CMS Proposing Cutting Hospital MD Pay 6-11% while increasing NP/PA pay 8%

[slowthai]

My favorite comments from the /r/residency thread:

"So, emergency physicians, responding to, and in some cases becoming ill and/or dying due to #COVID, are getting a 6% pay cut beginning in 2021 but NPS are getting at 8% increase

What the ACTUAL ****"

"American healthcare is a ****ing embarrassment at all levels.

**** CMS. **** congress. **** limp dicked physician lobbying."

"I been saying it for a while now - the true evil in this world is found in hospital administration"

"Ha and then get this. Some midlevels on meddit will bitch about how we complain about these "residencies and fellowships." They say we’re hypocrites for saying their education isnt good enough and then complaining when they try to get a better education.

Completely ignoring the fact about online diploma mills and their piss poor standardization. Completely ignoring we are mostly against independent midlevels. Completely ignoring that they’re getting paid more than residents to be trained. And most importantly completely ignoring that getting more training does not have to be synonymous to pretending you went through the same training a physician did by calling it a residency and fellowship and blurring lines.

YOu dOnt HaVe a MonOpoLy oN tHe TeRm ReSidEncy, cHecK yOur EgO"

Edit: For some reason, a mod removed the link to the thread. Don't know why.

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[slowthai]

So apparently the proposed reimbursement change favors follow up visits and decreases pay for procedures, so primary care and midlevels would be on the up and up, and EM/surgery/DR would mostly decrease.

A snapshot of the reimbursement changes, from @DOctorJay:

Full table of reimbursement changes:

 

[Ho0v-man]

As cheesy as it sounds, this is why everyone should just go for what interests them and ignore the pay when it comes to picking a specialty. With the stroke of a pen, your earnings can change overnight.

Furthermore, we should have all just went to PA school.

 

[Neopolymath]

As cheesy as it sounds, this is why everyone should just go for what interests them and ignore the pay when it comes to picking a specialty. With the stroke of a pen, your earnings can change overnight.

Furthermore, we should have all just went to CRNA/AA school.

Way more money and way less bs than being a PA.

 

[MavFab]

Way more money and way less bs than being a PA.

I agree CRNA/AA is a better route, but with these reimbursement changes their revenue is projected to decrease 10%

 

[Fatalis]

Sweet so we get a pay cut for taking on liability and they get more money for giving out steroid and abx shots all day...

 

[efle]

I'm a little confused how anyone's pay is expected to go up after a blanket 10% reduction per RVU? Can anyone explain?

 

[Lawpy]

Physicians need to be serious when it comes to lobbying and helping the profession. Why do nurses, midlevels and other health professions have strong advocacy and lobbying groups while doctors are practically ineffective?

 

[hamstergang]

I don't think I fully get it. The expected impact is broken down by specialty and shows that some would expect an increase in pay and some would expect a decrease in pay. NPs and PAs work in various specialties yet they are listed on just a single line each. That seems like it was almost done on purpose to skew the results. Wouldn't we expect midlevels in some fields to see a decrease in pay similar to the physicians in those fields?

 

[efle]

I don't think I fully get it. The expected impact is broken down by specialty and shows that some would expect an increase in pay and some would expect a decrease in pay. NPs and PAs work in various specialties yet they are listed on just a single line each. That seems like it was almost done on purpose to skew the results. Wouldn't we expect midlevels in some fields to see a decrease in pay similar to the physicians in those fields?

Yeah...and how does a 10% RVU reduction across the board lead to them gaining 8%? None of this makes sense as presented

 

[Vulf]

Yeah...and how does a 10% RVU reduction across the board lead to them gaining 8%? None of this makes sense as presented

My impression was that the gain of 8% is relative to other specialties' proportion of the remaining 90% of the RVU pie.

 

[risus_sardonicus]

When will the madness stop? Feel bad for new MS1s y’all are gonna be screwed by the time you see an attending salary

 

[Type2Fiber]

We're all "providers" and "clinicians" now. No need to pay us like physicians

 

[slowthai]

We're all "providers" and "clinicians" anymore. No need to pay us like physicians

I hate this term with a passion. Whoever came up with it must've had early-onset cerebral atrophy

 

[risus_sardonicus]

Ya I’m a provider like AT&T and spectrum.. cable phone internet provider.. what a joke

 

[Splenda88]

As cheesy as it sounds, this is why everyone should just go for what interests them and ignore the pay when it comes to picking a specialty. With the stroke of a pen, your earnings can change overnight.

Furthermore, we should have all just went to PA school.

How about the prestige ?

 

[Splenda88]

Physicians need to be serious when it comes to lobbying and helping the profession. Why do nurses, midlevels and other health professions have strong advocacy and lobbying groups while doctors are practically ineffective?

No one likes us...

 

[Ho0v-man]

How about the prestige ?

I’m already a DO student. What’s prestige?

 

[Splenda88]

I’m already a DO student. What’s prestige?

The cute nurses and dietitians won't call you DO Ho0v-man, they will say Dr. Ho0v-man. It's only in SDN you hear MD vs. DO distinction. No such thing in real life. I have a few colleagues that are DOs and no one gives a cr***p.

 

[odyssey2]

The cute nurses and dietitians won't call you DO Ho0v-man, they will say Dr. Ho0v-man. It's only in SDN you hear MD vs. DO distinction. No such thing in real life. I have a few colleagues that are DOs and no one gives a cr***p.

Weird that they would use his sdn username tho

 

[penpenclown]

What, you don't put your SDN username on your name badge???

How else will you flex on the other doctors unless they know how many 'likes' you've gotten?

 

[Fatalis]

I hate this term with a passion. Whoever came up with it must've had early-onset cerebral atrophy

Preach brother! Even pharmacists want to be “providers”

 

[MisterKitty]

Chicka chicka yeah psych is the new derm chicka yeah

 

[7331poas]

Physicians need to be serious when it comes to lobbying and helping the profession. Why do nurses, midlevels and other health professions have strong advocacy and lobbying groups while doctors are practically ineffective?

Because generally people like nurses but not doctors?

 

[Eye-eye]

Because generally people like nurses but not doctors?

I mean, I think there is probably a grain of truth that some people thinks doctors are all rich and nurses work harder and don't get paid well. But I'd say the bigger issue is that a lot of docs don't lobby for themselves because of inane subliminal (or explicit) messaging in the training process that it's beneath the profession to care about money at all, and certainly to fight to keep what you have, let alone ask for more. If you care or talk about anything other than patient care and safety, you're in it for the wrong reasons, just for money, and you don't care about your patients. That's the bull**** message I've heard implicitly or explicitly here in med school, anyway, and it has to stop if we're to move on. Any time it's brought up, someone in the room (an attending, every time) says "if you cared about the money, you should have gone into business" and nobody is willing to look bad by saying the truth: "No, that's bull****. Loans are going up astronomically, we're being asked to do more, and they keep cutting our pay. We have a right to stand up for ourselves." Until we can do that, we'll be given more abd more responsibilities for less and less pay. And it's not going to change until the profession is truly financially untenable, because that's the only way I see enough minds changing for us to take charge. Sadly, by then, it'll probably be too late, and the smarter folks will become midlevels instead of docs because they'll have seen the ****ty career prospects coming.

 

[VA Hopeful Dr]

I mean, I think there is probably a grain of truth that some people thinks doctors are all rich and nurses work harder and don't get paid well. But I'd say the bigger issue is that a lot of docs don't lobby for themselves because of inane subliminal (or explicit) messaging in the training process that it's beneath the profession to care about money at all, and certainly to fight to keep what you have, let alone ask for more. If you care or talk about anything other than patient care and safety, you're in it for the wrong reasons, just for money, and you don't care about your patients. That's the bull**** message I've heard implicitly or explicitly here in med school, anyway, and it has to stop if we're to move on. Any time it's brought up, someone in the room (an attending, every time) says "if you cared about the money, you should have gone into business" and nobody is willing to look bad by saying the truth: "No, that's bull****. Loans are going up astronomically, we're being asked to do more, and they keep cutting our pay. We have a right to stand up for ourselves." Until we can do that, we'll be given more abd more responsibilities for less and less pay. And it's not going to change until the profession is truly financially untenable, because that's the only way I see enough minds changing for us to take charge. Sadly, by then, it'll probably be too late, and the smarter folks will become midlevels instead of docs because they'll have seen the ****ty career prospects coming.

You're thinking too hard.

We don't lobby because a) doctors as a group are cheap b) lobbying takes away from seeing patients (which means less money earned, which goes back to point a) and c) we're a very heterogeneous group. First, most of us identify with our specialty first, medicine as a whole second. So our lobbying get fragmented. Second, even beyond that we have different goals. Think how many physicians want universal healthcare. Healthcare Professionals Divided on Medicare for All, Poll Shows

We're literally split in half on this. That doesn't make for effective lobbying.

 

[Neopolymath]

Because generally people like nurses but not doctors?

And no one realizes just how much more we have to know for training, how much pressure physicians are under, or how much more of our time is spent actually working/doing each day.

For example, some random occupational therapist was bitching to me about how hard their one exam for hand certification was because they had to draw the brachial plexus or something comical. Everyone thinks what they do is super hard. Go talk to people in nursing school and get a chuckle out of how "hard" they study lol. Docs can't win here because no one wants to admit that their training isn't actually hard and that they aren't anything but very average intelligence and work ethic. We have to be fair so that means that nurses being sweeter and being in front of the patient more means they are more likable because that previously mentioned stuff does not exist or count in the eyes of the average person.

 

[sunshinefl]

And no one realizes just how much more we have to know for training, how much pressure physicians are under, or how much more of our time is spent actually working/doing each day.

For example, some random occupational therapist was bitching to me about how hard their one exam for hand certification was because they had to draw the brachial plexus or something comical. Everyone thinks what they do is super hard. Go talk to people in nursing school and get a chuckle out of how "hard" they study lol. Docs can't win here because no one wants to admit that their training isn't actually hard and that they aren't anything but very average intelligence and work ethic. We have to be fair so that means that nurses being sweeter and being in front of the patient more means they are more likable because that previously mentioned stuff does not exist or count in the eyes of the average person.

my husband is even in healthcare as an RRT and I have to explain to him everything he doesn’t see when he talks about the pulmonologist “doing a drive by of patients on his rounds.” Nurses are more visible and so people think they work harder somehow, and ignore all the cognitive work, coordination, paper work, etc. of physicians. I get in debates all the time with nurses (not on rotations!! I’m not dumb. Just in my private life or social media) about schooling and they don’t believe anything I say even though I’m an RN and I’ve done both.

 

[Neopolymath]

my husband is even in healthcare as an RRT and I have to explain to him everything he doesn’t see when he talks about the pulmonologist “doing a drive by of patients on his rounds.” Nurses are more visible and so people think they work harder somehow, and ignore all the cognitive work, coordination, paper work, etc. of physicians. I get in debates all the time with nurses (not on rotations!! I’m not dumb. Just in my private life or social media) about schooling and they don’t believe anything I say even though I’m an RN and I’ve done both.

I imagine you and I could trade some stories about this stuff. I have too many to count. It would either be infuriating or cathartic.

One of my favorite people in the hospital prior to med school was a RRT but man, was he an outlier at my workplaces. The others would constantly berate the docs and anesthesia staff about messing with "their machine" LOL. Very entertaining if nothing else.

The rigor and standards for the students is orders of magnitude different that's for sure but no one else will ever know.

 

[TAVR4life]

I had been warning about this for years that the ultimate goal of hospital administrations push to give mid levels so much power is to drive down costs for hospitals in order to increase revenue specifically by driving down salaries for doctors.

 

[NotAProgDirector]

Yeah...and how does a 10% RVU reduction across the board lead to them gaining 8%? None of this makes sense as presented

Medicare defines the fee schedule each year. By law, the fee schedule has to be "budget neutral", which means that increasing the pay of any one part of the system needs to be balanced by a cut somewhere else. This doesn't actually keep Medicare cost neutral, since the volumes of services keep going up, and once new billing codes are announced docs find ways to generate more billing revenue. There used to be a way Medicare tried to deal with that, called the SGR (sustainable growth rate). This automatically caused across the board payment cuts if the cost of Medicare increased too quickly. WHich of course it did, and generated huge potential cuts. Congress repealed the SGR saying it was flawed, didn't replace it with anything, so costs have continued to skyrocket.

But back on topic, the issue in 2021 is that CMS decided to increase the RVU's for the outpatient E&M codes:

This is because outpatient work is considered undervalued (at least by some). Once they increased these RVU rates, they needed to cut other RVU allocations. They didn't. So, to compensate, the payment per RVU is decreased to keep the budget neutral -- basically every RVU becomes worth less since they are handing out more of them (somewhat like printing money).

40% of CMS payments are due to these codes, accounting for 20% of payments (found this stat on a website, not sure how accurate). The codes above are about a 33% increase:

0.2(1.33) + 0.8 = 1.066 -- so a 6.6% increase in total RVU's, therefore the conversion factor decreases by that percent. It's bigger than that because CMS also decided to increase payments to others (Nephrology, etc). But for PCP's, a 33% increase in RVU's x 10% decrease in RVU value = 20% increase in pay. That's not what's on the table above, not sure if the above table is accounting for payor mix (i.e. not all patients are Medicare), or if they are predicting that physicians will use less 4's and 5's with the new system (unlikely), or something else.

So, physicians who get most of their RVU's from office visits will see an increase in payments from CMS, and those who get more RVU's from procedures will see decreased payments. The rule doesn't directly increase pay to NP/PA's -- it's just that they more commonly bill E&M codes. Also, there's no guarantee that the increased billing from these codes will go to increase their salary directly (NP's that have a private practice would, if many exist).

The table (and the whole rule) is here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf Somewhat amused that CMS stores/serves all this content from AWS and S3 buckets. It's Table 90, you can search for it.

An outdated but simple summary of the Conversion Factor is here: E&M Changes: How Will They Affect Your Practice? - ICD10monitor. As mentioned, SGR has been repealed since.

There already is lots of noise asking Congress to exempt the budget neutrality of MPFS changes this year. Which would spend lots more money. Somewhere along the line, we will run out of money.

 

[efle]

Medicare defines the fee schedule each year. By law, the fee schedule has to be "budget neutral", which means that increasing the pay of any one part of the system needs to be balanced by a cut somewhere else. This doesn't actually keep Medicare cost neutral, since the volumes of services keep going up, and once new billing codes are announced docs find ways to generate more billing revenue. There used to be a way Medicare tried to deal with that, called the SGR (sustainable growth rate). This automatically caused across the board payment cuts if the cost of Medicare increased too quickly. WHich of course it did, and generated huge potential cuts. Congress repealed the SGR saying it was flawed, didn't replace it with anything, so costs have continued to skyrocket.

But back on topic, the issue in 2021 is that CMS decided to increase the RVU's for the outpatient E&M codes:

View attachment 315252

This is because outpatient work is considered undervalued (at least by some). Once they increased these RVU rates, they needed to cut other RVU allocations. They didn't. So, to compensate, the payment per RVU is decreased to keep the budget neutral -- basically every RVU becomes worth less since they are handing out more of them (somewhat like printing money).

40% of CMS payments are due to these codes, accounting for 20% of payments (found this stat on a website, not sure how accurate). The codes above are about a 33% increase:

0.2(1.33) + 0.8 = 1.066 -- so a 6.6% increase in total RVU's, therefore the conversion factor decreases by that percent. It's bigger than that because CMS also decided to increase payments to others (Nephrology, etc). But for PCP's, a 33% increase in RVU's x 10% decrease in RVU value = 20% increase in pay. That's not what's on the table above, not sure if the above table is accounting for payor mix (i.e. not all patients are Medicare), or if they are predicting that physicians will use less 4's and 5's with the new system (unlikely), or something else.

So, physicians who get most of their RVU's will see an increase in payments from CMS, and those who get more RVU's from procedures will see decreased payments. The rule doesn't directly increase pay to NP/PA's -- it's just that they more commonly bill E&M codes. Also, there's no guarantee that the increased billing from these codes will go to increase their salary directly (NP's that have a private practice would, if many exist).

The table (and the whole rule) is here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf Somewhat amused that CMS stores/serves all this content from AWS and S3 buckets. It's Table 90, you can search for it.

An outdated but simple summary of the Conversion Factor is here: E&M Changes: How Will They Affect Your Practice? - ICD10monitor. As mentioned, SGR has been repealed since.

There already is lots of noise asking Congress to exempt the budget neutrality of MPFS changes this year. Which would spend lots more money. Somewhere along the line, we will run out of money.

Fascinating that they are legally obligated to try and cut surgeon/rads/gas pay if they want to boost primary care. Thanks for the explanation!

 

[MisterKitty]

Medicare defines the fee schedule each year. By law, the fee schedule has to be "budget neutral", which means that increasing the pay of any one part of the system needs to be balanced by a cut somewhere else. This doesn't actually keep Medicare cost neutral, since the volumes of services keep going up, and once new billing codes are announced docs find ways to generate more billing revenue. There used to be a way Medicare tried to deal with that, called the SGR (sustainable growth rate). This automatically caused across the board payment cuts if the cost of Medicare increased too quickly. WHich of course it did, and generated huge potential cuts. Congress repealed the SGR saying it was flawed, didn't replace it with anything, so costs have continued to skyrocket.

But back on topic, the issue in 2021 is that CMS decided to increase the RVU's for the outpatient E&M codes:

View attachment 315252

This is because outpatient work is considered undervalued (at least by some). Once they increased these RVU rates, they needed to cut other RVU allocations. They didn't. So, to compensate, the payment per RVU is decreased to keep the budget neutral -- basically every RVU becomes worth less since they are handing out more of them (somewhat like printing money).

40% of CMS payments are due to these codes, accounting for 20% of payments (found this stat on a website, not sure how accurate). The codes above are about a 33% increase:

0.2(1.33) + 0.8 = 1.066 -- so a 6.6% increase in total RVU's, therefore the conversion factor decreases by that percent. It's bigger than that because CMS also decided to increase payments to others (Nephrology, etc). But for PCP's, a 33% increase in RVU's x 10% decrease in RVU value = 20% increase in pay. That's not what's on the table above, not sure if the above table is accounting for payor mix (i.e. not all patients are Medicare), or if they are predicting that physicians will use less 4's and 5's with the new system (unlikely), or something else.

So, physicians who get most of their RVU's from office visits will see an increase in payments from CMS, and those who get more RVU's from procedures will see decreased payments. The rule doesn't directly increase pay to NP/PA's -- it's just that they more commonly bill E&M codes. Also, there's no guarantee that the increased billing from these codes will go to increase their salary directly (NP's that have a private practice would, if many exist).

The table (and the whole rule) is here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf Somewhat amused that CMS stores/serves all this content from AWS and S3 buckets. It's Table 90, you can search for it.

An outdated but simple summary of the Conversion Factor is here: E&M Changes: How Will They Affect Your Practice? - ICD10monitor. As mentioned, SGR has been repealed since.

There already is lots of noise asking Congress to exempt the budget neutrality of MPFS changes this year. Which would spend lots more money. Somewhere along the line, we will run out of money.

Seems fair enough

 

[libertyyne]

You're thinking too hard.

We don't lobby because a) doctors as a group are cheap b) lobbying takes away from seeing patients (which means less money earned, which goes back to point a) and c) we're a very heterogeneous group. First, most of us identify with our specialty first, medicine as a whole second. So our lobbying get fragmented. Second, even beyond that we have different goals. Think how many physicians want universal healthcare. Healthcare Professionals Divided on Medicare for All, Poll Shows

We're literally split in half on this. That doesn't make for effective lobbying.

not to mention there are a lot fewer of us compared to how many nurses there are in the country. There is also a strong tradition of unions and representation in nursing where as there is a more of an ethos of individuality when it comes to physicians.

I mean, I think there is probably a grain of truth that some people thinks doctors are all rich and nurses work harder and don't get paid well. But I'd say the bigger issue is that a lot of docs don't lobby for themselves because of inane subliminal (or explicit) messaging in the training process that it's beneath the profession to care about money at all, and certainly to fight to keep what you have, let alone ask for more. If you care or talk about anything other than patient care and safety, you're in it for the wrong reasons, just for money, and you don't care about your patients. That's the bull**** message I've heard implicitly or explicitly here in med school, anyway, and it has to stop if we're to move on. Any time it's brought up, someone in the room (an attending, every time) says "if you cared about the money, you should have gone into business" and nobody is willing to look bad by saying the truth: "No, that's bull****. Loans are going up astronomically, we're being asked to do more, and they keep cutting our pay. We have a right to stand up for ourselves." Until we can do that, we'll be given more abd more responsibilities for less and less pay. And it's not going to change until the profession is truly financially untenable, because that's the only way I see enough minds changing for us to take charge. Sadly, by then, it'll probably be too late, and the smarter folks will become midlevels instead of docs because they'll have seen the ****ty career prospects coming.

Also its hard not looking like an a$$hole if you are advocating for more money when you already earn top 5% of incomes in the country.

 

[Splenda88]

not to mention there are a lot fewer of us compared to how many nurses there are in the country. There is also a strong tradition of unions and representation in nursing where as there is a more of an ethos of individuality when it comes to physicians.



Also its hard not looking like an a$$hole if you are advocating for more money when you already earn top 5% of incomes in the country.

To be fair, most RN do not think highly of NP...

 

[CanIMakeIt]

I mean, I think there is probably a grain of truth that some people thinks doctors are all rich and nurses work harder and don't get paid well. But I'd say the bigger issue is that a lot of docs don't lobby for themselves because of inane subliminal (or explicit) messaging in the training process that it's beneath the profession to care about money at all, and certainly to fight to keep what you have, let alone ask for more. If you care or talk about anything other than patient care and safety, you're in it for the wrong reasons, just for money, and you don't care about your patients. That's the bull**** message I've heard implicitly or explicitly here in med school, anyway, and it has to stop if we're to move on. Any time it's brought up, someone in the room (an attending, every time) says "if you cared about the money, you should have gone into business" and nobody is willing to look bad by saying the truth: "No, that's bull****. Loans are going up astronomically, we're being asked to do more, and they keep cutting our pay. We have a right to stand up for ourselves." Until we can do that, we'll be given more abd more responsibilities for less and less pay. And it's not going to change until the profession is truly financially untenable, because that's the only way I see enough minds changing for us to take charge. Sadly, by then, it'll probably be too late, and the smarter folks will become midlevels instead of docs because they'll have seen the ****ty career prospects coming.

this.
Also don't forget that with 5 doctors in one room, there are 10 opinions. We can never get along. Some are even happy to see other specialty getting dinged as if they deserved it. Also "the do-gooders, sitting in the front of the class, having read everything in advance, and knowing fully well what the answer is and still ask questions and try to explain it so everyone can know how smart they are" will never let us unite under one umbrella. We can't even fight our own MOC battles because of a few of us who believe that the size can only be measured by unnecessary testing so they can feel more important in their own heads, how are we ever going to fight a worse battle of reimbursement. Have you ever seen lawyers or law makers salary taking a hit, no matter what the economy is doing. We allowed this to happen to our profession by the passive BS as well put by @neuroguy91 .
Plus all that gives hospital administration more tools to control doctors by lumping everyone in providers category and take away the identity and pride - playbook from British era - a civilization can only be destroyed from within.

fine, I will get off my horse now.

 

[CanIMakeIt]

my husband is even in healthcare as an RRT and I have to explain to him everything he doesn’t see when he talks about the pulmonologist “doing a drive by of patients on his rounds.” Nurses are more visible and so people think they work harder somehow, and ignore all the cognitive work, coordination, paper work, etc. of physicians. I get in debates all the time with nurses (not on rotations!! I’m not dumb. Just in my private life or social media) about schooling and they don’t believe anything I say even though I’m an RN and I’ve done both.

I think even Obama made some comments that they spent most of the time with the nurse
" Now, as I said before, I have a longstanding bias towards nurses. When Sasha, our younger daughter, was diagnosed with a dangerous case of meningitis when she was just three months old, we were terrified. And we were appreciative of the doctors, but it was the nurses who walked us through the entire process to make sure that Sasha was okay. "
We live behind ever increasing mountain of paperwork and our visibility is getting worse by stupid check boxes culture/requirements

 

[Splenda88]

I think even Obama made some comments that they spent most of the time with the nurse
" Now, as I said before, I have a longstanding bias towards nurses. When Sasha, our younger daughter, was diagnosed with a dangerous case of meningitis when she was just three months old, we were terrified. And we were appreciative of the doctors, but it was the nurses who walked us through the entire process to make sure that Sasha was okay. "
We live behind ever increasing mountain of paperwork and our visibility is getting worse by stupid check boxes culture/requirements

Most people and even nurses (to my surprise) are ignorant on what it takes to care of patients. Hear it all time from nurses that 'you doctors only spend 5-10 minutes with patients.'

 

[readmypostsMD]

Just wait till the progressives shove m4a down our throats...

Hope you’re excited to make $150,000

government don’t give a **** what you make

 

[Splenda88]

Just wait till the progressives shove m4a down our throats...

Hope you’re excited to make $150,000

government don’t give a **** what you make

It seems like we are heading that way, but I fault republicans for being a***holes. Hussein Obama basically copied their plan (Heritage Foundation), but they would not accept it because it was Obama. I will be ok if Biden propose a public option.

 

[7331poas]

It seems like we are heading that way, but I fault republicans for being a***holes. Hussein Obama basically copied their plan (Heritage Foundation), but they would not accept it because it was Obama. I will be ok if Biden propose a public option.

Im not completely against a universal healthcare. But certainly not the sanders plan. There are options that still ensure there will be private payers. I think biden/pete had the right ideas.

 

[readmypostsMD]

Im not completely against a universal healthcare. But certainly not the sanders plan. There are options that still ensure there will be private payers. I think biden/pete had the right ideas.

lol multimillionaire bernie yelling at rich ppl

 

[Cornfed101]

Well I guess there is always cosmetic plastic surgery... JK imma be a DO

 

[slowthai]

Well I guess there is always cosmetic plastic surgery... JK imma be a DO

GS to plastic surgery is possible for DOs. Well if it's still a thing by the time you apply for fellowship. This pathway is gradually getting phased out, unfortunately.

 

[Matthew9Thirtyfive]

GS to plastic surgery is possible for DOs. Well if it's still a thing by the time you apply for fellowship. This pathway is gradually getting phased out, unfortunately.

As it should. Can’t have inferior barely-a-doctors in a field like plastic surgery.




lol jk jk

 

[slowthai]

As it should. Can’t have inferior barely-a-doctors in a field like plastic surgery.




lol jk jk

It's a Sunday so I'll let this pass

 

[Matthew9Thirtyfive]

It's a Sunday so I'll let this pass

lol a DO actually used some bone wizard magic on my ankle at a military training thing and helped it a lot.

 

[zero0]

Can I just say I love how they proposed this a month after peak pandemic. Whoever signs this can grab the nearest "thank you hereos" sign, roll it up, and shove it up their a$$. Like any of us fell for that crap anyway. It's just a cheap substitute for raises for harder working conditions. You wanna show how thankful you are? Pay us more.

 

[Splenda88]

The whole system (not only healthcare) in the US is a game and unfortunately it took me a while to realize that.

 

[sloh]

The whole system (not only healthcare) in the US is a game and unfortunately it took me a while to realize that.

The rule book they don’t teach you in med school or residency