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With the new Obama reform...

Discussion in 'Anesthesiology' started by nyyankz402, 03.19.10.

  1. nyyankz402

    nyyankz402

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    My teacher (I am in high school and going to college next year) says that with the new health care plan, the salaries of doctors are going to go down and paying for medical school and spending the years getting a doctorate is not worth it. I am studying medicine next year and want to be an anesthesiologist but can someone tell me how it will affect the salary. If it does, is it worth it to spend 12 years to become an anesthesiologist. No, I am not only in it for the money. I have plenty of personal reasons but the money for an anesthesiologist is very good.
  2. RedAnesthesia

    RedAnesthesia ASA Member

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    You might be a troll but I will bite.
    Hmmm....studying medicine next year? I don't think so, I think what you meant to say is that you will be doing pre-med next year. You have yet to even start college and still 4 years away from potentially going to med school(if you get in). It is likely salaries for physicians will decrease but I don't think anybody can accurately predict at this point how big an impact it will have. It is a moot point though because salaries could fluctuate greatly by the time you can even get to being an anesthesiologist. I suggest you study hard in college first and get accepted to med school before discussing this topic.
  3. neutro

    neutro

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    LOL...

    i am really perplexed at the teacher who said not to be a doctor because it has no money...LOL. LOL...

    no wonder he/she is going back to school to educate him/her self.
  4. pgg

    pgg Laugh at me, will they? Moderator

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    Your medicine decision point is years away. Revisit the question when application season opens for your year group.

    Go to college. Get very good grades. Do the med school prerequisites, but choose a major that gives you some options if you decide not to be a doctor, or can't get into medical school. Avoid debt. Drink beer (something fruity is acceptable if you have an extra X chromosome).
  5. Southpaw

    Southpaw ASA Member

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    Teacher knows best...become a dentist.
  6. aredoubleyou

    aredoubleyou Senior Member

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    I'd say your teacher is handing you some outstanding advice. I am impressed that she cares enough to be as well informed as she is. Salaries will unquestionably fall with a health care overhall, and by the time you finish residency we will all be likely in one form or another government employees if the trajectory doesn't change.

    Its a good idea to keep your mind and options open.
  7. hoyden

    hoyden

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    The pattern continues - people, who are already anesthesiologists give reasonable advices, crazy ( supposedly medical) students just continue optimistic blah-blah-blah :D
  8. SammyDavisJrJr

    SammyDavisJrJr

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    Well, I'm going to throw in my bit of quality advice... I suggest you become a doctor and ignore Uncle Sam (he's only going to laugh at you in the end). If you want to make money, do it the old fashioned way:

    1. Inherit it

    2. Marry into it

    Otherwise, enjoy a quality career with a bunch of debt. If you like it, it will be worth it. Otherwise, go into banking.
  9. Chloroform4Life

    Chloroform4Life

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    If you're smart enough to be a doctor, you're smart enough to make plenty of money in other ways.

    Hell, if you're smart enough to be a UPS driver, you're smart enough to make as much money as a doctor.
    http://www.er-doctor.com/doctor_income.html
  10. s204367

    s204367 Member

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    From Today's Boston Globe.

    http://www.boston.com/news/health/articles/2010/03/17/call_to_cap_medical_payments_is_likely/

    THe state is considering capping payments to doctors and hospitals at 110% of medicare. For an anesthesia doctor, that is about 25$/hr. Since Tufts medical school is 80k a year, that is 320k inloans before interest...even in todays ow interest days, sty maybe 425-450k in debt.

    With the change in healthcare reimbursement..ie the disappearance of fee for service, expect procedures to decline, and there to once again be an oversupply of anesthesia providers.....pushing folks back toward primary care that will likely pay better than now, while anes will take a big hit.

    Eventually, as Obama care progresses, docs will be salaried gov employees, make less, work less, and care a lot less about pts.

    IN most socialized states, the Dentists charge cash only, and clean up....nearly tripling the salary of the average doc in France and Germany.


    Do whatever makes you happy..however after you spend all of that money and time in training to graduate and realize that you are pushing 40 and cant afford a house, I'd second think a little bit......My guess is 5 years left with the current system....
  11. karizma098

    karizma098 Neon Tiger

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    okay kid,

    theres some good advice in this thread, but theres a lot of propogandal BS to.

    to those who are saying that salaries will decline, doctors may care less once government intervention increases, etc etc, i totally agree. the government is definitely pushing harder to have more control of healthcare. will you be making 275k/year in ER or 350k/year in anesthesia in 10 years? probably not. are you going to be making 25 bucks an hour or 100k a year or so? probably not. there will be cuts but it's likely that physicians will still be well compensated....you might go from 230k down to 160 in ER or from 350/300 down to 250k in Anesthesia, but honestly, i don't see it falling off much from there. not when specialized nurses are pulling in near 200k, pharmacists are making in the 120's, and dentists are making more than us all..the sky will fall a bit, but its not going to just come crashing down on us. ( which is something physicians have been predicting for years. )

    yes, you can work hard and get rich in a lot of other fields, but none of them will gaurantee you a six figure income like healthcare. don't do it for the money or you will hate every day of your life - it takes dedication to study 8+ hours a day for years and then work 80 hours a week just to finally have a 'slightly' crazy work schedule in private practice for the rest of your life.

    you will be compensated well, but you will work for it.
    you will still live a comfortable life as a doctor. i truly doubt you will end up a 'government employee' at any time. you will have to deal with more BS and outside control from the government as the docs out there right now, but if u work hard you will still do well financially. don't sweat the details - you will always make 3-4 X more than your teacher, at least.
  12. karizma098

    karizma098 Neon Tiger

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    i disagree. primary care will continue to fall down. yes, anesthesiology and all other specialties will take a hit - but will always do better than primary care. there's just no money to pay those primary care docs - their jobs will eventually be absorbed by midlevels.

    this isn't france or germany, and it won't be any time soon. the healthcare bill sucks, but i doubt there will be any 40 year old doctors who can't buy a house. ( maybe not million dollar houses? but half that at least. )
  13. jwk

    jwk AA-C ASA-PAC Contributor

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    $25 an hour? Or do you mean $25 a unit? (Big difference)

    I think reimbursement will certainly take a hit, but the sky isn't falling either. At some point, reimbursement will be low enough that people won't enter the profession. Supply dwindles - demand increases - then what happens? One guess.
  14. s204367

    s204367 Member

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    you are right....That is 25$/unit.

    In NY we are already starting to see procedures fall way off. So many of the procedures we do are purely elective, and partly driven by the fact that people dont really BUY the commodity of healthcare. Their knee hurts, they say I have health insurance and go see the doctor. They dont look at how much it will cost and shop around for the best deal. One fo the problems in my mind with healthcare.

    In terms of not being gov employees....Medicare and medicaid already cover nearly 50% of healthcare patients, so about 50% of your billing and reimbursement comes from uncle sam as is. The Obama healthcare will expand that greatly, and if you read the bill you can start to see that it is designed to put private insurance out of business over time.

    Now, I would be totally for a single payor as long as it was not uncle sam, and rates were approp negotiated.

    mark my words though...treat a doc like an employee and they will start to act like one. I am already seeing gen surgeons complain about operating all night then having to work the next day..whereas in residency most now have a 24 hr rule....

    We'll see, but I think anes will be one of the hardest hit. It will take the double whammy of a sharp cut in rates, as well as a lot less procedures being done when the shift goes from paying for outcome and not procedures. Just as in the 80s early 90s the only jobs out there were academic, the large upswing in americans in the field and increase in CRNAs will result in an oversupply of anes providers. We already se it in greater NY, and my group has increased the length of partnership.

    HOpe I am wrong...

    Hopa and Change.....Change is a coming for sure!!!!
  15. jwk

    jwk AA-C ASA-PAC Contributor

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    You make a lot of broad generalizations based on your NYC experience, but every group/facility is different. Some have far less of a CMS caseload, some have a much bigger totally indigent caseload. Although most of our cases are elective, most have solid indications as well. People still have stones, break bones, and get cancer despite the Democrats and Republicans. The caseload might decrease, but then again, with 32 million more people being insured, it might mushroom.

    What will be interesting to see is how it all pans out. I wouldn't be surprised to see a two-tiered system. There's already concierge primary practice for those who can afford it - I wouldn't be surprised to see the same thing happen in other specialties.
  16. badasshairday

    badasshairday Account on Hold

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    hmm, I see what you are saying. However, I don't think primary care "will continue to fall." It has nowhere to go but up. It is undervalued right now. Starting 2013, all Medicaid will pay out the same rate as Medicare for PCP's only. I see there salaries rising, plus they can realistically dodge any type of insurance and go cash only. Sure the specialists will make more $, but will it still be worth the extra years of training, longer work hours, and more liability?
  17. Narcotized

    Narcotized

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    .
    Last edited: 05.30.10
  18. kmurp

    kmurp Junior Member

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    This won't fly. In my area, 110% of medicare would be $21 per unit. The overall rate would be lower as medicaid pays$10. At 11500 unit per operating room, the revenue is such that the anesthesia care team model breaks down. There isn't enough $ to pay the crnas. CRNA and MD compensation goes to unity long before this level.
  19. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    The Obama plan in particular moves away from this model by significantly increasing the number of mandated specific benefits all plan most cover. This will send already rising insurance premiums through the roof. Worse, the Obama plan clearly intends to bring price controls into the health care sector. Obama promises Americans will be charged "fair" premiums and "minimal co-pays." Presumably, Congress would define these terms. This would put the federal government in the business of deciding what constitutes a fair price and a proper co-payment for benefits and ser­vices, leading to some type of centralized rate set­ting or standardization of payments for providers. In the FEHBP, prices are market-based. No price regulation is imposed on plans or services.

    It won't be Congress or your Insurance company deciding your services are worth 110% of Medicare. It will be Mrs. Sebelius.

    Those who don't thing the stakes are high now are about to find out that by 2012 they will be "all or nothing" depending on whether Obama stays in office for 4 more years.

    The only way this specialty of Anesthesia (soon to be DNAP CRNA) survives beyond this decade is if Obama loses the next election. THe can then gets kicked to the next Democrat to take office.
  20. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Sebelius doesn't support the "care team model" as seen in Kansas. Your relevance isn't her problem or concern. The hospital will need to "pick up the tab" for your services; hence, there will be no care team approach.

    Obama's next term should put the final blow to the Medical Specialty of Anesthesiology. We don't even get Canadian or U.K. Physician anesthetists in the USA; instead, we get Anesthesia nurses.
  21. ProRealDoc

    ProRealDoc Anti-AANA

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    If this bill goes through, what's the likelihood the american public will lash out at the dems on the upcoming november elections and place more republicans in congress hoping to reverse this bill
  22. ssmallz

    ssmallz California Dreamin

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    Why would you think republicans would reverse this? The american health care system has been broken for quite some time. Republicans were in power for 8 years. Did they do anything about health care? No. It's clear the dems don't care about us but the republicans aren't gonna help us either. The best they can offer is "let's keep the status quo" which sounds good but only buys time untill people get so fed up. We all know the system is broken and if the republicans truely cared they would have come up w/a system that helps people get insurance while preserving our payments. Instead they decided to go to iraq.....all of congress sux
  23. countingdays

    countingdays SDN Bronze Donor Bronze Donor

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    Takes 60 Senators and a new president to reverse it. :scared:
  24. ProRealDoc

    ProRealDoc Anti-AANA

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    I can think of a million reasons why, one of them being just to screw with the current administration.
  25. badgas

    badgas Member

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    I am not a democRAT or republican. I rarely vote. This November I WILL be voting and I really hope to vote all of these crooks out of office.
  26. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Yes. You are correct. Now, the Republicans have "cover" to blame the Dems for the health care mess just like the Dems blamed the Republicans for the iraq war and economic meltdown.

    I predict that obamacare is here to stay along with higher taxes. What i hope is that a Republican majority and Presidency can avert the complete transformation to socialized medicine.

    Remember, those illegal aliens will not be illegal much longer if obama gets his way. They will be "legal" citizens able to vote democratic and collect all those "freebies" like health care on your dime.

    This country won't survive economically if we keep spending a trillion dollars every 12 months. The illegal alien bill will cost another trillion. That is probably on the agenda for 2011.
  27. hoyden

    hoyden

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    Yep, that is exactly what happens in socialism. Nobody cares about anything, not only patients. You make only something to survive, but do not work at all ( compared to our working conditions).
    It may appeal to some.
    Last edited: 03.21.10
  28. Electronegative

    Electronegative

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    you are exactly right. back in my country my mom was a pediatrician, and she says all docs are paid by the government. And the only way a surgeon will perform a surgery is if he gets his bribe from a patient, besides he is still gets his small salary whether he does it or not.
  29. 2win

    2win

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    Hoyden - you are right.
    We will see a move from private practice towards academics and VA model of care. Already we saw a surge in application for academic positions. We will get out of OR-s at 3 pm, the number of surgical cases will decrease. The hospital employee position will increase...The major losers are the patients.
    As a patient you need connections to receive the best treatment (including surgery). I know the system and I never thought that it will happen in the USA. Way to go "progressive" movement! Seems that the 60's brain death hippies are in charge now...A historical day and unfortunately a sad one!
    2win
  30. s204367

    s204367 Member

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    So in anticipation of less income, you guys will screw the new guys to preserve your status a little bit longer even though you didn't have to go through that when you first signed on with the group. Wow, what a swell group of selfish #*<&$. Where can I send my CV to apply??


    Yes, you would indeed want to join the group. I am just stating the supply/demand we are faced with. We are located mostly outside NYC but have a few exclusive surg centers and endo centers in Manhattan. A few of these are cash only plastic surg centers. When I started it was a 4 yr track, now it is 5. Why?? We now have a surplus of folks wanting to work for our group, and the majority of partners increased the length. THis is happening all around as the number of US grads continues to increase. Now, when some of the older partners joined, groups would hire 4 docs and only keep one, so try to remember where they are coming from. Last year our partners made way closer to 7 figures than 500k. We are at the 99% of income with very little call thanks to a number of endo and surg centers that allow us to have a large pool of Docs. We get anywhere from low 80s to 113 a unit in parts of NJ. We show up and bust our *****es providing an exceptional service to our hospitals, surgeons and of course patients, and are very well reimbursed for it.

    Send off an application, but mind you the comp is tough. We dont place adds, simply call Columbia/Cornell and occ Sinai and ask the prog directors for the names of the top 2-3 candidates there....Take em out to dinner and show them what we have to offer....We get exceptional candidates, and we are fortunate to be able to choose our candidates. They are treated VERY well, and we treat them as investments in our future. None are turned awa from partnership. If they are not working out, they are gone from the getgo.....
  31. Narcotized

    Narcotized

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    I'm curious what the new guys are making those first 5 years, and what their hours are, call, vacation, etc? I don't think the partners will see that kind of money in 5 years from now, but who knows. It may be a great deal, but still, the length of partnership was increased for one reason, because the partners could; ie, excessive greed. Just doesn't smell right to me. Are we no better than lawyers now?

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