals my bud makes as an account exec creates wealth for his company. They operate at a profit and have more money to invest in development and capital. Hell, most of the goods today are bits rather than atoms completely disrupting the notion of physical manufacturing. I feel that sometimes we're using a 20th century measure of value... in the 21st century economy.

I think, however, that the accelerated pace at which our middle class is being eaten alive is what gets people's attention. I too have many friends in "service" industries doing pretty well for themselves. But, I don't think that stuff generates the real wealth that separates successful nations from where I think we're headed. Just look at our trade deficits to see that we're losing badly, albeit with numerous sectors (and companies) thriving.

We simply can't get into all of the reasons why we're screwed (overall as a nation), but suffice it to say there are many.
 
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I don't know.. I have friends who are in their 20's making good money doing jobs that would have paid less than or equal to analogous careers in the 80's 90's 00's. For example: One works for a major cable company installing cable making 70k w/ benfits, another makes 150k in corp sales, and another told me he makes 34/hr as a UPS driver. Two of them dont even have college degrees yet they're making good money and bought some 2000+ sq ft homes and will have no problem paying them off.

Three service economy jobs, in an economy that has seen the end of sustained 3% annual growth. I think those guys - especially the salesman - are closer to the edge than you think.


All I hear from people from my parents generation is how hard it was starting out when they were younger. My father worked hard without an education ~50+ hrs per wk and as a family we struggled to live in a 1400 sq ft home. I live in the same area I grew up in - my friends have it way better today than they would have 30 years ago in terms of standard of living.

Our parents' generation couldn't buy a house without great credit and 20%+ minimum down payment. The fact that unskilled laborers driving UPS trucks and installing cable boxes are buying houses (presumably with little or nothing down) isn't reassuring to me. Odds are they presently have little or no equity.

True, every American's Standard of living is universally higher now than 30+ years ago. Most of that is technology, some of it is debt (both theirs and government).


I think that physicians are being uniquely screwed.

Screwed disproportionately, maybe, but we're certainly not alone in screwville. :)
 
Who cares how the wealth is created? If we've moved from relatively inefficient, costly manufacturing that dominated the past to cheap, cost effective manufacturing in developing nations I see that as a good thing. More wealth for the developed countries because new markets & cheap goods help the developing country & our middle class obtain technologies and goods [further expanding the market] they could never afford otherwise. The only thing that has changed is that you cannot expect to simply graduate HS, not develop any skills, and land some sort of American-life-style J-O-B for life with a pension. Or sit on a house and have it appreciate 20% every year earning equity just by virtue of "owning" a home.

The deals my bud makes as an account exec creates wealth for his company. They operate at a profit and have more money to invest in development and capital. Hell, most of the goods today are bits rather than atoms completely disrupting the notion of physical manufacturing. I feel that sometimes we're using a 20th century measure of value... in the 21st century economy.

That's fine, if there are enough deal-making jobs to go around, and if there's actually wealth being created. The fact is, as a nation we're exporting wealth faster than we can create it. Our trade deficit peaked over $800 billion/year sometime before 2008 - the crash brought it down for a while, but it's on its way back up again. (Most of it is oil - a separate but equally terrifying issue.)

In the long run, it matters little if your account exec friend "creates" a little bit of wealth for his company, if the United States as a whole continues to export wealth valued at $500-800 billion / year to other countries.

It matters a great deal how wealth is created.
 
Who cares how the wealth is created? If we've moved from relatively inefficient, costly manufacturing that dominated the past to cheap, cost effective manufacturing in developing nations I see that as a good thing. More wealth for the developed countries because new markets & cheap goods help the developing country & our middle class obtain technologies and goods [further expanding the market] they could never afford otherwise. The only thing that has changed is that you cannot expect to simply graduate HS, not develop any skills, and land some sort of American-life-style J-O-B for life with a pension. Or sit on a house and have it appreciate 20% every year earning equity just by virtue of "owning" a home.

The deals my bud makes as an account exec creates wealth for his company. They operate at a profit and have more money to invest in development and capital. Hell, most of the goods today are bits rather than atoms completely disrupting the notion of physical manufacturing. I feel that sometimes we're using a 20th century measure of value... in the 21st century economy.

Seriously, what PGG said.

One of the biggest of all falacies of American "economics" is that manufacturing is inherently "inefficient" or crusty and "old economy". That mantra is from the same old establishment "economists" whom are essentially in the pockets of big banking and big business. Rather than invest (heaven forbid) in OUR infrastructure and PEOPLE, our policy makers (again in the pockets of corporate interests as if that's hard to believe) have sold us out by spouting that sh.t over and over on CNN, night after night, using the same old arguements about Americans being "net beneficiaries" of these trade policies (or lack thereof). Perhaps in the short term, but when you don't have a job, it's pretty hard to buy even the cheapest of Chinese goods at Walmart.

If manufacturing is so "crusty" and passe, why is it that virtually EVERY developing economy is COVETING manufacturing industries as 1) a way to generate REAL wealth, 2) as a means of growing their middle class, 3) as a means of putting good numbers of people to work and 4) balancing their trade (i.e. exporting more than they import which is the only way to CREATE net wealth???

And just so you think it's not just China and South Korea, and India and Brazil doing that. It's also the reason Germany is essentially leading Europe (again......) economically and THUS politically. Who knows, maybe even militarily in the future since they just relaxed German arms export laws (they have the 3rd largest arms industry second only to the US and Russia, but ahead of the UK and France, and China and India).

I'll admit, it takes a LOT more than JUST manufacturing (and more importantly perhaps, exporting those manufactured goods) to build and sustain an advanced economy. Just don't drink the Kool-Aid when it comes to what Alan Greenspan told the US public for over a decade, that manufacturing essentially doesn't matter.

Only in the U.S. can we be so stupid and short sighted.
 
So what do you plan to do: Invest in condos in the US at a premium for a small return? or get on the ground level in a developing nation and see 20% gains on your investments? It's not as easy as making companies manufacture in the US unless we have something proprietary that allows companies to want to manufacturer in the US.

Though, if it's any consolation, I have heard that foreign engineers are becoming too expensive and according to someone in the industry - US grads have more utility. That's a good sign and I can see this continuing as the rest of the world continues to 'grow up' economically.
 
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What we're living through is the beginning of a significant and permanent recalibration of the western standard of living. Most of the assumptions and circumstances that fueled the last ~50 years of mostly uninterrupted prosperity and growth are coming apart. There is no simple, practical, politically tenable solution. The next 20 or 30 years will be nothing like the 80s, 90s, and early 00s. I don't believe for an instant that we're in any kind of recovery.

Absolutely
 
What about a possible shortage of anesthesiologists?

"This demand raises an important issue. A 2010 study by the RAND Corporation found a shortage of 3,800 anesthesiologists and 1,282 nurse anesthetists. If current trends continue, a dramatic shortage of anesthesiologists and a significant surplus of nurse anesthetists are projected by 2020.

The projected shortage of anesthesiologists suggests that the country will soon face a gap in anesthesiology services. It is essential that physicians continue to supervise the administration of anesthesia as they have the specialized medical training to make split-second decisions, monitor patients' vital signs and manage pain."

http://www.kevinmd.com/blog/2012/01/2012-forecast-anesthesiology.html
 
Absolutely

Well, while we can certainly make predictions based upon historical data, one really cannot predict America's financial future any more than you can predict where the DJIA will be in 3 years. Or 3 months. Or tomorrow. If you could, you'd be a billionaire. It's all speculation. Even if you knew where 20% of the marketplace were going to a certainty it's like getting 2 blood tests back and not knowing 30 others...

What I find interesting is that alllllllllllll this financial chaos, at least to the lay financial market watcher, happened on the heels of 9/11. You can say that the 90s led up to the market downturn, and the bubble popped and this and that, and the mortgage crisis and so on, but it ALL happened on the heels of 9/11. ALL of it. On the heels of the war, of war #2, housing, jobs, economy, tax issues, tax cuts, crappy loans, all of it. So, I hate to steer this thread, but, in a disgusting way, did those F-in terrorists get EXACTLY what they wanted? Regime change and financial chaos in the US? We changed a staunch republican to a dem and fell into financial chaos from - what I think - was the Govts cost of the wars and the entire trickle down effect.

It begs the question, seriously, what EXACTLY will these DIC K HEADS do next to top their last attack? Because as sure as you are reading this, they are planning it. Terrorism 101: the next one has to be bigger in order to effect their goals. This country needs to get its crap together and stop cutting defense budgets. While I want clean playgrounds and health funding and research funding and nice roads and safe airplanes and teacher salaries and PD hirings and all that -- NONE of it is going to mean much if a NUKE goes off within our borders. ALL of those amazing American values will be thrown out the window for 1-2 decades if the HIT-SHAY hits the fan.

D712
 
Well, while we can certainly make predictions based upon historical data, one really cannot predict America's financial future any more than you can predict where the DJIA will be in 3 years. Or 3 months. Or tomorrow. If you could, you'd be a billionaire. It's all speculation. Even if you knew where 20% of the marketplace were going to a certainty it's like getting 2 blood tests back and not knowing 30 others...

Totally agree. I haven't cashed out my retirement accounts and bought a bunker in Idaho, I still have money in stocks. Financial plan A is still a boring life and boring retirement - to do otherwise is chicken-little Y2K Mayan Apocalypse caliber foolish.

Doesn't hurt to have a plan B though. For me and mine, that's paid-off property in a place that's likely to be safe and secure even amidst prolonged Depression-style socioeconomic disaster or Argentina-style 1st world collapse. Some level of basic personal and family resiliency in the face of degraded or absent government or social services that we've come to rely on (everything from police, to fire, to power and water, to FDA protection of the commercial food chain, etc). There's a lot of silly survivalist bravado out there amongst the doom & gloom societal collapse cults, but reasonable people can do reasonable things to prepare for bad times. It takes some time, some effort, some money - but doesn't detract from plan A.


What I find interesting is that alllllllllllll this financial chaos, at least to the lay financial market watcher, happened on the heels of 9/11. You can say that the 90s led up to the market downturn, and the bubble popped and this and that, and the mortgage crisis and so on, but it ALL happened on the heels of 9/11. ALL of it. On the heels of the war, of war #2, housing, jobs, economy, tax issues, tax cuts, crappy loans, all of it. So, I hate to steer this thread, but, in a disgusting way, did those F-in terrorists get EXACTLY what they wanted? Regime change and financial chaos in the US? We changed a staunch republican to a dem and fell into financial chaos from - what I think - was the Govts cost of the wars and the entire trickle down effect.

Crediting the terrorists for pushing the US over the edge is a lot like crediting Reagan for pushing the USSR over the edge.

Factors, sure ... but the real weakness and vulnerability was always within.


While I want clean playgrounds and health funding and research funding and nice roads and safe airplanes and teacher salaries and PD hirings and all that -- NONE of it is going to mean much if a NUKE goes off within our borders. ALL of those amazing American values will be thrown out the window for 1-2 decades if the HIT-SHAY hits the fan.

IMO

a) Don't choose to live in a city you think might be a target. If you think there's a non-trivial chance of a nuclear terrorism incident in NY or DC sometime in the next 30 or 50 years, maybe those cities aren't good places to anchor your professional life or buy your retirement home.

b) Quit worrying about terrorists.
 
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What cracks me up is that someone accused me of "drinking the coolaid" when it comes my views on the economy/manufacturing/etc.; yet, EVERY SINGLE ONE of you are saying the exact same freaking things about every issue! I have friends personally who say the SAME things and have the SAME exact views as you too. Most likely because you all read the same sources, listen to the same radio, operate from the same world view shaped by similar doctrines. Nothing wrong with that but don't delude yourselves into thinking your views are totally authentic and original and therefore most correct.

Your views are as canned, hyped, and common as mine. If anything my views are much more original and outside the lay persons understanding. It's the case of "They took our jobs" VS. "It's more complicated than that".
 
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What cracks me up is that someone accused me of "drinking the coolaid" when it comes my views on the economy/manufacturing/etc.; yet, EVERY SINGLE ONE of you are saying the exact same freaking things about every issue! I have friends personally who say the SAME things and have the SAME exact views as you too. Most likely because you all read the same sources, listen to the same radio, operate from the same world view shaped by similar doctrines. Nothing wrong with that but don't delude yourselves into thinking your views are totally authentic and original and therefore most correct.

Your views are as canned, hyped, and common as mine. If anything my views are much more original and outside the lay persons understanding. It's the case of "They took our jobs" VS. "It's more complicated than that".

I'm not sure what you mean by this. The world's always more complicated than 10 second sound bites pretend.

I agree with you when I think you're right, and disagree with you when I think you're wrong.

I'm less concerned with how original my views are, and more concerned with how correct they are. And how I should hedge my bets in case I turn out to be wrong.
 
Fair enough. I just felt I was being marginalized because someone claimed my POV is mainstream.

I agree with how you're hedging, though. I also plan to keep my debt as low as possible and make sure that I can secure a livable place for my family [read: affordable lifestyle]. Unfortunately I'll be in training for the next 8 years so there is really not much to do except keep my debt low... In fact I sometimes wonder if I'm just spinning my wheels for nothing. If the world falls apart it wont matter what my skill set is - I'll have just spent my time training when I could have been working or having fun. I'll be broke life everyone else :confused:

I'm not sure what you mean by this. The world's always more complicated than 10 second sound bites pretend.

I agree with you when I think you're right, and disagree with you when I think you're wrong.

I'm less concerned with how original my views are, and more concerned with how correct they are. And how I should hedge my bets in case I turn out to be wrong.
 
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Fair enough. I just felt I was being marginalized because someone claimed my POV is mainstream.

I agree with how you're hedging, though. I also plan to keep my debt as low as possible and make sure that I can secure a livable place for my family [read: affordable lifestyle]. Unfortunately I'll be in training for the next 8 years so there is really not much to do except keep my debt low... In fact I sometimes wonder if I'm just spinning my wheels for nothing. If the world falls apart it wont matter what my skill set is - I'll have just spent my time training when I could have been working or having fun. I'll be broke life everyone else :confused:

I take some comfort in knowing that the world has always been on the edge of falling apart. This time's always different, this generation is always going to hell in a handbasket, old people don't get enough respect, young people have loose morals. :)

At the end of it though, I do think this time really is different and that the energy and debt issues are bringing the world to a turning point, for the worse. Whether the turn will be abrupt or slow, in 2 years or 20, is impossible to predict. But I'm convinced enough that it'll be in my lifetime that I have the aforementioned plan B. ;)
 
http://fana.org/pdf/RAND_TR688.pdf

That is the rand report its 151 pages but im sure you can skip around and get the information you need out of it.
Everyday I am struggling with the possibility of transfering into anesthesia from IM where I am now bc I frankly hate IM but the future of Anesthesia is scary. With that being said a few things actually give me some comfort into the entering this field that some people see as doomed. there are similar situations as crna's in every field midwives in obgyn and PA and nursepracs in IM and PA's encroaching on derm. Every field is seeing this. Also every few years there seems to be this apocalypse of medicine remember a few years back when primary care was supposed to be the gate keepers of specialists? what happened specialists made more and more money. The president of the ASA going back to 2009 has been trying to extend the scope of practice of anesthesia to being the perioperative physician so will anesthesia as it is now change in the future 100% it has too washington wants as many people getting care as they can regardless of the quality of care and who is giving it, and this is really a shame and really just the government way. Will anesthesia get pay cuts 100% but so is almost everyone else and doing anesthesia your still gonna come out doing better than most physicians... along with probably enjoying your job. Also no matter what field of medicine your in its really really important to have multiple streams of income so doing anesthesia really shouldnt be your only source of cash flow. The scariest thing not only for anesthesia but for medicine in general is the single payer system. Im pretty positive this will happen Obama has really set it up for it to happen gradually in about 13-14 years and then everyone is gonna be SOL. Americans have been living off the fat of the land for a long time now and we had a huge MI in 2007-2008 and now we will be dealing with that for a very long time. Do not plan on the republicans taking back the white house and the senate bc the majority of people are benefiting from this welfare state.
 
http://fana.org/pdf/RAND_TR688.pdf

That is the rand report its 151 pages but im sure you can skip around and get the information you need out of it.
Everyday I am struggling with the possibility of transfering into anesthesia from IM where I am now bc I frankly hate IM but the future of Anesthesia is scary. With that being said a few things actually give me some comfort into the entering this field that some people see as doomed. there are similar situations as crna's in every field midwives in obgyn and PA and nursepracs in IM and PA's encroaching on derm. Every field is seeing this. Also every few years there seems to be this apocalypse of medicine remember a few years back when primary care was supposed to be the gate keepers of specialists? what happened specialists made more and more money. The president of the ASA going back to 2009 has been trying to extend the scope of practice of anesthesia to being the perioperative physician so will anesthesia as it is now change in the future 100% it has too washington wants as many people getting care as they can regardless of the quality of care and who is giving it, and this is really a shame and really just the government way. Will anesthesia get pay cuts 100% but so is almost everyone else and doing anesthesia your still gonna come out doing better than most physicians... along with probably enjoying your job. Also no matter what field of medicine your in its really really important to have multiple streams of income so doing anesthesia really shouldnt be your only source of cash flow. The scariest thing not only for anesthesia but for medicine in general is the single payer system. Im pretty positive this will happen Obama has really set it up for it to happen gradually in about 13-14 years and then everyone is gonna be SOL. Americans have been living off the fat of the land for a long time now and we had a huge MI in 2007-2008 and now we will be dealing with that for a very long time. Do not plan on the republicans taking back the white house and the senate bc the majority of people are benefiting from this welfare state.

You hate IM. If you'll like anesthesia, get out. Do what you love. If you only make 250, it still beats clinic every time.:D


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"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."
 
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You hate IM. If you'll like anesthesia, get out. Do what you love. If you only make 250, it still beats clinic every time.:D

It's a great job and I'd do it for $100k...but the surgeons would pony up plenty more, because the days of mr. hussle, no lunch and swallowing hard would be long gone baby.
 
I have thought a lot about the bold print over the past few years. I often get into discussions with older generational people about weather the world is better today or worse. I never instigate but I always remind them that because of increased media forms and reporting it only appears that the world is worse. In fact the mortality from violence has been on a steady decline for hundreds of years. Even our own country no longer has institutionalized racism. I don't understand how they could argue that we're going to hell-in-a-hand-basket today but were not 50 years ago in the 60's when they were younger. If you read about what life was like a few hundred years ago it becomes very apparent we have it much better.

As to your Plan B - do you own additional property? Or are you just choosing to have your primary residence in a safer location [what criteria do you use to determine this]? Do you have a massive amount of guns or a network of close friends that you plan to meet up with?




I take some comfort in knowing that the world has always been on the edge of falling apart. This time's always different, this generation is always going to hell in a handbasket, old people don't get enough respect, young people have loose morals. :)

At the end of it though, I do think this time really is different and that the energy and debt issues are bringing the world to a turning point, for the worse. Whether the turn will be abrupt or slow, in 2 years or 20, is impossible to predict. But I'm convinced enough that it'll be in my lifetime that I have the aforementioned plan B. ;)
 
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Totally agree. I haven't cashed out my retirement accounts and bought a bunker in Idaho, I still have money in stocks. Financial plan A is still a boring life and boring retirement - to do otherwise is chicken-little Y2K Mayan Apocalypse caliber foolish. Doesn't hurt to have a plan B though.

Agreed. Well said.

For me and mine, that's paid-off property in a place that's likely to be safe and secure even amidst prolonged Depression-style socioeconomic disaster or Argentina-style 1st world collapse.

Did you just call Argentina 1st world? :eek: Please visit Argentina. Hit up Brazil when you're down there too. Why not. And then every other state in South America. :) Then we will talk First World.

Some level of basic personal and family resiliency in the face of degraded or absent government or social services that we've come to rely on (everything from police, to fire, to power and water, to FDA protection of the commercial food chain, etc).

Agreed 100%.


but reasonable people can do reasonable things to prepare for bad times. It takes some time, some effort, some money - but doesn't detract from plan A.
Indeed. This is a simple idea based upon you feeling a certain way about things happening in the future -- I would make the argument that the terrorist one is not much different.

Crediting the terrorists for pushing the US over the edge is a lot like crediting Reagan for pushing the USSR over the edge.
Factors, sure ... but the real weakness and vulnerability was always within.
Potato, potahto. Which killed the 60yo man? 40 years of CAD? the massive MI? The pastrami sandwich the morning of?
I would think that his relatives would say he died of an AMI. A cardiologist might say he should have paid attention to the warning signs.
The Coroner will say MI. His wife will say it was the "F-ing pastrami sandwich that killed Harold..." Does it matter? Bottom line is, his CAD could have gone on for 20 more years without that MI, agreed? BUT he had the MI (9/11). And then died. If we're living in a post-MI world, which we are, we have to recognize what ultimately and immediately led to our demise. I think 9/11 was a MASSIVE MI.

a) Don't choose to live in a city you think might be a target.
Right now I don't have to worry about that, per se. Not in NY/DC/CHICAGO, at least FT. LA is a target, I'm there a bunch. And will live there again. When I'm older, I think living in NYC would be amazing, and when I'm older and ready to die in a Nuke blast or "whatever the hell gets me, my time has come (I ain't there yet), I would LOVE to live in NY. Terrorists or not. It's taken a long time to want to go home after being in LOWER NYC on 9/11.

If you think there's a non-trivial chance of a nuclear terrorism incident in NY or DC sometime in the next 30 or 50 years, maybe those cities aren't good places to anchor your professional life or buy your retirement home.
I do think there is more than a non-trivial chance of a terrorist attack in the US in the next decade and beyond, however, I just don't know where it will hit, any more than I can predict the market in a month. They could go to PHIL, KANSAS, MIAMI, who knows. But I know they are intent on hurting us, it's a fact. Agencies around the US are planning and preparing and defending and I have more than one relative involved in all of that. [/QUOTE]

b) Quit worrying about terrorists.
Now now, PGG, play nice. :D I'll tell you what though, I'll stop worrying about terrorists, when you stop worrying about the decline of the American financial way. ;) Deal? I mean, it's no coincidence that when Bill Clinton left office, during his first interview he was asked about his biggest fear. I paraphrase, -- he said a nuclear attack on US soil. This coming from a man with the most TSI/SC knowledge of any human on the planet. Briefed every morning. He didn't hesitate a FRACTION of a second to answer that question, I recall it clearly. I wouldn't gage the next 30 years on his hunch, but then 9/11 happened, and as a PoliSci student during Undergrad who focused on Terrorism, as I said, the next one HAS to be bigger to accomplish goals. Bigger isn't an airliner, or a cruise ship or killing some peeps with an IED. Bigger is a Nuke, and we all know that. The question is, how are we willing to allow that to affect our everyday life. Mine is that I wouldn't feel comfy living in DC right now. That's about it. Do I know where "safe" is? Nope. So, I take the same precautions with my family as you do yours. Just a different means to an end if you think about it. :thumb up:

D712
 
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