An idea to solve the physician shortage problem

[kpcrew]

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Yes. Let the politicians handle it. They're the real experts.

lmao nice one

 

[Alejandro]

Pre-meds: can you guys pretty, pretty please stop trying to "fix" the healthcare system until you're actually working and have the faintest clue what you're talking about? Thanks!

lol. true. I work in a GP's office during the week and moonlight in an ER during the weekends in a urban general hospital. you learn pretty quickly how emtala turns any ER into a primary care clinic. lol.

But frankly, it really does come down to the money.

 

[LittleLuck]

Anyone trying to downplay the importance of how much money is involved in being an attending after all the crap students go through should off themselves. I hate hearing arguments like, if you love something you would do it for free, or it's not about the money it's about helping others. These people couldn't be more wrong. Everyone wants to make money and live comfortably, especially after dedicating vast amount of time and money to your career. Cutting residency salaries to zero will increase the "physician shortage" in my opinion. No one wants to be 27-28 and work for free. No matter how much someone "loves" what they do, the sad truth is this country is messed up and money runs the world. ****, i wanna get paid for saving people, i dont know about ya'll.

 

[NickNaylor]

It scares me how naive the majority of pre-med & even med students are when it comes to the business/economic side of medicine. Maybe we should start requiring pre-meds work for 2-3 years after undergrad before coming to medical school so they can develop some economic understanding and see how the real world works.

There's really only one option that will solve the physician shortage. The general public actually taking a positive interest in the medical field. You'd think that peoples' health would be the absolute most important thing to someone, but that's hardly how it is. Nobody wants to think about giving any kind of stimulus to physicians because those greedy bastards already make $1 million a year and all drive porsches, right? If anything, the general opinion of the public is to cut physician reimbursement year after year, all the while it costs more and more every year to actually become a physician.

Considering the way you started, I'm pretty unimpressed with your post.

 

[aalmario]

just felt like adding fuel to the fire.

http://a4.sphotos.ak.fbcdn.net/hphotos-ak-ash4/s720x720/314715_263392260359153_100000651442523_823874_358859117_n.jpg

 

[235788]

Pre-meds: can you guys pretty, pretty please stop trying to "fix" the healthcare system until you're actually working and have the faintest clue what you're talking about? Thanks!

If you dont like you, you can troll back to the allopathic forum

 

[Will2Survive]

I'm one of the 4500 FP doctors! I know pay is not as great as others specialties. But if your smart and know how to manage a business it can be good cash

 

[slatermd]

I think it's reasonable to cut the salaries of specialty residencies to zero.

lmao cut the salary of residents to zero?

This thread was over in the first two posts.

Here's the scenario you're describing:

You're working 80 hours per week, and receiving no pay. For five years.

During this time, you have to make payments on your student loans. You have to eat. You have to pay rent or a mortgage.

How can you meet monthly expenses that are in the thousands on an income of $0?

retain the paid specialty slots for the highly competitive residents, but give an option for unpaid residency slots for those who aren't as competitive but want to get into that field.

Agree. People know what they want to become and will not let debt get in their way. I'll gladly take the hit in order to one day be a urologist.

Ok. You didn't match into a paid residency. I'm giving you the choice of working 80 hours a week for $0 for five years.

How are you going to pay your bills? Let's say conservatively that your food, rent, loan payments, car insurance, fuel costs, etc. all total $2000 per month.

To survive 5 years, you'll need to come up with $120,000. Let's revisit basic multiplication.

5 years x 12 months = 60 months.
60 months x $0/month = $0.

If I write a check for $0.00 to pay a balance of $120,000, it won't work. I've tried it several times before.

FM never fills all their slots. So improving the incentives on FM slightly could be expected to cause fewer slots to be left unfilled, and thus improve the situation.

There are already incentives like the loan forgiveness programs mentioned, and still unfilled spots. It's obviously more complicated than "simple economics."

Some people like FM for reasons that have nothing to do with compensation or incentives. Others wouldn't touch FM no matter how much it paid.

It's all about the money for some people, and for others it's all about what you have to get up and do every day.

And then you have to factor in the realities of whether or not a person has a legitimate shot at applying to more competitive residencies. All of these things affect the number of people going into FM.

There's no one quick solution to getting more people interested in FM.

Another reason the OP's idea would never work is that FM residency is only 3 years long, but practicing as an FM attending is for the rest of your career. I would think it pretty dumb to take the bait of a higher salary for 3 years and ignore the reality of practicing in FM for the next 40 - 50 years.

The only way to get more people interested in FM is to change what they'd be dealing with for the 40-50 career years, not the 3 years of residency. And just augmenting FM reimbursement isn't going to do the trick.

TheProwler you still have to admit there would most likely be people who aren't competitive enough coming out of medical school to get into a specialty slot who would choose an unpaid specialty spot if it meant they could get into the specialty they wanted.

Again, even if they want the option of an unpaid residency, how are they going to survive? You can give people the option, but they'll be homeless within the first year so what's the point? You can't pay rent on an income of $0.

Obviously something would need to be done to cover living expenses in the absence of student loans.

Something would have to be done, like what? A $46K/year salary? I think they've figured out pretty close to the minimum they can pay residents. Cutting it down further in any specialty is just going to drive talented people away from medicine as a whole.

I guess it is just my opinion then which is understandable that you'll have the views that you have. To me, I'm not going go through 4 years or more of undergrad, hundreds of hours studying for tests, spending more than 1000 dollars on the AMCAS in hopes that I get into somewhere, (hopefully) going to a med school of my choosing, spending even more time and money studying and preparing for Step I and other med schools tests, just to be unsatisfied when I don't match into my top choice and regret the rest of my career as a physician

But thats just me

This is all a matter of perspective. Some people could legitimately be happy in a number of different specialties. Other people are not wired that way. Neither one is good or bad, just different strokes for different folks.

lol. true. I work in a GP's office during the week and moonlight in an ER during the weekends in a urban general hospital. you learn pretty quickly how emtala turns any ER into a primary care clinic. lol.

But frankly, it really does come down to the money.

See, one guy cares about the money, another one doesn't care if he ends up in FM, Gyn, or Psych.

Increase FM reimbursement and you might get both of those guys into FM residency, but you won't get me, because the day-to-day doesn't entail the kind of work I want to do for the rest of my career.

It's more complicated than people think. Even these "solutions" that only address compensation would require reform of the whole system.

For reform to actually address these "problems" it would have to be much broader than a change to compensation.

 

[Morsetlis]

You're assuming that "basic" changes to compensations involve small numbers.

If the FM salary were to be multiplied by a factor of 10 (pretty basic), there would be droves more US Allo grads matching into it.

The issue here is that small changes aren't enough to overcome the facts of primary care in an FM environment. The government has two options (which are not mutually exclusive): deflate specialist reimbursement, and/or increase primary care reimbursement.

The first is easier to do. The second will not happen because the US is running out of money.

The specialists will eventually start their own private cash-only clinics, anyway. (Nothing stops the primary care physicians from doing this, either, except the lack of willing, paying primary care patients that aren't Medicare/Medical.)

 

[slatermd]

You're assuming that "basic" changes to compensations involve small numbers.

If the FM salary were to be multiplied by a factor of 10 (pretty basic), there would be droves more US Allo grads matching into it.

The issue here is that small changes aren't enough to overcome the facts of primary care in an FM environment. The government has two options (which are not mutually exclusive): deflate specialist reimbursement, and/or increase primary care reimbursement.

The first is easier to do. The second will not happen because the US is running out of money.

The specialists will eventually start their own private cash-only clinics, anyway. (Nothing stops the primary care physicians from doing this, either, except the lack of willing, paying primary care patients that aren't Medicare/Medical.)

Yes, I am "assuming" that FM compensation won't change from something like $150k to $1.5 mil a year. Do we need to argue about whether or not that's a safe assumption? It doesn't matter what would happen if family docs made eleventy bazillion dollars, cause it's neither plausible nor relevant.


Your other idea is getting to the point, because levelling pay across specialties would require broader change. You're talking about changing things like how office visits are reimbursed relative to how procedures are reimbursed. It's not as simple as just taking a few zeros off the vascular surgeon's paycheck and tacking them onto the family doc's. Total pay parity means changing the values we have attached to different aspects of medical care. Ultimately it would involve putting a higher value on "primary care" responsibilities like preventative medicine, continuity of care, and lifestyle counseling. It would involve decreasing the value we have attached to things like surgical interventions for lifestyle-related, arguably "preventable" problems.

That would change a lot more than just who and how many choose to go into FM. It would change how physicians practice medicine and how different specialties interact.

In other words, equalizing pay isn't a simple or basic change. You can't just lobby a hospital CEO or call up your payroll provider and say, "hey, give family a raise and cut vascular, plastics, and ortho." When you talk about changing compensation, you're talking about reforming the whole system.

So I maintain that there is no plausible "basic" solutions. It's also still true that equal pay for FM wouldn't make me any more interested in it, or any less interested in the OR, and I'm not the only one who feels that way. Compensation and environment are huge factors, but they aren't the only ones.

 

[phltz]

Your other idea is getting to the point, because levelling pay across specialties would require broader change. You're talking about changing things like how office visits are reimbursed relative to how procedures are reimbursed. It's not as simple as just taking a few zeros off the vascular surgeon's paycheck and tacking them onto the family doc's. Total pay parity means changing the values we have attached to different aspects of medical care. Ultimately it would involve putting a higher value on "primary care" responsibilities like preventative medicine, continuity of care, and lifestyle counseling. It would involve decreasing the value we have attached to things like surgical interventions for lifestyle-related, arguably "preventable" problems.

A good first step would be for the government to not always just cave in to specialist groups trying to "defend their turf". If CRNAs empirically do just as good a job as Anesthetist MDs for many surgeries, let them compete with the MDs. I have no real objection to specialists who make tons of money doing stuff that legitimately requires tremendous skills, like surgery. But the only reason that a dermatologist can charge boatloads of money for, say, freezing a wart off is that they've legally blocked out any competition from non dermatologists, and they carefully restrict the supply of dermatologists. It doesn't take particular skill or knowledge to freeze off a wart, but they've got a lock on it anyway. It's monopoly price-gouging, pure and simple.

 

[QuizzicalApe]

How are you going to assess whether or not CRNA's are as good as anaesthesiologists? Let them handle the high-risk cases on their own and then see if mortality spikes?