An ignored consequence of the new HC plan?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

JThinker22

Full Member
10+ Year Member
Joined
Jun 26, 2009
Messages
12
Reaction score
0
I have read quite a few posts on this forum debating the implication of Obama’s newly proposed healthcare plan, specifically in regard to how it would effect physician salaries.

I think it is clear that, under the proposed plan, physician salaries are going to get slashed. I know there has been rather harsh debate here about whether doctors actually ‘deserve’ the amount of money they get paid, whether they should get more, or whether should be willing to accept less given the current economic condition of this country. No matter what you think, I think there is an important point missing from this debate (and perhaps someone has mentioned it and I have missed it).

I think most people would agree that we want our ‘top minds’ in medicine. Our society could benefit the most from revolutionary medical advances, new treatments and technologies, thus we want the best and brightest to go to medical school. Under the current structure though, I feel as though this reality is dying a slow death (if it even is reality anymore). Sure, some of the smartest people still go into medicine. More and more students, however, are slowly questioning whether medicine is ‘worth it’ and have transitioned to finance, law, or other ‘lucrative’ professions.

I am sure many of you had similar experiences to me. I went to a ‘top university,’ at which many of the best banks and consulting firms recruit. I watched, throughout 4 years, as many premeds who I know and who had done very well in the premed classes they had taken, decide that they would give up the desire to become a physician for other jobs, most notably banking, trading, and other finance jobs that offered high first-year salaries and great financial opportunity.

Personally, while this was upsetting, it was also completely understandable. While my desire to become a physician was strong enough to not be lured by the opportunity that finance or other jobs offered, it is reasonable that many wanted to forego the prep for medical school, endless training, and the continuously decreasing salary that physicians make. I realize some of you will say that “Well, if that is why they decided they didn’t want to be doctors, then they weren’t in it for the right reasons anyway.” I say that is ridiculous. Medicine, in my opinion, offers endless opportunities and what is perhaps the most rewarding career one could have. This alone, however, is not enough.

Simply put, there needs to be incentives to enter a career in medicine. How else should we expect to lure the best and brightest into a career that requires 4 years of medical school, 4-6 years of being overworked on minimum-wage salary as a resident, not to mention 200-300k worth of debt? Simply hoping that students will enter medicine out of the ‘goodness of their heart,’ their desire to ‘help people,’ or their curiosity in the human body will ultimately not be enough. Part of formulating appropriate incentives is looking at what else is our there. Of course, doctor’s salaries will never equal that of investment bankers or commodity traders…however, given the current scheme of things, a 150k/year salary is clearly out of proportion (especially with so much debt at about age 30). While it may stand up next to teacher's salaries or the normal person's salary, it doesn't come close against those real competetive careers.

We’re trying to develop a more effective healthcare system that can offer better medical care at a lower price. I understand that one way to cut cost right off the bat is to drastically cut physician reimbursement. However, this is merely a short-term solution that will have potentially devastating long-term consequences. I fear that the United States will slowly lose many of its best minds to other jobs and fields. This will ultimately be to the detriment of the system, as a whole.

Simply put, salaries and incentives have a direct influence on the quality and quantity of the doctor’s in this country. This is not just simple economics, its common sense. Nevertheless, it seems a reality that is seldom brought up throughout this healthcare debate (and seemingly in these forums).
 
I have read quite a few posts on this forum debating the implication of Obama’s newly proposed healthcare plan,

Sorry, but this is a pet peeve of mine: whatever plan manages to land on Obama's desk does not belong to him. It will be conceived, written, hashed, and rehashed by Congress. Reuters has a June 19 update on the status of reform here.
 
I absolutely agree with the OP. There has to be financial incentives involved for medicine to be attractive. WHile going into medicine for money alone will be frowned upon, those countless years of training and retraining will need to show some sort of financial benefit for the practicing physician, and to students who wish to enter medicine.

Just look at our Primary care field. This is such a shortage of these doctors that many doctors in rural areas are working into their 80's, and are yet to find a replacement (recent NYT article). Further, medicare's horrible reimbursement to PCPs has contributed to making primary care a less attractive field for new doctors. And now, the upcoming universal healthcare plan is going to cut payments even more, along with the increase in the flood of Americans seeking healthcare. It is absolutely wonderful to provide healthcare to all americans - it really is. But, there has to be a decent reimbursement for the healthcare providers too. Most new physicians have over $150,000 in loans, and they will end up paying close to double (over double in some cases), by the time they finish paying them off. A salary of $150,000 (and decreasing into the future, relative to inflation, etc), may just not cut it for some of these physicians. There has to be more of an incentive for entering primary care, and more of an incentive for students to go through so much training and so much debt, than the sole satisfaction of helping people.

Providing healthcare for human beings is a wonderful opportunity and privilege, but not being reimbursed adequately to take care of your own expenses is surely a matter of concern.
 
Last edited:
If you cut physician salaries, you could still provide financial incentives for going into medicine. How about loan forgiveness? I was watching a program on Fox (believe it or not) where these two guys were arguing over how students who take out loans should or should not repay in the same way, based on their academic interests. For example, one guy believes that students who are science majors in college should have greater loan forgiveness than someone who takes out the same loan and studies classics or gender studies, because the former can make a more direct contribution to society later on. Thoughts?
 
If you cut physician salaries, you could still provide financial incentives for going into medicine. How about loan forgiveness? I was watching a program on Fox (believe it or not) where these two guys were arguing over how students who take out loans should or should not repay in the same way, based on their academic interests. For example, one guy believes that students who are science majors in college should have greater loan forgiveness than someone who takes out the same loan and studies classics or gender studies, because the former can make a more direct contribution to society later on. Thoughts?

I agree that loan forgiveness is a great way to stimulate incentive for students to enter medicine. However, I'm not sure about the whole "contribution to society", becuase those who study classics or gender studies can contribute by teaching students at institutions and by adding to the body of knowledge regarding how humans relate to themselves and their gender roles. This stuff can be valuable and therefore a contribution to society.

If we just look at the "direct contribution" argument, being a science major isnt really a direct contribution to society when compared with a classics major. Both graduates can do some basic research and teach at institutions, and can have equal future contributions. So, I dont think loan forgiveness should be extended to pre-meds or classics majors.

However, studying medicine is a direct contribution to society, as the majority of medical graduates practice medicine. I would like to see loan forgiveness for medical students who show plans on entering residency.
 
I agree that loan forgiveness is a great way to stimulate incentive for students to enter medicine. However, I'm not sure about the whole "contribution to society", becuase those who study classics or gender studies can contribute by teaching students at institutions and by adding to the body of knowledge regarding how humans relate to themselves and their gender roles. This stuff can be valuable and therefore a contribution to society.

If we just look at the "direct contribution" argument, being a science major isnt really a direct contribution to society when compared with a classics major. Both graduates can do some basic research and teach at institutions, and can have equal future contributions. So, I dont think loan forgiveness should be extended to pre-meds or classics majors.

However, studying medicine is a direct contribution to society, as the majority of medical graduates practice medicine. I would like to see loan forgiveness for medical students who show plans on entering residency.

I totally agree, the TV program was only talking about college students at the time though. I'm sure if they were looking at loans for medical school vs. other grad schools (grad school for classics as an example) his argument would be the same.
 
If you cut physician salaries, you could still provide financial incentives for going into medicine. How about loan forgiveness? I was watching a program on Fox (believe it or not) where these two guys were arguing over how students who take out loans should or should not repay in the same way, based on their academic interests. For example, one guy believes that students who are science majors in college should have greater loan forgiveness than someone who takes out the same loan and studies classics or gender studies, because the former can make a more direct contribution to society later on. Thoughts?

I completely agree with those guys.
 
The financial incentive argument has been made in some of the debates on this forum. I think I've seen it a couple times in the threads I have been involved in.

I think there may be a correlation between financial incentive and the "brightest" students but I would like everyone to consider a few points about this.

1.) The best students don't always make the best doctors. This is true in any profession, and particularly true about a career in medicine. Being a quality physician requires more than just the processing of information--it requires compassion, it requires the ability to communicate, and it requires the ability to not condescend to coworkers and patients.

2.) The most intelligent people do not always chase the money. I think many engineers would take exception to the assumption that the smartest people go into the highest paid professions--law, medicine, and business/finance. While some engineers no doubt make money by starting a business or selling a patent, the majority work hard for several years to scrape 100k and must go into management to even sniff 150k. I'm not going to go into my thoughts on why I think everyone on here seems to think all super intelligent people go only to the highest paying professions, as it might change the character of this discussion

3.) this is related, but a little different from my first argument. I think that lowering the salary a bit might draw a different type of would be physician. Now, this is in no way directed toward anyone specific on this board, but there are people who pursue medicine for pay. Making the assumption that those doctors will intrinsically be better than others is flawed. If people's intelligence/dedication to their craft was based solely on their pay, there would be no good teachers, construction craftsmen, line cooks, etc. While there are plenty of terrible teachers, cooks, waiters and the like, there are many that are quite good at their jobs without demanding a high salary.

NOTE: I do not think that physicians should be low payed civil servants or whatever viewpoint you might assign to me arbitrarily. Nor do I think physician salaries are the problem in health care. Further, I think that if salaries do get cut, there should be an effort made to reign in the costs associated with med school.


Something else to think about is that Stafford and Graduate Plus loan repayments were changed this week to take into account level of income. However, I doubt that will affect physicians much, but I do not know for sure.
 
I agree with the OP. After years and years of training (think of college as starting in first grade again, starting medical school as fourth grade, and then looking forward to your high school graduation all over again!! It's a lot of training!) I definitely look forward to being well-compensated. I'm not too interested in "incentives" like loan forgiveness and all that--just pay me well and I can take care of it myself!

In terms of "retaining talent", all the bailed-out banks are using money to keep their "skilled and knowledgeable" employees. The same thing should go for medicine. If you want to make sure the best of the best are entering (and staying in medicine), one way to make it attractive is to make sure that they receive good compensation. This goes for the altruistic do-gooder as well as the smart, driven student who is also looking for some good pay.

The financial incentive argument has been made in some of the debates on this forum. I think I've seen it a couple times in the threads I have been involved in.

I think there may be a correlation between financial incentive and the "brightest" students but I would like everyone to consider a few points about this.

1.) The best students don't always make the best doctors. (and poor students have an even lower chance to make the best doctors. :meanie: I think the best combination is a more complete student: best students+compassion+communication=best doctors. I have been more than impressed by many of my peers, and am very confident that they are not just good students. They will make great doctors, so I don't put up with people trying to shortchange America by saying we need dumber doctors that can show some sympathy--We need the whole package!) This is true in any profession, and particularly true about a career in medicine. Being a quality physician requires more than just the processing of information--it requires compassion, it requires the ability to communicate, and it requires the ability to not condescend to coworkers and patients.

2.) The most intelligent people do not always chase the money. I think many engineers would take exception to the assumption that the smartest people go into the highest paid professions--law, medicine, and business/finance. While some engineers no doubt make money by starting a business or selling a patent, the majority work hard for several years to scrape 100k and must go into management to even sniff 150k. I'm not going to go into my thoughts on why I think everyone on here seems to think all super intelligent people go only to the highest paying professions, as it might change the character of this discussion. (This is true, there are plenty of smart people that do all sorts of things. At least engineers can make some solid money with a four year degree. Notwithstanding, my hat is off to my hardcore engineering buddies.)

3.) this is related, but a little different from my first argument. I think that lowering the salary a bit might draw a different type of would be physician. (With all respect, just because a person is smart AND wants money doesn't mean they are a terrible physician. On the flipside, just because they are not looking for money doesn't mean they will be an awesome physician.) Now, this is in no way directed toward anyone specific on this board, but there are people who pursue medicine for pay. Making the assumption that those doctors will intrinsically be better than others is flawed. If people's intelligence/dedication to their craft was based solely on their pay, there would be no good teachers, construction craftsmen, line cooks, etc. While there are plenty of terrible teachers, cooks, waiters and the like, there are many that are quite good at their jobs without demanding a high salary. (Imagine if teachers, cooks etc. made tons of money?? I guarantee it would be very competive to join their ranks, instead. If teachers were payed well, for example, I don't think it would take long before many of the best minds would be trying to teach.)

NOTE: I do not think that physicians should be low payed civil servants or whatever viewpoint you might assign to me arbitrarily. Nor do I think physician salaries are the problem in health care. Further, I think that if salaries do get cut, there should be an effort made to reign in the costs associated with med school.

It seems to me that health care costs have been exploding over the last decades while physicians' salaries have not. I don't know about you, but I think something else is the problem. Let's identify and fix that, while still allowing doctors to finally get a good paycheck when they are in their 30s and just starting to practice.
 
Last edited:
I agree with the OP. After years and years of training (think of college as starting in first grade again, starting medical school as fourth grade, and then looking forward to your high school graduation all over again!! It's a lot of training!) I definitely look forward to being well-compensated. I'm not too interested in "incentives" like loan forgiveness and all that--just pay me well and I can take care of it myself!

In terms of "retaining talent", all the bailed-out banks are using money to keep their "skilled and knowledgeable" employees. The same thing should go for medicine. If you want to make sure the best of the best are entering (and staying in medicine), one way to make it attractive is to make sure that they receive good compensation. This goes for the altruistic do-gooder as well as the smart, driven student who is also looking for some good pa

I look forward to being well compensated. That was the point of the note that I put at the bottom. I just think better compensation=better doctor is a flawed way to evaluate it.

As far as your bank analogy, I don't agree with it in that case either. They are giving the bonuses to the people who drove their institutions into the ground.

I think hard work=better <insert profession> more than higher pay=better <insert profession>. Which is why I think NoMoreAmcas will probably be a good doctor, though he seems (from his posts here, but I do not know him personally) to not really care about the humanistic aspects of the profession. He seems like he wants to work his ass off. But let's be honest, if he decided not to go into medicine there will be someone else who will work just as hard, because of the humanistic aspects instead of the money.



It seems to me that health care costs have been exploding over the last decades while physicians' salaries have not. I don't know about you, but I think something else is the problem. Let's identify and fix that, while still allowing doctors to finally get a good paycheck when they are in their 30s and just starting to practice.

I agree which is why I typed, "I don't think salaries are the problem."
 
(and poor students have an even lower chance to make the best doctors. I think the best combination is a more complete student: best students+compassion+communication=best doctors. I have been more than impressed by many of my peers, and am very confident that they are not just good students. They will make great doctors, so I don't put up with people trying to shortchange America by saying we need dumber doctors that can show some sympathy--We need the whole package!)

And I didn't say that, but you're not answering my point. The best students/brightest minds don't all chase money. Please point to where I say we need "dumber" doctors.

EDIT: one more point here, there is always talk on this board about how there are more than anough qualified candidates applying to med schools. Many of us who may not get in would still jump at the chance to be a physician, even if it means making 120k.

(This is true, there are plenty of smart people that do all sorts of things. At least engineers can make some solid money with a four year degree. Notwithstanding, my hat is off to my hardcore engineering buddies.)

Good, that means reducing salaries does not mean medicine would no longer get the brightest minds. Not only that, ABET is strongly considering making a Masters a requirement to get your PE. That would require more schooling while taking away the pay incentive of getting a Masters. They don't seem worried about losing some of the brightest minds by increasing time/money investment without a commiserate increase in salaries.
(Imagine if teachers, cooks etc. made tons of money?? I guarantee it would be very competive to join their ranks, instead. If teachers were payed well, for example, I don't think it would take long before many of the best minds would be trying to teach.)

Cool, but there are amazing teachers and cooks NOW. The point is not that physician salaries should be lower per se, I am pointing out that if many other professions read this board, they would be offended by the characterization of non-law/non-business/non-finance/non-medical professionals as "less than bright."
 
Last edited:
(With all respect, just because a person is smart AND wants money doesn't mean they are a terrible physician. On the flipside, just because they are not looking for money doesn't mean they will be an awesome physician.)

I never said either of those are true. It's not as if suddenly the bottom of the barrel are going to go to med school. But let's not kid ourselves, DO acceptees have lower numbers, but they turn out physicians who are every bit as good as most Allopathic schools.
 
haha whoa three post response! Sorry, I didn't mean to rile anything up, I was just giving some of my thoughts on the subject. Just like you said, it seems like we agree on most of the major points, with only minor differences, if that. No worries, man! 😛

I was just trying to point out that, even though better compensation won't always equal better doctors, I feel confident that crappy compensation will make it difficult to get as many of the able people that we have in medicine today. Sure, others will take their spots, but it won't be the same because people follow the money (dermatology, anyone? Is it really that cool and difficult that it needs the top of the top of each medical school class? It's competitive because of the the lifestyle and pay!) Of the few people I know, some would jump ship if the compensation turned terrible with the new health system--and these doctors and residents aren't slackers at all, or terrible people, they just want to make sure that giving up their 20's will be worth it in the end, and why shouldn't they?

As for the bank analogy, I hate what they are doing; they give bonuses to keep the talent that is partly culpable in this whole economic mess. Why not give those crazy bonuses to keep some talent in medicine? 😉

I didn't mean my earlier response to be a comprehensive rebuttle to any view about physician compensation or to belittle any other field, but rather just my opinion with a few sarcastic jabs. There are many talented people everywhere, but I hope, for healthcare's sake, that the competition for becoming a doctor stays just as stiff as we go into the next few decades. If compensation crashes, it might not be the same as it has been.

So now my little response has turned into a bit of a novel! I appreciate the response, though, Col., because I think more people like you and everyone else need to realize what it's like to make the sacrifice to become a physician. I don't even understand it yet, but I will in the next few years and I hope it will be worth it in the end!
 
I have to agree with the OP here. The more money we offer doctors, the better and more competent they will be. Period. There are plenty of people out there who would make fabulous physicians but are just not willing to put in such a crazy amount of work for a comparatively low compensation. If I thought I could tolerate I-banking, that's where I'd be. The fact that I could not handle that type of career in no way means that if I could, I would have made a bad doctor.
 
I never said either of those are true. It's not as if suddenly the bottom of the barrel are going to go to med school. But let's not kid ourselves, DO acceptees have lower numbers, but they turn out physicians who are every bit as good as most Allopathic schools.

That's debatable.
 
haha whoa three post response! Sorry, I didn't mean to rile anything up, I was just giving some of my thoughts on the subject. Just like you said, it seems like we agree on most of the major points, with only minor differences, if that. No worries, man! 😛

You didn't. Actually, I just realized twice I had not responded to what you said...no worries here either.
 
To the OP: this opinion has echoed a number of times throughout the forums, but no one has brought it out as explicitly as you have.
And yes, I totally agree with what you say, as I hold the same beliefs. "Wanting to help mankind" or "being interested in medicine" or "wanting to learn" is certainly not a motivation that will carry the pre-med/medical student for at least 12 years on its back. This is especially the case since most doctors start making a "comfortable" salary by the time their 30, and many of them don't even have their own family by then. An interest in serving mankind will never take the place of a doctor wanting to have his own family and living with 200 grand debt just form med school really exacerbates that.

Forget the cap on mal practice lawsuits, I think what should really be done is some federal aid with med school debt. The whole mal practice cap is relative to region and person.

And also I get the feeling that, when an engineer, lawyer, or any other profession talks about living big with fancy cars and big houses, it is considered "Dreaming big" or "thinking ahead", but when a doctor does that, its considered "you're doing medicine for the wrong reason"
 
...
Forget the cap on mal practice lawsuits, I think what should really be done is some federal aid with med school debt. The whole mal practice cap is relative to region and person...

I agree with everything you said, except for the above. It would be a good start, but be careful, the tuition reimbursement thing is a trap. Eventually they're going to get us to trade a 20-30% reduction in earnings over 20+ years for a comparatively measly 200-300K in debt. It's enticing to have no debt, but do the math...this plan would really only work for primary care docs and those who are already just managing to pull in 6 figures. Not to mention, our training is still significantly longer than most other places with "socialized" medicine, where some doctors begin medical training right out of high school. And, I'm not positive, but I'd wager our post-graduate training is also much longer.
 
Last edited:
Top