10% cut to reimbursements for many procedures

[ER BlueBlood]

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS


Oh wow - this is gonna make some heads spin. Good luck folks

I’m guessing Ortho and other heavy procedure specialties get hit

---

Members don't see this ad.

 

[Frazier]

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS


Oh wow - this is gonna make some heads spin. Good luck folks

I’m guessing Ortho and other heavy procedure specialties get hit

The cut will hurt. 6% of revenue, with ever-increasing overhead (read: bloat), will be a larger cut likely experienced by the doc.

 

[GeneralVeers]

For those of you who said $150/hour isn't in the near future.....

 

[Alvarez13]

For those of you who said $150/hour isn't in the near future.....

Good bye

 

[gamerEMdoc]

Yeah every field is freaking out about this right now, rightfully so. We are in the middle of an overwhelming pandemic and our legislators are actively looking for ways to cut our paychecks. Its incredibly sad and pathetic, but physicians have given all power and control of the healthcare system to administrators and politicians.

 

[gamerEMdoc]

So true. And unfortunately, like most businesses, when you aren't turning a profit, the people who are doing the work are the ones that get squeezed, not administrators. Because... capitalism. The reality is, unfortunately health care is way too costly in this country to be sustainable. That's not because of physician salaries, but I guarantee our salaries will feel it when it comes to things starting to clamp down on cost.

In the end, if I lost 10% of my salary would I hurt? Nope. I honestly probably wouldn't even notice the difference after taxes anyways. The issue is, where does it stop. Once we lose say 5% or 10% of reimbursement, and healthcare is still unsustainable, when do they come for the next cut, and the next one, etc. If our government is willing to cut reimbursement during a global pandemic when we are literally having colleagues die to provide frontline healthcare, they aren't going to have any shame in cutting reimbursement later.

 

[Spikebd]

billionaires laughing at wannabe millionaires.

 

[migm]

this is really final now?

 

[deleted941485]

this is really final now?

Yes it is CMS finalized it

 

[ER BlueBlood]

Healthcare is a business. It’s become almost impossible to practice medicine anymore outside of this business. We don’t run healthcare, and we no longer control practicing medicine like physicians once did. The only piece of leverage we still have is that medicine is hard and we spent years of training attempting to master the complexity. Administrators don’t understand medicine and so they still depend on us. Most pre-meds don’t see the realm of healthcare and business that doctors live in. I wish I wasn’t so naive regarding that when I went into medicine because I wanted something more meaningful than business. Full circle and now I feel like a middle manager in a massive corporation. Working for a SDG helps provide a little more control, but it’s still slowly slipping away.

Thanks for the post, kind of wish I didn’t read this this AM bc it’s so true.

 

[deleted941485]

So true. And unfortunately, like most businesses, when you aren't turning a profit, the people who are doing the work are the ones that get squeezed, not administrators. Because... capitalism. The reality is, unfortunately health care is way too costly in this country to be sustainable. That's not because of physician salaries, but I guarantee our salaries will feel it when it comes to things starting to clamp down on cost.

In the end, if I lost 10% of my salary would I hurt? Nope. I honestly probably wouldn't even notice the difference after taxes anyways. The issue is, where does it stop. Once we lose say 5% or 10% of reimbursement, and healthcare is still unsustainable, when do they come for the next cut, and the next one, etc. If our government is willing to cut reimbursement during a global pandemic when we are literally having colleagues die to provide frontline healthcare, they aren't going to have any shame in cutting reimbursement later.

Which is why docs should not have any shame playing hardball with them from now on.

This is how much CMS values you.

 

[southerndoc]

Yes it is CMS finalized it

Not completely. CMS has finalized it, but they have done so for nearly every year and Congress has emergently enacted legislation to counter their cuts. CMS is required to make cuts almost annually, but they haven't been passed through.

Now is the time to contact your legislators. I mention it on here a lot, but without our voices being heard, then they won't take action to prevent this.

There are two ways Congress can see this: One is that we're risking our lives by dealing with COVID patients and this is a blow to us, the other is that they're spending like crazy on COVID relief bills and need to reign in spending somehow.

Regardless, we need to make our voices known. Email, write letters, send faxes, make phone calls. Definitely voice your concerns that this payment reduction will compromise emergency care in all hospitals in the nation. Don't forget that surprise medical billing legislation could be slid into any legislation by the of the Congressional year, so don't let your guard down.

 

[bravotwozero]

If anyone has any links where we can go sign a petition and it will be directed to our legislators using our postal code, please post it here.

 

[deleted941485]

Not completely. CMS has finalized it, but they have done so for nearly every year and Congress has emergently enacted legislation to counter their cuts. CMS is required to make cuts almost annually, but they haven't been passed through.

Now is the time to contact your legislators. I mention it on here a lot, but without our voices being heard, then they won't take action to prevent this.

There are two ways Congress can see this: One is that we're risking our lives by dealing with COVID patients and this is a blow to us, the other is that they're spending like crazy on COVID relief bills and need to reign in spending somehow.

Regardless, we need to make our voices known. Email, write letters, send faxes, make phone calls. Definitely voice your concerns that this payment reduction will compromise emergency care in all hospitals in the nation. Don't forget that surprise medical billing legislation could be slid into any legislation by the of the Congressional year, so don't let your guard down.

I’m making calls

 

[Brigade4Radiant]

So nurse practitioners make more and so do physician assistants. I don’t see how it’s a cut to procedures if cardiology still makes 1% more.

CRNAs were felt a major blow. All the surprise billing the anesthesia does it seems that there reimbursement will continue to go down.


I love how during a pandemic our salaries are going down and spoiler alert I make 150 an hour in the south. This will start in March with a take it or leave it policy with an RVU component. Plus 10 Percent reduction of metrics aren’t met.

 

[WilcoWorld]

So nurse practitioners make more and so do physician assistants. I don’t see how it’s a cut to procedures if cardiology still makes 1% more.

CRNAs were felt a major blow. All the surprise billing the anesthesia does it seems that there reimbursement will continue to go down.


I love how during a pandemic our salaries are going down and spoiler alert I make 150 an hour in the south. This will start in March with a take it or leave it policy with an RVU component. Plus 10 Percent reduction of metrics aren’t met.

Leave it?

 

[southerndoc]

If anyone has any links where we can go sign a petition and it will be directed to our legislators using our postal code, please post it here.

Call them and email them directly. It's much better to do it with a personal letter/email/fax and phone call than it is to generate a form letter. Although if that's all you can do, then that's all you can do. ACEP will likely post something soon.

 

[Brigade4Radiant]

Leave it?

The contract says if you refuse to sign we will regretfully begin the separation process.

No one is hiring right now.

 

[bronx43]

Not completely. CMS has finalized it, but they have done so for nearly every year and Congress has emergently enacted legislation to counter their cuts. CMS is required to make cuts almost annually, but they haven't been passed through.

Now is the time to contact your legislators. I mention it on here a lot, but without our voices being heard, then they won't take action to prevent this.

There are two ways Congress can see this: One is that we're risking our lives by dealing with COVID patients and this is a blow to us, the other is that they're spending like crazy on COVID relief bills and need to reign in spending somehow.

Regardless, we need to make our voices known. Email, write letters, send faxes, make phone calls. Definitely voice your concerns that this payment reduction will compromise emergency care in all hospitals in the nation. Don't forget that surprise medical billing legislation could be slid into any legislation by the of the Congressional year, so don't let your guard down.

previous cuts were different and was under the guise of SGR. This is an overhaul of billing as a whole as well as RVU allocation. Outpatient specialty societies are championing this hard. I highly doubt Congress will pass anything to overrule this.

 

[southerndoc]

previous cuts were different and was under the guise of SGR. This is an overhaul of billing as a whole as well as RVU allocation. Outpatient specialty societies are championing this hard. I highly doubt Congress will pass anything to overrule this.

Maybe not, but not all hope is lost yet.

 

[deleted941485]

previous cuts were different and was under the guise of SGR. This is an overhaul of billing as a whole as well as RVU allocation. Outpatient specialty societies are championing this hard. I highly doubt Congress will pass anything to overrule this.

to the points made above, they could barely get a stimulus through and have no qualms with cutting during the pandemic.

 

[deleted941485]

So nurse practitioners make more and so do physician assistants. I don’t see how it’s a cut to procedures if cardiology still makes 1% more.

CRNAs were felt a major blow. All the surprise billing the anesthesia does it seems that there reimbursement will continue to go down.


I love how during a pandemic our salaries are going down and spoiler alert I make 150 an hour in the south. This will start in March with a take it or leave it policy with an RVU component. Plus 10 Percent reduction of metrics aren’t met.

Not are cardiologists do procedures. So it helps them

 

[bronx43]

Healthcare is a business. It’s become almost impossible to practice medicine anymore outside of this business. We don’t run healthcare, and we no longer control practicing medicine like physicians once did. The only piece of leverage we still have is that medicine is hard and we spent years of training attempting to master the complexity. Administrators don’t understand medicine and so they still depend on us. Most pre-meds don’t see the realm of healthcare and business that doctors live in. I wish I wasn’t so naive regarding that when I went into medicine because I wanted something more meaningful than business. Full circle and now I feel like a middle manager in a massive corporation. Working for a SDG helps provide a little more control, but it’s still slowly slipping away.

That’s not leverage, that’s just your investment... which is rapidly losing value. Leverage would be if enough of us quit at fast enough speed where they can’t easily replace us with fresh grads and midlevels. However, that’s not going to happen.
So no, we have no leverage at all.

 

[Hercules]

If anyone has any links where we can go sign a petition and it will be directed to our legislators using our postal code, please post it here.

This literally takes less than 30 seconds to do (less time than it takes to post here or scroll through social media)

Text message from ACEP today:

ACEP Members: Tell Congress why a 6% Medicare cut will hurt access for patients. Urge their help before year end. Click here Urge Congress to Halt Impending Medicare Cuts for Emergency Physicians

 

[Porfirio]

Inactive Campaign

Here you go. I am not sure what good this will do.

 

[sylvanthus]

Why do I feel like we as a group are always always on the defensive? The best we can hope to do is have things not get worse. Thats not a good future outlook. Anyone got advice on starting up a concierge practice? Anyone wanna go in on a medispa,, oxygen bar, botox, ketamine for depression, BS concierge practice| ?

 

[bravotwozero]

This literally takes less than 30 seconds to do (less time than it takes to post here or scroll through social media)

Text message from ACEP today:

ACEP Members: Tell Congress why a 6% Medicare cut will hurt access for patients. Urge their help before year end. Click here Urge Congress to Halt Impending Medicare Cuts for Emergency Physicians

done and done!

thanks for posting.

 

[Spikebd]

Why do I feel like we as a group are always always on the defensive? The best we can hope to do is have things not get worse. Thats not a good future outlook. Anyone got advice on starting up a concierge practice? Anyone wanna go in on a medispa,, oxygen bar, botox, ketamine for depression, BS concierge practice| ?

As long as you’re ok not being part of the “cool” crowd in medicine and are willing to be ridiculed by your peers, then this is probably a fantastic way to proceed. Many of us are caught up in seeking the approval of our “expert” colleagues, though.

 

[VA Hopeful Dr]

As long as you’re ok not being part of the “cool” crowd in medicine and are willing to be ridiculed by your peers, then this is probably a fantastic way to proceed. Many of us are caught up in seeking the approval of our “expert” colleagues, though.

It has very little to do with that and much more to do with our personal ethical standards.

 

[Spikebd]

It has very little to do with that and much more to do with our personal ethical standards.

I don’t plan on opening a med-spa, but it’s very worrisome how everything is so centralized.

 

[sloh]

Why do I feel like we as a group are always always on the defensive? The best we can hope to do is have things not get worse. Thats not a good future outlook. Anyone got advice on starting up a concierge practice? Anyone wanna go in on a medispa,, oxygen bar, botox, ketamine for depression, BS concierge practice| ?

Ethics aside, outside of a few rare exceptions are these even lucrative?

 

[alpinism]

Considering how many docs hand out antibiotics like candy I don't think they're worried about ethical standards.

 

[RustedFox]

Why do I feel like we as a group are always always on the defensive? The best we can hope to do is have things not get worse. Thats not a good future outlook. Anyone got advice on starting up a concierge practice? Anyone wanna go in on a medispa,, oxygen bar, botox, ketamine for depression, BS concierge practice| ?

I remember when oxygen bars were a "thing" back in the 00's.

They've got to be more agitating now (if they still exist), with instagrammers and all.

 

[bravotwozero]

So this is what John Cornyn (R-TX) told me in response:

Dear Bravotwozero:

Thank you for contacting me regarding changes to the Medicare program. I appreciate having the benefit of your comments on these issues.

In 2016, the federal government spent more than $3.5 trillion, with Medicare accounting for 15 percent of the entire federal budget. I believe Medicare provides vital health care to millions of Americans, but we must also ensure we are working to keep costs under control for taxpayers.

Congress has an obligation to restore America's fiscal health. According to current projections, the Medicare trust fund will be insolvent by 2026. Inaction is not an option. We must make structural reforms to Medicare to ensure it is a sustainable program. To strengthen Medicare and ensure it meets the health care needs of current and future seniors, we must develop long-term solutions. These solutions must encourage market-oriented policies to foster competition, lower costs, protect the doctor-patient relationship, and promote efficiency.

The patchwork of payment policies accumulated over many decades do not serve Medicare beneficiaries and providers well. Private sector competition in the Medicare Prescription Drug Program is benefiting both seniors and our health care system. I support proposals to encourage competition in the Medicare program by allowing private insurance plans to compete with traditional Medicare. Beneficiaries should be empowered to choose the plan that best fits their needs, including the option to enroll in traditional Medicare. These long-term solutions ensure that taxpayer dollars are spent efficiently and produce better health outcomes for our seniors.

As a member of the Senate Finance Committee, which has primary jurisdiction over Medicare issues, I will keep your views in mind as reform proposals are considered during the 116th Congress. I appreciate having the opportunity to represent Texas in the United States Senate. Thank you for taking the time to contact me.

Sincerely,

JOHN CORNYN
United States Senator

 

[Porfirio]

Blah, blah, blah, costs high, blah blah blah blah, whatever it takes to decrease costs, blah blah blah blah, no solution but decrease budget, Don’t mess with Texas

Classic

 

[RustedFox]

Blah, blah, blah, costs high, blah blah blah blah, whatever it takes to decrease costs, blah blah blah blah, no solution but decrease budget, Don’t mess with Texas

Classic

Yeah; no mention of "we could cut waste by cutting regulations and red tape"... or "maybe we shouldn't spend all the monies on people who are already functionally dead."

Politicians.

 

[ER BlueBlood]

So this is what John Cornyn (R-TX) told me in response:

Dear Bravotwozero:

Thank you for contacting me regarding changes to the Medicare program. I appreciate having the benefit of your comments on these issues.

In 2016, the federal government spent more than $3.5 trillion, with Medicare accounting for 15 percent of the entire federal budget. I believe Medicare provides vital health care to millions of Americans, but we must also ensure we are working to keep costs under control for taxpayers.

Congress has an obligation to restore America's fiscal health. According to current projections, the Medicare trust fund will be insolvent by 2026. Inaction is not an option. We must make structural reforms to Medicare to ensure it is a sustainable program. To strengthen Medicare and ensure it meets the health care needs of current and future seniors, we must develop long-term solutions. These solutions must encourage market-oriented policies to foster competition, lower costs, protect the doctor-patient relationship, and promote efficiency.

The patchwork of payment policies accumulated over many decades do not serve Medicare beneficiaries and providers well. Private sector competition in the Medicare Prescription Drug Program is benefiting both seniors and our health care system. I support proposals to encourage competition in the Medicare program by allowing private insurance plans to compete with traditional Medicare. Beneficiaries should be empowered to choose the plan that best fits their needs, including the option to enroll in traditional Medicare. These long-term solutions ensure that taxpayer dollars are spent efficiently and produce better health outcomes for our seniors.

As a member of the Senate Finance Committee, which has primary jurisdiction over Medicare issues, I will keep your views in mind as reform proposals are considered during the 116th Congress. I appreciate having the opportunity to represent Texas in the United States Senate. Thank you for taking the time to contact me.

Sincerely,

JOHN CORNYN
United States Senator

His interns cut and paste reply to anything he receives on the matter I’m sure...this guys only concern is if Trump likes him.

Here is an idea, John, stop bailing out airlines. We don’t need 5 different insolvent airlines getting bailed out by taxpayers .

John doesn’t care because he gets the best healthcare, heck they even have some pharmacy hand deliver all senators medications in DC every week. Imagine having that level of service on the taxpayers dime.

 

[emergentmd]

This pertains to not just EM but medicine in general. Everyone needs to face the facts that this is NOT sustainable and government run healthcare is inevitable. What it will look like I have no clue.

The Medicare pyramid will collapse. Once Medicare rates plummet, all of the private carriers will follow suit b/c they peg their reimbursement on Medicare rates.

When this will happen or what a gov run healthcare will look like, no one knows. But in 20 years we will have some type of gov run system.

Be ready, save your $$, create passive income so you can leave on your own terms. Be warned. Otherwise most docs will be making 50% of their current pay and "forced" to work to maintain their lifestyles.

 

[southerndoc]

ACEP news release: The 2021 Physician Fee Schedule Final Reg: The Good, the Bad, and the Ugly

 

[WilcoWorld]

So this is what John Cornyn (R-TX) told me in response:

Dear Bravotwozero:

Thank you for contacting me regarding changes to the Medicare program. I appreciate having the benefit of your comments on these issues.

In 2016, the federal government spent more than $3.5 trillion, with Medicare accounting for 15 percent of the entire federal budget. I believe Medicare provides vital health care to millions of Americans, but we must also ensure we are working to keep costs under control for taxpayers.

Congress has an obligation to restore America's fiscal health. According to current projections, the Medicare trust fund will be insolvent by 2026. Inaction is not an option. We must make structural reforms to Medicare to ensure it is a sustainable program. To strengthen Medicare and ensure it meets the health care needs of current and future seniors, we must develop long-term solutions. These solutions must encourage market-oriented policies to foster competition, lower costs, protect the doctor-patient relationship, and promote efficiency.

The patchwork of payment policies accumulated over many decades do not serve Medicare beneficiaries and providers well. Private sector competition in the Medicare Prescription Drug Program is benefiting both seniors and our health care system. I support proposals to encourage competition in the Medicare program by allowing private insurance plans to compete with traditional Medicare. Beneficiaries should be empowered to choose the plan that best fits their needs, including the option to enroll in traditional Medicare. These long-term solutions ensure that taxpayer dollars are spent efficiently and produce better health outcomes for our seniors.

As a member of the Senate Finance Committee, which has primary jurisdiction over Medicare issues, I will keep your views in mind as reform proposals are considered during the 116th Congress. I appreciate having the opportunity to represent Texas in the United States Senate. Thank you for taking the time to contact me.

Sincerely,

JOHN CORNYN
United States Senator

Cleary cutting physician reimbursement has bipartisan support.

 

[TheComebacKid]

This pertains to not just EM but medicine in general. Everyone needs to face the facts that this is NOT sustainable and government run healthcare is inevitable. What it will look like I have no clue.

The Medicare pyramid will collapse. Once Medicare rates plummet, all of the private carriers will follow suit b/c they peg their reimbursement on Medicare rates.

When this will happen or what a gov run healthcare will look like, no one knows. But in 20 years we will have some type of gov run system.

Be ready, save your $$, create passive income so you can leave on your own terms. Be warned. Otherwise most docs will be making 50% of their current pay and "forced" to work to maintain their lifestyles.

So let me get this straight...

Medicare, for all intents as a purposes, is a form of government healthcare. I think this thread, and just in general my experience with the Medicare model of reimbursement, has proven that it is horrifically corrupt and loaded with all sorts of fraudulent practices. They pay hospitals 50% of what they bill. I agree, physician salaries will be the first to be affected, but beyond that, hospital systems will not be able to provide adequate care. They can't even find nurses to staff ICUs with some places running 4 to 1 staffing ratios in critical care settings. It won't be palatable to voters.

A government run system is appealing, because why exactly? Going to a fully government run system will lead to the eventual collapse of the US healthcare system. It is simply not sustainable. Regardless of who is in office in the near future, this country is built upon private enterprise and capitalist principles. What do you think will happen, tomorrow the executives at Cigna, Blue Cross, Anthem, United Healthcare are just going to pack up their bags and concede to the federal government?

Nobody will go to medical school. Nobody will go to nursing school. Who is going to take 300k in student loan debt to be paid 100k a year? Again, it's not sustainable from a workforce standpoint, and I don't see market forces going in that direction. Right now this forum is on edge with the whole "oversupply and not enough demand" stance, which I agree is an issue at this point in the middle of a pandemic with lots of new residencies, but in many countries with government run systems, it's not easy to find a physician who will see you because there just aren't enough. It's not worth the training/sacrifice for the terrible pay off.

I'm not sure why this forum is so hell bent on thinking in "absolute" terms. People have been saying we will be going to a fully government run model of healthcare delivery for decades now. It hasn't happened.

 

[Vandalia]

Nobody will go to medical school. Nobody will go to nursing school. Who is going to take 300k in student loan debt to be paid 100k a year?

Sure they will. I have posted this before, at my not-elite state medical school they have reported for the last several years that they had had between 12-15 applicants who met qualifications for every slot. Lets say that the top two-thirds don't apply, that still leaves five qualified applicants per slot.

Heck, there are people who go into $300K of debt by going to USC or DePaul and getting an English doctorate and teaching community college for $50,000 a year. There are plenty who will gladly do that and earn 3x as much.

There will always be people who want to be in medicine; that will not be the issue. Even in the Soviet Union where physicians were paid the same as factory workers there were still plenty who wanted to be physicians.

How many medicine related tv shows are there? How many are there about the lives of adjunct humanities faculty members?

 

[zero0]

Apparently there's a 2-year freeze on cuts proposed... but what then?

Bill puts 2-year freeze on Medicare services set for 2021 pay cuts

 

[TheComebacKid]

Sure they will. I have posted this before, at my not-elite state medical school they have reported for the last several years that they had had between 12-15 applicants who met qualifications for every slot. Lets say that the top two-thirds don't apply, that still leaves five qualified applicants per slot.

Heck, there are people who go into $300K of debt by going to USC or DePaul and getting an English doctorate and teaching community college for $50,000 a year. There are plenty who will gladly do that and earn 3x as much.

There will always be people who want to be in medicine; that will not be the issue. Even in the Soviet Union where physicians were paid the same as factory workers there were still plenty who wanted to be physicians.

How many medicine related tv shows are there? How many are there about the lives of adjunct humanities faculty members?

There are a handful of "Good Samaritan" pre-meds out there who are ready to take on and save the world. I guarantee you if tell them that there is a reasonable chance they will not make a six figure income, the numbers of people going into medicine would drop significantly. The loudest voices that make up the "I'm going to save the world like Noah Wylie on ER" crowd are in the minority in my opinion. Despite how altruistic people seem on the surface, if you don't pay them, they won't do the work. History has shown this over and over again. They will go elsewhere and use their good grades in the finance sector, or somewhere else that will fairly compensate them.

I don't think comparing the US to Soviet Russia where morally repugnant crimes occurred and people died in excess numbers of starvation and other treatable conditions is fair. Also, what is the cost of going to medical school in communist Soviet Russia? (I don't know, I'm guessing it's nothing and they tell you you have to go to medical school). Unless we completely make medical school free in the US which probably won't happen, I don't see how it works where you still maintain the same number of physicians in the workforce.

I don't believe the American public will stand for having less doctors to take care of an aging/sicker patient population. Also, don't forget, we live in a world of people showing up to the ED saying "I've had neck pain for 6 months, my best friends sister says I need to get an MRI as soon as possible". These people aren't going to stand by idly and wait for a year to get an MRI they don't need because they don't have enough radiologists or MRI techs.

This is a failed experiment in every corner of the world. It has been tried over and over. 49.999% of Americans who voted for the other guy, a majority Republican Senate and conservative Supreme Court aren't going to just roll over and take it.

 

[GeneralVeers]

People still go to medical school in the UK and other countries where they pay doctors with magic beans. We will still have graduates from our U.S. medical schools regardless of what doctor pay becomes. I feel bad for these suckers who endure 10+ years of training for almost not reward.

 

[bronx43]

There are a handful of "Good Samaritan" pre-meds out there who are ready to take on and save the world. I guarantee you if tell them that there is a reasonable chance they will not make a six figure income, the numbers of people going into medicine would drop significantly. The loudest voices that make up the "I'm going to save the world like Noah Wylie on ER" crowd are in the minority in my opinion. Despite how altruistic people seem on the surface, if you don't pay them, they won't do the work. History has shown this over and over again. They will go elsewhere and use their good grades in the finance sector, or somewhere else that will fairly compensate them.

I don't think comparing the US to Soviet Russia where morally repugnant crimes occurred and people died in excess numbers of starvation and other treatable conditions is fair. Also, what is the cost of going to medical school in communist Soviet Russia? (I don't know, I'm guessing it's nothing and they tell you you have to go to medical school). Unless we completely make medical school free in the US which probably won't happen, I don't see how it works where you still maintain the same number of physicians in the workforce.

I don't believe the American public will stand for having less doctors to take care of an aging/sicker patient population. Also, don't forget, we live in a world of people showing up to the ED saying "I've had neck pain for 6 months, my best friends sister says I need to get an MRI as soon as possible". These people aren't going to stand by idly and wait for a year to get an MRI they don't need because they don't have enough radiologists or MRI techs.

This is a failed experiment in every corner of the world. It has been tried over and over. 49.999% of Americans who voted for the other guy, a majority Republican Senate and conservative Supreme Court aren't going to just roll over and take it.

Wait how did we get from single payer to Soviet Russia? Oh, right. Cuz anything that isn't status quo must mean communist totalitarianism.

Single payer is likely coming within your lifetime, whether you like it or not. I don't like it, but it is what it is.

 

[Vandalia]

I guarantee you if tell them that there is a reasonable chance they will not make a six figure income, the numbers of people going into medicine would drop significantly.

You started at $150K and now have dropped down to "won't make six figures."

You realize that physicians in Canada, the UK, France, Germany all have salaries that are all in the mid to high six figures in American dollars?

People in the future will gladly take a job "not making six figures" as physicians because if that is the case, then accountants, lawyers, and dentists will not top $50,000.

 

[GeneralVeers]

There are a handful of "Good Samaritan" pre-meds out there who are ready to take on and save the world. I guarantee you if tell them that there is a reasonable chance they will not make a six figure income, the numbers of people going into medicine would drop significantly. The loudest voices that make up the "I'm going to save the world like Noah Wylie on ER" crowd are in the minority in my opinion. Despite how altruistic people seem on the surface, if you don't pay them, they won't do the work. History has shown this over and over again. They will go elsewhere and use their good grades in the finance sector, or somewhere else that will fairly compensate them.

I don't think comparing the US to Soviet Russia where morally repugnant crimes occurred and people died in excess numbers of starvation and other treatable conditions is fair. Also, what is the cost of going to medical school in communist Soviet Russia? (I don't know, I'm guessing it's nothing and they tell you you have to go to medical school). Unless we completely make medical school free in the US which probably won't happen, I don't see how it works where you still maintain the same number of physicians in the workforce.

I don't believe the American public will stand for having less doctors to take care of an aging/sicker patient population. Also, don't forget, we live in a world of people showing up to the ED saying "I've had neck pain for 6 months, my best friends sister says I need to get an MRI as soon as possible". These people aren't going to stand by idly and wait for a year to get an MRI they don't need because they don't have enough radiologists or MRI techs.

This is a failed experiment in every corner of the world. It has been tried over and over. 49.999% of Americans who voted for the other guy, a majority Republican Senate and conservative Supreme Court aren't going to just roll over and take it.

I wish I had your optimism. My opponents are singularly focused on having a government takeover of healthcare. It's 16% of the economy, and they are salivating at the thought of having that much money and control. They own 40% of that 16%, and are going after the other 60% as soon as they can. Right now private insurers are the only thing keeping the government honest(ish) as far as pay. Once the government has control over most health care, we end up with a two tier system where most patients and doctors function in the poorly funded public system, and a few wealthy people (including all our members of Congress) can get excellent care in a concierge private system. Obamacare was proof that these hypocrites won't take their own medicine as our ruling staff exempted themselves, and their staffers from the mandates.

 

[wamcp]

You started at $150K and now have dropped down to "won't make six figures."

You realize that physicians in Canada, the UK, France, Germany all have salaries that are all in the mid to high six figures in American dollars?

People in the future will gladly take a job "not making six figures" as physicians because if that is the case, then accountants, lawyers, and dentists will not top $50,000.

Mid to high six figures? Uh No?

No one is making 500k-900k. In europe and canada they making more like 150k, down to 100k in UK

 

[GeneralVeers]

Mid to high six figures? Uh No?

No one is making 500k-900k. In europe and canada they making more like 150k, down to 100k in UK

Agreed. I've researched multiple options of countries to move to. For EPs, really only Australia, Canada, and Dubai/Saudi Arabia make any sense from a salary perspective. Countries like Singapore and New Zealand are paying in the range of $100K to 150K per year.


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