Devastating 13.7% Cut in Medicare Reimbursement

[BIS]

These cuts hurt CRNA's as well as Anesthesiologists. This hits Independent Contractor CRNA's as well as those CRNA's that work for MD run groups. This will hit everyones take home pay. The AANA spent tons of money lobbying againts the cuts as did the ASA.

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[jetproppilot]

Gas docs strike and its a matter of days before the govt changes the regs essentially allowing CRNAs to run roughshod over your specialty.

Agreed.

Thats why it'd haffta be ALL physicians.

United as one.

Yeah, sounds like a pipedream.

But ya never know.

Every groundbreaking idea/invention/movement hassta start somewhere.

Most good things start out as a bust.

Like John Grisham's first book signing....know how many people showed up????

One.

His buddy.

Now Dude's worth about fifty-mil.

Ya gotta start somewhere.

 

[rufio173]

I don't see any other way besides reimbursement cuts to save our failing medical system.

Socialized medicine is definitely on its way. There is no way we could return to the "golden ages" since the US is strapped for cash already secondary to debt up to our eyeballs because of wars, foreign policy, China.

Listen, if all physicians walked out, how many people/patients will die... has anyone thought of this? I don't see it mentioned once in this thread.

I guess I'm just extremely naive, but I got into medicine for the patients and I'm glad I found anesthesiology. I wouldn't really care if I made 150,000 per year for what I do as long as I loved my work. At 150,000 bucks per year, you can support your family with ease (Well, I guess it depends on where you are living). I would easily accept such pay... My parents combined make roughly 60,000 per year and have been able to put 3 kids through school as well as provide a roof over our heads. Hell, we even got to go on vacation at times.

If re-imbursements do continue to go down, then I can only imagine that school tuition would follow, but they aren't low enough yet to institute such a plan.

Anyways, just my two cents. I know every cut hurts practicing physicians used to the current reimbursement rates, but you've gotta understand that when I go into practice, that in the end... I'll have never experienced those cuts and will be very happy with my 125,000-150,000 dollar paycheck every year. I'm not going to quit medicine or stop taking care of my patients because of budget cuts.

When I stop being able to provide for me and my family, then there will be a backlash, however for me (just a MS4) and for many physicians out there I believe, it is not at that level yet. I think it just depends on your definition of "provision".

Different people have different tolerances/ideas of what is considered a good lifestyle. I guess for most current and up and coming anesthesiologists... it's making 250-300K per year. I don't know about you, but you can easily pay off your loans within 2 years if you continue living a moderate lifestyle (just think of it as two more years as a resident) with that pay. I definitely don't plan on living in a house worth more than 300,000-400,000. I'm not ever going to drive a luxury car. But then again, these things aren't important for me. Personally, I have no fear that I will be able to provide for myself and my future family and pay back my loans on time. Then again, I live a pretty frugal life and don't need many of the luxuries that most Americans require.

Also, if you are financially savvy or just plain take some time to read about investing and actually just invest in the S&P fund. You can pay off your loans over the next 15-30 years and still actually be ahead of the game because your investments should (if the current rates continue) actually put you ahead of the game by that time.

Wow, that was longer than expected, and I know I will be getting a lot of angry/irritated responses, but I just had to chime in because what most people are saying on this thread just sound callous and downright catastrophic for medicine as a whole. I'm sure a lot of your are just venting, but it's scary to think what might happen if all healthcare stopped for a few days.

Imagine if you had a loved one with a serious illness that died because they had NO ONE to provide even rudimentary care for them.

Peace,
John

 

[matt1234321]

This might be shocking. I was digging around the foreign doctors forums and saw this.

I guess it's a matter of what you really want to do/achieve in your life. If a doctor wants to get rich/get work easily in other countries, then being a nurse is a good option. But if a doctor really wants to help people...I think he should stick in medicine.

I'm actually being biased, because that is the growing trend in the Philippines, and it's a shame, because a lot of Filipino citizens are still underserved. I understand though, that some doctors have families to feed, or they're really just sick of the way things are run in the country, so they go into nursing. But I believe in the principle that if you want to get rich, you should have gone into something else in the first place --business, maybe -- not medicine. Medicine, more than a profession, is a service. At least right now, in this part of the world.

 

[matt1234321]

My point is we still have the greatest healthcare system in the world and the HIGHEST PAID PHYSICIANS on planet earth. So even if they cut reimbursement by 50%, is it really that bad?

 

[badgas]

My point is we still have the greatest healthcare system in the world and the HIGHEST PAID PHYSICIANS on planet earth. So even if they cut reimbursement by 50%, is it really that bad?

I agree that 150K would be fine. It sounds like I'm after about the same lifestyle as rufio173. What I have a problem with is the principle. Everytime there needs to be some more money cut the first place they look is to cutting reimbursements. Why are the doctors the ones they always go after? Why not go after insurance companies? Why not go after drug companies? If we just keep letting them hack away at our salaries, we are gonna wake up making 40K and kicking ourselves for not standing up to them. So it's not about the fact that I need 300K... it's the fact that they'll be going after me first while the hospital CEO is giving themself a raise.

 

[lakerjock]

wow, working for 150k? going through years of medical school and residency, not thoroughly enjoying the best years of your life, and starting out with enough debt to buy another house and you still only want 150K? meanwhile traveling nurses are making over 100K, MBA's start at 100K and quickly ramp up, airline pilots 120K, etc. 150K was a lot of money 10 years ago, but 150K isn't much anymore.... Remember taxes are going to leave you with only 80K to do anything with....take out of all things health insurance for your family, gas for your car, house payment, car payment, debt repayment, money for retirement, saving for your kids education - all the time you are getting up at 5AM, standing up all day working, taking on risk, and at least once a week working for 24 hours straight! You truly don't value the services you render.

 

[badgas]

wow, working for 150k? going through years of medical school and residency, not thoroughly enjoying the best years of your life, and starting out with enough debt to buy another house and you still only want 150K? meanwhile traveling nurses are making over 100K, MBA's start at 100K and quickly ramp up, airline pilots 120K, etc. 150K was a lot of money 10 years ago, but 150K isn't much anymore.... Remember taxes are going to leave you with only 80K to do anything with....take out of all things health insurance for your family, gas for your car, house payment, car payment, debt repayment, money for retirement, saving for your kids education - all the time you are getting up at 5AM, standing up all day working, taking on risk, and at least once a week working for 24 hours straight! You truly don't value the services you render.

Technically I could SURVIVE off 150K... I'd prefer what I'm worth.

 

[blocks]

My point is we still have the greatest healthcare system in the world and the HIGHEST PAID PHYSICIANS on planet earth. So even if they cut reimbursement by 50%, is it really that bad?

It is that bad when I paid 200K to go to med school, I am currently amongst the lowest paid per hour employees in the hospital so I can't afford to pay my loans, and my loan interest capitalizes to the tone of $5000 per year. Cutting reimmbursement by 14% at a single shot IS a big deal to physicians, but it is going to save peanuts in terms of healthcare costs becuase physicians salaries are a small piece of the pie. It's being done because it's easy to do...because people in the field, like you, accept it---but not because it's going to save patients money or improve the healthcare system, it will do the opposite.

 

[VolatileAgent]

i'm still trying to figure out how we as individuals purporting the ability to unite ourselves (somehow) can do a better job or be more effective than the asa and the asa-pac, already established advocacy and professional organizational groups.

you need people in office. these are the guys that can help:

http://www.asahq.org/news/asanews111006.htm

perhaps we do need a "physician walkout day", and i'd be the first to support this. but, this will not come from any single professional organization. it has to be a confederacy of all physicians organizations, and it would have to be for non-emergent cases. i think it would be an incredible way to make people realize that the policy wonks have misdiagnosed the problem are aiming the wrong treatment against a group who isn't causing the problem.

here's the asa's position.

http://www.asahq.org/news/asanews110306.htm

they have to walk a fine political line, inherent in any organization its size, and appease and answer to a diverse crowd. what more do you want from them? that's a serious question. please tell me. shouldn't we try to work within the system to make it a more effective organization? why do some want to throw the baby out with the bathwater?

 

[Sammich81]

Hey does anyone know how often the ASA site gets updated? I went to the CapWiz site to write a letter and the Virginia senator is not so much George Allen anymore ...by all of .3% of the votes

Just wondering when I should check back.

And as a neophyte to most of this--about to start residency next year--how would the more experienced among you recommend getting involved, instead of just reading threads like this and pulling my hair out in rage?

 

[thegasman]

I don't want to work for 150K when some CRNA is making 180-200 or even more.

 

[matt1234321]

I imagine if the anesthesiolists salary dropped to 150k, then likwise crna salary would fall to 80k.

 

[Conflicted]

CRNAs make 140K on a national level and i doubt you would see this ever drop.

However, MD/DO should never, NEVER accept such a salary. The fact is, 4 years of medical school, 3-4 of residency and all that debt could never be paid off with 150K a year until yer dead. Im a strong proponent of "more school = more pay".

(lets not forget the life drain med school and residency is)

 

[gradoman]

it makes me sick to hear future gasdocs say they would accept 150k cause that is enough for them....bull s h i t ...cause you say that to the right people and that is what you will get...you have to know your worth cause you are cheapening the field for all docs..so stop saying that ridiculous statement..it doesnt prove that you are a great person in love with anesthesia and patient care and that money doesnt matter..it just shows your financial ignorance..
even if the cuts go through alot of groups(mine included) get a sizable stipend from the hospital to maintain our salaries...but who knows how long this gravy train ride will be? i dont know the answer..this is all my humble opinion and being one year out i want to preserve this great specialty for future docs and maintain the good income level to attract talented medical students to this field...when people thought the jobs and salaries werent in anesthesia look at the people that the specialty had to take..no offense to them and i wish them all the success but too many years of lower quality residents will be bad for the field and cause a glut of unboarded anesthesiologists running around accepting 150k because they have too...and then your group will lose their contract and the hospital will be restaffed with cheaper docs....perhaps a worse case scenario but you see where i am going

 

[sallyjoe]

CRNAs make 140K on a national level and i doubt you would see this ever drop.

However, MD/DO should never, NEVER accept such a salary. The fact is, 4 years of medical school, 3-4 of residency and all that debt could never be paid off with 150K a year until yer dead. Im a strong proponent of "more school = more pay".

(lets not forget the life drain med school and residency is)

If you can't live on 150K and pay your loans off in less than five years. You got a serious spending control problem. If you can't live on an excessive salary like 150K you are destined to have to work till you drop dead. With the average US annual pre tax wages less than 37K you should be able to live comfortably on double that or pre tax 75K. This leaves pre tax 75K left to pay off your loans and save for retirement. Only after you have over funded you retirement account you can start spending you money like a drunken sailor. Until then unless you want to work forever keep your extravagance under control.





Table 1. Average annual wages for 2001 and 2002 for all covered workers by state

Average annual wages

State................................Year 2001...2002....Percent change,


UNITED STATES................ $36,219... $36,764... 1.5

Alabama......................... 30,102... 31,163... 3.5
Alaska.......................... 36,170... 37,134... 2.7
Arizona......................... 33,411... 34,036... 1.9
Arkansas........................ 27,260... 28,074... 3.0
California...................... 41,327... 41,419... 0.2
Colorado........................ 37,952... 38,005... 0.1
Connecticut..................... 46,993... 46,852... -0.3
Delaware........................ 38,427... 39,684... 3.3
District of Columbia............ 55,908... 57,914... 3.6
Florida......................... 31,553... 32,426... 2.8

Georgia......................... 35,136... 35,734... 1.7
Hawaii.......................... 31,253... 32,671... 4.5
Idaho........................... 27,768... 28,163... 1.4
Illinois........................ 39,083... 39,688... 1.5
Indiana......................... 31,779... 32,603... 2.6
Iowa............................ 28,837... 29,666... 2.9
Kansas.......................... 30,153... 30,825... 2.2
Kentucky........................ 30,021... 30,904... 2.9
Louisiana....................... 29,131... 30,115... 3.4
Maine........................... 28,815... 29,736... 3.2

Maryland........................ 38,253... 39,382... 3.0
Massachusetts................... 44,975... 44,954... 0.0
Michigan........................ 37,391... 38,135... 2.0
Minnesota....................... 36,587... 37,458... 2.4
Mississippi..................... 25,923... 26,665... 2.9
Missouri........................ 32,421... 33,118... 2.1
Montana......................... 25,195... 26,001... 3.2
Nebraska........................ 28,377... 29,448... 3.8
Nevada.......................... 33,121... 33,993... 2.6
New Hampshire................... 35,481... 36,176... 2.0

New Jersey...................... 44,320... 45,182... 1.9
New Mexico...................... 28,702... 29,431... 2.5
New York........................ 46,727... 46,328... -0.9
North Carolina.................. 32,024... 32,689... 2.1
North Dakota.................... 25,707... 26,550... 3.3
Ohio............................ 33,283... 34,214... 2.8
Oklahoma........................ 28,016... 28,654... 2.3
Oregon.......................... 33,204... 33,684... 1.4
Pennsylvania.................... 34,978... 35,808... 2.4
Rhode Island.................... 33,603... 34,810... 3.6

South Carolina.................. 29,255... 30,003... 2.6
South Dakota.................... 25,601... 26,360... 3.0
Tennessee....................... 31,520... 32,531... 3.2
Texas........................... 36,045... 36,248... 0.6
Utah............................ 30,077... 30,585... 1.7
Vermont......................... 30,238... 31,041... 2.7
Virginia........................ 36,733... 37,222... 1.3
Washington...................... 37,459... 38,242... 2.1
West Virginia................... 27,981... 28,612... 2.3
Wisconsin....................... 31,540... 32,464... 2.9
Wyoming......................... 28,043... 28,975... 3.3

Puerto Rico..................... 19,728... 20,662... 4.7
Virgin Islands.................. 29,210... 30,506... 4.4

 

[gradoman]

you realize that your argument is really pointless? fine..if you want to be like a socialist country and pay everyone the same then yes 150k is extravagant...but when you have lawyers, accoutnants, engineers etc..the professional class competing with you for resources,houses, school tuition etc...and for the amount of hard work and dedication and responsibility involved and you still dont think physicians "deserve" more than that is your opinion...but i think in light of other educated professionals 150k is underpaid..imho...are you really trying to compare a physician with a family making 37k and think that their needs are the same?

 

[blocks]

sallyjoe, your post is ridiculous. gee, that's nice that physicians make more than the national average for all workers, including unskilled and uneducated laborers. sorry, but i exect more than that, and making just a comfortable living is not good enough for me after all these years of work, and sacrifice. i never want to see that my salary is getting cut and lining some fat cat's pocket.

 

[blocks]

BTW sallyjoe, did you know that middle management at Kaiser HMO makes 150K + with a MBA? In fact, my friend's dad has an MBA from an average business school and makes well over 300K/year as an executive at Kaiser. You keep accepting paycuts as a physician and have fun slaving away nights, weekends and holidays to keep the money coming in to your hospital.

 

[fakin' the funk]

High "startup costs" and salaries of the 250-to-300K & above range, and are part of what keeps medicine so competitive and guarantees that those who become doctors are committed people of the intelligent-to-super-intelligent & above range.

Additionally: if the public, gov't, etc, thinks that 250-300K & above is too much to pay a physician, then why are they willing to pay stock brokers, lawyers, and dentists that same salary? The answer is because good investing, winning lawsuits, and having pretty teeth is in the public's self-interest. So, why isn't healthcare as high up in the self-interest scale?

sallyjoe, your post is ridiculous. gee, that's nice that physicians make more than the national average for all workers, including unskilled and uneducated laborers. sorry, but i exect more than that, and making just a comfortable living is not good enough for me after all these years of work, and sacrifice. i never want to see that my salary is getting cut and lining some fat cat's pocket.

 

[sallyjoe]

sallyjoe, your post is ridiculous. gee, that's nice that physicians make more than the national average for all workers, including unskilled and uneducated laborers. sorry, but i exect more than that, and making just a comfortable living is not good enough for me after all these years of work, and sacrifice. i never want to see that my salary is getting cut and lining some fat cat's pocket.

You obviously didn't bother to read my post.

I never commented on the merits of paying an Anesthesiologist 150K versus the MGMA average of approx. 340K.

I was only commenting on Conflicted's ridiculous assertion that he could not possibly survive on 150K per year.

Knock you self out blowing your 300K+ per year, on stupid stuff, over priced cars, houses, boats, aircraft, stereo systems, home entertainment systems, & whatever else it take to stroke your enormous ego. If you spend like that you will condemn your self to have to work till you die. "The Millionaire next store" has a great store of two doctors who make the same salary one blows it on stupid stuff and is in dept. The other saves and has a multi million dollar net worth. The choice is yours.

As one of my attendings warned me,

"It is not how much you make but how much you keep which is most important."

 

[me454555]

Sally,

Making 150k really isn't that much if you want to live someplace good. Look at the typical upscale, desireable neighborhood where most physicians want to live. Houses start @ 400k and move up real quick. We're not talking about mansions either, just a typical 4 BR. Most people say that your house shouldn't be more than 3x your annual salary so @ 150k we're talkin about a 450k house, not exactly a lot. Add in the costs of loans, kids, college, malpractice, and taxes its not a lot of money.

I've sacked the best years of my life for this profession and I will have to sacrifice a couple more. I work more hours in a week than some of my friends do in 2. I'm smarter and much more dedicated than most of them and I expect to be compensated justly. Sure if I wanted to live in BFE I could make do w/150k and be a king, but thats not why I worked so hard and gave up so much. Most medical students feel this way and residents will agree. BTW, I almost forgot to mention that we are one of the few proffessions that WILL get sued at least once in our career. How does that make you feel? Your "victim" can make a good couple mil off your "mistake". This will also add to your expenses. Consider this when you still think 150k is a lot of money. d

 

[lakerjock]

My vote: SallyJoe.

You seriously have to be kidding me.

 

[matt1234321]

High "startup costs" and salaries of the 250-to-300K & above range, and are part of what keeps medicine so competitive and guarantees that those who become doctors are committed people of the intelligent-to-super-intelligent & above range.

Additionally: if the public, gov't, etc, thinks that 250-300K & above is too much to pay a physician, then why are they willing to pay stock brokers, lawyers, and dentists that same salary? The answer is because good investing, winning lawsuits, and having pretty teeth is in the public's self-interest. So, why isn't healthcare as high up in the self-interest scale?

That is a good point. That is also the current problem. When peeps choose not to goto med school, reimbursement will increase.

SUPPLY AND DEMAND

 

[Faebinder]

Not a GAS person here but Sallyjoe.. you are smoking too much weed.

Take that 4 years of med school and 4 years of residency... calculate accumulated interest, loss of income and OH-The-Invaluable-Years-Of-Youth (or is your time on books free?). 250k+ is what it should be... not the 150k.

 

[Silent Cool]

You obviously didn't bother to read my post.

I never commented on the merits of paying an Anesthesiologist 150K versus the MGMA average of approx. 340K.

I was only commenting on Conflicted's ridiculous assertion that he could not possibly survive on 150K per year.

Knock you self out blowing your 300K+ per year, on stupid stuff, over priced cars, houses, boats, aircraft, stereo systems, home entertainment systems, & whatever else it take to stroke your enormous ego. If you spend like that you will condemn your self to have to work till you die. "The Millionaire next store" has a great store of two doctors who make the same salary one blows it on stupid stuff and is in dept. The other saves and has a multi million dollar net worth. The choice is yours.

As one of my attendings warned me,

"It is not how much you make but how much you keep which is most important."

What department are they in? Do they have any debt?

Thanx.
SC

 

[Mman]

What department are they in? Do they have any debt?

Thanx.
SC

did you just bump a 10 year old thread to ask about a typo?

 

[Silent Cool]

did you just bump a 10 year old thread to ask about a typo?

I was bored and it was late.

 

[Ignatius J]

I was bored and it was late.

At least we know his typo wasn't from fat fingering on the cellphone.