So you want to specialize, eh? Good for you.

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jippyslim

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This article kind of ticks me off. Really makes physicians to be the bad guy and once again continues to reinforce this thought that the public has that because physicians make more than you then they should lower payments so they aren't as rich... Which is really just a bigger symptom of the public stigmatizing people that are highly educated

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I don'y have an opinion either way. I feel like the work specialists provide is mostly necessary and I foresee myself specializing. @Lya was right in that the payment model incentivizes procedures, but the same lobby groups for each specialty seem to uphold this status quo. @Awesome, I think it's more so the physicians at the upper limit that reinforce this stereotype. And I wouldn't generalize that the public stigmatizes the highly educated.
 
This thought it somewhat unrelated, but does anyone else feel pressure to go into primary care? All of the doctors I know bring it up, every book*/article about medicine I read discusses the need for more primary care doctors as well as the respect that should be associated with that path...

*Most recently, How We Die by Sherwin Nuland.
 
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This thought it somewhat unrelated, but does anyone else feel pressure to go into primary care? All of the doctors I know bring it up, every book*/article about medicine I read discusses the need for more primary care doctors as well as the respect that should be associated with that path...

*Most recently, How We Die by Sherwin Nuland.

I think it's natural to feel that way.

I wanted to go into primary care because of my childhood upbringing and what I want to do with health policy eventually, but many people change their minds once they are in a position to choose a particular career within medicine. Dr. Gawande had a similar goal before medical school--do internal medicine and do some policy/politics work, but eventually he chose and loves surgery after OR rotation.
 
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Joints just became incredibly interesting to me.

But on a serious note, why are Orthopedic surgeons who specialize in hip and joint paid so handsomely?
 
Primary care is important and thus should be compensated accordingly. It sucks that is not. I feel the shortage of primary care is partially due to this.
Money is honest.

If primary care was so important, people/government would pay primary care providers more.

They don't. End of story.
 
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920k median for orthopedic surgeons who focus on joints and/or hips? How accurate is that? I have never seen it that high before.
 
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As it stands now I'm down for primary care and would be happy with the expected salary. My main and only fear for now is the job demands on primary care in the near future in terms of needing to see more patients and etc.
 
Seriously hate these articles.

Also think about it, if you needed something like a heart transplant or a bypass, you think the surgeon would do as great when he is compensated ~300+k a year as when his pay is reduced to 150k or lower? No way. There's a lot more work to being a physician besides OR and patient contact time, like keeping up with the latest technology, keeping board certification, going to conference and making sure that my surgery goes and ends well and I can come to him with any issues. A specialist that doesn't make much won't offer the same level of care since it is shown that money is one of the biggest (if not THE biggest) motivator.

Inb4 people think we live in a perfect world that people should offer the best care they can no matter what their compensation. Even as a premed I know that the salary is justified.
 
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Joints just became incredibly interesting to me.

But on a serious note, why are Orthopedic surgeons who specialize in hip and joint paid so handsomely?

Their patients have money? My high school SO's dad is an orthopedic surgeon. He always talked about how he did two surgeries: knees for athletes and obese patients, and hips for the elderly. Everyone wants to walk/run/... The patients getting these surgeries tend to have money. Your average joe won't get knee surgery for anything but the worst pain, when Medicaid covers it
 
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920k?! It's settled. I love hips and joints and stuff.
 
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This thought it somewhat unrelated, but does anyone else feel pressure to go into primary care? All of the doctors I know bring it up, every book*/article about medicine I read discusses the need for more primary care doctors as well as the respect that should be associated with that path...

*Most recently, How We Die by Sherwin Nuland.

I don't necessarily feel pressured to pursue primary care, but I am very interested in it, having worked/volunteered with individuals who had no access to primary care. Unfortunately, I do worry about paying back loans with a lower salary. Although one can specialize and still work in preventive medicine/public health..

Primary care is important and thus should be compensated accordingly. It sucks that is not. I feel the shortage of primary care is partially due to this.

yeah
 
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Their patients have money? My high school SO's dad is an orthopedic surgeon. He always talked about how he did two surgeries: knees for athletes and obese patients, and hips for the elderly. Everyone wants to walk/run/... The patients getting these surgeries tend to have money. Your average joe won't get knee surgery for anything but the worst pain, when Medicaid covers it

Another possible reason, though I'm not sure if it applies to hip and joint - a lot of procedural work has advanced significantly and gotten quicker. Combine this with the fact that payment rates are relatively sticky. A decade ago it may have taken 10 hrs to do a procedure that takes 1 hr today. Because of fee for service, your revenue has just gone up 10X. (exaggeration)
 
If you are interested in primary care, just become a nurse (or PA).

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I hate so say this, but a lot of NPs I have gone to have completely misdiagnosed me.
 
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This thought it somewhat unrelated, but does anyone else feel pressure to go into primary care? All of the doctors I know bring it up, every book*/article about medicine I read discusses the need for more primary care doctors as well as the respect that should be associated with that path...

*Most recently, How We Die by Sherwin Nuland.

Admissions committees are definitely pressuring applicants toward primary care, or at least creating a situation where it pays to profess your love for underserved primary care. If you polled the perentage of students that said they wanted to go into primary care before and after getting accepted, it would probably drop by like 60%.:laugh:
 
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Those who get paid worse than a dentist are doing it wrong.
 
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Admissions committees are definitely pressuring applicants toward primary care, or at least creating a situation where it pays to profess your love for underserved primary care. If you polled the perentage of students that said they wanted to go into primary care before and after getting accepted, it would probably drop by like 60%.:laugh:

sadly, I think this is kind of true.
 
sadly, I think this is kind of true.

Yes, but sometimes they get around this by targeting URMs and people with lower SES since it has been statistically shown that medical school grads tend to go back and practice in their hometown/area. So adcoms aren't going to believe that someone who comes from a wealthy family but says that they want to practice primary care in the backwoods of Alabama, unless they show it thru their ECs.
 
Seriously hate these articles.

Also think about it, if you needed something like a heart transplant or a bypass, you think the surgeon would do as great when he is compensated ~300+k a year as when his pay is reduced to 150k or lower? No way. There's a lot more work to being a physician besides OR and patient contact time, like keeping up with the latest technology, keeping board certification, going to conference and making sure that my surgery goes and ends well and I can come to him with any issues. A specialist that doesn't make much won't offer the same level of care since it is shown that money is one of the biggest (if not THE biggest) motivator.

Inb4 people think we live in a perfect world that people should offer the best care they can no matter what their compensation. Even as a premed I know that the salary is justified.

Your scenario is silly and unrealistic. If you're a heart surgeon correcting someone's aortic stenosis, are you going to consciously or subconsciously stop and think "gee, I am making way less than I should, maybe I'll do a bad job here." Most people want to do a good job when they do something, regardless of other factors, like pay. That goes for any professional. I don't decide to offer worse care because I'm compensated less. Now, what it would do is disincentivize people from pursuing heart surgery training in the first place. But that's entirely different than what you're suggesting.
 
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I don't think the salary of a dermatologist is justified. What they do is not life or death work for the most part. Not trying to bash their profession, but honestly I think they get paid way to much.
Seriously hate these articles.

Also think about it, if you needed something like a heart transplant or a bypass, you think the surgeon would do as great when he is compensated ~300+k a year as when his pay is reduced to 150k or lower? No way. There's a lot more work to being a physician besides OR and patient contact time, like keeping up with the latest technology, keeping board certification, going to conference and making sure that my surgery goes and ends well and I can come to him with any issues. A specialist that doesn't make much won't offer the same level of care since it is shown that money is one of the biggest (if not THE biggest) motivator.

Inb4 people think we live in a perfect world that people should offer the best care they can no matter what their compensation. Even as a premed I know that the salary is justified.
 
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Your scenario is silly and unrealistic. If you're a heart surgeon correcting someone's aortic stenosis, are you going to consciously or subconsciously stop and think "gee, I am making way less than I should, maybe I'll do a bad job here." Most people want to do a good job when they do something, regardless of other factors, like pay. That goes for any professional. I don't decide to offer worse care because I'm compensated less. Now, what it would do is disincentivize people from pursuing heart surgery training in the first place. But that's entirely different than what you're suggesting.

So you're saying pay has no bearing on a person's performance when they're already a cardiothoracic surgeon? That when a person's pay decreases each year that I will receive the upmost care when they're making 150k as opposed to ~300k?
 
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I don't think the salary of a dermatologist is justified. What they do is not life or death work for the most part. Not trying to bash their profession, but honestly I think they get paid way to much.

It is apparently an extremely long demanding residency in terms of studying and learning things you never touched on in school.
 
It is apparently an extremely long demanding residency in terms of studying and learning things you never touched on in school.

This is absolutely true, although I don't think it should be used as a way of justifying our salaries.

The "life or death" argument is idiotic though. Nearly every physician spends most of their time dealing with stuff that is "not life or death." And, even putting aside the number of patients with actually potentially life threatening diseases that I see (e.g. Pemphigus, melanoma SJS/TEN), patients tend to actually ascribe more value to what we do versus what many other doctors do. I'm not saying that's in any way how it should be, but I've met a lot more people who are willing to pay out of pocket to fix a dermatologic issue than people willing to pay out of pocket to keep their diabetes or blood pressure under control.

Part of it is business, and that's how it goes.

And when the dust settles, it's not any of the physicians that are really driving up the costs. Physician reimbursement makes up such a small percentage of the healthcare pie. It's healthcare executives who have the economy by the balls . . . and they're the ones who can easily influence irresponsibly-executed garbage articles like this one.
 
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Something else you guys should be concerned with: the overwhelming sentiment among the general US population is that "if Europe can charge so much less and pay doctors a lot less , why can't we?!" And while physician salaries are generally not plummeting or reflecting this desire just yet, the push for it certainly won't be lessening any time soon.

There is a huge disconnect between the rising cost of medical school and the declining reimbursements. Whereas just a generation (or less) ago you could attend medical school for ~$50,000 for all 4 years included and then start making $300k in certain fields right off the bat, now students are graduating with debt 5-7 times greater, and people are heavily advocating chopping down the salaries and inhibiting your ability to dig yourself out of the enormous debt hole. The people who are going to see the effects of greatly diminished reimbursement are not the ones who have enjoyed the low debt/high salary tradeoff for decades. It will be all of you/us, the ones who had to pay an exorbitant amount of money for our training, only to arrive at the big dance and realize that all the pretty girls left hours ago.
 
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Something else you guys should be concerned with: the overwhelming sentiment among the general US population is that "if Europe can charge so much less and pay doctors a lot less , why can't we?!" And while physician salaries are generally not plummeting or reflecting this desire just yet, the push for it certainly won't be lessening any time soon.

There is a huge disconnect between the rising cost of medical school and the declining reimbursements. Whereas just a generation (or less) ago you could attend medical school for ~$50,000 for all 4 years included and then start making $300k in certain fields right off the bat, now students are graduating with debt 5-7 times greater, and people are heavily advocating chopping down the salaries and inhibiting your ability to dig yourself out of the enormous debt hole. The people who are going to see the effects of greatly diminished reimbursement are not the ones who have enjoyed the low debt/high salary tradeoff for decades. It will be all of you/us, the ones who had to pay an exorbitant amount of money for our training, only to arrive at the big dance and realize that all the pretty girls left hours ago.




This is more or less what I was getting at not so eloquently. Seems like every person I talk to says docs make too much, at which I am like, should they not? Typically in jobs more training means more pay. So lets say a two year degree gets you 40k, why should 10 years not net you 200k at least.

For me the bigger issue though truly is among the gap between specialists and primary care. I don't think anyone could compare how hard each works, or the stress that each has. But both have challenging jobs and have significant training, the gap should be less



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Something else you guys should be concerned with: the overwhelming sentiment among the general US population is that "if Europe can charge so much less and pay doctors a lot less , why can't we?!" And while physician salaries are generally not plummeting or reflecting this desire just yet, the push for it certainly won't be lessening any time soon.

There is a huge disconnect between the rising cost of medical school and the declining reimbursements. Whereas just a generation (or less) ago you could attend medical school for ~$50,000 for all 4 years included and then start making $300k in certain fields right off the bat, now students are graduating with debt 5-7 times greater, and people are heavily advocating chopping down the salaries and inhibiting your ability to dig yourself out of the enormous debt hole. The people who are going to see the effects of greatly diminished reimbursement are not the ones who have enjoyed the low debt/high salary tradeoff for decades. It will be all of you/us, the ones who had to pay an exorbitant amount of money for our training, only to arrive at the big dance and realize that all the pretty girls left hours ago.

I understand what you're saying but I just don't quite see a dramatic drop in physician compensation in the near future. The demand for doctors is only growing, and I feel like if we reach a point where the dept accumulated during training is no longer justified by the salary provided the health system will be in a much deeper hole than it currently is. Perhaps I'm being more optimistic than I should be, but society needs doctors and doctors need incentive to dedicate so much time and money to training.
 
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Just recently, I read an article stating how a 6 figure salary is more of a burden than being well off. Anyways, I feel that when ppl attack doctors why don't they see the insurance companies and celebrities that are making in the millions and billions? I think after that comparison, doctors deserve to have what their skill offers in return. Compared to a primary physician, specialists are very quick to diagnose illnesses or atleast narrow them down. Went to a primary some 8 years ago about a foot problem. The person said I'd need surgery. Went to a surgeon, the person literally spent 5 min and cured me without any surgical instruments! If people want to complain, they should go over to the places that make those expensive instruments and your insurance for not covering when you pay so much each month to be covered. Physicians just don't have the time to deal with this. Even if they have the money, they don't usually get to enjoy it as much as celebrities or other professions do. Sadly, I see them enjoying their hard earned cash when they are pretty old. Most now complain that reimbursement is going down but hours are still the same or going up, training is still life-long. Interviewed a student surgeon and he said that they had to go to conferences all the time to learn new techniques from successful research. It seemed to me that there was a very small window to master a specific technique. That's amazing when you think about it.
 
I understand what you're saying but I just don't quite see a dramatic drop in physician compensation in the near future. The demand for doctors is only growing, and I feel like if we reach a point where the dept accumulated during training no longer justifies the salary provided the health system will be in a much deeper hole than it currently is. Perhaps I'm being more optimistic than I should be, but society needs doctors and doctors need incentive to dedicate so much time and money to training.


Obviously I hope you're correct, but it's good to be mindful of alternative scenarios as well. Despite small fluctuations based on the state of the economy, there has been and will probably continue to be (for a while) no shortage of premeds who are willing to sacrifice their first born to become physicians. The powers that be know this, and coupled with the realization that there's not ACTUALLY a physician shortage, I'm not sure your scenario is all that much more likely than mine.

The scariest part, I feel, is that there is so much potential for continued reform that harms physician earning, and the people who would potentially suffer from this will have already plopped down a $200-300k investment. I'm anything but a chicken little when it comes to this stuff, but it is pretty worrisome to realize that you're paying an obscene amount of money for a product you won't receive for ~10 years; one that is already depreciating in value.
 
Something else you guys should be concerned with: the overwhelming sentiment among the general US population is that "if Europe can charge so much less and pay doctors a lot less , why can't we?!" And while physician salaries are generally not plummeting or reflecting this desire just yet, the push for it certainly won't be lessening any time soon.

There is a huge disconnect between the rising cost of medical school and the declining reimbursements. Whereas just a generation (or less) ago you could attend medical school for ~$50,000 for all 4 years included and then start making $300k in certain fields right off the bat, now students are graduating with debt 5-7 times greater, and people are heavily advocating chopping down the salaries and inhibiting your ability to dig yourself out of the enormous debt hole. The people who are going to see the effects of greatly diminished reimbursement are not the ones who have enjoyed the low debt/high salary tradeoff for decades. It will be all of you/us, the ones who had to pay an exorbitant amount of money for our training, only to arrive at the big dance and realize that all the pretty girls left hours ago.

I don't understand why ppl also don't note that the very european doctors get free medical training from their government? Their population is also not the big compared to the US. The standard of living is better too because the doctors are able to have a life in the first place. OUR doctors are better in qualification too. If they want to be treated like european ppl, they should first learn the abcd of what their system entails. I wouldn't mind such a model but it seems that in every article I read, the doctor is made the 'bad guy/gal' and everyone is just angry at the good things they have, so such a reform would probably depreciate the doctor even more over the years to come until there is bounce again like it was in the 80's
 
I don't understand why ppl also don't note that the very european doctors get free medical training from their government? Their population is also not the big compared to the US. The standard of living is better too because the doctors are able to have a life in the first place. OUR doctors are better in qualification too. If they want to be treated like european ppl, they should first learn the abcd of what their system entails.

Because America is filled with anti-intellectual idiots. They don't want to learn the details, they just know the facts: Physicians are paid way too much, drive fancy sports cars and live in mansions, don't care about their patients, and strike back alley deals with big pharmacy companies to keep drug costs high so they can pay their green fees at the local golf club.

People will believe what they want if it fits their narrative. Even if you brow beat the public with data about the differences in cost of medical training in the US vs other countries, it will make little impact. The public will only hear "US physicians pay $250k+ for training while European physicians get it for free . . . big deal, that's just one extra year's worth of salary they can pay off immediately." Obviously you and I see the glaring problem with that line of thought, but it's one (to varying degrees) that I've encountered quite a bit (even my wife initially was of the thought that after the first or second year I'm out of residency, we would be debt-free and living large . . . until I sat down with her and explained it a lot more).

When you don't actually think about it, it's easy to make ridiculous conclusions. But who would bother to scrutinize it further? I don't think long and hard about the intricate inner workings of my toilet and the plumbing/sewage system when I use it, I just flush my **** down the magical poop-stealer and go about my daily business.
 
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I don't think the salary of a dermatologist is justified. What they do is not life or death work for the most part. Not trying to bash their profession, but honestly I think they get paid way to much.
Again, it goes back to the short window of learning they have to get. Their specialty can deal with life threatening situations (think skin cancer). Your skin condition is very important, just as your eye, nose, or other things (think ophthalmology and plastic surgery). Derm is the top specialty where you have to digest things very quickly during residency. Cosmetics is also a huge business. Don't forget that while doctors' salaries are based on their skills, it is also tipped over based of supply and demand, popularity, and ppl's need (not necessarily life or death situations).

Funny thing: How is a computer programmer from google graduate from college with a 4 yr degree get paid 6 figures while doctors devote 11 years or more just to get that amount? Just b/c the company pays for it, while pts pay for physician salary, the physician is undeserving? I am laughing at the economic scale in the article underneath "Richer doctors and rich doctors"...did the person google that out from 'indeed' or something? So superficial
 
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So you're saying pay has no bearing on a person's performance when they're already a cardiothoracic surgeon? That when a person's pay decreases each year that I will receive the upmost care when they're making 150k as opposed to ~300k?

Yes, that's exactly what I'm saying. Why would you suddenly decide to start delivering suboptimal care? How poorly does that reflect on you and your morals/work ethic? It doesn't make any sense, and if you are in that position one day in the future I'd be willing to bet you are not going to all of the sudden decide that it's time to do an unsatisfactory job and compromise the care of your patients because you find yourself in the "unique" position that your pay is being decreased. That just blows my mind.
 
I couldn't read the whole article. Just terrible. Very one sided and sensationalist. No mention of time in training? Cost of medical school? Opportunity costs? And of course they choose derm to attack since it's one of the highest paid specialties.

Furthermore, specialist salaries have most certainly not sky rocketed in the past 15 years. Maybe it seems that way if you go back all the way to 1985, but most specialists I know comment that they make less than they did in the 90s, not even taking inflation into account.
 
It is apparently an extremely long demanding residency in terms of studying and learning things you never touched on in school.

Also a lot of their income is from cash-only procedures. If insurance companies don't cover it, I'm totally fine with the free market determining the value of elective procedures.
 
Yes, that's exactly what I'm saying. Why would you suddenly decide to start delivering suboptimal care? How poorly does that reflect on you and your morals/work ethic? It doesn't make any sense, and if you are in that position one day in the future I'd be willing to bet you are not going to all of the sudden decide that it's time to do an unsatisfactory job and compromise the care of your patients because you find yourself in the "unique" position that your pay is being decreased. That just blows my mind.

I've shadowed surgeons and they know already that a big portion of their patients will find a way not to pay but they still do their best so it seems like your reasoning is true in some cases. I think the more likely scenario would be people leaving the job, not doing a crappy job.

I understand what you're saying but I just don't quite see a dramatic drop in physician compensation in the near future. The demand for doctors is only growing, and I feel like if we reach a point where the dept accumulated during training is no longer justified by the salary provided the health system will be in a much deeper hole than it currently is. Perhaps I'm being more optimistic than I should be, but society needs doctors and doctors need incentive to dedicate so much time and money to training.

I also don't see physician pay plummeting so dramatically. People need doctors around and salaries won't be cut so much that it causes physicians to find other jobs. Maybe it'll decrease to a level where it's not as satisfactory (but still plenty) but I can't see it being cut in half even. Doctors are people too and people care about money so no money = no doctors and even anti-intellectuals are smart enough to realize that's stupid.
 
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Your scenario is silly and unrealistic. If you're a heart surgeon correcting someone's aortic stenosis, are you going to consciously or subconsciously stop and think "gee, I am making way less than I should, maybe I'll do a bad job here." Most people want to do a good job when they do something, regardless of other factors, like pay. That goes for any professional. I don't decide to offer worse care because I'm compensated less. Now, what it would do is disincentivize people from pursuing heart surgery training in the first place. But that's entirely different than what you're suggesting.
Seriously? I admit that no one here has presented hard evidence supporting the notion that someone who is well-compensated will be more likely to be willing to put in the off-the-clock hours reading, practicing, etc. than someone who is stressed and feels underappreciated...but it's a legitimate concern. It seems premature to call the statement 'silly and unrealistic'. It's a valid prediction.
 
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I've shadowed surgeons and they know already that a big portion of their patients will find a way not to pay but they still do their best so it seems like your reasoning is true in some cases. I think the more likely scenario would be people leaving the job, not doing a crappy job.

They know that they'll still get paid (as of now, at least) despite these people not paying, because you and I will foot the bill. Take away anything resembling this reassurance and the story is a bit different.
 
They know that they'll still get paid (as of now, at least) despite these people not paying, because you and I will foot the bill. Take away anything resembling this reassurance and the story is a bit different.

Ah that's fair. I still think people would leave the job rather than do a bad job though if compensations weren't up to par
 
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Seriously? I admit that no one here has presented hard evidence supporting the notion that someone who is well-compensated will be more likely to be willing to put in the off-the-clock hours reading, practicing, etc. than someone who is stressed and feels underappreciated...but it's a legitimate concern. It seems premature to call the statement 'silly and unrealistic'. It's a valid prediction.

You think the feelings of being stressed and underappreciated are limited to those who are undercompensated? Furthermore, you're willing to say that if your paycheck drops in the future, you are fine with delivering suboptimal care? I don't believe you for a second. As the other poster suggested, leaving the job is far more likely than you willingly doing a bad job. How could you live with yourself knowing you have patient's lives in your hand and willingly not doing your best to deliver the best care possible? I'll say it again, it blows my mind.
 
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They know that they'll still get paid (as of now, at least) despite these people not paying, because you and I will foot the bill. Take away anything resembling this reassurance and the story is a bit different.

You are a physician, right? You are willing to tell me that should your pay be cut, you would willingly offer suboptimal care? I don't believe you if you tell me that. I still think you are going to try to do a good job because that is just the nature of a professional who is well-trained to do something.
 
You are a physician, right? You are willing to tell me that should your pay be cut, you would willingly offer suboptimal care? I don't believe you if you tell me that. I still think you are going to try to do a good job because that is just the nature of a professional who is well-trained to do something.

Where did I ever even get close to suggesting that?

No one is that stupid. I'd alter my practice to become more financially sustainable, or I'd find another job. Don't confuse me with another poster.
 
Where did I ever even get close to suggesting that?

In your post that I quoted, that is EXACTLY what you suggested other people would do if their reassurance that they would eventually get paid for those cases was taken away. If you think that other people would be willing to offer suboptimal care in that scenario, why isn't it reasonable for me to assume that you would do it yourself? And to be clear, I even said I don't think you would do it. The onus is now on you to explain to me why you think other people would.
 
In your post that I quoted, that is EXACTLY what you suggested other people would do if their reassurance that they would eventually get paid for those cases was taken away.

No, it isn't. All I stated was that the reason people like the surgeon in the example are content to keep practicing is because they know the money is coming from SOMEWHERE. I didn't speak to whether or not someone would offer suboptimal care. That was an assertion made by another poster that I never addressed. The "story is a bit different" part had nothing at all to do with whether or not someone would "intentionally do a bad job", which is an idiotic prospect.

Stop tilting at windmills.
 
No, it isn't. All I stated was that the reason people like the surgeon in the example keep practicing is because they know the money is coming from SOMEWHERE. I didn't speak to whether or not someone would offer suboptimal care.

Stop tilting at windmills.

Lol, whether you want to admit it or not, that's exactly what you suggested when you said: "Take away anything resembling this reassurance and the story is a bit different."
 
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