Another negative thread

Med School Insiders
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auburnO5 said:
Well he needs to learn how to actively work a little faster if he plans on making above minimum wage.
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So what, you think he's asking too many questions about his patients health? I think you're missing the larger point here...
 
CityLights said:
So what, you think he's asking too many questions about his patients health? I think you're missing the larger point here...
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No I am fully aware of the larger point, and I do think that it is a huge problem. I'm just saying that if this MD is so worried that he will be making minimum wage, he needs to either drop the medicare patients or start seeing a larger volume.
 
auburnO5 said:
No I am fully aware of the larger point, and I do think that it is a huge problem. I'm just saying that if this MD is so worried that he will be making minimum wage, he needs to either drop the medicare patients or start seeing a larger volume.
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Oh, I completely agree with that. Just not the "working faster" part. The latter would tend to turn patients into cattle.
 
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
 
CityLights said:
So what, you think he's asking too many questions about his patients health? I think you're missing the larger point here...
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Just another example of the decline of PC. How long till this expands to every other field as well?
 
guyski79 said:
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
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I think there giving a perspective, 7k at 33%, how much will be lost if its at 100% is what the article is about.
 
guyski79 said:
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
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The 21% cut doesn't come out of profit, it comes out of revenue.
 
serenade said:
Just another example of the decline of PC. How long till this expands to every other field as well?
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From what I understand, procedural specialties are the safest as it is easier to bill for tangible services (vs consulting w/ patients like in primary care). But I assume medicare and insurance companies are always looking to decrease reimbursements for procedures as well.... this is something that anesthesiologists are worried about.

Also, I think it's safe to assume that Medicare is representative of what a government "option" or plan would be like... ie, constantly regulated reimbursements, and constantly trying to balance the checkbooks by decreasing these reimbursements. I think this problem will spread fairly quickly with more government intervention. But that's only one of many threats.
 
CityLights said:
From what I understand, procedural specialties are the safest as it is easier to bill for tangible services (vs consulting w/ patients like in primary care). But I assume medicare and insurance companies are always looking to decrease reimbursements for procedures as well.... this is something that anesthesiologists are worried about.

Also, I think it's safe to assume that Medicare is representative of what a government "option" or plan would be like... ie, constantly regulated reimbursements, and constantly trying to balance the checkbooks by decreasing these reimbursements. I think this problem will spread fairly quickly with more government intervention. But that's only one of many threats.
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Which is what the article and movie is about. Its worrying that possibility that doctors might be kinda screwed over.
 
Dear god why does he have two NP's. One nurse, one medical assistant, and one biller are all you need.

I can kinda understand *one* NP to assign the well-child checkups and well-visits to. But two...

This guy needs to shadow my doctor to see the model of efficiency that he is. Full time hospitalist + full time 9a-5p 6-days-a-week office practice. The waiting room is always full by 10am. Nobody is ever unhappy except the pain-med addicts. Manners are always impeccable (hello Asians). We even see deaf people and do immigration (civil surgeon).
 
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Morsetlis said:
Dear god why does he have two NP's. One nurse, one medical assistant, and one biller are all you need.
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My PCP has 2 nurses. Well, 1 is his wife, regardless its a bit difficult to work 8 hours non-stop diluted over probably 12 hours without some assistance.
 
DrYoda said:
The 21% cut doesn't come out of profit, it comes out of revenue.
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Yup. So he's not just losing 21% of what he takes home. He's losing much, much more than that. Cost of overhead and payroll for his NPs will stay pretty much the same. Less revenue due to Medicare cuts followed by private insurance cuts. Sucks to be a primary care doc these days.
 
guyski79 said:
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
Click to expand...
Yes, it's more likely a 42% drop in his Medicare salary, maybe more. You subtracted it from his salary rather than his practice's gross income. He's not going to cut his staff's salaries by 33% of 21%.
 
Kaushik said:
Also, if you want negativity, take a look at all the physician-bashing comments for the article. Good to see how much the general public loves us!
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Forever more people will believe physicians are over-payed and barely work. And forever more physicians will slave and save people's lives and take the brunt of insane difficulties of the public opinion and lawyers.
 
That article's comments reaffirm my belief that Americans suck at math.
 
TooMuchResearch said:
EM docs handle it nicely. Some surgeons, too.
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You're missing the context here...

We're talking about an outpatient private office setting, not a hospital with 10 nurses and a bajillion techs.
 
Maybe I'm missing something here..

1. These cuts are prospective, so he hasn't lost anything yet..

2. Ain't these the cuts that Congress ALWAYS defers, just like the AMT fix?? If I recall the medicare cut is based on the work of some economist (in the 90s) who tried to figure out how doctors should get paid and their pay, among other things, is pegged to the economy's growth to control pay inflation. It was adopted by Congress but never implemented, in practice, bcos the cuts are ALWAYS deferred...

Am I missing something here...
 
This may be a little off-topic, but I wanted to comment on the expected decrease in Medicare reimbursements...

The expected cuts in Medicare Reimbursements are tied to the sustainable growth rate, which was supposed to decrease Medicare payments over a period of time. However, this won't happen. In exchange for the AMA's support for the health care bill, Congress will delay cutting Medicare reimbursements. In addition, GAO expects the health care bill to save money over the next ten years, but in reality this is not the case. The numbers are skewed because (i) the government will be collecting taxes now even though the law won't take effect until much later, and (ii) Medicare cuts aren't likely to occur. If you include the amended SGR bill with the overall health care reform package, then the reforms will not cut health care costs as its proponents claim.
 
DocHomer said:
This may be a little off-topic, but I wanted to comment on the expected decrease in Medicare reimbursements...

The expected cuts in Medicare Reimbursements are tied to the sustainable growth rate, which was supposed to decrease Medicare payments over a period of time. However, this won't happen. In exchange for the AMA's support for the health care bill, Congress will delay cutting Medicare reimbursements. In addition, GAO expects the health care bill to save money over the next ten years, but in reality this is not the case. The numbers are skewed because (i) the government will be collecting taxes now even though the law won't take effect until much later, and (ii) Medicare cuts aren't likely to occur. If you include the amended SGR bill with the overall health care reform package, then the reforms will not cut health care costs as its proponents claim.
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I guess u then disagree with the CBO numbers on the savings, but the CBO is god in Washington and they've ruled on this.
 
Bernoull said:
I guess u then disagree with the CBO numbers on the savings, but the CBO is god in Washington and they've ruled on this.
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I think they only look at the bill that is presented and rule on it. On the face of it, the health care reform bill will lead to some cost-savings. However, when you include the two instances described above, that is simply not the case. So yes, they are technically correct, but the conclusion is misleading.
 
guyski79 said:
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
Click to expand...


  • 800K gross revenue, 100K of which the physician takes home as profit/salary/pay.


  • 21% reduction to 1/3 of gross revenue, meaning total gross revenue drops to 744K [2(800/3)+(800/3)(.79)].

Any reduction in gross revenue can't be made up by not paying his nurses, electricity, building rent etc. and so the physician's salary has to absorb the cut. So, if by the above numbers we assume his fixed costs are 700K, then his new salary will be 44K/yr.

It should be noted that this figure assumes private rates stay constant, however typically they fluctuate proportionally with medicare payments.

Feel free to tell me if I messed up the math.
 
JonBonesJones said:
  • 800K gross revenue, 100K of which the physician takes home as profit/salary/pay.


  • 21% reduction to 1/3 of gross revenue, meaning total gross revenue drops to 744K [2(800/3)+(800/3)(.79)].

Any reduction in gross revenue can't be made up by not paying his nurses, electricity, building rent etc. and so the physician's salary has to absorb the cut. So, if by the above numbers we assume his fixed costs are 700K, then his new salary will be 44K/yr.

It should be noted that this figure assumes private rates stay constant, however typically they fluctuate proportionally with medicare payments.

Feel free to tell me if I messed up the math.
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Hmm a salary of 44k... that is kinda depressing.
 
JonBonesJones said:
  • 800K gross revenue, 100K of which the physician takes home as profit/salary/pay.


  • 21% reduction to 1/3 of gross revenue, meaning total gross revenue drops to 744K [2(800/3)+(800/3)(.79)].

Any reduction in gross revenue can't be made up by not paying his nurses, electricity, building rent etc. and so the physician's salary has to absorb the cut. So, if by the above numbers we assume his fixed costs are 700K, then his new salary will be 44K/yr.

It should be noted that this figure assumes private rates stay constant, however typically they fluctuate proportionally with medicare payments.

Feel free to tell me if I messed up the math.
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A lot of small business owners work their tails off for 44k/year. It's nothing new or different. That said...I wouldn't bother for that kind of money. I'd become a PA and call it a day. Too much responsibility, stress and potential for lawsuits to justify being a physician for that little.
 
morning said:
A lot of small business owners work their tails off for 44k/year. It's nothing new or different. That said...I wouldn't bother for that kind of money. I'd become a PA and call it a day. Too much responsibility, stress and potential for lawsuits to justify being a physician for that little.
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I really think that if MD/DO's start making less nurses and PA's will make less too. In the end I think that this is a tribulation period. However freshman and sophomores are lucky we still have time to avoid a drowning ship if it takes a turn for the worse. However the guys in medical school or applying for medical school are screwed because they are left just hoping that everything will turn for the best.
 
serenade said:
I really think that if MD/DO's start making less nurses and PA's will make less too. In the end I think that this is a tribulation period. However freshman and sophomores are lucky we still have time to avoid a drowning ship if it takes a turn for the worse. However the guys in medical school or applying for medical school are screwed because they are left just hoping that everything will turn for the best.
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The thing with nurses and PAs is that they are better able to lobby for their rights. Physicians don't appear to be a cohesive whole at all. If medicine had half the determination the Mundinger crew has, it wouldn't be in this situation.
 
we just gotta hope by the time we're done with residency things are worked out in a fair and opportunistic manner.
 
morning said:
The thing with nurses and PAs is that they are better able to lobby for their rights. Physicians don't appear to be a cohesive whole at all. If medicine had half the determination the Mundinger crew has, it wouldn't be in this situation.
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Well that's because every specialty of medicine has its own little organization/association, they are truly divided. The Cardiologist association cares about cardiologists and sued the government in defense of their field. The AMA has proved ineffective and basically supports the government and its statements of physician's voluntarily amputating for money. If the AMA achieved cohesian medicine will be saved I guess.
However if a doctor's making 70k a PA couldn't possibly make more then the doctor. Even with proper determination, that is unless the PA's and Nurses slowly begin to take over primary care and general surgery.
 
msb1190 said:
we just gotta hope by the time we're done with residency things are worked out in a fair and opportunistic manner.
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Neh and if they aren't? I'll openly say that if I had to choose between a PhD ( making 60k starting and maybe 80ish within a while) over a MD making ( 100k to 120k) I'll take the PhD and have fun saving 300k debt.
 
serenade said:
Neh and if they aren't? I'll openly say that if I had to choose between a PhD ( making 60k starting and maybe 80ish within a while) over a MD making ( 100k to 120k) I'll take the PhD and have fun saving 300k debt.
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i agree with you. if they arent, i'll do what i have to to pay my loans and then probably go into academics.
 
auburnO5 said:
Sounds like he should be seeing more than just 120 patients a week.
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Any more than that and you would be compromise the quality of patient care since he works eight hours a day and assuming he doesn't work weekends, he has an average of 7 minutes a patient.
 
msb1190 said:
i agree with you. if they arent, i'll do what i have to to pay my loans and then probably go into academics.
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Neh I get the feeling military service for MD's will be very popular when I grad college in 2013. I mean what alternative is there unless your parents have 500k laying around. Today the average tuition's 160k + living expenses ( 20k a year?) + interest and not making any money till at min 3 years after medical school. Tomorrow when its my turn it'll probably be around 200k and that'll be epic fun, I will be a slave to a ungrateful society :laugh:.
 
serenade said:
Neh I get the feeling military service for MD's will be very popular when I grad college in 2013. I mean what alternative is there unless your parents have 500k laying around. Today the average tuition's 160k + living expenses ( 20k a year?) + interest and not making any money till at min 3 years after medical school. Tomorrow when its my turn it'll probably be around 200k and that'll be epic fun, I will be a slave to a ungrateful society :laugh:.
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physicians are already in that position (the slave to an ungrateful society)
 
mediterranean said:
Any more than that and you would be compromise the quality of patient care since he works eight hours a day and assuming he doesn't work weekends, he has an average of 7 minutes a patient.
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I calc if he see's a patient average for like 20 minutes he'll be spending 8 hours of pure work. However he'll probably see those 120 ppl spread out around a 12 hour period or so.
Really your right if he starts seeing more the quality will go down and the reality is that this is probably how the quality of medicine will be in primary care and possibly specialties eventually.
 
msb1190 said:
physicians are already in that position (the slave to an ungrateful society)
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Well now at least we have prestige and a relatively good amount of income and stability. Especially in this recession period.
 
serenade said:
Neh I get the feeling military service for MD's will be very popular when I grad college in 2013. I mean what alternative is there unless your parents have 500k laying around. Today the average tuition's 160k + living expenses ( 20k a year?) + interest and not making any money till at min 3 years after medical school. Tomorrow when its my turn it'll probably be around 200k and that'll be epic fun, I will be a slave to a ungrateful society :laugh:.
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It's only a good deal if your residency is not surgery, not competitive, and 4 years or less. Try serving 7 years in the military as a neurosurgeon (if you can even get the residency) being paid at $100k/year while you could make $500k-$1 mil/year.

On the other hand, it's great for pediatricians 🙂
 
guyski79 said:
So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕
Click to expand...

Many private insurers base their reimbursements on a multiple of Medicare's reimbursements. That means he'll lose out on more than just 7000 dollars.
 
Guys is this cut real? Isn't it deferred annually since the 90s? Where's da beef?
 
serenade said:
My PCP has 2 nurses. Well, 1 is his wife, regardless its a bit difficult to work 8 hours non-stop diluted over probably 12 hours without some assistance.
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lol I guess he had some downtime in the past that allowed him to play nookie with one of his nurses huh? Reminds me of what Ari from Entourage said "fire a man you get a competitor, fire a woman you get a wife"
 
Bernoull said:
Yes, but seriously, this has happened many times b4 and medicare delays processing bills by enough days/wks for the fix to be passed. Therefore docs don't get a pay cut, only some delay in payment. The news stories are a little sensational and devoid of context..
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Unless your overhead is stagnant, what Medicare needs to do is RAISE their rates each year. These shenanigans are absurd.
 
TheProwler said:
Unless your overhead is stagnant, what Medicare needs to do is RAISE their rates each year. These shenanigans are absurd.
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I agree the cost of practicing medicine is significant. However, we need to consider the context, medicare's growth rate is simply UNSUSTAINABLE, it's outstrips the GDP and inflation by a big margin. The current cost inflation rate of the entitlements (medi care/caid + SS) will, in time, consume the entire federal budget if it continues unchecked. Simply unsustainable.

As a nation, we've overpromised benefits to seniors relative to our tax base. Everyone loves more benefits and tax cuts, therefore politicians keep expanding benefits and cutting taxes. This schizophrenia/paradox is unreal and fiscally unsustainable. At some point we'll have to cut a mix of reimbursements/benefits and/or raise taxes..

Now the challenge is that everyone involved hospitals/doctors/beneficiaries think they're "underpaid" and deserve more bcos everyone's simply looking out for their interest/paycheck. Realistically, we'll all have to give a little benefits/pay and/or pay more taxes, as unpopular as it as. There's no magic wand here, and everyone won't be happy but there's no choice. The cost inflation of medicare, medicaid, SS (but especially medicare) is UNSUSTAINABLE.

We need to have a more nuanced and broader discussion on this issue bcos it's tough, entrenched and there's few, if any, good/palatable options.
 
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