Everyone is telling me not to be a physician because of Obamacare?

[plumazul]

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Tom Baker.

my favourite "old" Doctor, 👍👍👍

 

[CDI]

my favourite "old" Doctor, 👍👍👍

Favourite?

 

[yehhhboiii]

doctorcox did you just finish an introductory economics course or something? jesus

also, it has been my experience that the more randomly capitalized words that are in a post, the less knowledge that poster tends to have about a topic.

 

[fourhumours]

http://www.youtube.com/watch?v=gMHY21VA8WE

notice he answer "no" to the eventual question "should we let him die" but he imidiately pivots away from the question. this is why "free market" doesn't work because as a society we inherently attach value to every human life (well at least every american human life).

 

[Gut Shot]

Wtf are you talking about, physicians don't get paid more to order more tests and drugs.

Actually I do make more money the more tests I order, because I interpret them. The amount I pull in is only a fraction of the actual costs associated with running the tests, so I am part of the tail that wags the dog.

This arrangement is similar throughout much of medical practice, where some hospitals and providers allow reimbursement margins to influence decision making. I would recommend Atul Gawande's The Cost Conundrum as an interesting read on this subject. It is excellent.

They order more tests because they're afraid of missing a Dx and getting the **** sued out of them.

Interestingly, tort reform has had zero to minimal measurable impact on health spending. See this nice NBER summary of The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums. You may also enjoy New study: Tort reform has not reduced health care costs in Texas.

It would seem that one man's defensive is another man's thorough.

 

[Jewels86]

Actually I do make more money the more tests I order, because I interpret them. The amount I pull in is only a fraction of the actual costs associated with running the tests, so I am part of the tail that wags the dog.

I've heard this misconception from the patients I worked with in the ER; they think they only reason why the doc orders more tests is to make more dough. I'm constantly rebutting this ideology by telling people that the doc is taking a holistic look at everything that could be going on to make a more comprehensive assessment/decision. That seems to simmer this argument.

I want to be a Family Doc because this is where my heart is, regardless of who's running the show. I want to educate my future patients about their illnesses, disease management, healthy living, etc., to improve the quality of their lives. I'd do it for my nurse pay, as long as I can pay down those loans 🙂

 

[IJL]

I want to be a Family Doc because this is where my heart is, regardless of who's running the show. I want to educate my future patients about their illnesses, disease management, healthy living, etc., to improve the quality of their lives. I'd do it for my nurse pay, as long as I can pay down those loans 🙂

Sounds good, keep practicing that for the adcoms.

 

[Radon XP]

yea because being forced to run your business according to the government is what capitalism and liberty is all about right?

Go read the Constitution and come back to me.

Capitalism and liberty don't belong in the same sentence, unless "is not" is in between them.

If you want to keep these companies around, fine, but at least create a public option that can easily undermine them so that they will be forced to cut their own prices. Otherwise: yes, if you work in an industry that is vital to the health of the nation, and you're putting your own profit ahead to an unreasonable extent, you should absolutely be forced to change or have your insurance company seized.

Therefore health care becomes cheaper.... is that a bad thing? Refer to my original post- free market will increase competition so you can decrease health care costs, and increase quality. Doctors wages will be determined by the demand of care for their particular field.

No, wages would then be determined by whoever has the most $$$ and the largest shares in medical companies.

You're throwing physicians to the sharks.

 

[Status Sciaticus]

d00d they're not screwed. They'll still bank, just a little less. They're getting stuff out of the bill, all right. (Too late EST to type it all out on my phone.)

Here, we'll switch. You go read Marx and figure out all the nuances of his political philosophy, and we'll run a CTRL+F on an online version of the Constitution to see if "capitalism" is mentioned in there at all. If that's the goal of the longest standing Constitution in the world, it's time to get out of 'murica.

Thats my point, they are still losing money. And no business is every happy with losing money they dont have to.

Capitalism is the idea of a free market economy and is protected under the commerce clause, and under various amendments.

The whole point of the Constitution was to limit federal government from impinging on the rights of its people.

The 10th amendment delegates all powers not listed in the Constitution to the States.
The ACA violates that.

It definitely doesnt grant them the right to regulate corporations or companies.

Here is Article 1 Section 8 of the Commerce Clause:
Congress shall have the power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes.

Since insurance is not any of those, its also a violation of the Constitution and by extension of the democratic government process.

 

[Conflagration]

First off, a shout out to non-science premeds! I'm a Math major. ^^

In a perfect world economics wise, the free market would equalize wages and trim the fat through stiff competition and the like. However, there's no such thing as perfect, especially in economics. Health care by its very nature is extremely hard to construct like a business. Insurance is stupidly hard to comprehend, and costs have been allowed to balloon because, for lack of a better way of phrasing it, no one really knows what's going on. Tests are ordered as a CYA attempt because of med mal suits, which hasn't been looked at in a study yet. Insurance has low reimbursement rates, which begs the question- where is everyone's money going?

I think in order to mitigate the SNAFU that has become the health care system, we need to figure out what's going on first. Legislation doesn't help anything unless we're sure we're dealing with the issue. And it's a compound problem.

I admire the attempt on the part of ACA, but I don't think it'll help out as much as people think it will.

 

[thesauce]

Interestingly, tort reform has had zero to minimal measurable impact on health spending. See this nice NBER summary of The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums. You may also enjoy New study: Tort reform has not reduced health care costs in Texas.

It would seem that one man's defensive is another man's thorough.

The effect is very unlikely to be an immediate one. It has to trickle down through the training levels first. If you are used to ordering XYZ when a patient comes in with complaint A, you aren't going to suddenly stop once a law is passed, particularly if they've been burned in the past. Once tort reform passes, the young docs that are going through training will begin to learn how to practice in a different way. Even that will take time, as their attendings will be in the above boat and teaching them some "archaic" methods of practice. However, it will eventually trickle down and we will see the effects of those laws.

 

[thesauce]

First off, a shout out to non-science premeds! I'm a Math major. ^^

LOL. That's science. It's even included in your sGPA.

 

[Conflagration]

LOL. That's science. It's even included in your sGPA.

I should have clarified: not a Biology or Chemistry major. But that works out good for me, then!

Sorry for derping, everybody. ^^;

 

[plumazul]

Capitalism is the idea of a free market economy and is protected under the commerce clause, and under various amendments.

The whole point of the Constitution was to limit federal government from impinging on the rights of its people.

The 10th amendment delegates all powers not listed in the Constitution to the States.
The ACA violates that.

It definitely doesnt grant them the right to regulate corporations or companies.

Here is Article 1 Section 8 of the Commerce Clause:
Congress shall have the power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes.

Since insurance is not any of those, its also a violation of the Constitution and by extension of the democratic government process.

I 😍 the "logic" in rants like this. They "love" the Constitution, but the Constitution lays out exactly how we determine what is Constitutional and what is not. But they don't like that part of the Constitution.

I call them "Cafeteria Constitutionalist".

 

[fourhumours]

Thats my point, they are still losing money. And no business is every happy with losing money they dont have to.

Capitalism is the idea of a free market economy and is protected under the commerce clause, and under various amendments.

The whole point of the Constitution was to limit federal government from impinging on the rights of its people.

The 10th amendment delegates all powers not listed in the Constitution to the States.
The ACA violates that.

It definitely doesnt grant them the right to regulate corporations or companies.

Here is Article 1 Section 8 of the Commerce Clause:
Congress shall have the power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes.

Since insurance is not any of those, its also a violation of the Constitution and by extension of the democratic government process.

yo bud, I have health insurance from an RI provider of a national company and go to a doctor where I am temporarily living in maryland (and then in New Orleans where I will be for medical school). I am pretty sure three states means several.

also anyone who lives on a border of two states will probably be accessing healthcare in those two states at least (i.e. my homestate of RI and people going to either MA or CT). or what about when people go to renowned hospitals and centers like mayo or JHH? I am pretty sure the health industry and by extension the health insurance industry is commerce that is "among several states"

 

[CDI]

I should have clarified: not a Biology or Chemistry major. But that works out good for me, then!

Sorry for derping, everybody. ^^;

Don't apologize for derping. That's the very foundation of Pre-Med forums.

 

[Status Sciaticus]

yo bud, I have health insurance from an RI provider of a national company and go to a doctor where I am temporarily living in maryland (and then in New Orleans where I will be for medical school). I am pretty sure three states means several.

also anyone who lives on a border of two states will probably be accessing healthcare in those two states at least (i.e. my homestate of RI and people going to either MA or CT). or what about when people go to renowned hospitals and centers like mayo or JHH? I am pretty sure the health industry and by extension the health insurance industry is commerce that is "among several states"

It doesnt matter if your provider is a national company... Most insurance agencies (BCBS/Humana/Aetna/UHS) are.

You are not '"trading" anything by visiting doctors in different states since insurance is not goods but rather a service.

Also the clause referring trade among states... as in the states being unique entities and conducting trade between themselves, not individuals traveling to receive a service in different states. For example, the state of NY trading with the state of California is subject to intervention by Congress.

 

[plumazul]

It doesnt matter if your provider is a national company... Most insurance agencies (BCBS/Humana/Aetna/UHS) are.

You are not '"trading" anything by visiting doctors in different states since insurance is not goods but rather a service.

Also the clause referring trade among states... as in the states being unique entities and conducting trade between themselves, not individuals traveling to receive a service in different states. For example, the state of NY trading with the state of California is subject to intervention by Congress.

What are you proposing Gandalf? Do you want to repeal Article III? Do you want to repeal the entire Constitution? Every point you have mentioned is settled law (some over 100 years old)

I suggest you get yourself appointed to the SCOTUS. Only then will your opinions on this topic matter.🙂

 

[inycepoo]

What are you proposing Gandalf? Do you want to repeal Article III? Do you want to repeal the entire Constitution? Every point you have mentioned is settled law (some over 100 years old)

I suggest you get yourself appointed to the SCOTUS. Only then will your opinions on this topic matter.🙂

U.S. District Appeals first. Then a right-wing geezer has to retire or croak, while a GOP President is around to appoint him, and a GOP majority Senate has to be radical or drunk enough to confirm him with his past record of striking down commerce clause cases.

Yep, I'd say it's one in ten billion, but hey, that's still a chance! 🙄

 

[inycepoo]

Tom Baker.

I was referring to: www.amazon.com/gp/aw/d/0226036499/ref=redir_mdp_mobile regarding all the malpractice stuff.

Didn't even know who the other guy was.

 

[CDI]

I was referring to: www.amazon.com/gp/aw/d/0226036499/ref=redir_mdp_mobile regarding all the malpractice stuff.

Didn't even know who the other guy was.

Tom Baker.

 

[Status Sciaticus]

What are you proposing Gandalf? Do you want to repeal Article III? Do you want to repeal the entire Constitution? Every point you have mentioned is settled law (some over 100 years old)

I suggest you get yourself appointed to the SCOTUS. Only then will your opinions on this topic matter.🙂

U.S. District Appeals first. Then a right-wing geezer has to retire or croak, while a GOP President is around to appoint him, and a GOP majority Senate has to be radical or drunk enough to confirm him with his past record of striking down commerce clause cases.

Yep, I'd say it's one in ten billion, but hey, that's still a chance! 🙄

Actually I'm a libertarian, not a republican.

I probably will end up running for political office at some point late in my career.

Not enough doctors in Congress.

 

[CDI]

Actually I'm a libertarian, not a republican.

I probably will end up running for political office at some point late in my career.

Not enough doctors in Congress.

You're gonna sell-out like they all do. No vote for you.

 

[Status Sciaticus]

You're gonna sell-out like they all do. No vote for you.

I think selling out is a strong term.
A lot of libertarians end up in the democratic party because its impossible to be recognized as an independent.

If I had to say with absolute certainty, then I would call myself either a libertarian or a conservative democrat.

 

[inycepoo]

Actually I'm a libertarian, not a republican.

I probably will end up running for political office at some point late in my career.

Not enough doctors in Congress.

Also not enough premeds knowledgeable about politics.

 

[Dave89]

I think selling out is a strong term.
A lot of libertarians end up in the democratic party because its impossible to be recognized as an independent.

If I had to say with absolute certainty, then I would call myself either a libertarian or a conservative democrat.

Maybe ~40 years ago. This election cycle, the Democratic Party all but embraced Big Government ("the one thing we all belong to", Julia, etc.) as its platform. It's the Republicans that are slowly adopting some libertarian attitudes (e.g. on pot), not the Democrats.

 

[CDI]

I think selling out is a strong term.
A lot of libertarians end up in the democratic party because its impossible to be recognized as an independent.

If I had to say with absolute certainty, then I would call myself either a libertarian or a conservative democrat.

I don't care about all the lame names that ppl create to sound more legitimate. A politician is just that, a politician. You won't give 2 sh*ts about doctors once you are one. 👍

 

[fourhumours]

Maybe ~40 years ago. This election cycle, the Democratic Party all but embraced Big Government ("the one thing we all belong to", Julia, etc.) as its platform. It's the Republicans that are slowly adopting some libertarian attitudes (e.g. on pot), not the Democrats.

errr.... re pot. Washington and Colorado have Dem Govs, and I am pretty sure dem legislatures. also this map shows that the majority of states that at least partially legalize pot are democratic stronges hold (some Rep. states too). http://www.theatlanticwire.com/politics/2013/04/map-shows-dramatic-spread-legal-weed-us/63997/

I would say that, generally speaking, libertarians could fall in either party depending on which aspect of libertarianism is more important to you. is it social freedom (government less involved in our private/social lives) that's probably the dems (though the gun control push is a big exception). is it a smaller government that provides less services and an increased liberalization of our economy? well that's the Rep generally speaking. it all comes down to what aspect of personal liberty and small government you think is more important. its unfortunate for true libertarians because neither party really serves them well.

 

[GypsyHummus]

Non science major shout-out!

Personally, I do not like the the affordable care act. Yes, everybody should get covered yes, nobody should be at denied access to healthcare pre-existing conditions, but the bill in its present state gives way to much power to the insurance companies and not enough power to the physicians and patients.

With regards to position salary, if I'm going to take in $300,000+ worth of debt , I want to make sure that I can be able to pay it off and then have enough money left over to support myself and or a family. It's not even the amount of schooling that it takes, it's the amount of that that physicians are being forced into. Everybody's wondering why we have a primary care physician shortage. Why go to primary care, if I can make double or three times the amount of money being a surgeon or an anesthesiologist? I think that we should increase primary care physician salaries, this will give an incentive to young physicians to look at family medicine, internal medicine, as areas that they can live survive in.

 

[Status Sciaticus]

I don't care about all the lame names that ppl create to sound more legitimate. A politician is just that, a politician. You won't give 2 sh*ts about doctors once you are one. 👍

Sweeping generalizations aside, I dont think you know me and obviously cant speak for me.

 

[Radon XP]

lol @ all this talk of Democrats, Republicans, and Lolbertarians

When will folks realize this is all bread and circus?

 

[jw3600]

I don't even have words for this thread.

 

[Radon XP]

Might have to zoom a bit to read.

 

[jw3600]

Might have to zoom a bit to read.

cartoon[/QUOTE]

That's good reading.

 

[thesauce]

Non science major shout-out!

Personally, I do not like the the affordable care act. Yes, everybody should get covered yes, nobody should be at denied access to healthcare pre-existing conditions, but the bill in its present state gives way to much power to the insurance companies and not enough power to the physicians and patients.

With regards to position salary, if I'm going to take in $300,000+ worth of debt , I want to make sure that I can be able to pay it off and then have enough money left over to support myself and or a family. It's not even the amount of schooling that it takes, it's the amount of that that physicians are being forced into. Everybody's wondering why we have a primary care physician shortage. Why go to primary care, if I can make double or three times the amount of money being a surgeon or an anesthesiologist? I think that we should increase primary care physician salaries, this will give an incentive to young physicians to look at family medicine, internal medicine, as areas that they can live survive in.

The number of residency positions in all specialties are set, and they fill completely every year. Encouraging people to go into primary care will do ABSOLUTELY NOTHING. If everyone wanted to be a PCP, it wouldn't change the number of PCPs because there are only so many training slots. That's the bottle-neck. Secondly, perhaps specialists are paid twice as much, but they also have twice as much training. Thirdly, increasing the salaries of the large number of PCPs out there will cost an exorbitant amount of money, and there really isn't a good reason to do so given that it can't/won't result in a single additional PCP (see my first point).

 

[Dave89]

Might have to zoom a bit to read.
[/IMG]

LOLd at Creepy, Gunner Joe, and Stoned. Excellent.

EDIT: Not that I don't respect libertarians.

 

[plumazul]

Might have to zoom a bit to read.

image snipped

😆

 

[Gut Shot]

The 10th amendment delegates all powers not listed in the Constitution to the States.
The ACA violates that.

The ACA (read individual mandate) was upheld based on Congress's power to tax, not the commerce clause. The mandatory Medicaid expansion went down in flames. And most of the ACA's provisions are being functionally decided and implemented at the state level. States can even apply for a waiver (like Vermont has) and go their own way. In summary, yours is a weak argument that hasn't gotten any stronger with age and repetition.

 

[Status Sciaticus]

The ACA (read individual mandate) was upheld based on Congress's power to tax, not the commerce clause. The mandatory Medicaid expansion went down in flames. And most of the ACA's provisions are being functionally decided and implemented at the state level. States can even apply for a waiver (like Vermont has) and go their own way. In summary, yours is a weak argument that hasn't gotten any stronger with age and repetition.

Just because it is upheld now doesnt mean it wont be found unconstitutional later down the road.

Regardless of it's constitutionality, forcing insurance companies to change their policies and eligibility criteria is still interfering with their business practices. I'm not against the 16+ million Americans that were added onto government insurance/assistance. But I am against the government deciding how others conduct their business.

 

[Gut Shot]

The effect is very unlikely to be an immediate one. It has to trickle down through the training levels first. If you are used to ordering XYZ when a patient comes in with complaint A, you aren't going to suddenly stop once a law is passed, particularly if they've been burned in the past. Once tort reform passes, the young docs that are going through training will begin to learn how to practice in a different way. Even that will take time, as their attendings will be in the above boat and teaching them some "archaic" methods of practice. However, it will eventually trickle down and we will see the effects of those laws.

Sounds nice. Nice but specious. Got any evidence?

The proponents of defensive medicine as a huge problem in medicine usually make it sound like physicians generally know where the true line of reasonable testing is drawn, and they constantly and consciously overstep it for CYA reasons. But I think you and I both know that the reality behind most medical decision making is extremely complex. We are also prisoners of our rather human ability to perceive and judge risk, which is often quite shoddy in these circumstances.

In general terms I think the risk of a lawsuit either exists or it doesn't. If I make a decision on Monday that carries a 0.0000002% chance of bringing litigation, I don't change it because tort reform passes on Wednesday and drops the likelihood to 0.0000001% on Friday.

That said, I would agree that there are certain pockets of high liability/high payout (OB in Florida stand out to me) where changes in the law could affect clinical behavior in short order. Perhaps we're just considering different sides of the same coin.

 

[Gut Shot]

Just because it is upheld now doesnt mean it wont be found unconstitutional later down the road.

Regardless of it's constitutionality, forcing insurance companies to change their policies and eligibility criteria is still interfering with their business practices. I'm not against the 16+ million Americans that were added onto government insurance/assistance. But I am against the government deciding how others conduct their business.

So you're essentially against civilization. Have a happy, happy life.

 

[Status Sciaticus]

So you're essentially against civilization. Have a happy, happy life.

Yea since I am against Obamacare, I must be against civilization.

Your powers of deductive reasoning are quite stellar. 🙄

 

[Gut Shot]

Yea since I am against Obamacare, I must be against civilization.

Your powers of deductive reasoning are quite stellar. 🙄

Well, you just said you are against the government deciding how others conduct their business. Kinda makes it hard to run anything second world or better with that attitude.

 

[Bamfu]

I think Gut Shot just likes to argue. I've seen him/her in other threads, and he/she never quits.

 

[A7X]

Don't listen to what others say. Do it if you want to.

 

[Skyrich]

<3 Obama

 

[GypsyHummus]

So you're essentially against civilization. Have a happy, happy life.

Wow. Ok. Just because he doesn't want the government to force themselves into healthcare makes him anti civilization? Get off your high horse buddy. I dont think I have ever read such an arrogant comment before on SDN. How dare you. I dont care if you are an attending, you are wrong to make such assumptions.

 

[Skyrich]

I dont really understand though like....

More insured Americans=more money for insurance companies

Why doesn't that translate to higher or the same salary for doctors

plz school me

 

[oldbearprofessor]

The number of residency positions in all specialties are set, and they fill completely every year. Encouraging people to go into primary care will do ABSOLUTELY NOTHING. If everyone wanted to be a PCP, it wouldn't change the number of PCPs because there are only so many training slots. That's the bottle-neck. Secondly, perhaps specialists are paid twice as much, but they also have twice as much training. Thirdly, increasing the salaries of the large number of PCPs out there will cost an exorbitant amount of money, and there really isn't a good reason to do so given that it can't/won't result in a single additional PCP (see my first point).

This is a vastly oversimplified analysis. Whereas it is true that residency positions in FM, pedi and IM are virtually all filled, that does not mean that there is no way to increase the number of PCPs without increasing residency slots. First of all, about 80% of IM and 50% of pedi trainees will do a specialty fellowship and are therefore not ultimately practicing primary care. In pedi, many of these subspecialty slots are never filled as hospitals are decreasingly willing and able to offer these positions to those who did residencies outside the US. Although doing most fellowships in pedi does not benefit salary, it is not true that nothing could be done to encourage pedi residents (and IM residents) to practice primary care and thus increase the number of PCPs.

Some of the greatest need in pedi is providing care to underserved populations, whose needs are great but whose ability to pay isn't. There is plenty of room to enhance the number of pediatric residency graduates that fill this role. Improving the financial aspect of taking such a job would increase the number of PCPs providing such care. In addition, such an improvement might be very helpful in getting some pediatricians who are near retirement or working part-time to provide such care to increasing number of children.

As noted before, despite the awful thoughts of many on this board about it, the AAP and many pediatricians support universal coverage for children so that those who serve medicaid and low income children can be more readily covered for this type of care, especially community based PCP pediatric physicians.

 

[Status Sciaticus]

Wow. Ok. Just because he doesn't want the government to force themselves into healthcare makes him anti civilization? Get off your high horse buddy. I dont think I have ever read such an arrogant comment before on SDN. How dare you. I dont care if you are an attending, you are wrong to make such assumptions.

He might just be trolling... which is kind of interesting for an attending.

This is a vastly oversimplified analysis. Whereas it is true that residency positions in FM, pedi and IM are virtually all filled, that does not mean that there is no way to increase the number of PCPs without increasing residency slots. First of all, about 80% of IM and 50% of pedi trainees will do a specialty fellowship and are therefore not ultimately practicing primary care. In pedi, many of these subspecialty slots are never filled as hospitals are decreasingly willing and able to offer these positions to those who did residencies outside the US. Although doing most fellowships in pedi does not benefit salary, it is not true that nothing could be done to encourage pedi residents (and IM residents) to practice primary care and thus increase the number of PCPs.

Some of the greatest need in pedi is providing care to underserved populations, whose needs are great but whose ability to pay isn't. There is plenty of room to enhance the number of pediatric residency graduates that fill this role. Improving the financial aspect of taking such a job would increase the number of PCPs providing such care. In addition, such an improvement might be very helpful in getting some pediatricians who are near retirement or working part-time to provide such care to increasing number of children.

As noted before, despite the awful thoughts of many on this board about it, the AAP and many pediatricians support universal coverage for children so that those who serve medicaid and low income children can be more readily covered for this type of care, especially community based PCP pediatric physicians.

👍

One of the proposed ways to reduce the shortage is to increase the number of residency slots for primary care and incentivize those slots.

These incentives could included subsidized or free cost of attendance for a certain amount of years served in rural/underserved areas. While these programs already exist, the incentives are not as great to attract the majority of medical students.

The lower salary of PCPs coupled with 250-400K debt is not an attractive career move. Not to mention, the proposed salary cuts and reduction in medicare and thus residency positions will serve to worsen the problem.