Coming Changes in Medicine - What do you think and will it affect your choices?

DrArete

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I just read a WSJ article about changes in medicine - http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsSecond

Currently, where I am living in Spain, there is a national health system which covers all care.

Under it, doctors make amounts that would be unaccepted by US students.

The father of one of my friends is a general surgeon with 30 years of experience who works at one of the most important public hospitals, and he makes about 3,500 euros a month.

Another man I know heads the most important private opthamological clinic in the city, and he makes close to 6,000 euros a month after all his expenses.

So, a few questions:

1. How many of you would be willing to go into primary care? How do you address the lack of prestige it has?

2. How many of you feel that the USA will gradually move toward a system with European level wages for doctors?

3. Would you still work as a doctor, the same number of hours, for a third of the money? This assumes of course, that as in Europe, the cost of medical school was largely payed for by the state.
 

robflanker

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What does this have to do with post-bac programs or SMPs?

Might want to PM a mod to have it moved to pre-allo or something
 

darkjedi

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I agree with rob, it's quite a political topic for the postbac forum. That said, the coming health care reform and the issues it needs to address is one of the reasons I wish to pursue a career in medicine now. There are clearly a lot of issues that need to be addressed and fixed if the healthcare system is going to be sustainable.

I think the wages might be shifted across the different specialties so that more doctors have an incentive to go into primary care. I don't think that the amount of money that is put into the healthcare system is going to drop however.
 

epione

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personally, i don't see a problem with it being posted here. it's a good read and it's not necessarily more relevant to those in the pre-allo forum than it is here. i think sometimes we get caught up in our low gpa and rate a postbacc threads. i actually posted a similar article from the WSJ not too long ago and it was received perfectly well. :]

thanks, dr. arete. and to answer your questions:

1. i'm open to anything at this point, including primary care, although i have a few doubts that i'll actually end up there. and i don't really care about perceived prestige.

2. i don't feel that way. the u.s. has a hard enough time luring enough students to take on the financial burden of medical school that lowering the pay, i think, would be detrimental to the cause. with that being said, i think a lot of u.s. doctors ARE overpaid (don't attack me-- both my parents are doctors). many are able to pay back their loans VERY quickly.

3. that depends -- you say 1/3 of the money, same number of hours, but i have no frame of reference. how many hours are you talking? however, i'm inclined to say i would. i know a few american doctors who moved to europe to practice just to get away from being controlled by the health insurance industry here and are extremely happy with their decision.
 

drizzt3117

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People have been prophesizing the demise of our healthcare system for the last 20 years, in that time, annual physician salaries have increased. I'm less than concerned. In a previous life, I was a strategy consultant for large HMO/insurance companies. All I can say about this is 1) physicians make more than is reported in the media, and 2) physicians will be just fine.

Personally I have 0.0% interest in primary care. I'm going into academic medicine in order to further knowledge in the field and fully intend to consult and be involved in the business side of medicine (primarily medical device) but even if I were going into PC I'd be less than worried about the economics.
 

robflanker

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1. How many of you would be willing to go into primary care? How do you address the lack of prestige it has? Prestige isn't important to me and while there maybe other specialties that interest me more than IM or FM does - I would rather be an IM/FM doc than I would be another career option. So within the field it might not be my first choice, but the field is definitely my 1st choice.

2. How many of you feel that the USA will gradually move toward a system with European level wages for doctors? Lol never going to happen.

3. Would you still work as a doctor, the same number of hours, for a third of the money? This assumes of course, that as in Europe, the cost of medical school was largely payed for by the state. I'd be ok with less money if there were no loans or a different legal system or one didn't have to do a 4-yr degree before going to medical school. If a bunch of things changed, I guess i'd be ok with it. But if you were to just 1/3 the pay right now without changing anything else - i would tell you it wouldn't happen.
Eh seen as ppl are answering it, I will too...

Overall I agree with Drizzt - there will always be sick people and the economy will change every few years. The US media is really good at overblowing things and making them seem like its the end of the world (regardless of political affiliation).
 

jslo85

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I just read a WSJ article about changes in medicine - http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsSecond

Currently, where I am living in Spain, there is a national health system which covers all care.

Under it, doctors make amounts that would be unaccepted by US students.

The father of one of my friends is a general surgeon with 30 years of experience who works at one of the most important public hospitals, and he makes about 3,500 euros a month.

Another man I know heads the most important private opthamological clinic in the city, and he makes close to 6,000 euros a month after all his expenses.

So, a few questions:

1. How many of you would be willing to go into primary care? How do you address the lack of prestige it has?

2. How many of you feel that the USA will gradually move toward a system with European level wages for doctors?

3. Would you still work as a doctor, the same number of hours, for a third of the money? This assumes of course, that as in Europe, the cost of medical school was largely payed for by the state.
Well as I do agree with Rob in that this is not the most appropriate place for this thread, it makes for a nice deviation from the normal WAMC or "I'm an international dentist" post. Sorry that was a bit uncalled for but I couldn't resist.

Anyway.

1. I would be willing to go into primary care. It's not my first choice but it's a close second. I've always loved healthcare but what drew me to medicine was the physician patient interaction. This is purely my own experiences, but I've done a few preceptorships in FM and IM as well as worked in dermatology office among other things. I can safely say that I learned far more about what it means to be a good doctor by working with the FM doctor for 8 months and seeing how much his patients trusted/valued him as opposed to the 5 min the dermatologist gave to each of her patients. She was a great mentor/employer to me but seeing 60 patients in one day by herself just isn't something I can see myself doing.

There are so many people out there that only see one physician for most if not all of their lives and it is a huge responsibility for FM doctors to be knowledgeable about all things and to recognize/identify certain symptoms to refer them to the appropriate specialist. I think the future of primary care is really not in private practice but as a hospitalist or as apart of a large medical group. I personally don't want to pursue medicine to spend a large portion of my time doing paperwork.

2. Never.

3. For the most part yes if it can maintain an adequate style of living for my future family. I can't see money compromising what I really want to do in the future. There is a saying that I really felt holds true regarding one's decision on careers. "There is something that you're good at. There is something that you like to do. Then there's something that pays you well for you to do it. If you can match up even 2 of the 3, then you're set for life." Medicine was something that encompassed all three though the first is a bit subjective and is debatable for me :(.
 

darkjedi

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There is a saying that I really felt holds true regarding one's decision on careers. "There is something that you're good at. There is something that you like to do. Then there's something that pays you well for you to do it. If you can match up even 2 of the 3, then you're set for life." Medicine was something that encompassed all three though the first is a bit subjective and is debatable for me :(.
Hahah I like that, though looking back on my own (albeit limited) career, I wish I had placed more of an emphasis on #2 as opposed to 1 and 3.
 

DrArete

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What does this have to do with post-bac programs or SMPs?

Might want to PM a mod to have it moved to pre-allo or something
Well, this is really the only forum on SDN that I look at.

I really do think those that are going through or have been through the Postbacc route have a different set of concerns and perspectives than others.

To put it another way, I identify more strongly with the people on this part of SDN than in other areas.
 

DrArete

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People have been prophesizing the demise of our healthcare system for the last 20 years, in that time, annual physician salaries have increased. I'm less than concerned. In a previous life, I was a strategy consultant for large HMO/insurance companies. All I can say about this is 1) physicians make more than is reported in the media, and 2) physicians will be just fine.

Personally I have 0.0% interest in primary care. I'm going into academic medicine in order to further knowledge in the field and fully intend to consult and be involved in the business side of medicine (primarily medical device) but even if I were going into PC I'd be less than worried about the economics.
That is interesting. My first instinct is not primary care. That is something I could do later in my career, particularly if I follow the lead of one of the doctors I consider a mentor and spend extensive time post retirement volunteering abroad.
One thing that gets me with academic medicine, which also interests me, is that I perceieve that the ranking of your medical school matters quite a lot in terms of what opportunities are open to you.
 

DrArete

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I will answer my own questions:

1. I would consider primary care but it is not high on my list at this point. As for "prestige," I think being an MD is all the prestige one should desire. Whatever your specialty is should depend on what feels right for you, and what suits your ability to contribute in the most meaningful way.

2. In the short term, I dont think that doctors wages will decline that much. However, in time, I think they will. The health system will gradually morph into a single payer system, will there will still be private clinics. Those working in the public system will see their wages erode, as there will be immense pressure to control costs, as there is across Europe. However, since the public system invariably competes for a limited number of doctors with the private system, the wages wont be as low in the USA as they are in Spain. To state it more clearly, the private sector of medicine in Spain is relatively weak, and so, with less opportunities than the USA, so the public system can get away with paying much lower wages than it would otherwise.

3. Yes, I would work for much less than the prevailing wage in the USA. I think this question is a good litmus test for whether or not you should be in medicine or a specific specialty. While I might not have thought the same way a decade ago, recently I have spent several years in developing countries, mostly in Latin America, and I have a much different perspective now on how much money is needed, and what constitutes a good living standard. Also, I have decided to sacrifice having a family to focus completely on medicine, and as long as I have enough for loans, rent, and food, that is fine by me.
 

drizzt3117

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That is interesting. My first instinct is not primary care. That is something I could do later in my career, particularly if I follow the lead of one of the doctors I consider a mentor and spend extensive time post retirement volunteering abroad.
One thing that gets me with academic medicine, which also interests me, is that I perceieve that the ranking of your medical school matters quite a lot in terms of what opportunities are open to you.
I think your residency and fellowship matter a lot, the two aren't necc correlated that well but going to a top 25 program will help you.
 

JeetKuneDo

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1. Might change later, but no primary care for me.

2. Let's hope not, at least not in our lifetime.

3. Depends on how the gov't handles our debt. If the debt is gone and the salary is at GS-15, then I'd say yes. However, if we have to start at 40k with a max at about 100, I'd seriously consider another career.


3. Yes, I would work for much less than the prevailing wage in the USA. I think this question is a good litmus test for whether or not you should be in medicine or a specific specialty. While I might not have thought the same way a decade ago, recently I have spent several years in developing countries, mostly in Latin America, and I have a much different perspective now on how much money is needed, and what constitutes a good living standard. Also, I have decided to sacrifice having a family to focus completely on medicine, and as long as I have enough for loans, rent, and food, that is fine by me.
That's dedication right there.