socialized medicine..whats the possibility this sh*** will actually happen

kg062007 said:

I dont even know where to start, every aspect of it is Fuc*** up, you mean i suppose to go through eight years of yell and not be compensated for it? I jus want to know base on actual facts, whats the possibility that this will happen in the next ten years... based on what yall say, i may change my major tommorow. i know that afer i post this i will get a wave of fakes who will say " its not about the money" pleasr be real with yourself... no matter how much you want to help people you still want what your owed for those eight years of your prime you lost.

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Wow......I'm the reigning king of the temporary post hold here, and I don't think I've ever used that particular obscenity in the title of a thread. I foresee a short tenure here in your future.....

Oh and by the way, if you really spell and write as poorly as you did in that post, don't worry about changing your major.....your GPA and VR score on the MCAT will keep you out of medicine.

kg062007 said:

another insecure know it all jackass who thinks he has to point out every typing error in a post, i typed it in a hurry...... nice avatar.. why don't you take your own advice.

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Have fun dealing with the mods......

Go with the flow...

Some years ago I met a gastroenterologist who went into medical practice ~1960. His father-in-law was also a physician and the older man was all doom and gloom about Medicare and Medicaid. He called it "socialized medicine". It was going to ruin the practice of medicine and hurt doctors' incomes. Instead, from the mid-1960s through the early 1980s, it was the golden goose, he said (things have tightened up since) and subspecialists made very, very good livings. The doc I knew found it ironic that the programs his father-in-law so feared turned out to be so good for his daughter's family.

There was another post on here. As Law2Doc said on that previous post, if salaries start to decline it won't be comparable to walking into the ocean and then dropping off the continental shelf. As of now, it appears that many Republicans and Democrats (or atleast Democrats) definitely want to nationalize health insurance. Is it a doomsday for doctors? I don't think so. I know it would bring change but not as drastic as you seem to think its going to happen. The government is slow and it would probably take atleast 2 terms of a determined president to work out all the kinks and truly provide nationalized care. To address your comment about "its not just about the money." Its not, everyone that wants to practice medicine has been drawn to it by some personal connection or experience. That being said, money also plays a factor. I don't think you'll have to worry about your salary getting tanked immediately due to nationalization/socialization of healthcare. If you're that worried going into a specialty that makes 250-300k so that it won't hurt too much to have the salary chopped down to a smaller size. All in all, don't worry about it right now and rethink why you're getting into this work. 80 hour weeks in residency, endless hours of studying, debt until you're 50s or 60s, along with all the other cons do not outweigh the pros of medicine unless your heart isn't in it.

kg062007 said:

I dont even know where to start, every aspect of it is Fuc*** up, you mean i suppose to go through eight years of yell and not be compensated for it? I jus want to know base on actual facts, whats the possibility that this will happen in the next ten years... based on what yall say, i may change my major tommorow. i know that afer i post this i will get a wave of fakes who will say " its not about the money" pleasr be real with yourself... no matter how much you want to help people you still want what your owed for those eight years of your prime you lost.

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Have you been drinking, because that's one yell of a rant. Good work.

kg062007 said:

i know that afer i post this i will get a wave of fakes who will say " its not about the money" pleasr be real with yourself... no matter how much you want to help people you still want what your owed for those eight years of your prime you lost.

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You aren't "owed" anything. No more than someone who loses at blackjack is owed his money back -- predicting a future salary and government action many years out is simply a gamble, and like blackjack, you have to know that odds aren't as much in your favor of late. You haven't started yet and you seem to know the risks, which is good. However if they are too steep, simply find something else. No one is asking you to do this. You need to change this attitude because you are acting like it's an entitlement and you haven't even walked the walk.
Many people aren't in it for the money. On the nontrad board you can find quite a few of us who took a nice pay haircut to go this route. If you are going to be working 60+ hours a week for the rest of your life, you had better enjoy it -- if it is just about the paycheck you will be miserable and have wasted what's left of your life.

As for your original question, there is likely to be some form of change coming out of next election, unless a bigger issue/event takes front and center. Probably not socialized medicine, but certainly something targeted to increase coverage of the uninsured. Some of the money to do that may come out of physicians' pockets, as well as that of the pharmaceutical industry. We have somehow become the bad guys in this -- see last weekend's NYTimes article. In the meantime insurance companies will continue tightening the screws on reimbursements. My personal opinion is that this slow gradual decline of income that has been seen the past decade will continue. Expect to be comfortable, but not rich, by the time you get into the field.

kg062007 said:

I dont even know where to start, every aspect of it is Fuc*** up, you mean i suppose to go through eight years of yell and not be compensated for it?

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Sounds like you want some sort of government guarantee. How... socialized.

Socialized medicine = Doctors being government employees

This isn't even the case in Australia and Canada (government=payer of healthcare, not owner of healthcare resourses i.e. socialism). Do you really think the US government is going to make the health care system more liberal here than Canada?

Gut Shot said:

Sounds like you want some sort of government guarantee. How... socialized.

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Owned!
http://kg062007.justgotowned.com

All it takes to win votes is to get the uninsured a little more coverage. They'll probably just expand Medicaid and SCHIP (or whatever that's called) and call it a day.

I'm not really too worried about us turning into Canada or France.. I have a feeling there would be far too much of a backlash by the medical community for it ever to happen. We're far too set in our ways, even in our bad ways--read PandaBear's blog about how messed up and pointless residency hours are.

Am I wrong to think that, even with socialized healthcare, an individual can still set up private practice and make serious cash? I guess the poor won't be the typical customers but for those who can afford a private doctor would certainly eliminate the "new waiting time" we all predict. This would really benefit surgeons seeing that most of their customers aren't paying today.

adamMD said:

Am I wrong to think that, even with socialized healthcare, an individual can still set up private practice and make serious cash? I guess the poor won't be the typical customers but for those who can afford a private doctor would certainly eliminate the "new waiting time" we all predict. This would really benefit surgeons seeing that most of their customers aren't paying today.

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People do set up "conceirge" medical practices now and then, where folks have to pay cash and go outside their insurance companies/medicare. They tend to work best in certain cosmetics practices and thngs not covered by insurance, but they have been used in other situations as well. The catch is that each wealthy community can at best support a couple such businesses (as most people who have money have insurance through work and prefer to use that for their med expenses), and so every now and then you see cases where too many people set up such businesses and they all go broke due to the small handful of cash customers being spread too thin. As a lawyer I have worked with some of these bankrupt doctors. So yes they can work, but you create a ton of business risk.

The doomsday scenario that people like to drum up is that we'll all (meaning everyone would be forced) be waiting in line for the basic healthcare that the government would theoretically provide, having to wait days, months, and years to get things done. In reality, what would happen is that those that can't get health insurance or get poor health insurance now would be subjected to that level of healthcare (which would be an improvement over what they have now), and everyone else who now pays for "premium" healthcare wouldn't miss a beat. You'd still be able to buy your premium health insurance, goto the doctor you choose, and pay for all of the bells and whistles you want out of medicine. If you can't afford healthcare, then you'd get a minimal amount of care...which is a far cry better than no care at all.

of course the unfair part is that those with "premium healthcare" also have to pay for "basic healthcare," which they didn't previously have to do. the middle-class, barely-scraping-by are now bottom rung, with no extra money because they're spending even more on healthcare.

as long as taxes don't shoot up like 10% I think it's going to happen. they'll just find somewhere else to cut costs to fund it.

LifetimeDoc said:

The doomsday scenario that people like to drum up is that we'll all (meaning everyone would be forced) be waiting in line for the basic healthcare that the government would theoretically provide, having to wait days, months, and years to get things done. In reality, what would happen is that those that can't get health insurance or get poor health insurance now would be subjected to that level of healthcare (which would be an improvement over what they have now), and everyone else who now pays for "premium" healthcare wouldn't miss a beat. You'd still be able to buy your premium health insurance, goto the doctor you choose, and pay for all of the bells and whistles you want out of medicine. If you can't afford healthcare, then you'd get a minimal amount of care...which is a far cry better than no care at all.

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If everone had a little healthcare, than most would probably afford half-assed medical care. For example, someone could get a heart transplant but then not get funding for the costly drug therapy. No care at all is better in this case because the heart should've gone to someone who could truly afford it.

adamMD said:

No care at all is better in this case because the heart should've gone to someone who could truly afford it.

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I award you no points, and may God have mercy on your soul.

Gut Shot said:

I award you no points, and may God have mercy on your soul.

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Yeah, if you (adam) get asked about healthcare reform at an interview (and you might), I hope you don't plan to use that.

This is America where we believe in getting rewarded for hard work. Many people will say they are not going into medicine for the money, and I believe they really feel this way, but I also believe that they would all agree that the salary is a nice perk. America is not going to set up a system where people go through all the education required to become a doctor and end up with a lower, fixed salary...especially if the cost of education stays the way it is currently. Our politicians aren't stupid, and they know that people would stop going to med school if the final financial reward didn't reflect the amount of time spent along the way. Doctors don't need mansions and a yacht, but at the very least a nice, middle class lifestyle and the ability to pay back those college loans in a reasonable amount of time.

Gut Shot said:

I award you no points, and may God have mercy on your soul.

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LOL. What if the interviewer told me that? I'd feel pretty bad. But seriously, I think I have a valid point. It's like the game of Risk. If you spread out your armies too thin you'll get crushed. I think we should completely heal one patient before moving on to the next. In a socialized system, I don't think it's possible to completely heal patients because I envision the government standing in the way of tests and therapies that they don't deem necessary. I know this is already happening with insurance companies today but I think socialized medicine would exacerbate the problem.
In an interview, I'd try my best to illustrate my concerns but not back any side too firmly. After all, if the solution to health care were simple it would have been fixed along time ago.

Abilene85 said:

America is not going to set up a system where people go through all the education required to become a doctor and end up with a lower, fixed salary...especially if the cost of education stays the way it is currently. Our politicians aren't stupid, and they know that people would stop going to med school if the final financial reward didn't reflect the amount of time spent along the way.

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I think you are projecting your own ideals onto the nation as a whole. America doesn't "set up a system" here -- it just prunes back what is being portrayed to the public as excesses. Nor will they link one concept (salary too high) with the other (tuition too high). They will address the former because it is sellable to voters. I agree politicians aren't stupid -- they demonize a group as being the bad guy, and lay out a plan of attack to "fix the problem", and they get votes. George Bush attacked medmal lawyers, Clinton attacked the pharmaceuticals, and this next go around they will attack the doctors. Their job is to get elected, and making things fair for doctors isn't a winning point in that effort -- making healthcare cheaper is. As far as folks stopping going to med school, (1) I'm not sure that's true --teachers keep flocking to educational programs notwithstanding no money, (2) there is currently a huge backlog of passable med school hopefulls that don't get in, so you can do a lot of damage to salaries before you eliminate a big chunk of the applicant pool, and (3) even if what you say is accurate, there will be a delay between cutting the salaries and seeing any effect that needs to be addressed. In fact, if salaries are cut slowly (as I suspect), you won't see enough of an effect to address for many decades, and by then the expectations will be lower anyhow.

Law2Doc said:

I think you are projecting your own ideals onto the nation as a whole. America doesn't "set up a system" here -- it just prunes back what is being portrayed to the public as excesses. Nor will they link one concept (salary too high) with the other (tuition too high). They will address the former because it is sellable to voters. I agree politicians aren't stupid -- they demonize a group as being the bad guy, and lay out a plan of attack to "fix the problem", and they get votes. George Bush attacked medmal lawyers, Clinton attacked the pharmaceuticals, and this next go around they will attack the doctors. Their job is to get elected, and making things fair for doctors isn't a winning point in that effort -- making healthcare cheaper is. As far as folks stopping going to med school, (1) I'm not sure that's true --teachers keep flocking to educational programs notwithstanding no money, (2) there is currently a huge backlog of passable med school hopefulls that don't get in, so you can do a lot of damage to salaries before you eliminate a big chunk of the applicant pool, and (3) even if what you say is accurate, there will be a delay between cutting the salaries and seeing any effect that needs to be addressed. In fact, if salaries are cut slowly (as I suspect), you won't see enough of an effect to address for many decades, and by then the expectations will be lower anyhow.

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Comparing a doctor to a teacher isn't the same ballpark. Teachers don't have 1/100th of the work load as a med student. I know plenty of people that became elementary or high school teachers. Trust me, learning how to set up a curriculum for fourth graders does not compare to the intense rigors of a medical education.

What do you mean by backlog? Are you saying that only the pre-meds that get into medical school are money hungry and the rest are altruistic saints?

Law2Doc said:

As far as folks stopping going to med school, (1) I'm not sure that's true --teachers keep flocking to educational programs notwithstanding no money, (2) there is currently a huge backlog of passable med school hopefulls that don't get in, so you can do a lot of damage to salaries before you eliminate a big chunk of the applicant pool, and (3) even if what you say is accurate, there will be a delay between cutting the salaries and seeing any effect that needs to be addressed. In fact, if salaries are cut slowly (as I suspect), you won't see enough of an effect to address for many decades, and by then the expectations will be lower anyhow.

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Hopefully politicians will not attack doctors and see that it is actually insurance companies causing the problems. As for your points above:
1) I understand this example, but I don't think it is the same as medicine. Teaching is a 4-6 year degree and teachers are guaranteed regular work hours, every holiday with their families, and the entire summer off. HUGE perks there. I still think they probably don't get paid quite as much as they should, but I also think people forget all the vacation time when they see the average teacher salary.
2) True that tons of qualified students aren't accepted to med school, but their minds are no different than the ones who are. If salaries were cut, I'm thinking just as many of them would withdraw their applications.
3) Definitely, any cause/effect will be delayed. A generation will try it, but when the norm becomes the inability to pay off loans and doctors become very bitter, many of the shadowing pre-meds will start to rethink their career choices (I was pushed to reconsider medicine as a career when a couple physicians I know were forced to relocate or close part of their practice (OB) because they could no longer handle the cost of ridiculously expensive malpractice insurance). Perhaps, if this situation arises, America will see an increase in foreign med students who don't mind working hard for average pay, given the chance to live in America.

My hope is that when politicians begin to design a national program, they include doctors in the discussions. Medicine is about patient/doctor. Universal healthcare needs to keep both parties happy. If someone needs to get screwed, it should be insurance companies.

Abilene85 said:

If someone needs to get screwed, it should be insurance companies.

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Truer words have never been spoken.

They should be able to cut a lot of healthcare spending just by coming out with common forms and going paperless. Combine that with some kind of program that encourages good health through proper diet & exercise and an increase in mid-level providers for the poor, things might be salvageable.

armybound said:

Truer words have never been spoken.

They should be able to cut a lot of healthcare spending just by coming out with common forms and going paperless. Combine that with some kind of program that encourages good health through proper diet & exercise and an increase in mid-level providers for the poor, things might be salvageable.

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But in a profit-driven health insurance system, they have no impetus to encourage their policy-holders to have good health or to change in any way. Their concern is maximization of profits for their shareholders in the short term. The long-term health of their clients and the population isn't in their game-plan for the majority of private health insurance providers.

What private health insurance companies want are young, upwardly mobile patients who won't utilize healthcare, pay their premiums on time, and maximize the profits to the company. You won't get them to provide health insurance to the poor as they can't afford the premiums they want to charge, and they sure as hell don't want to have to pay out claims for somebody who hasn't been able to take care of their health.

Going paperless will cut costs and lower medical errors, which is a good thing, but it won't solve the problem all by itself.

LifetimeDoc said:

But in a profit-driven health insurance system, they have no impetus to encourage their policy-holders to have good health or to change in any way. Their concern is maximization of profits for their shareholders in the short term. The long-term health of their clients and the population isn't in their game-plan for the majority of private health insurance providers.

What private health insurance companies want are young, upwardly mobile patients who won't utilize healthcare, pay their premiums on time, and maximize the profits to the company. You won't get them to provide health insurance to the poor as they can't afford the premiums they want to charge, and they sure as hell don't want to have to pay out claims for somebody who hasn't been able to take care of their health.

Going paperless will cut costs and lower medical errors, which is a good thing, but it won't solve the problem all by itself.

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oh, I didn't mean that the insurance companies should do that on their own. I meant the government should come up with some kind of mandated forms or something that companies can either adhere to or get bent.

I keep thinking of something like private insurers that are approved by the government.. basically the same thing that the government would provide in a single-payer system, but with the added bonus of not destroying capitalism and the peoples' ability to choose who they get their insurance from.

Of course the more I think there should be a standard and stricter policies for private insurance companies, the more it sounds like just piling on more beauracracy. I think that insurance reform is necessary, though.. and can improve our healthcare system and coverage to the uninsured without going socialized.

LifetimeDoc said:

What private health insurance companies want are young, upwardly mobile patients who won't utilize healthcare, pay their premiums on time, and maximize the profits to the company. You won't get them to provide health insurance to the poor as they can't afford the premiums they want to charge, and they sure as hell don't want to have to pay out claims for somebody who hasn't been able to take care of their health.

Going paperless will cut costs and lower medical errors, which is a good thing, but it won't solve the problem all by itself.

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This is true, but at the same time, the incentive for physicians to get paid isn't all that good either. Many times, physicians will do the more expensive procedure so that they can get paid more for it. Paying doctors more for the health of their patients after a procedure than the procedure itself could do something to both reduce costs and keep the pay of physicians at a reasonable sum. It might also keep the insurance companies happy, because they would have to pay less for the heath of any given patient than they might otherwise pay. Medicare seems to think it's a good idea, anyway.

All in all, there's no one solution for this problem. A lot of things need to be done, and it will take a number of years before we see much of a change.

mvenus929 said:

Paying doctors more for the health of their patients after a procedure than the procedure itself could do something to both reduce costs and keep the pay of physicians at a reasonable sum.

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I have no idea how you could get this to work. This transfers responsibility away from the patient and toward the doctor. Why should a doctor be held accountable for how many Big Macs you eat, whether or not you decide to form an addiction to heroin, or if you like to sit in front of the TV 20 hours a day? The doctor can't control how you live your life.

How would you pay specialists, like oncologists? By the number of people who don't die? Yeah, that's going to work out really well. How about trauma surgeons, who don't exactly have the healthiest patients to start out with?

People should be more healthy in general, I agree completely--I think it's necessary to reduce healthcare spending--but that's an individual responsibility, not the responsibility of any health provider.

kg062007 said:

I dont even know where to start, every aspect of it is Fuc*** up, you mean i suppose to go through eight years of yell and not be compensated for it? I jus want to know base on actual facts, whats the possibility that this will happen in the next ten years... based on what yall say, i may change my major tommorow. i know that afer i post this i will get a wave of fakes who will say " its not about the money" pleasr be real with yourself... no matter how much you want to help people you still want what your owed for those eight years of your prime you lost.

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you're right in that you should be well compensated for the prime that you've lost, but that's not why you should go into medicine. you've predicted what I would say: do your future patients a service and choose another profession.

I think unnecessary testing was a problem in the past but today I feel the risk of not testing enough far outweighs the superfluous charges. I work in a pathology lab and occasionally we'll receive a specimen from a doctor who wants a gross examination only. In other words, the doctor doesn't want to charge the patient for tissue processing fees and microscopic analysis. Unfortunately, without microscopic examination, diseases like cancer can easily go undetected. Of course, the pathologist I work for refuses to give a diagnosis because he just can't. If you're going to catch a disease early in its progression seemingly unnecessary tests are required.

armybound said:

I have no idea how you could get this to work. This transfers responsibility away from the patient and toward the doctor. Why should a doctor be held accountable for how many Big Macs you eat, whether or not you decide to form an addiction to heroin, or if you like to sit in front of the TV 20 hours a day? The doctor can't control how you live your life.

How would you pay specialists, like oncologists? By the number of people who don't die? Yeah, that's going to work out really well. How about trauma surgeons, who don't exactly have the healthiest patients to start out with?

People should be more healthy in general, I agree completely--I think it's necessary to reduce healthcare spending--but that's an individual responsibility, not the responsibility of any health provider.

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Did you read the article I posted with it?

I agree that it's difficult, and I don't think it should be the sole means of payment.

For oncologists... depends what sort of oncologist it is. Surgical oncologists could be paid by how well they remove the tumor, within reason. Like breast cancer... if you have to do another surgery because you didn't get enough tissue the first time, you wouldn't get the bonus... something like that. Radiation oncologists would obviously be more difficult to give bonuses to, as would those who regulate chemotherapy. Maybe about how good their follow-ups with the patients are.

I'm not saying it would work for every specialty, but for a number of surgeries, it might. Making sure you perform the surgery on the right body part, for one. Those that don't don't get the bonus. I remember an article a while back about a hospital that enforced a certain procedure for a certain type of surgery, and had a much better rate of success with the surgery when they used that procedure. Things like recovery time might play a factor.

For other specialties... maybe getting the diagnosis right the first time, instead of saying it's one thing and finding out 6 months later that it's something different. A person comes in with a cough, and it's diagnosed as a cold, when it was bronchitis. Or maybe even something as simple as choosing the right test for the procedure. For radiation oncologists, giving one dose that is as effective (and cheaper) than giving 10 doses of a lesser amount. Or making sure that the patient understands the directions for any prescriptions they are given in another specialty.

True, the doctors can't account for everything, and the patients are responsible for a great deal of their care. But as I said, costs could be cut by doing alternative testing that is as effective. Physicians could be given bonuses (not necessarily regulating their pay) by the effectiveness of their practice.

I read your article. It was very vague and never actually seemed to mention what it is they're trying to do or how they expect to save money. The only thing I saw was calling patients after they go home, which seems to me like it's not some drastic change in healthcare. It also said that the hospitals found it extremely difficult to make the changes and most did not find it financially rewarding.. so why would they do it? There's very little incentive to work harder for no gain.

It seems like your arguments are for getting more tests (making sure it's bronchitis instead of a cold, etc) and further oversight (how do you measure the quality of a surgery?). More tests = more money, so while your initial diagnosis of a cold may be incorrect 1/10 times, you just paid for 9 tests you didn't need, just to make sure you didn't misdiagnose 1 patient and avoid getting your bonus. That's financial-incentive driven and defensive medicine.

A lot of patients will simply be non-compliant. My dad was given very thorough instructions to diet and exercise after he became diabetic a few years ago. I remind him often that he should be, just like a hospital might. He still eats the fattiest foods you can imagine and hasn't exercised in years. That's not the hospital's fault at all, they shouldn't lose anything because they can't get patients to comply.

Now that sozialized medicine is looming in the horizon, doctors will just have to accept lower pay checks. If you really love the field of medicine, the fact that you'll have to live in a one bedroom shack with several roomates, riding a bicycle to work everyday shouldn't matter. I thought being a doctor was supposed to be about helping people, not paying off your medical school debt or having a decent lifestyle. There will now be a considerable self-sacrifice to be made in order to persue medicine.

To the original poster:

Sort it out. If the risks (to you personally) outweigh the benefits of going into medicine, go back to the drawing board. But keep in mind that the grass isn't necessarily greener in any other career choice. Everything goes in cycles. And if the "get rich quick" or "easy, enjoyable job" career qualities in other fields seem to good to be true, they probably are.

usermike8500 said:

Now that sozialized medicine is looming in the horizon, doctors will just have to accept lower pay checks. If you really love the field of medicine, the fact that you'll have to live in a one bedroom shack with several roomates, riding a bicycle to work everyday shouldn't matter. I thought being a doctor was supposed to be about helping people, not paying off your medical school debt or having a decent lifestyle. There will now be a considerable self-sacrifice to be made in order to persue medicine.

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What, there isn't already considerable self-sacrifice?

You can't expect people to work as hard as doctors do and go through as much training as they do for very little reward. It's a basic principle in life, people want to be rewarded for their work. Doctors may want to help people, sure, but most people realize that they need to make a living. You can "help people" in many ways other than being a doctor.

mvenus929 said:

For oncologists... depends what sort of oncologist it is. Surgical oncologists could be paid by how well they remove the tumor, within reason. Like breast cancer... if you have to do another surgery because you didn't get enough tissue the first time, you wouldn't get the bonus... something like that. Radiation oncologists would obviously be more difficult to give bonuses to, as would those who regulate chemotherapy. Maybe about how good their follow-ups with the patients are.

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That's moving backwards, not forwards. Kinda like Hammurabi's Code:

"If a physician operates on a man for a severe wound... and cause the man's death... they shall cut off his fingers."

Doctors should not be rewarded, or punished, for being flawless or lucky. Medicine isn't a perfect science.. positive or negative reinforcement really does not apply.

Abilene85 said:

Hopefully politicians will not attack doctors and see that it is actually insurance companies causing the problems. As for your points above:
1) I understand this example, but I don't think it is the same as medicine. Teaching is a 4-6 year degree and teachers are guaranteed regular work hours, every holiday with their families, and the entire summer off. HUGE perks there. I still think they probably don't get paid quite as much as they should, but I also think people forget all the vacation time when they see the average teacher salary.
2) True that tons of qualified students aren't accepted to med school, but their minds are no different than the ones who are. If salaries were cut, I'm thinking just as many of them would withdraw their applications.
3) Definitely, any cause/effect will be delayed. A generation will try it, but when the norm becomes the inability to pay off loans and doctors become very bitter, many of the shadowing pre-meds will start to rethink their career choices (I was pushed to reconsider medicine as a career when a couple physicians I know were forced to relocate or close part of their practice (OB) because they could no longer handle the cost of ridiculously expensive malpractice insurance). Perhaps, if this situation arises, America will see an increase in foreign med students who don't mind working hard for average pay, given the chance to live in America.

My hope is that when politicians begin to design a national program, they include doctors in the discussions. Medicine is about patient/doctor. Universal healthcare needs to keep both parties happy. If someone needs to get screwed, it should be insurance companies.

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Don't expect government to side with doctors and screw the insurance companies. Insurance companies are well organized in Washington. Medicine pales by comparison. Which is why the last time healthcare reform was discussed in Washington (during the Cliniton era) doctors were largely excluded. Same will occur again.

I only mentioned teachers as an example of a group of folks who are flocking to a career where there is no money and who cannot repay their educational debt. So there is precedent for this -- it raises question to people's arguments that no one smart will go into medicine if the money is not there. (The fields are not the same, but the fact that people are often willing to do what they enjoy for crummy perks is the same).

As for expecting the entire applicant pool to dwindle if salaries are cut, I tend to doubt it. Heck even on SDN when money is discussed there are dozens of people who pipe up that they would do it for half, or a third the salary. So even if you cut the applicant pool substantially as you sliced salaries, you will still have enough folks to fill the schools. The fact that 50+% of applicants already don't get in gives folks a ton of cushion to play with -- you can keep cutting salaries and letting people drop out of the pool a very long time before it runs dry.

SavingJaneDoe said:

That's moving backwards, not forwards. Kinda like Hammurabi's Code:

"If a physician operates on a man for a severe wound... and cause the man's death... they shall cut off his fingers."

Doctors should not be rewarded, or punished, for being flawless or lucky. Medicine isn't a perfect science.. positive or negative reinforcement really does not apply.

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I agree completely. A lot of medicine is luck with both good times and bad. That fact of the matter is there are roughly 30,000 genes that make us human. We don't have a clue what most of them are and are even more confused about how they interact with one another. The underlying mechanisms of any disease are so far from an actual understanding that immediate diagnosis is extremely difficult.
Financial incentive should never be the reason to perform on a particular patient. I never want to see my patients as dollar bills. That's for retail. It has absolutely no benefit in medicine. We'll all firmly realize this once our first patient dies.

adamMD said:

We'll all firmly realize this once our first patient dies.

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Especially so since for pretty much everyone, your first patient will die while you are in med school or early residency, when you really have no financial incentive.

Law2Doc. Good points. However I feel that now a days that physicians are a stronger unit. Look what happen for the 2007 budgets proposed cuts in medicare by 5%. The AMA found that half of physicians surveyed said they would be forced to NOT take anymore new medicare patients. Because of this, the 5% cut did not occur.

Back in 1994 or whenever it was during the early Clinton era when healthcare reform was big, doctors were pretty content with salaries etc, because they were not being screwed by insurance companies. Actually it was the docs who were screwing the insurance company which is why we now have the Managed Care system we have now.

I just feel that doctors and future doctors are now more in tune with each other and are more likely to look after each other and the profession. Look at SDN forums, this type of support didn't even exist back in the day. Look at what the opinions are of the future doctors of america. They will not be screwed.

Law2Doc said:

Insurance companies are well organized in Washington. Medicine pales by comparison.

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A few years ago I would have agreed with you wholeheartedly, but the insurance companies aren't the only powerful lobbies with a stake in healthcare reform. E.J. Dionne Jr. mentioned this in a recent WaPo column:

The same inconsistencies apply even to that dreaded concept "socialized medicine." Last week, American auto companies opened what will be difficult negotiations with the United Auto Workers union. The toughest issue will be health care. General Motors paid $4.8 billion for health care last year, including $3 billion for retirees. Is it any wonder that the good capitalists at GM and the other car companies would love the government to pick up some of these costs?

"There's been an enormous paradigm shift in the business community," says Gov. Jennifer Granholm, a Democrat who has led Michigan during the crisis in the auto industry. Health care, she said, has "gone from being a moral issue to being an economic issue," meaning that business leaders who once had objections in principle to government-led health-care reform now have a powerful interest in making it happen.

Shrewd industrialists who love the free-enterprise system have noticed how "countries that have big-government health care" are at a competitive advantage, Granholm said in a telephone interview, and "they're asking government to help them out."

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Gut Shot said:

A few years ago I would have agreed with you wholeheartedly, but the insurance companies aren't the only powerful lobbies with a stake in healthcare reform. E.J. Dionne Jr. mentioned this in a recent WaPo column:

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I agree that other interest groups are at play --however GM etc have a hand in the insurance/credit business, so don't expect them to be an ally of doctors. My point was that there will be battles in DC and the doctors are bringing scalpels to a gunfight.

Law2Doc said:

I agree that other interest groups are at play --however GM etc have a hand in the insurance/credit business, so don't expect them to be an ally of doctors. My point was that there will be battles in DC and the doctors are bringing scalpels to a gunfight.

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Yes, and my prediction is that after all is said and done, the only true losers will be doctors. Afterall, they are the only party in this fight that claim the don't need money or compensation. That whole "we are in this because we love to save lives and cuddle hobos" is going to cost physicians bigtime. All the other players in the healthcare industry (Insurance companies, pharma, lawyers, and HMOs) have all made it clear they want money, and they are getting stronger by the day, while physicians are getting weaker. By the laws of natural selection, we know who is going to get f$cked.

Law2Doc said:

I agree that other interest groups are at play --however GM etc have a hand in the insurance/credit business, so don't expect them to be an ally of doctors. My point was that there will be battles in DC and the doctors are bringing scalpels to a gunfight.

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And my point wasn't that industry is going to leap to the side of doctors, but that the insurance lobbies aren't the only powerful, highly organized and highly influential force in Washington with healthcare reform on its agenda. I think we're more likely to see substantial policy changes in the next few years than we have been in decades.

Gut Shot said:

And my point wasn't that industry is going to leap to the side of doctors, but that the insurance lobbies aren't the only powerful, highly organized and highly influential force in Washington with healthcare reform on its agenda. I think we're more likely to see substantial policy changes in the next few years than we have been in decades.

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I agree there are other well organized and influential forces in this fight. Insurance, Pharm, Auto manufacturers (employers). But the one thing they all have in common is that they have no great interest in protecting physician salaries, and some incentive to throw blame in that direction. I agree that we will see some sort of plan implemented -- but I think physicians are going to get screwed if they don't take the initiative, lobby and try to set the agenda, rather than shrug their shoulders and wait to see what healthcare is going to become.

adamMD said:

Comparing a doctor to a teacher isn't the same ballpark. Teachers don't have 1/100th of the work load as a med student. I know plenty of people that became elementary or high school teachers. Trust me, learning how to set up a curriculum for fourth graders does not compare to the intense rigors of a medical education.

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Sweeping generalization FTL.

If you are talking about primary or secondary education, this might be accurate, but it will depend on the school district. If you're talking about being a college professor, you are entirely wrong. Graduate education for the PhD takes several years *more* than medical school, in which you are required to know just as much information, and there are expectations to maintain cognizance of the major developments in field. A PhD is just as much lifelong learning as an MD/DO, and, depending on the field, may require *more* knowledge and research. MD/DO's have minimum CME's that must be completed to maintain the medical license; PhD's who want to keep their jobs must publish or perish.

On-topic, socialized medicine does not necessarily mean price caps on services; stop conflating the two. It is entirely possible to make *a lot* of money in a socialized system. The only question is *where the money comes from*, rather than *what someone's salary will be*. Separate issues, folks.

Quix said:

On-topic, socialized medicine does not necessarily mean price caps on services; stop conflating the two. It is entirely possible to make *a lot* of money in a socialized system. The only question is *where the money comes from*, rather than *what someone's salary will be*. Separate issues, folks.

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While the two are not necessarilly equated, every plan floated in the US thus far has involved some nonphysician payor entity deterining what services get reimbursed and for how much. So in all probability any change in the US will involve restrictions on charges per patient/procedure, ie salary. As for where the money comes from, that which doesn't come from taxes has to come from savings. And in the short run savings can only come from cutting costs/salaries. (In the long run one would hope a healthier society where people see doctors before they have acute issues would be cheaper to manage).