As I previously mentioned, most fields have nurse practictioners. Even dentists in my state had EDFCA's or whatever they are called that act as midlevel providers.
While Blade made the point that people still prefer a physician (I agree to SOME extent), I believe most people will still be okay with a non-physician provider as demonstrated by the reasonable profitability of the "Minute Clinics" outside of CVS.
Even Michael Jackson, was seeing them (see below).
Many of these posts are missing the larger points that I have brought up:
It's the fundamental underlying MODEL that is the issue with anesthesiology / much of medicine.
Unless there is some ability to respond to market forces (ie cosmetic surgery, high end dentistry) to give consumers a product they want then we are not going to do well.
In 10 years, a dental specialist may make more than most physician specialists, they are not on a fixed income (ie medicare rates) model in the setting of big time inflation, can adapt to the market etc, are less regulated by government, and offer stuff people want. Below is a real post from a newly solo private practice opthamologist illustrating this.
My conclusions:
Private practice medicine based on medicare / insurance model is dying...
We will likely all work for a big hospital as part of the ACO. At that point, who knows what salaries will be, but at 96K a year, many of us would have better options and the field would cease to exist...
http://iballdoc.blogspot.com/search?updated-min=2011-01-01T00%3A00%3A00-08%3A00&updated-max=2012-01-01T00%3A00%3A00-08%3A00&max-results=50
Math
"Beetles brought up the 30% SGR Medicare cut looming at the end of the year. I'm hoping that it will get "delayed" once again so that we end up facing a 50% cut in 2 years. However, if the cut does become permanent, there will definitely be some changes to the medical community.
So I've come to thinking about it and attempted a little math, and it looks like the large high overhead practices will be the first ones to take a hit. By the way, please correct any flaws in my math or logic.
Example 1
Let's say you have a small solo practice where your overhead is 45% and you see 20 patients a day. which I think is realistically possible. Using Ophthalmology Management's figure of $125 per patient after all is said and done, and assuming you work 5 days a week and 50 weeks a year, your current annual revenue would be $625K, overhead $281K, and take home pay $344K. An awesome deal.
Now, with the 30% SGR cut, your annual revenue would be $438K, overhead still $281K, and take home pay $157K. Not horrible, but much much less than the status quo.
Example 2
Now let's try this with a high overhead ophthalmic empire. Let's say you see 45 patients a day with 65% overhead (mostly attributing to more employees and larger office space rent). Using the same criteria, you would currently pull in $1.41 million a year, spend $914K in overhead, and take home $492K, which is nearly $150K more than example 1.
Enter the 30% SGR cut. Then you would bring in $984K, still spend $914K, and take home $70,000! In order to make the same post-cut $157K, the overhead will have to be between 58 and 59%, which I guess is possible.
The point I'm trying to make is that lower overhead will be key regardless of how big your operation is. And lower overhead will be even more important if the SGR cut goes through. I would imagine that the larger the practice you have, the larger the overhead will be. With the cuts in place, higher overhead practices will need to start cutting staff, including associate ophthalmologists. The job market for entry level ophthalmologists will probably be even more dismal. I wouldn't be surprised if some practices completely implode. That's why a lot of people are freaking out."
http://ac360.blogs.cnn.com/2009/06/30/transcript-of-cherilyn-lee-interview/
"Campbell: so just to give a sense of your relationship with him, how long had you known him, what was the relationship?
Cherilyn Lee: well I met him in January. And because someone called me and said his children had a runny nose and a little cough and could I come out to the house and see them. And because it was a referral person he felt very comfortable. And so when I arrived at the house I saw three children. And actually I love working with children and I kind of set something up for them some vitamin c and, you know, as a practitioner I listened to their lungs to make sure they were clear and went ahead and did the routine physical exam and everything. And after I finished with the children and had given them some vitamin c that they had, you know, the vitamin c powder and a couple of other things, it's a homeopathic; they told their dad they were feeling a lot better. So he looked at me and said what else do you do? And so I said well I help people, you know, when they want to very more energy. And he said, oh, well, okay, that's really good. And so we start taking it from there and I try to find out why is it you don't have any energy? And just went through the whole course of, you know, not that day. He asked me if I could come back the following day. So I went and drew some blood, maybe you're anemic or maybe it's this or that, but let's not second guess anything. I did full lab work. A full work-up on him. Then I told him from there that nutritionally we could get you set up.
http://ac360.blogs.cnn.com/2009/06/30/transcript-of-cherilyn-lee-interview/"
I'd like to thank the OP for starting this thread, it's nice to hear something positive about the specialty I've chosen. Although I can't think of any other specialty in medicine I'd rather be a part of, I do at times find myself pondering/worrying on the negative aspects of the field. I'm excited to get back in the OR's next year.
According to my attendings psych has it's own issues with reimbursement as well. They do pretty well and have a decent lifestyle right now, but they too believe the sky is falling. I like the analogy of the Titanic someone mentioned, really puts things into perspective.
