lessismore123

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Knowing that medscape often publishes some dubious articles, this one suggests that COVID has affected IM generalists and subspecialists in general in the following order: GI > endo/rheum/nephro/PCP > Cards > hospitalist?/PulmCrit/HemOnc

Theres bound to be geographic variation, practice setting, etc. of course, but does this generally ring true for attendings in the different subspecialties?
 

Gastrapathy

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short term there is no question it’s had a major impact on GI practices but it’s way to soon to tell the long term impact. I’m optimistic GI will rebound completely.
 
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rokshana

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Knowing that medscape often publishes some dubious articles, this one suggests that COVID has affected IM generalists and subspecialists in general in the following order: GI > endo/rheum/nephro/PCP > Cards > hospitalist?/PulmCrit/HemOnc

Theres bound to be geographic variation, practice setting, etc. of course, but does this generally ring true for attendings in the different subspecialties?
not so sure about endo so much..its less procedure dependent and many have been doing telemedicine...the question is of course reimbursement, but of course the effect on them is probably the same as most output practices.
 
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bronx43

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There's no point in asking what specialties are being affected at this point. Things are in flux month by month and region by region. The real question for the long haul is what happens to US healthcare. I am not bullish on the landscape for physicians in the future. I would put money on the implementation of a public option in the next 24 months, which then will rapidly become single payer.
 
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deleted746658

There's no point in asking what specialties are being affected at this point. Things are in flux month by month and region by region. The real question for the long haul is what happens to US healthcare. I am not bullish on the landscape for physicians in the future. I would put money on the implementation of a public option in the next 24 months, which then will rapidly become single payer.

yup, let's be real. being a physician was cool in the 90s and early 2000s. we've been on a steady decline since.

any "rapid" change, especially to single payer, sounds aggressive. i'm not optimistic for us tho.

tbh, in the days of modern medicine, us young guys picked the worst time to become MDs.

if our pay is cut, i'd probably leave for a more lucrative career. i'll finish residency with 300k in loans. and i'm lucky compared to some!
 

DrMetal

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yup, let's be real. being a physician was cool in the 90s and early 2000s.

I'm still cool, I don't know about the rest of you.

if our pay is cut, i'd probably leave for a more lucrative career.

Like what? Sad thing is we're locked in. After so many years of education and training, it's hard to leave and just go do something else. It's a lot easier to bail on a job when all you spent was 2 years getting that MBA.
 

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if our pay is cut, i'd probably leave for a more lucrative career. i'll finish residency with 300k in loans. and i'm lucky compared to some!

If medical pay is significantly reduced there will be an exodus of physicians seeking to leave the field just as you are. Opportunities to leverage the MD in non clinical ways have always been fairly limited, and it's going to get exponentially harder as the number of MDs trying to do so rises dramatically.
 
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DrSnips

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If medical pay is significantly reduced there will be an exodus of physicians seeking to leave the field just as you are. Opportunities to leverage the MD in non clinical ways have always been fairly limited, and it's going to get exponentially harder as the number of MDs trying to do so rises dramatically.

I think employers' ability to reduce medical pay will be limited strongly by location, because at the end of the day you still need to have someone hired to do the job. Can you get away with lowering pay in big cities where people want to work? Probably. What about in more rural areas where they already struggle to find employees at competitive pay rates? I doubt it.
 

bronx43

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I think employers' ability to reduce medical pay will be limited strongly by location, because at the end of the day you still need to have someone hired to do the job. Can you get away with lowering pay in big cities where people want to work? Probably. What about in more rural areas where they already struggle to find employees at competitive pay rates? I doubt it.
There only needs to be a fixed differential between "desirable" and "undesirable" locations. Currently, rural pays anywhere from 20-50% more than metro jobs for medical specialties. This means that if both cut by 30%, there will still be a 20-50% differential between the two - and I would argue that's enough to draw a physician workforce.

Furthermore, the job market is more or less musical chairs. There's only a certain amount of elasticity of supply that can be absorbed in big cities. At a certain point, there will be no more jobs available in big cities due to the fact that a substantial portion of rural patients rather seek no care (voluntary or otherwise) than drive hours to see a physician in the city.
 
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owenwilsonwoah

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There's no point in asking what specialties are being affected at this point. Things are in flux month by month and region by region. The real question for the long haul is what happens to US healthcare. I am not bullish on the landscape for physicians in the future. I would put money on the implementation of a public option in the next 24 months, which then will rapidly become single payer.

how would a single payer system affect the various specialties? would all be affected equally? if the incentive for pay is not there, would the fields with worse lifestyles begin to have better hours?
 

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There only needs to be a fixed differential between "desirable" and "undesirable" locations. Currently, rural pays anywhere from 20-50% more than metro jobs for medical specialties. This means that if both cut by 30%, there will still be a 20-50% differential between the two - and I would argue that's enough to draw a physician workforce.

Furthermore, the job market is more or less musical chairs. There's only a certain amount of elasticity of supply that can be absorbed in big cities. At a certain point, there will be no more jobs available in big cities due to the fact that a substantial portion of rural patients rather seek no care (voluntary or otherwise) than drive hours to see a physician in the city.

Yeah, people have a tough time grasping the relative sizes of macro things. Rural demand isn't going to save anyone from a sufficiently large shock to the overall physician market. It's as silly as thinking that if medicine in the States dies, you can just go to Canada, Australia, or the Middle East. Nope, you can't, any more than you'd be able to escape via a little used side street in the event a major accident blocks all traffic on a LA highway during rush hour.
 
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wamcp

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There's no point in asking what specialties are being affected at this point. Things are in flux month by month and region by region. The real question for the long haul is what happens to US healthcare. I am not bullish on the landscape for physicians in the future. I would put money on the implementation of a public option in the next 24 months, which then will rapidly become single payer.

Yes. Single payer is the biggest threat to our current income and lifestyle.


Taiwan and South Korea are single payer.

In Korea the average salary is 126K.
in Taiwan it is 116K at the HIGHER END of the scale.

in both countries, the attendings are worked HARDER than in the US. They both have THREE TIMES the number of consultations/visits than the OECD average.

How would you feel getting paid less than half of what you make today, but have three times the workload?

oh and don’t forget about single payer canada, where if you want to practice, you have a 20% chance of being unemployed. Nearly one in five new specialist doctors can’t find a job after certification, survey shows


 
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bronx43

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how would a single payer system affect the various specialties? would all be affected equally? if the incentive for pay is not there, would the fields with worse lifestyles begin to have better hours?
This will also evolve over time, and is dependent on the market players and forces. Single payer doesn't mean single vertically integrated system a la UK's NHS. It simply means that there is one source of financial reimbursement for the entire health care system - basically Medicare for All. Independent health care systems won't go down easily, as they will first cut costs to balance their books in conjunction with reduced reimbursement rates. This means that physicians' incomes will drop but they may not necessarily be the kind of salaried federal employees that one would be under a federally run system.

In the short and medium term, I expect independent health care systems to maintain productivity based compensation models for physicians, but at drastically reduced wRVU conversion. In other words, you will still be incentivized to be productive, but your overall income will drop. Will hours improve for "bad lifestyle" specialties? Maybe but I wouldn't count on it.
 

lessismore123

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Yes. Single payer is the biggest threat to our current income and lifestyle.


Taiwan and South Korea are single payer.

In Korea the average salary is 126K.
in Taiwan it is 116K at the HIGHER END of the scale.

in both countries, the attendings are worked HARDER than in the US. They both have THREE TIMES the number of consultations/visits than the OECD average.

How would you feel getting paid less than half of what you make today, but have three times the workload?

oh and don’t forget about single payer canada, where if you want to practice, you have a 20% chance of being unemployed. Nearly one in five new specialist doctors can’t find a job after certification, survey shows


Grossly underestimating pay in other countries. At least speaking for the SK data, that average quoted on the website includes residents and fellows as well as those serving as military officers as part of mandatory military service with pay on par with residents. Physician pay, esp considering COL, is on par with US salaries. Whether workload is higher is arguable-more patients seen but less documentation burden.
 
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