We could be in a physician compensation bubble, DOs write - The DO
I realize it’s an opinion piece but the guy makes some good points. Thoughts?
I realize it’s an opinion piece but the guy makes some good points. Thoughts?
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A Brewing Bubble?
Started by PathoTurnUp1865
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Problem is we got so many narrow minded and naive classmates that toot the horn for Medicare for all. That’s all good if your parents paid ur med school off but for the rest of us we want to pay off our loans and the govt would surely not increase reimbursement at proper rates if they had full control.
Meh. Fluff piece.
Yes some physicans are paid more than they bring in. You know why? Because they are needed to keep the hospital open and in compliance with Medicare rules.
Expansion of midlevels could definately lead to decrease in salaries. Downward pressure on PC, but probably no impact on Physicans that do surgery or procedures.
Yes some physicans are paid more than they bring in. You know why? Because they are needed to keep the hospital open and in compliance with Medicare rules.
Expansion of midlevels could definately lead to decrease in salaries. Downward pressure on PC, but probably no impact on Physicans that do surgery or procedures.
Yeah I agree in part he said mba degree is useful all around sorta makes u lol
I agree completely. Medicaid and Medicare are nice and all but from a business standpoint it’s not sustainable. As it’s been stated before, docs need better lobbying. N=1 but all the students at my school who are heavy into the politics side of medicine and want to do be in medical politics do tend to lean heavily to the left. They heavily support these programs and want more government involvement. I’m in a Midwest red state too. Makes me scared for the future of medicine as a business.
I’m sure hospitals will make cuts in other things before doc salary but who knows. We are wrongfully villainized by the public as well as by co workers. Something has to change.
In other news I’ve recently started seeing ads on tv that are pushing for limits on crna powers. So kudos to the gas team and whoever is fronting that.
Yeah same we got them in my class too it’s so annoying because they are so uninformed and none of them have ever had a real job besides milking mommy and daddy’s wallets
40-60% of hospital reimbursement comes from medicare.
A majority of physicans are employed by said hospitals.
Therefore currently a majority of physicans depend on remimbursement from Medicare.
Physician reimbursement accounts for a 15-20% of all costs.
The system before ACA was unsustainable with increasing costs and the average consumer being priced out of the health insurance and healthcare costs constituted 60% of all personal bankruptcies.
The current system remians unsustainable with premium and costs still increasing, although at a slower rate.
I would love to hear some conservative solutions.
Eliminating medicare will lead to what we had before medicare which was seniors in destitution , and dying due to lack of care. Will also reduce need for physican services as evidenced by the fact that 40-60% of reimbursement is medicare based. Cant get seniors to pay if they dont have the money.
Privatizing medicare wont really help either, just increased middleman costs.
The private market failure is what has lead us to this.
We could completely freemarket it , patients could get their own drugs from pharmacy without a precription, chiropractors could perform surgery, and NPs could call themselves physicians. Probably not a good idea, wont be pretty for physicans since reimbursement is a function of scarcity.
Increasingly the people being squeezed are people who dont qualify for medicaid or medicare and have reasonable paying jobs probably in the 20-60k range.
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Yep, it's a lot easier to support leftist causes and redistributionist policies (which have ironically driven up the cost of higher education) when you've got a trust fund safety net parked away in overseas tax havens and someone else is paying all your bills for you and subsidizing your lifestyle while a student.
Open insurance markets to force competition and transparent pricing to get rid of the outrageous billing practices and backdoor deals by "non profit" hospitals.
Safety net only for children, elderly, and legitimately disabled.
Working age adults don't get free healthcare paid for by other working age adults, period. If that means they can't get a lifesaving treatment without having their wages garnished or declaring bankruptcy, tough. That's life. You should have made better choices.
This "republicans want to let people die on the street" argument is bogus. That will never happen. They just want working-age adults to be accountable and create a system where healthcare services are reasonably priced and people don't get a $100,000 bill for a 2-day hospital stay they can never pay back.
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You are acting like conservatives havent been in power a single time since 1965. Or they havent cut state funding to state schools or Liberty and Bob jones arent in on this. Or GW didnt remove bankruptcy protections from student loans.
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Then the current system is working just fine for you. And dont be surprised when people seek emergency care we end up footing the bill anyway . Also Dont be surprised when the middle class people who work and still cant afford care will push for Medicare for all.
Nobody talking about eliminating it but healthcare as is isn’t much of a free market as is. No other group has as much restriction as physicians on them. Address the administrative bloat and let doctors own hospitals like they should be able to. It’s ridic they can’t own them and literally any other professional can own their own business without too much restriction. Admin salaries are ridic bc of government intervention.
Medicaid is highly abused by patients who do not want to work. Not saying we can’t have it but once u see RL you might think differently. Patients are notorious for wasting care when they don’t have skin in the game
Oh please. Leftists have driven up education cost through their self-created academia industry. Schools waste so much on things that are totally unnecessary and have created all these wasteful administrative positions that should not exist. Who are these administrators and professors at universities? All leftists. All feeding off the loan industry teet while proclaiming the virtues of socialism and providing naïve young people degrees in liberal art disciplines that have no value in the labor market damning them to a lifetime of indentured servitude and reliance on the state for support rather than providing them with a useful education that allows them to become self-sufficient and financially independent..
Occasionally a conservative school, like Liberty University, takes advantage of these leftist-created policies too that siphon money from tax-payers to schools through the middleman loan industry. And they do it well by maximizing profit with low cost online courses. However it's intellectually dishonest to point to a couple of schools like this, which comprise a tiny minority of the overwhelming liberal higher education industry and say, "it's all THEIR fault, look at all the money THEY are making!"
Want to see what a "free college" looks like? Go to Europe and look at a public school. Bare architecture. Weeds growing around buildings. A basic cafeteria. Minimal support staff. No fancy art hanging on walls. Education result is the same. Last I checked Germany still produced the world's best engineers. While it's still not right to steal taxpayers dollars like this, at least they're more responsible with them and try to keep costs low.
They complain about teacher salaries, but no tax dollars or bond money ever goes to teacher salaries.
Look at how much the liberal institutions pay their "adjunct faculty," who have PhDs but can't make a living teaching, while the tenured professors who really do no teaching at all (that's what the adjunct suckers and desperate foreign TAs with visas do) champion a $15 minimum wage for high school drop outs and medicare for all and welfare for those who are "unwilling to work." It's criminal.
It works fine for me because I work and budget and save money for medical expenses. You know, being a responsible adult. I have been to a doctor probably a half dozen times the past year and fork over around $50-$100 each time at the time of service followed by the remainder later as I never hit my deductible. I'm paying for a service that's only reasonable in cost because I have to pay my "insurance" company $150 a month to get their super secret discount they negotiate with the provider.
At no point did I ever think I was entitled to just walk into a providers office, get a service, go to a pharmacy, get a bottle of pills, and then go get better without any money leaving my bank account at any point.
haha criticize leftists with and hold up a publicly funded university system. This is a joke right?
You like to blame leftists a lot yet fail to take responsibility for the all the administrations that continued to allow this to happen and remove bankruptcy protections and reduce funding for state schools.
Instead of attacking people maybe engage in some constructive dialogue. Provide some solutions. I agree that higher education spending is unsustainable.
Most universities have transitioned to minimizing tenure. Most admins are far from leftist, they are MBA types.
Seems like you are fine with the current system. Thats great a large portion of americans are not. You can blame them or you know you could solve the problems in the system. If you are just going to blame them dont be surprised when medicare for all becomes an actual thing.
When a family making 36 k after taxes is paying 12 k in premiums and 5 k deductible things are barely sustainable.
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Still doesnt solve the private health insurance.
Wow.
“Physicians need to diversify their skillset so that they have another source of income in addition to clinical medicine.”
He’s basically saying that being a doctor won’t allow you to support a family in the future.
“Physicians need to diversify their skillset so that they have another source of income in addition to clinical medicine.”
He’s basically saying that being a doctor won’t allow you to support a family in the future.
I'm not attacking you. I'm pointing out flaws in your reasoning and providing my opinion as to what constructive solutions are.
What you are doing is mis-representing my position and putting words in my mouth (I'm certainly NOT fine with the current system) and resorting to hyperbole and logical fallacies.
I am not a fan of GW Bush for many reasons. You seem fixated on this particular strawman. FWIW, his administration created the PSLF program. When you look at the high level the policies of Clintons, Bushes, and Obama in their dealings with large industries and tendancy to screw over the little guys really aren't that different.
You can thank your own party for torpedoing Bernie Sanders despite being the popular choice in favor of the next Bush/Clinton to carry on the bipartisan cronyism.
Sigh.
This is what I get for clicking on "show ignored content."
you literally are blaming all of higher educaiton on leftists. I am merely saying that if it is a failure of government Leftists havent run the governmetn consistently. There are have been conservatives in power in a position to change this, yet have allowed it continue, allowed middlemen loan servicers to get rich off the backs of students and the public and look the other way.
Im yet to hear a flaw in my reasoning about medicare , except your personal responsibility argument. I am giving you examples of why people in the middle are having a difficult time affording care and how certain conservative solutions may play out.
When you say things like "it works for me I budget" sounds like you are fine with the current system.
To address your edits,
1. False.
Student affairs administrators even more liberal than professors, survey shows
Survey: College leadership is overwhelmingly liberal
Administrators, Not Academics, Drive Leftward Bias on Campuses
Liberal professors are bad — college administrators are even worse
Study: Liberal Bias Among Campus Administrators 'Astonishing,' Worse Than Professors
A quick google search reveals myriad more lay press articles citing the same recent studies.
2. I agree that it's horrible that a family has to pay outrageous premiums and deductibles.
As I said multiple times, the problem is the prices and the artificial system in place to fix those prices in the realm of absurdity. Not the fact that people have to pay something for healthcare that is anything other than zero dollars.
For the record I did not mean for this to turn into a political battle lol just thought it was an interesting article. 🙂
Not all of it, just the vast majority.
You have not heard a flaw in your reasoning other than the one I provided to you that you didn't like? Ok.
This is a non-productive conversation at this point, and I've stated my case. Done here.
I stand corrected about the adminster piece. But the still doesnt change the fact that it is a government problem. Our elected representatives are also responsible. But you decide to blame on one group of people who stand to benefit from unlimited loans, yet not the people who allow the unlimited loans to be government backed and dispensed. You also uphold germany as a good system, yet you would probably blow a fuse if there was conversation about eliminating tutition all together.
Ok dude. we all get it you hate liberals. Your solution to healthcare has soo far been personal responsibility. Lol. why not one better, lets just tell middle class people not to get sick.
Physicians study the natural history of disease. If you contract tuberculosis, and do not receive treatment, we understand the natural history of that process. When the government introduces a single player system ,what happens. Ok for awhile, then money gets tight, services then get restricted, wait times increase, people develop complications from delayed treatment. We have 50+ years of observation of the NHS in the UK. The international Red Cross a few years back called the NHS an international human disaster
Private insurance is a thriving industry in the UK. The NHS is reserved for those who cant pay and must wait. I was in China and discovered the Chinese must pay for health ins. My tour guide stared at me, incredulous for a full 5 sec when I told them we treat people with no insurance and cant pay. In China, if you have a fractured femur and no ins, you lay on a gurney until your family shows up with the cash. I am not advocating this, just observing history. I think we are headed to a 2 tiered system. Private for those who can pay , medicaire/ Medicaid for those who cant. We are there now, actually, only 1 in 10 Americans have no health ins. It would not take much to get the last 10% insured
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Melanogaster
Full Member
What about the increasing political and financial climate of practices going to universities and hospital systems? Seems like agency is getting taken away from practicing physicians and turning them into employees rather than their own bosses.
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deleted787552
I'm confused as to why a 2 tier system isn't being talked about as a viable option right now?
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deleted87051
A 2-tier system will emerge naturally as it has in many other countries. There’s not really a need to talk about it. We currently have at least a 4-tier system.
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deleted787552
Well that’s the point I’m making. If we’re bound to end up with a two tier anyway and have a really complex 4ish tier system now, why not skip all the steps in between and work to establish it now? The fact that we haven’t talked about it is pretty alarming. I’ve yet to see it brought up in the political sphere. We’ve watched so many other countries go through this yet center the debate on a 1 tier or 4+ tier
Medicare for all will lead to 5-10 mins pt encounter. No doc will give a crap about pt satisfaction. Oh, you don't like me. Feel free to get back in the 6-12 months waiting line for the next guy in my specialty. Zero babysitting. I think a lot of docs might welcome the change.
Yes, this is correct.
In my field, neurohospitalists are usually paid much higher than they generate (in wRVU's) because they allow hospitals to admit and treat acute neurological disorders, specifically, stroke. Hospitals are more than willing to dip into the massive DRG fund they get from admitting someone with an acute ischemic stroke to have a stroke specialist available 24/7.
Therefore, it's important that physicians understand their true value when time comes to negotiate salary.
This is standard in my field.
But not in mine
This is technically illegal and violates Stark Law. I’m not saying there are some doctors who get paid more than they directly bring in, I’m just saying you expose yourself to risk if you allow it to happen, and a lot of hospitals legal department won’t allow it, and it’s somewhat unreasonable to go into contract negotiations expecting a hospital to pay you more than what you generate in fees.
That’s really interesting. How is that sustainable?
Stop with the censorship moderators
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Not every department in the hospital makes money, even clinical departments. Some are loss leaders but they are subsidized by more profitable departments. The reason is, you need those departments to
1. either fulfill part of your mission
2 or you need it for regulatory compliance like the example mentioned above to retain stroke center of excellence certification.
3. It is a department that you need to capture market share in a particular segment that may lead to patient retention (especially in areas where there is hospital saturation).
Some of these departments are small and specialized where the physicians you need are in short supply. So you pay in excess of billings not because of referral potential which would indeed be a stark law violation , but because there arent enough of those physicians willing to take the job so you pay to attract the physicians thus making the market value of those physicians higher than just what billings alone would bring in.
It’s not. Eventually the government will sue the doctor and the hospital.
The way this typically happens is a nurse or administrator finds out that the physician’s compensation formula is based on ancillary services that are being generated through referrals to other providers in the system. That individual then files a whistleblower lawsuit and collects a large portion of the settlement, typically millions.
Obviously there is a huge incentive for nurses and secretaries who know about this to be on the lookout because they can go from making $20/hour to getting a $7 million windfall from a whistleblower settlement and retire immediately.
Tread carefully and always make sure your compensation agreement is reviewed by an outside consultant that documents that it represents “fair market value” to legally protect yourself.
One of hundreds of examples easily searchable: https://www.cmhealthlaw.com/2016/02...physicians-approved-by-georgia-federal-court/
I mean I’m with ya haha
Just seems like a trend I’ve noticed over the last 5-10 years. It’s concerning and I think more students/docs need to be aware of what’s been going on. Seems like more docs are doing something about it though as of recently but there’s still a huge backlash to us. Hopeful for the future of medicine.
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Because too many people making too much money on the current system and don't want that to change. And they buy the politicians too with "donations" so the status quo doesn't change.
Drain the swamp?
This should definitely be taught in school lol I feel like that’s something most docs probably don’t even think about when they’re signing a contract.
Typically the hospital severely underpays the physician these days so it’s rarely an issue except for rural hospitals doing anything they possibly can to recruit subspecialists, or in the few remaining specialties with a favorable supply and demand curve.
You know, the bolded holds true at the University level as well. The Bio and Chem Dep'ts may fund the money losing Art or Music Depts, or a med school may keep afloat the PT/OT schools.
Did any of you think this, when you first saw the thread title?
Obviously I''m way ahead of myself, but is this something that you ever learn in training (med school or residency), if not, do you recommend any resources to learn more about it?
I always here tons of doctors aren't financially smart, but I don't understand why schools aren't doing something about this. I definitely don't wanna spend 10 years of my life learning a skill and then have no idea what my work is worth. Sounds like a nightmare.
There’s usually a club that discusses the points. My school had a special class for us that wanted to learn about the business side of medicine but it turned out poorly.
During residency they’ll have seminars and such usually.
But as far as curriculum goes, no not really. You briefly skim it for ethics for boards but that definitely doesn’t teach you what you need to know in the real world. As far as what I’ve seen so far anyways.
There are also a lot of books on this subject. I’ve read a couple that were pretty helpful.
I think doctors will remain well paid as long as we stick up for ourselves. I don’t anticipate any issues going forward. This seems rather alarmist to me having seen some real world experience.
I have the White Coat Investor, any books beyond that you'd recommend?
Youre worth is A LOT more than they are paying you thats for sure. Thats why you dont know you're worth. They make you believe if you know youre worth you are a greedy sob that needs to be reported to the boards.
Medicaid across the board would basically eliminate billing, coding, and a large number of compliance jobs, bringing overall costs down. Come that with the simpler charting requirements that are in the pipeline and you would end up with far more efficient operations. Salaries might take a drop but whatever, at this point I think it would be worth it. Or you could just take cash only if your services are that good.
medicare for all I think would bring a significant slowdown in the economy short term while it reset itself. That is the danger of doing it. It would have to be done incrementally
