anyone else feel that this is the worst time to be a med student

[surgery2121]

I have to pick my specialty in a year. I really love cardiology so I am leaning towards internal medicine. But with this healthcare reform coming I just don't know what to expect. I dont want to go through six brutal years of training only to see a salary of 150,000. I wish I was in this position 5 years from now so I can see how this reform shapes up. Is it true that they are getting rid of fee for service? I hear there may be a disincentive to do procedures and an incentive to manage patients. If so cardiology will take a big hit.

---

Members don't see this ad.

 

[The Angriest Bird]

getting rid of fee for service? I hear there may be a disincentive to do procedures and an incentive to manage patients

so when a patient coming in with an acute abdomen, you either talk him out of it or ex lap him for free?

 

[PremedIowa]

I would guess it will be almost impossible to know which fields will get hit the most over the next 5 years. Nothing wrong with internal medicine-you will have access to plenty of fields that are either procedural and medical in nature, and you will have the ability to work independently of any hospital system.

 

[TopSecret]

It depends. If you invested over $300,000 in your education and you're expecting a decent return on your investment, then you may be disappointed once health care is reformed and payments are slashed by 40-50% over the next 10-20 years (2-4% decrease each year or so).

 

[The Angriest Bird]

Here's the deal: PAs make $100k. If doctors make that same amount, too, many pre-meds will defect to PA to save themselves from MCAT, 3.6+ college GPA, USMLE I, II, III, 20 interviews (10 for med school 10 for residency), at least four years of less training (70+ hrs/wk with q4 call) and tuition, the brutal match system.

I know there are a lot of anti-Obama-care going around out there, especially if you live in a red state. But I don't think Obama is attempting to do a trial of "let's mess around with the doctors and hopefully they will volunteer as angels".

 

[ClockworkDoc]

I'm not all that worried. I would rather be a student then a laid off research associate. I highly doubt that the future is as bleak for medicine as many paint it to be.

 

[surgery2121]

One of the reasons I originally went into medicine was because it is a field where you know what to expect. I see other doctors practicing and know this is how I want to set up my practice. But right now there is so much uncertainty in medicine and thats why i feel this is the worst time to be a med student. I wish I can see ten years into the future and see how certain specialties practice. I don't want to end up in a field where my goal is to do as little as possible to the patient and get him out of the hospital as fast as I can just so I save the government money and break even on my reimbursement.

 

[The Angriest Bird]

This whole thing Obama has put together may not fly at all.

Many have tried to tackle the US health care system, and many have failed.

 

[OPPforlife]

I concur. This is a terrible time to be a medical student. Especially when I think about the fact that it cost me zero dollars to become an engineer and even in this shoddy economy I could probably find some kind of a job some where. Where as now I am looking forward to a 150+k loan and government service to pay it off over my life time.

What makes me really mad about this situation is that I am pretty sure 90% of medical students could probably pursue about 90% of academic professions out there. Yet for some stupid reason we chose medicine ( I don't actually believe this reason is stupid) and what do we get for that? decreased compensation.

 

[surgery2121]

This whole thing Obama has put together may not fly at all.

Many have tried to tackle the US health care system, and many have failed.

Its eventually gonna happen. If not Obama then the next democratic president will try. The cycle will continue until it eventually passes. But right now it seems like obama has a good chance. He's got the Big pharm, AMA, and public opinion supporting him. Also the insurance companies are laying low for some reason.

 

[TexasTriathlete]

I think its a great time to be a medical student. It sure beats working.

Especially for me. I was a personal trainer, which is somewhat of a luxury for most people. If people got fired/income reduced/etc., I would have been one of the first things to go. And I was a pretty good trainer, with strong credentials and experience.

Hopefully, in a couple years, when I'm making my final decision about where to train, I'll have a better idea about what field will be best for not getting ****ed in the ass by the government.

 

[maceo]

I'm not all that worried. I would rather be a student then a laid off research associate. I highly doubt that the future is as bleak for medicine as many paint it to be.

im glad you are not worried. The whole healthcare system is about to be overhauled to decrease your autonomy, compensation and dictate the way you practice. and you are not worried? You are an ostrich with his head in the sand.

 

[gman33]

While money and lifestyle are big things people look at, I'd say to put them a little lower on your list right now. Reason being, by the time you are done training, you have no idea of how they will shake out. If you really like cards and want to deal with that patient population, at least you know that won't change that much.

There is nothing wrong with wanting to make big $$$, but who knows if cards will still provide that is 6-7 years.

 

[Deferoxamine]

Yes, they are about to push us all off the cliff, and one of these days they will.

So make sure you've got your parachute strapped on tight.

 

[Random Anesthesiologist]

I'm not all that worried. I would rather be a student then a laid off research associate. I highly doubt that the future is as bleak for medicine as many paint it to be.

I agree about the future, but I do worry. I also question Obama's motives severely. He's a politician first.

 

[dilated]

Here's the deal: PAs make $100k. If doctors make that same amount, too, many pre-meds will defect to PA to save themselves from MCAT, 3.6+ college GPA, USMLE I, II, III, 20 interviews (10 for med school 10 for residency), at least four years of less training (70+ hrs/wk with q4 call) and tuition, the brutal match system.

Incorrect. PA salaries do not emerge from some sort of vacuum. They come from professional fee reimbursements just like doctor salaries. If they cut reimbursements in half doctors will make 100 and PAs 50.

In reality it's a bit more flexible such that PAs/NP would take less of a pay cut because RN salaries provide something of a floor for midlevel salaries. But they're still never going to be paid what an MD does. The difference may become small enough to be infuriating, though.

 

[hal9000]

I don't want to end up in a field where my goal is to do as little as possible to the patient and get him out of the hospital as fast as I can just so I save the government money and break even on my reimbursement.

That's what Obama's trying to fix... right now it's more patients, more $$$$. So the incentive for physicians is on seeing as many patients as possible, with little incentive in the outcomes beyond "good to go" and actual caring. This is what's putting our healthcare system so down the ladder in comparison with other countries.

Now whether Obama's plan will actually fix the system I really doubt. In fact, he's creating a system that's a hodge-podge of different systems... rather than just adopting a "universal healthcare" model that has been known to work well. So more likely than not, a splattering mess of crap will arise. I guess that's what you get for trying to fix something while pleasing everybody.

 

[DevonL]

One of the reasons I originally went into medicine was because it is a field where you know what to expect. I see other doctors practicing and know this is how I want to set up my practice. But right now there is so much uncertainty in medicine and thats why i feel this is the worst time to be a med student. I wish I can see ten years into the future and see how certain specialties practice. I don't want to end up in a field where my goal is to do as little as possible to the patient and get him out of the hospital as fast as I can just so I save the government money and break even on my reimbursement.

I have to agree. I think a lot of people go into medicine (depending on the field) because there are concrete answers/solutions to problems at hand. When you throw in the doubt and uncertainty that many of us (both pre-med and med students alike) now have, it's a scary thought of what's to come.

With that said, I think we all just have to have faith that people will rally up and speak out against something which can only ultimately bring negative change. Although I lost faith in people a long time ago, so I remain concerned until I see the final answer/end of the debate.

That's what Obama's trying to fix... right now it's more patients, more $$$$. So the incentive for physicians is on seeing as many patients as possible, with little incentive in the outcomes beyond "good to go" and actual caring. This is what's putting our healthcare system so down the ladder in comparison with other countries.

Now whether Obama's plan will actually fix the system I really doubt. In fact, he's creating a system that's a hodge-podge of different systems... rather than just adopting a "universal healthcare" model that has been known to work well. So more likely than not, a splattering mess of crap will arise. I guess that's what you get for trying to fix something while pleasing everybody.

I am curious where you're coming from with saying that a "universal healthcare" model has been known to work well. From what I've seen, it quite often fails quite miserably and ends up with patients suffering in an unneeded manner.

 

[sprinkibrio]

One of the reasons I originally went into medicine was because it is a field where you know what to expect. I see other doctors practicing and know this is how I want to set up my practice. But right now there is so much uncertainty in medicine and thats why i feel this is the worst time to be a med student. I wish I can see ten years into the future and see how certain specialties practice. I don't want to end up in a field where my goal is to do as little as possible to the patient and get him out of the hospital as fast as I can just so I save the government money and break even on my reimbursement.

Internal medicine is already like this... welcome to your personal hell.

You guys are all so pessimistic. There is really no where for healthcare to go but up. Those looking for money were those who should have been weeded out. I don't feel for you at all. And don't forget, we're not losing job security.

 

[Cp22kjer]

It depends. If you invested over $300,000 in your education and you're expecting a decent return on your investment, then you may be disappointed once health care is reformed and payments are slashed by 40-50% over the next 10-20 years (2-4% decrease each year or so).

If they lower it that much, you'll see doctors defaulting on loans for the first time.......

 

[old_boy]

If they lower it that much, you'll see doctors defaulting on loans for the first time.......

Uh... Michael Jackson's doctor recently defaulted on his student loans from the 80s. Oh, and he's a cardiologist.

Link: http://www.montereyherald.com/entertainment/ci_13005437

 

[hal9000]

I am curious where you're coming from with saying that a "universal healthcare" model has been known to work well. From what I've seen, it quite often fails quite miserably and ends up with patients suffering in an unneeded manner.

Seriously?

http://en.wikipedia.org/wiki/Health_care_in_France
http://en.wikipedia.org/wiki/Health_care_in_Singapore
http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm
And of course:
http://en.wikipedia.org/wiki/Health_care_in_the_United_States

Healthcare in U.S is mediocre. Not the worst, but not the best. And for the prices paid, it makes no sense.

 

[Samus Aran]

i worry any time a lawyer or politician tries to dictate what i should and shouldn't do in my future career.

 

[275079]

Uh... Michael Jackson's doctor recently defaulted on his student loans from the 80s. Oh, and he's a cardiologist.

Link: http://www.montereyherald.com/entertainment/ci_13005437

He's NOT a cardiologist, freak show.

 

[OPPforlife]

Dude we're not looking for money, not me at least. However, I am looking for a smooth and easy repayment of my loans. With the way our health care may get reformed, the repayment of student loans seems more difficult every day.

 

[MossPoh]

Its eventually gonna happen. If not Obama then the next democratic president will try. The cycle will continue until it eventually passes. But right now it seems like obama has a good chance. He's got the Big pharm, AMA, and public opinion supporting him. Also the insurance companies are laying low for some reason.

You need to brush up on your history if you think it is exclusively democratic presidents that have tried.

As an aside, the sky is not falling. The vast majority of information being forwarded on is misinterpreted or not going to happen either way. There needs to be reform. That has been established across most party lines. Pick a specialty that you enjoy. You'll be fine....for real.

 

[lildave2586]

I think that the government is going to drastically lower reimbursement in order to keep doctors practicing at high volume. he baby boomers are about to retire, and all of them will have free healthcare (keep in mind the declining health of our nation due to T2DM, obesity, syndrome X, ect. We are going to need a lot of providers. The only way I'm going to be able to pay back my loans is to practice at extremely high volume (which means more time away from home).

As much as I hate unions, I'm afraid docs are going to have to come together with something better than the AMA.

 

[newdoc2013]

I would say this is the most EXCITING time to be a doc in training. WE get to mold the system in which we will practice! I do worry that we are being educated in the mold of the old system only to be ushered into the new -- leaving debts that we simply cannot repay. I really hope that the current health care reform efforts tackle this issue.

 

[Zoom-Zoom]

I don't know. Even if the gov't stepped in and paid off our loans for us, it still wouldn't be a good trade. I mean, a 300K bonus still doesn't justify a 40% (pessimistic estimate) cut on our salary over 20+ years. I suppose the next thing we'll hear is how lucky we are that Uncle Sam is going to finance our medical educations...

 

[Zoom-Zoom]

I don't know. Even if the gov't stepped in and paid off our loans for us, it still wouldn't be a good trade. I mean, even a $300K bonus still doesn't come close to justifying a 40% (pessimistic estimate) cut on our salary over 20+ years. I suppose the next thing we'll hear is how lucky we are that Uncle Sam is going to finance our medical educations...

You guys are all so pessimistic. There is really no where for healthcare to go but up. Those looking for money were those who should have been weeded out. I don't feel for you at all. And don't forget, we're not losing job security.

Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

 

[OPPforlife]

Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

 

[Mombosuthu]

I don't know. Even if the gov't stepped in and paid off our loans for us, it still wouldn't be a good trade. I mean, even a $300K bonus still doesn't come close to justifying a 40% (pessimistic estimate) cut on our salary over 20+ years. I suppose the next thing we'll hear is how lucky we are that Uncle Sam is going to finance our medical educations...



Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

QFW!!!

 

[-Goose-]

I would say this is the most EXCITING time to be a doc in training. WE get to mold the system in which we will practice! I do worry that we are being educated in the mold of the old system only to be ushered into the new -- leaving debts that we simply cannot repay. I really hope that the current health care reform efforts tackle this issue.

HOly sheet... I just vomited from your overflowing naivety.

 

[DevonL]

Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

 

[The Angriest Bird]

Those looking for money were those who should have been weeded out. I don't feel for you at all.

Yeah, how about we ask the Congress to put a $40K cap on physican salary and see how AMCAS applications we receive in this fall.

 

[Cp22kjer]

a 40% (pessimistic estimate) cut on our salary over 20+ years

Forgive my ignorance. This is the second figure I've seen like this. What is this based on? I've read one preliminary bill proposing a ~21% cut.

Is this based on the idea that the aforementioned will just repeat itself for years to come?

Ex: propose 21% and settle at 11%.........3 years later propose 18% and settle at 9% etc, etc until we hit a summated number near 40%

 

[maceo]

I don't know. Even if the gov't stepped in and paid off our loans for us, it still wouldn't be a good trade. I mean, even a $300K bonus still doesn't come close to justifying a 40% (pessimistic estimate) cut on our salary over 20+ years. I suppose the next thing we'll hear is how lucky we are that Uncle Sam is going to finance our medical educations...



Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

sprinkinrio is still naive.. he is stillwriting notes about soapnotes and what snacks to put in your white coat. he hasnt felt the wr ath of the system yet. He will though! he will dont worry he will... and his assinine remarks will be no more

 

[maceo]

I think that the government is going to drastically lower reimbursement in order to keep doctors practicing at high volume. he baby boomers are about to retire, and all of them will have free healthcare (keep in mind the declining health of our nation due to T2DM, obesity, syndrome X, ect. We are going to need a lot of providers. The only way I'm going to be able to pay back my loans is to practice at extremely high volume (which means more time away from home).

As much as I hate unions, I'm afraid docs are going to have to come together with something better than the AMA.

excellent point. Im sure there is collusion out there to make reimbursements so low that we have to put in 100 hour work weeks to be able to afford a 4 bedrrom house..

I go to the derby in louisville every year. i hit up phoenix hill tavern when im there

 

[mednsports]

i worry any time a lawyer or politician tries to dictate what i should and shouldn't do in my future career.

Exactly

 

[Black Surgeon]

This thread is a little depressing. But honestly, Healthcare reform or not, there is no where else I'd rather be and there's nothing else I'd rather do, and if I wasn't in Med school, I'd be fighting to get in.

 

[Samus Aran]

This thread is a little depressing. But honestly, Healthcare reform or not, there is no where else I'd rather be and there's nothing else I'd rather do, and if I wasn't in Med school, I'd be fighting to get in.

same here.

i pray that any reform bill that does pass includes tort reform. politicians need to stop spinning it as reducing the awards that patients receive from legit malpractice claims. i can't imagine that physician wants that if a malpractice suit is justified. all we want is to stop ordering unnecessary tests and procedures and keep our malpractice insurance costs reasonable. everyone wins except the ambulance chasers who knowingly take on frivolous lawsuits hoping for a settlement. those people (imo) deserve a special place in hell.

 

[sjdsn135]

same here.

i pray that any reform bill that does pass includes tort reform. politicians need to stop spinning it as reducing the awards that patients receive from legit malpractice claims. i can't imagine that physician wants that if a malpractice suit is justified. all we want is to stop ordering unnecessary tests and procedures and keep our malpractice insurance costs reasonable. everyone wins except the ambulance chasers who knowingly take on frivolous lawsuits hoping for a settlement. those people (imo) deserve a special place in hell.

I think this is key, although I've heard that Obama's campaign received mass support from ambulance chasing lawyers so he feels indebted to them.

 

[lildave2586]

Has anyone seen these "medicare review boards" popping up at thier hospitals? It's happening in the 'ville. The government is paying doctors to review cases of people on medicare to try to find "billing errors." If a doc charged tier 3 and someone on the medicare review board thinks it should be tier 2, then they send the doc a bill for the difference. Supposedly they set up some sort of hearing where the doctor can come and argue a case for why they charged at a particular tier, but why MD really has time to put up with that crap? What happens if the docs don't pay up? The government charges you with medicare fraud. Just the other day I heard of a case where a doc was sent the hospital bill for a patient who medicare deemed should not have been hospitalized. What kind of crap is that? This is going to be the norm when Obamacare gets passed. Docs are not only going to have to look over their shoulder for the lawyers, but also for the government. This is going to put us in a situation where we will be screwed for practicing defensive medicine (the governemnt will charge us) but will also be screwed if we don't (the lawyers will sue us). That's going to be a lot of suck.

 

[rachmoninov3]

Obama has accomplished one thing already: He's getting me to re-think family practice! If physician salaries become more level, then chosing FP rather than IM or peds means that I get to go home to my mountains 2 years earlier and get out of this stupid city!

Of course, I know that you choose your specialty based on interest, not money, but it's just an example of how if you're not paid more for more work, you won't work quite so hard.

I'm still waiting to see how this all plays out, and hopefully we'll have a better idea by next summer when I have to pick electives for 4th year

And yes, this whole Obamacare feels like a black cloud sitting over the 3rd year of medical school when you know you're past the point on no return.

 

[MrAgreeable]

Is there a way one could actually access the text of the bill?

Also, has anyone besides Fox News (and similar quasi-scare mongers) commented on reimbursement rates under the proposed plan?

In all seriousness, I am really curious about this facet of the proposed plan (as I start in a week) and struggle to get a straight answer.

 

[Tolip]

Is there a way one could actually access the text of the bill?

Also, has anyone besides Fox News (and similar quasi-scare mongers) commented on reimbursement rates under the proposed plan?

In all seriousness, I am really curious about this facet of the proposed plan (as I start in a week) and struggle to get a straight answer.

I believe this is the full text:

http://big.assets.huffingtonpost.com/AAHCA-BillText-071409.pdf

 

[TRN1983]

Incorrect. PA salaries do not emerge from some sort of vacuum. They come from professional fee reimbursements just like doctor salaries. If they cut reimbursements in half doctors will make 100 and PAs 50.

Exactly. I wonder why the nursing unions, etc, havent figured this out yet. They claim it's about autonomy, but when you read their blogs, etc, they really complain about making less than physicians while "feeling" equally as qualified. When it comes down to it, when physicians get a cut, eventually the mid-levels will follow.

They need to find all of the socialized countries on this list:

http://www.worldsalaries.org/professionalnurse.shtml

They're working themselves toward getting a huge paycut with their "autonomy" and it will all have been in vain for them. Paying attendtion to the USD column on that page (Note AUS uses $ as well, but NOT USDollars), they work fewer hours than many socialist countries and make considerably more. I hope they figure out the joke is on them before it's too late.

I'm gonna be a physician whether I make $120k or $220k, but I do worry about this so-called reform because of how it will affect the patients, the economy, and the power structure in this country (i.e. government >> citizens).

 

[sprinkibrio]

Are you serious? Really? No, seriously? It's a sin to love medicine and want to be compensated well? You are quite obviously a colossal ***** if you actually think this black-and-white.

These statements are also coming from someone who has lived in a city that is one of the most expensive draws on healthcare with the most business-minded doctors. The doctors own the town and take cash only. I hate what I've seen enough to not yet care about a cut in my pay if it means we're trying to get that fixed. I also have no loans, which may be an influence.

I respect other people's opinions, but this thread is called "anyone else think this is a bad time to be a med student" not an attending, resident, or even an intern. If the med students getting in these days are no longer naive or idealistic we're going to be in for a rough ride.

BTW, I'd appreciate not using low personal blows to get your point across. This is a political conversation, and we're not going to agree. Keep it civil.

 

[Salpingo]

I'd argue that it's a pretty good time to go into medicine. Nanotechnology and genetic medicine will probably enter common practice within our time, while information technology will eliminate a lot of the administrative hassles people have had to put up with (and by 2013, there will actually be financial incentive to implement EMR).

But if you're worried about money, invest in real estate. Or, marry well.

 

[chessknt]

These statements are also coming from someone who has lived in a city that is one of the most expensive draws on healthcare with the most business-minded doctors. The doctors own the town and take cash only. I hate what I've seen enough to not yet care about a cut in my pay if it means we're trying to get that fixed. I also have no loans, which may be an influence.

I respect other people's opinions, but this thread is called "anyone else think this is a bad time to be a med student" not an attending, resident, or even an intern. If the med students getting in these days are no longer naive or idealistic we're going to be in for a rough ride.

BTW, I'd appreciate not using low personal blows to get your point across. This is a political conversation, and we're not going to agree. Keep it civil.

Flat out wrong. Idealists are the ones the govt gets to go along with this ****ed up plan and everyone will have to pay for your lack of vision. Id rather have a generation of stark pessimists that would help shake some sense into capitol hill with a unanimous and powerful resounding NO.