AAMC Endorses Resident Physician Shortage Reduction Act of 2021

[efle]

Unemployment seems a bit dramatic

The EM and Radonc guys would've agreed with you a few years ago...people are right to take any residency expansions seriously

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[ohmanwaddup]

The EM and Radonc guys would've agreed with you a few years ago...people are right to take any residency expansions seriously

Correct me if I'm wrong, but this expansion seems nowhere as aggressive as those fields. didn't Florida alone have 30 EM programs open within a short period

EDIT: The numbers each year show that we might not need more residency spots, Id rather this money go towards creating spots/training programs that are solely for the purpose of unmatched US grad. Something similar to what MO and AZ do so they can have something to do while reapplying the following year.

All the same, I have a really hard time caring if some doc making 400-600K a year gets a paycut

 

[efle]

Correct me if I'm wrong, but this expansion seems nowhere as aggressive as those fields. didn't Florida alone have 30 EM programs open within a short period

EDIT: The numbers each year show that we might not need more residency spots, Id rather this money go towards creating spots/training programs that are solely for the purpose of unmatched US grad. Something similar to what MO and AZ do so they can have something to do while reapplying the following year.

All the same, I have a really hard time caring if some doc making 400-600K a year gets a paycut

Again its employment not income. Radonc graduates arent screwed because positions pay too little, they're screwed because they cant find positions.

 

[Lem0nz]

Correct me if I'm wrong, but this expansion seems nowhere as aggressive as those fields. didn't Florida alone have 30 EM programs open within a short period

EDIT: The numbers each year show that we might not need more residency spots, Id rather this money go towards creating spots/training programs that are solely for the purpose of unmatched US grad. Something similar to what MO and AZ do so they can have something to do while reapplying the following year.

All the same, I have a really hard time caring if some doc making 400-600K a year gets a paycut

I'm not sure people who are concerned about pay cuts are worried about that bracket either. I think they're worried about pay cuts in peds, or IM where people are living in the 200k land. I think it will have zero impact on surgical salaries which tend to be the ones you're describing, as I don't think they can expand surgical residencies that fast anyway because there's a lot more that goes into minimums to be competent and issues with diluting training pop up very quickly.

 

[ohmanwaddup]

I'm not sure people who are concerned about pay cuts are worried about that bracket either. I think they're worried about pay cuts in peds, or IM where people are living in the 200k land. I think it will have zero impact on surgical salaries which tend to be the ones you're describing, as I don't think they can expand surgical residencies that fast anyway because there's a lot more that goes into minimums to be competent and issues with diluting training pop up very quickly.

I mean will this expansion affect those specialties much? people still won't go into them because of salary, and if those start to get paid any lower people will presumably stop doing them.

 

[harrislakers123]

Major downside to this bill is that a far greater % should be allocated to underserved areas and high need specialties. A blanket increase in spots is not helpful

 

[Skullcutter69]

Things are a lot more nuanced than just going from a great job market to unemployment, or simply not caring about the overall issue because you think someone makes too much money. These things develop over the course of years. First you’ll see an even larger imbalance in jobs between “desirable” areas and the rest of the country. Your choices will be to live in a nice area and/or by your family and take more call, have fewer patients, and make 1/2 the money vs. leaving the area to get the jobs of old. Then you start to see even those positions go away, leaving only academics or a corporate job where you’re a cog in the machine with no leverage to negotiate whatsoever. Want a new piece of equipment, more staff, or additional help? You’re out of luck. You suck it up and do what you’re told or you’re out. Finally, you end up in the land of rad onc, where your options are to live in a completely rural area, or live 2-3 hours away from a mid-metro to make 1/3 the MGMA salary.

In short, by the time you see large salary cuts, it’s already way too late. Increasing residency spots to compete with midlevels is a losing proposition. We fundamentally have a maldistribution of physicians, not a shortage. Trying to fix this by pumping out more doctors is counterproductive, because you would have had to tank the job market so spectacularly and make the working conditions/pay so bad that people are willing to uproot and leave. I understand why this is difficult to see from a medical student’s perspective. They look at Medscape, see 400K+/year for radiology or cardiology and their eyes go wide. They don’t understand that if you want to live anywhere near a large city or nice area that you’re making ½ that, taking 2x the call, and likely working for a PE-bought practice that’s bossing you around and taking a cut of your collections. There are a lot of things that go into a healthy job market that are hard to see until you go through the process yourself or study the issue.

 

[efle]

Things are a lot more nuanced than just going from a great job market to unemployment, or simply not caring about the overall issue because you think someone makes too much money. These things develop over the course of years. First you’ll see an even larger imbalance in jobs between “desirable” areas and the rest of the country. Your choices will be to live in a nice area and/or by your family and take more call, have fewer patients, and make 1/2 the money vs. leaving the area to get the jobs of old. Then you start to see even those positions go away, leaving only academics or a corporate job where you’re a cog in the machine with no leverage to negotiate whatsoever. Want a new piece of equipment, more staff, or additional help? You’re out of luck. You suck it up and do what you’re told or you’re out. Finally, you end up in the land of rad onc, where your options are to live in a completely rural area, or live 2-3 hours away from a mid-metro to make 1/3 the MGMA salary.

In short, by the time you see large salary cuts, it’s already way too late. Increasing residency spots to compete with midlevels is a losing proposition. We fundamentally have a maldistribution of physicians, not a shortage. Trying to fix this by pumping out more doctors is counterproductive, because you would have had to tank the job market so spectacularly and make the working conditions/pay so bad that people are willing to uproot and leave. I understand why this is difficult to see from a medical student’s perspective. They look at Medscape, see 400K+/year for radiology or cardiology and their eyes go wide. They don’t understand that if you want to live anywhere near a large city or nice area that you’re making ½ that, taking 2x the call, and likely working for a PE-bought practice that’s bossing you around and taking a cut of your collections. There are a lot of things that go into a healthy job market that are hard to see until you go through the process yourself or study the issue.

Radonc hit unemployment without their MGMA values dropping by half. EM is gonna be there soon too, but I dont think itll be grads taking 150k, itll be grads unable to find a job. What exactly is the nuance here besides way too many spots opening relative to the number of positions? Of course hot locations will feel the squeeze first, but with 9000 extra boarded EM docs in the next 9 years I dont see how they avoid straight up jobless grads

 

[MavFab]

I mean will this expansion affect those specialties much? people still won't go into them because of salary, and if those start to get paid any lower people will presumably stop doing them.

People will take any specialty they can get if the alternative is not matching. You don't think the thousands of unmatched IMGs and FMGs wouldn't be more than happy to take rural peds residency spots?

 

[ohmanwaddup]

People will take any specialty they can get if the alternative is not matching. You don't think the thousands of unmatched IMGs and FMGs wouldn't be more than happy to take rural peds residency spots?

Idk man people seem to really hate kids and so many students have massive egos

 

[Skullcutter69]

Radonc hit unemployment without their MGMA values dropping by half. EM is gonna be there soon too, but I dont think itll be grads taking 150k, itll be grads unable to find a job. What exactly is the nuance here besides way too many spots opening relative to the number of positions? Of course hot locations will feel the squeeze first, but with 9000 extra boarded EM docs in the next 9 years I dont see how they avoid straight up jobless grads

I agree with you. My point was more directed at someone who said that they're not losing sleep because some specialties still make 400K+. The nuance is that average salary nationally is poorly reflective of the job market and is one of the last things to tank. Like you said, there are established rad onc guys who are making a killing and pulling the average up, even though the market for new grads is horrendous. It was the same thing for EP for a while (the MGMA mean was close to neurosurgery/ortho joints), but new grads couldn't find any jobs near mid-market metros.

The four main forces that affect physician salary/job market are: 1) reimbursement for services, 2) supply/demand (eg number of graduating residents + practicing physicians relative to need), 3) an alternative workforce (NP/PAs in EM and primary care + CRNAs in anesthesia), and 4) corporate/PE takeover of practices who take 20% of your earnings and do everything they can to cut costs. EM has been hammered by 2-4 at the same time, which is why this is happening. #4 is like gasoline on a fire and accelerates the already existing supply/demand problems, since they'll be the first to replace you with a lower cost alternative and/or cut your pay. Again, like you said, the easiest thing for us (physicians in general) to control and fix is #2 (and I guess #4 if you're a partner at a practice).

 

[qwerty89]

Things are a lot more nuanced than just going from a great job market to unemployment, or simply not caring about the overall issue because you think someone makes too much money. These things develop over the course of years. First you’ll see an even larger imbalance in jobs between “desirable” areas and the rest of the country. Your choices will be to live in a nice area and/or by your family and take more call, have fewer patients, and make 1/2 the money vs. leaving the area to get the jobs of old. Then you start to see even those positions go away, leaving only academics or a corporate job where you’re a cog in the machine with no leverage to negotiate whatsoever. Want a new piece of equipment, more staff, or additional help? You’re out of luck. You suck it up and do what you’re told or you’re out. Finally, you end up in the land of rad onc, where your options are to live in a completely rural area, or live 2-3 hours away from a mid-metro to make 1/3 the MGMA salary.

In short, by the time you see large salary cuts, it’s already way too late. Increasing residency spots to compete with midlevels is a losing proposition. We fundamentally have a maldistribution of physicians, not a shortage. Trying to fix this by pumping out more doctors is counterproductive, because you would have had to tank the job market so spectacularly and make the working conditions/pay so bad that people are willing to uproot and leave. I understand why this is difficult to see from a medical student’s perspective. They look at Medscape, see 400K+/year for radiology or cardiology and their eyes go wide. They don’t understand that if you want to live anywhere near a large city or nice area that you’re making ½ that, taking 2x the call, and likely working for a PE-bought practice that’s bossing you around and taking a cut of your collections. There are a lot of things that go into a healthy job market that are hard to see until you go through the process yourself or study the issue.

Med students are you guys taking notes?

This is basically how it goes.

Even if you already have a job when the market implodes you aren't necessarily safe. The glut of people wanting a job puts downward pressure on salaries. If you are an EM doc in a major metro area right now you are clinging to your job. There is a general fear of the unknown since you don't know if you will be able to find another job without have to relocate. Or just plain find a new job. The new residency grad who once posted on SDN that they would be happy working for $100 an hour will be happy to take the $150/hr rate that Envision is offering. Nevermind the fact that you are currently getting paid 225-250/hr and generate billing much higher than that. Envision or USACS or HCA or whomever will be happy to profit the difference. But hey its all OK! They are serving free latte's for Doctor's Day this year!

That means no complaining when the monthly schedule comes out and you think you got screwed with more busy evening and weekend shifts.
That means taking an unfair shift trade proposal if it comes from a higher-up (don't want to piss people off after all)
That might even mean coming in early and staying a bit later after your shift to make sure you "look good"

In a good job market Peter Gibbons doesn't have to come in last minute on the weekend for Bill Lumbergh. Instead Bill Lumbergh has to work hard to keep Peter Gibbons working for Initech. In a bad job market Peter knows he has no or few other options and so he not only happily works the extra weekend but washes Bill's car for free.

All of these things can make your "dream specialty" become a nightmare.

 

[Lem0nz]

Things are a lot more nuanced than just going from a great job market to unemployment, or simply not caring about the overall issue because you think someone makes too much money. These things develop over the course of years. First you’ll see an even larger imbalance in jobs between “desirable” areas and the rest of the country. Your choices will be to live in a nice area and/or by your family and take more call, have fewer patients, and make 1/2 the money vs. leaving the area to get the jobs of old. Then you start to see even those positions go away, leaving only academics or a corporate job where you’re a cog in the machine with no leverage to negotiate whatsoever. Want a new piece of equipment, more staff, or additional help? You’re out of luck. You suck it up and do what you’re told or you’re out. Finally, you end up in the land of rad onc, where your options are to live in a completely rural area, or live 2-3 hours away from a mid-metro to make 1/3 the MGMA salary.

In short, by the time you see large salary cuts, it’s already way too late. Increasing residency spots to compete with midlevels is a losing proposition. We fundamentally have a maldistribution of physicians, not a shortage. Trying to fix this by pumping out more doctors is counterproductive, because you would have had to tank the job market so spectacularly and make the working conditions/pay so bad that people are willing to uproot and leave. I understand why this is difficult to see from a medical student’s perspective. They look at Medscape, see 400K+/year for radiology or cardiology and their eyes go wide. They don’t understand that if you want to live anywhere near a large city or nice area that you’re making ½ that, taking 2x the call, and likely working for a PE-bought practice that’s bossing you around and taking a cut of your collections. There are a lot of things that go into a healthy job market that are hard to see until you go through the process yourself or study the issue.

This is (unfortunately) the way.

 

[efle]

Did y'alls classmates even know about MGMA data or read about job markets when you guys were M3s choosing specialties? I've yet to meet someone else who looked into salaries and was apparently the first to bring the ACEP projections to the attention of a friend going into EM. Nobody else was aware of the radonc situation during the resulting conversation either. If someone doesnt use the medical subreddits or SDN, I guess it's easy to be unaware. The school certainly never addresses anything about the financial/career implications of specialty choice at all.

 

[Lem0nz]

Did y'alls classmates even know about MGMA data or read about job markets when you guys were M3s choosing specialties? I've yet to meet someone else who looked into salaries and was apparently the first to bring the ACEP projections to the attention of a friend going into EM. Nobody else was aware of the radonc situation during the resulting conversation either. If someone doesnt use the medical subreddits or SDN, I guess it's easy to be unaware. The school certainly never addresses anything about the financial/career implications of specialty choice at all.

I didn’t know about MGMA data until PGY5 of general surgery residency, and even then I only knew it existed. Not what the actual numbers were. I still can only tell you about my specialty and not the other general surgery subspecs.

 

[Ho0v-man]

Did y'alls classmates even know about MGMA data or read about job markets when you guys were M3s choosing specialties? I've yet to meet someone else who looked into salaries and was apparently the first to bring the ACEP projections to the attention of a friend going into EM. Nobody else was aware of the radonc situation during the resulting conversation either. If someone doesnt use the medical subreddits or SDN, I guess it's easy to be unaware. The school certainly never addresses anything about the financial/career implications of specialty choice at all.

I didn’t know about MGMA data until PGY5 of general surgery residency, and even then I only knew it existed. Not what the actual numbers were. I still can only tell you about my specialty and not the other general surgery subspecs.

This is insane. I know people are idiots about job markets (“that place I scribed for 5 years ago had every doc making 500k and getting tons of job offers rofl”). Then that person is shocked they can’t make that in LA or NYC. But I can’t imagine not doing real research into your specialty’s earning potential.

 

[Neopolymath]

Did y'alls classmates even know about MGMA data or read about job markets when you guys were M3s choosing specialties? I've yet to meet someone else who looked into salaries and was apparently the first to bring the ACEP projections to the attention of a friend going into EM. Nobody else was aware of the radonc situation during the resulting conversation either. If someone doesnt use the medical subreddits or SDN, I guess it's easy to be unaware. The school certainly never addresses anything about the financial/career implications of specialty choice at all.

Same here. Didn't really bring it up because I didn't want to come across as "terminally online" like some hyperpolitical weirdos are, for example. Me telling a classmate that they should consider is a juice that ain't worth the squeeze.

It's pretty alarming how ignorant most students are to real life, bills, industry, politic trajectory, jobs outside academic medicine etc. The list could go on forever.

 

[Lawpy]

Med students are you guys taking notes?

This is basically how it goes.

Even if you already have a job when the market implodes you aren't necessarily safe. The glut of people wanting a job puts downward pressure on salaries. If you are an EM doc in a major metro area right now you are clinging to your job. There is a general fear of the unknown since you don't know if you will be able to find another job without have to relocate. Or just plain find a new job. The new residency grad who once posted on SDN that they would be happy working for $100 an hour will be happy to take the $150/hr rate that Envision is offering. Nevermind the fact that you are currently getting paid 225-250/hr and generate billing much higher than that. Envision or USACS or HCA or whomever will be happy to profit the difference. But hey its all OK! They are serving free latte's for Doctor's Day this year!

That means no complaining when the monthly schedule comes out and you think you got screwed with more busy evening and weekend shifts.
That means taking an unfair shift trade proposal if it comes from a higher-up (don't want to piss people off after all)
That might even mean coming in early and staying a bit later after your shift to make sure you "look good"

In a good job market Peter Gibbons doesn't have to come in last minute on the weekend for Bill Lumbergh. Instead Bill Lumbergh has to work hard to keep Peter Gibbons working for Initech. In a bad job market Peter knows he has no or few other options and so he not only happily works the extra weekend but washes Bill's car for free.

All of these things can make your "dream specialty" become a nightmare.

Capitalism is completely broken and is ruining medicine. We need a dramatic overhaul.

In before i get accused of being a Marxist/communist/socialist because #murica #freedom

 

[Skullcutter69]

Med students are you guys taking notes?

This is basically how it goes.

Even if you already have a job when the market implodes you aren't necessarily safe. The glut of people wanting a job puts downward pressure on salaries. If you are an EM doc in a major metro area right now you are clinging to your job. There is a general fear of the unknown since you don't know if you will be able to find another job without have to relocate. Or just plain find a new job. The new residency grad who once posted on SDN that they would be happy working for $100 an hour will be happy to take the $150/hr rate that Envision is offering. Nevermind the fact that you are currently getting paid 225-250/hr and generate billing much higher than that. Envision or USACS or HCA or whomever will be happy to profit the difference. But hey its all OK! They are serving free latte's for Doctor's Day this year!

That means no complaining when the monthly schedule comes out and you think you got screwed with more busy evening and weekend shifts.
That means taking an unfair shift trade proposal if it comes from a higher-up (don't want to piss people off after all)
That might even mean coming in early and staying a bit later after your shift to make sure you "look good"

In a good job market Peter Gibbons doesn't have to come in last minute on the weekend for Bill Lumbergh. Instead Bill Lumbergh has to work hard to keep Peter Gibbons working for Initech. In a bad job market Peter knows he has no or few other options and so he not only happily works the extra weekend but washes Bill's car for free.

All of these things can make your "dream specialty" become a nightmare.

This post is pure gold – one of the best things I’ve ever read on here.

In medical school, and a large part of junior residency you're completely used to being at the bottom of the totem pole. You take crap from everyone and stay quiet, because a) you’re still learning and b) you never want to rock the boat with people ahead of you. Nurses will question your decisions and you’ll get crap from everyone all over the hospital. From all my friends who have graduated, the most rewarding thing about becoming an attending isn’t even just the pay raise, it’s the complete autonomy you get. You finally get to take care of people the way you want to. You finally have some control over your time. Most importantly, your opinion is truly valued and your years of training garner some respect. People in the hospital/practice go out of their way to look out for you and your family. You finally bring value and have leverage, rather than being at the mercy and whim of other people.

There are data that almost half of physicians don’t stay in the same job 2 years after training. Some of this is from the RVU minimum pitfall (people sign a job with a high income guarantee and then can’t get the volume to earn that salary 2-3 years later, resulting in a huge loss of pay). The majority of switches (at least among my classmates, friends, and colleagues), however, are from disrespect shown to them by their employer. There’s nothing more demoralizing after a decade of training than having some MBA or predatory partner tell you to jump and you having to ask how high. “You don’t mind covering Christmas again this year do you?” “Oh, we have 3 patients with private insurance who were referred here? I’ll take them if you don’t mind. You can just get some more on call.” Loss of respect, autonomy, and semblance of control over your life and career is probably the worst thing. It’s just like being that third year med student all over again.

 

[Skullcutter69]

Capitalism is completely broken and is ruining medicine. We need a dramatic overhaul.

In before i get accused of being a Marxist/communist/socialist because #murica #freedom

With all due respect, how would a socialized system solve anything? Single payer would simply crush reimbursements for every specialty without solving any of the supply/demand problems. You would just be working for Envision for 130K/year. If you incorporated capitation like in Europe, you would decimate both the job market and salaries (but your lifestyle would be better since there’s no incentive to see patients or operate). Sure, some of the PE/VC groups would go away (some might just squeeze your margins more), but that’s like cutting your nose to spite your face. If the government took control over hospitals, you’d just be making 80-120K /year across specialties, just like the UK. Have fun.

Private insurance and the reimbursement they provide over Medicare is actually the only leverage we have at the moment. This is what allows privately owned groups to stay private and independent (and not sell to large hospital groups or corporations). Reductions in payments are what force most groups to shut down and sell.

 

[efle]

With all due respect, how would a socialized system solve anything? Single payer would simply crush reimbursements for every specialty without solving any of the supply/demand problems. You would just be working for Envision for 130K/year. If you incorporated capitation like in Europe, you would decimate both the job market and salaries (but your lifestyle would be better since there’s no incentive to see patients or operate). Sure, some of the PE/VC groups would go away (some might just squeeze your margins more), but that’s like cutting your nose to spite your face. If the government took control over hospitals, you’d just be making 80-120K /year across specialties, just like the UK. Have fun.

Private insurance and the reimbursement they provide over Medicare is actually the only leverage we have at the moment. This is what allows privately owned groups to stay private and independent (and not sell to large hospital groups or corporations). Reductions in payments are what force most groups to shut down and sell.

I know VA docs make less but isnt 80-120k a bit extreme

 

[qwerty89]

I know VA docs make less but isnt 80-120k a bit extreme

You aren't thinking this through. The VA pays what it pays because it has to pay that much in order to get anyone to actually work there. They pay that much because physicians currently have other options.

What do you think would happen if everything truly went single payor and the government ran everything. Like skullcutter69 said reimbursement would fall through the floor.

Even now many places like Kaiser and other hospital systems devise their pay scales based on MGMA numbers. So as more docs take lower paying jobs the average, 25th, 75th percentile income all drop. Then the hospitals will follow suit and drop their pay just saying "well we are paying __ percentile of MGMA...its a very competitive offer."

Even if you aren't making $$$ the fact that some guy down the street is helps you since that means the employers know that and they have an incentive to at least maintain current reimbursement levels otherwise you'll presumable waltz down the street and join um.

In radiology the VA can pay 380K a year for a light workday, 5 days a week, no nights/weekend/call. Historically the VA paid their National Teleradiologists up to 250/hr for weekday nights, 300/hr for weekend nights, and up to 400/hr for holidays. Now its max 250/hr flat regardless of weekend or holidays. At another VA I know weekend daytime moonlighters used to get paid slightly over $200/hr. Now its been cut by 10% over the last couple of years. And thats with a good radiology job market. If private practice pays less and less the VA will follow suit.

 

[Skullcutter69]

I know VA docs make less but isnt 80-120k a bit extreme

The VA operates in a unique environment (every other group/employer in the US pays more) and is forced to pay at least within the ballpark of the market or they wouldn't have any doctors. In other countries you have no choice because the government owns every hospital (I used example figures from countries with government ownership; there are private/hybrid models in some places but it's difficult to really increase your pay). If every hospital in the US became like the VA, the salaries wouldn't stay where they are now because you'd have nowhere to run.

 

[ohmanwaddup]

Again its employment not income. Radonc graduates arent screwed because positions pay too little, they're screwed because they cant find positions.

You and other posters here have good points. I've made some assumptions that appear to not be true

 

[Lawpy]

With all due respect, how would a socialized system solve anything? Single payer would simply crush reimbursements for every specialty without solving any of the supply/demand problems. You would just be working for Envision for 130K/year. If you incorporated capitation like in Europe, you would decimate both the job market and salaries (but your lifestyle would be better since there’s no incentive to see patients or operate). Sure, some of the PE/VC groups would go away (some might just squeeze your margins more), but that’s like cutting your nose to spite your face. If the government took control over hospitals, you’d just be making 80-120K /year across specialties, just like the UK. Have fun.

Private insurance and the reimbursement they provide over Medicare is actually the only leverage we have at the moment. This is what allows privately owned groups to stay private and independent (and not sell to large hospital groups or corporations). Reductions in payments are what force most groups to shut down and sell.

Wait will physicians be unemployed in socialized health system? I'm prioritizing having a job over reimbursements

 

[Lem0nz]

Wait will physicians be unemployed in socialized health system? I'm prioritizing having a job over reimbursements

With your level of debt and the training and worth of physicians in American medicine you should be prioritizing both. That is the point your elders are trying to make here. Stop freaking settling and rolling over.

 

[Lawpy]

With your level of debt and the training and worth of physicians in American medicine you should be prioritizing both. That is the point your elders are trying to make here. Stop freaking settling and rolling over.

I mean i agree but i don't think med students in countries with socialized healthcare are struggling with crippling debt (although correct me if i'm wrong on this)? Of course, i don't know if this means US med school debt would crash if we transitioned over to socialized system

I will say i agree that the corporatization of medicine is contributing to a lot of problems and skullcutter's point on private insurers paying better than Medicare is true. Maybe perhaps there should be a hybrid system of sorts to decorporatize medicine (if that's even possible) while keeping a sort of private insurer opt out

 

[Mad Jack]

Do you consider unemployment a salary reduction lol

There'll be a lower limit on salary pressure where it doesn't make sense to hire a midlevel instead of a physician. Probably around the 160-200k mark for most fields, as physicians are often twice as productive as a midlevel but only need one benefits package

 

[efle]

There'll be a lower limit on salary pressure where it doesn't make sense to hire a midlevel instead of a physician. Probably around the 160-200k mark for most fields, as physicians are often twice as productive as a midlevel but only need one benefits package

Haha by the time we're in the high 100s it'll be all residents - 1/4th as much for 3x the production

 

[jambro]

I mean i agree but i don't think med students in countries with socialized healthcare are struggling with crippling debt (although correct me if i'm wrong on this)? Of course, i don't know if this means US med school debt would crash if we transitioned over to socialized system

I will say i agree that the corporatization of medicine is contributing to a lot of problems and skullcutter's point on private insurers paying better than Medicare is true. Maybe perhaps there should be a hybrid system of sorts to decorporatize medicine (if that's even possible) while keeping a sort of private insurer opt out

Ironically, the most "extreme" politicians that want a single-payer system have also been the most liberal with full student loan forgiveness (with 0 cap even though it helps higher earners like med students). Imo whatever nightmare scenarios that could come (docs making 100k?) are significantly less likely than full student loan forgiveness, which I also dont think is very likely.

The VA operates in a unique environment (every other group/employer in the US pays more) and is forced to pay at least within the ballpark of the market or they wouldn't have any doctors. In other countries you have no choice because the government owns every hospital (I used example figures from countries with government ownership; there are private/hybrid models in some places but it's difficult to really increase your pay). If every hospital in the US became like the VA, the salaries wouldn't stay where they are now because you'd have nowhere to run.

I generally agree with you but our country is significantly less "equal" than the countries youre talking about. Where I'm from teachers make more than 2x (sometimes 3x) the median salary even though they're on the public payroll. You can look at what some cops make too. They blow the salaries of other countries workers out of the water, so why wouldn't it be the same for physicians?

 

[Kuratz]

Some smooth brain earlier in the thread said "I don't feel bad for people making $400-$600k who have to take a pay cut"

This type of crab-in-the-bucket mentality is a very shortsighted and frankly embarrassingly negative outlook on life. Someone who goes to 4 years of undergrad, 4 years of medical school, and then in many cases another 6 years of hard training and ends up in the hole $200-400k+ absolutely deserves a high salary. Especially when you factor in that these same people continue to get their ass up early every day, go do actual work at a fast clip basically the entire day, and still work some nights and weekends. Have you seen some of these corporate business and tech jobs? They literally wake up, turn on zoom, send a few emails and listen to a few meetings, take a full lunch and then sign out without even leaving their homes. Plenty of these jobs clear $200k. Other people in other sectors like real estate make gobs of money passively, without having to actually DO much of anything. Physicians are underpaid for what they bring to society. I'd argue for current salaries their true worth would be a 4 day work week with a relaxed pace while at work. Implying "**** you" to the cardiologist or orthopod who works their balls off because they make a nice number is a surefire mentality that will lead to all of us ending up making $200k, which frankly is not nearly what it sounds like especially in the current economy. I for one would love to see all docs have a strong job market with high salaries and good urban opportunities, even if it means we train fewer docs. The narrowmindedness/obtuseness of some people in this career is astonishing.

/rant

 

[Lawpy]

Some smooth brain earlier in the thread said "I don't feel bad for people making $400-$600k who have to take a pay cut"

This type of crab-in-the-bucket mentality is a very shortsighted and frankly embarrassingly negative outlook on life. Someone who goes to 4 years of undergrad, 4 years of medical school, and then in many cases another 6 years of hard training and ends up in the hole $200-400k+ absolutely deserves a high salary. Especially when you factor in that these same people continue to get their ass up early every day, go do actual work at a fast clip basically the entire day, and still work some nights and weekends. Have you seen some of these corporate business and tech jobs? They literally wake up, turn on zoom, send a few emails and listen to a few meetings, take a full lunch and then sign out without even leaving their homes. Plenty of these jobs clear $200k. Other people in other sectors like real estate make gobs of money passively, without having to actually DO much of anything. Physicians are underpaid for what they bring to society. I'd argue for current salaries their true worth would be a 4 day work week with a relaxed pace while at work. Implying "**** you" to the cardiologist or orthopod who works their balls off because they make a nice number is a surefire mentality that will lead to all of us ending up making $200k, which frankly is not nearly what it sounds like especially in the current economy. I for one would love to see all docs have a strong job market with high salaries and good urban opportunities, even if it means we train fewer docs. The narrowmindedness/obtuseness of some people in this career is astonishing.

/rant

What are your suggestions on how to reduce med school debt?

 

[efle]

What are your suggestions on how to reduce med school debt?

Freeze tuition rates for a while and then tie it to inflation

 

[Lawpy]

Freeze tuition rates for a while and then tie it to inflation

Who is doing that?