I am trying to get some opinions on this topic without creating a flame war. I am a medical student interested in primary care. I am concerned however about Obama's support for increasing the number of privately functioning NP's. I know Oregon allows NP's to practice seperately from MD's/DO's. Do you guys think this trend will continue? It worries me because I see this trend as having the potential to drive primary care salaries down and at the very least keep them constant.
My thoughts on future scenarios are as follows. Obama's plan: Increase primary care salaries by 8% (maybe a pay increase of 10k a year, maybe?). Decrease specialist (ie Radiologist) salaries by 15% ( a drop of perhaps 100k per year) thus decreasing the average physician salary on average. Increase the number of training programs in NP, PA, FP and IM. The new FP/IM spots will go primarily to foreign grads. (as you could fill 3000+ spots in primary care residency programs with foreign grads if you wanted to). The supply of NP's PA's FP's IM's increases as a whole, thus filling the demand and hence limiting the pay increase to primary care, ie primary care will never be making 250k+ salaries in the long run. (of course i am talking about the starting salaries that you get hired into and not Dr. X who is entrepreneurial enough to make 500k+ off his business model bc this isnt the avg Physician).
I thus think that Obama is "pretending" to favor primary care docs but creating a rift between physicians to decrease the avg salaries of all docs and simultaneously sticking it to GP physicians by increasing competition from NP/PA's that could function privately, thus increasing supply and stagnating pay increases to primary care in the long term.
Ok, that was really long, but what are your thoughts on this? 20 years from now will it still be much better (financially speaking) to be a specialist?
I mean sometimes I feel insulted that starting salaries in primary care in cities are 100k-140k (7 yrs education post bac; goes up to 200k) PA's make 90-120k (2 yrs education; goes up to 160k), CRNA's make 120k-180k (2 yrs education; goes up to 300k+) and our fellow docs start at 200-500k+ ( (8-11 yrs education; goes up to 250k-800k+). Why does society value us so poorly? The politicians say they want primary care and value PCP's but where is the proof? An 8%/7k increase in salaries (half of which goes for taxes)????? Are you kidding me???? No wonder no US grad wants to go into primary care. I suppose it doesnt matter bc you can fill the demand with IMG's.
As future PCP's can we do anything to change this? Should we move to Canada or GB? Or maybe all start concierge practices?
I sacrificed a lot to be where I am and will be 160k+ in debt. This figure will grow in residency. I feel like society doesnt respect us at all. We get ridiculed by nurses, PA's, NP's and even our own physicians and patients. (i'm venting). I've had surgeons stop teaching me in the OR after I tell them I want to do general IM or FM?! Our own collegues! Peds, OB and IM attendings referring to FP residents as "there's the stupid FP resident." There's only so much you can take. And you know what, the sad thing is that it is all about dollars and cents. If we made 300k+ a year, people wouldnt be calling us "stupid GP".
I love primary care (particularly FP) and the interaction with patients/breath of practice, but i've had residency faculty members tell me not to do FM/IM bc they are so unhappy. The starting salary in my city is 90-110k for FM. My PA friends are making more than this 2+ years out. They are done paying their student loans, stable careers in big cities, moving on with their lives. We get nothing for our extra time/sacrifice/responsibility (and exposure to getting sued). Oh wait, Obama gave us an 8%/7k increase in salaries?!?
😕
Honestly, someone should stick this post on CNBC or MSNBC. People would probably just write it off as another "greedy doctor."
At least stop sueing us or cap litigation? (oh wait, Pres. Obama doesnt want to do that, not to trial lawyers (their value to society is equal to the bankers/financial institutions who got 700 billion dollars)).
20 yrs from now there will be VERY FEW US trained PCP's. But I suppose it doesnt matter bc IMG's, NP's and PA's will fill in the gaps. (until the IMG's realize its better to be a PCP in GB/Canada and incorporate.)
Maybe the new trend will be to make 2/3 year med schools with 2/3 year residencies to be a PCP (as has already started). Or maybe the 5 years of training that a PCP does over his PA/NP collegues is a waste. After all, it only takes 2 years to master the pathophysiology of the complex interactions taking place in multiorgan disease. ( sarcasm intended).
Being complacent and "sitting back and watching change happen" is why we are in this mess. GP's need to get more active in politics. PA's/NP's are very active and very aggressive, and hence, for better or worse, their practice privledges are increasing.
The question is will our fellow physician specialists help us? If not, what is the point of even being part of the AMA. United we stand, divided we fall. Do we need a seperate body to support GP's outside of the AMA? Is that what it will come to? If 'yes' is the answer, then physicians, GP's and specialists, have already lost on a political front.
For specialists who do not want to support the plight of the GP....maybe your opinions will change when NP's start opening CME clinics on colonoscopies, injections etc. Guess what, it doesnt take an Albert Einstein to do a lot of the procedures that specialists rake it in with. My last statement is that once you allow another political body to train in your field and do what you do for a living, they will continue to proliferate and grab turf until they are your equal. Currently DO's are the equivalent of MD's and are governed by a seperate licensing body that is allowed to create schools and residency programs. We work together and that is great. Perhaps it is time that our governing bodies stopped bickering on who is better/more prestigious, and joined together to create a unified governing council of Physicians that regulate who is allowed to practice medicine. Maybe one day allopathic docs can train at osteopathic residency programs as osteopaths can train at allopathic programs. Imagine that? If you want to learn OMM, you would be able to! And bill for it!!
Or our communities, MD's and DO's, specialists and generalists can squabble amongst ourselves and watch NP's create the AANP with one year residency programs in outpatient GI (scopes), Cards (EKG's/stress tests), Pain (injections), Cosmetics, Anesthesia (oh wait, CRNA's already exist...their first residency program!!) etc. Their argument might be that you dont need a physician to do simple procedures. Physicians are only needed for interpretations and more complex, hospital based procedures or to handle complications.
My thoughts on future scenarios are as follows. Obama's plan: Increase primary care salaries by 8% (maybe a pay increase of 10k a year, maybe?). Decrease specialist (ie Radiologist) salaries by 15% ( a drop of perhaps 100k per year) thus decreasing the average physician salary on average. Increase the number of training programs in NP, PA, FP and IM. The new FP/IM spots will go primarily to foreign grads. (as you could fill 3000+ spots in primary care residency programs with foreign grads if you wanted to). The supply of NP's PA's FP's IM's increases as a whole, thus filling the demand and hence limiting the pay increase to primary care, ie primary care will never be making 250k+ salaries in the long run. (of course i am talking about the starting salaries that you get hired into and not Dr. X who is entrepreneurial enough to make 500k+ off his business model bc this isnt the avg Physician).
I thus think that Obama is "pretending" to favor primary care docs but creating a rift between physicians to decrease the avg salaries of all docs and simultaneously sticking it to GP physicians by increasing competition from NP/PA's that could function privately, thus increasing supply and stagnating pay increases to primary care in the long term.
Ok, that was really long, but what are your thoughts on this? 20 years from now will it still be much better (financially speaking) to be a specialist?
I mean sometimes I feel insulted that starting salaries in primary care in cities are 100k-140k (7 yrs education post bac; goes up to 200k) PA's make 90-120k (2 yrs education; goes up to 160k), CRNA's make 120k-180k (2 yrs education; goes up to 300k+) and our fellow docs start at 200-500k+ ( (8-11 yrs education; goes up to 250k-800k+). Why does society value us so poorly? The politicians say they want primary care and value PCP's but where is the proof? An 8%/7k increase in salaries (half of which goes for taxes)????? Are you kidding me???? No wonder no US grad wants to go into primary care. I suppose it doesnt matter bc you can fill the demand with IMG's.
As future PCP's can we do anything to change this? Should we move to Canada or GB? Or maybe all start concierge practices?
I sacrificed a lot to be where I am and will be 160k+ in debt. This figure will grow in residency. I feel like society doesnt respect us at all. We get ridiculed by nurses, PA's, NP's and even our own physicians and patients. (i'm venting). I've had surgeons stop teaching me in the OR after I tell them I want to do general IM or FM?! Our own collegues! Peds, OB and IM attendings referring to FP residents as "there's the stupid FP resident." There's only so much you can take. And you know what, the sad thing is that it is all about dollars and cents. If we made 300k+ a year, people wouldnt be calling us "stupid GP".
I love primary care (particularly FP) and the interaction with patients/breath of practice, but i've had residency faculty members tell me not to do FM/IM bc they are so unhappy. The starting salary in my city is 90-110k for FM. My PA friends are making more than this 2+ years out. They are done paying their student loans, stable careers in big cities, moving on with their lives. We get nothing for our extra time/sacrifice/responsibility (and exposure to getting sued). Oh wait, Obama gave us an 8%/7k increase in salaries?!?
😕Honestly, someone should stick this post on CNBC or MSNBC. People would probably just write it off as another "greedy doctor."
At least stop sueing us or cap litigation? (oh wait, Pres. Obama doesnt want to do that, not to trial lawyers (their value to society is equal to the bankers/financial institutions who got 700 billion dollars)).
20 yrs from now there will be VERY FEW US trained PCP's. But I suppose it doesnt matter bc IMG's, NP's and PA's will fill in the gaps. (until the IMG's realize its better to be a PCP in GB/Canada and incorporate.)
Maybe the new trend will be to make 2/3 year med schools with 2/3 year residencies to be a PCP (as has already started). Or maybe the 5 years of training that a PCP does over his PA/NP collegues is a waste. After all, it only takes 2 years to master the pathophysiology of the complex interactions taking place in multiorgan disease. ( sarcasm intended).
Being complacent and "sitting back and watching change happen" is why we are in this mess. GP's need to get more active in politics. PA's/NP's are very active and very aggressive, and hence, for better or worse, their practice privledges are increasing.
The question is will our fellow physician specialists help us? If not, what is the point of even being part of the AMA. United we stand, divided we fall. Do we need a seperate body to support GP's outside of the AMA? Is that what it will come to? If 'yes' is the answer, then physicians, GP's and specialists, have already lost on a political front.
For specialists who do not want to support the plight of the GP....maybe your opinions will change when NP's start opening CME clinics on colonoscopies, injections etc. Guess what, it doesnt take an Albert Einstein to do a lot of the procedures that specialists rake it in with. My last statement is that once you allow another political body to train in your field and do what you do for a living, they will continue to proliferate and grab turf until they are your equal. Currently DO's are the equivalent of MD's and are governed by a seperate licensing body that is allowed to create schools and residency programs. We work together and that is great. Perhaps it is time that our governing bodies stopped bickering on who is better/more prestigious, and joined together to create a unified governing council of Physicians that regulate who is allowed to practice medicine. Maybe one day allopathic docs can train at osteopathic residency programs as osteopaths can train at allopathic programs. Imagine that? If you want to learn OMM, you would be able to! And bill for it!!
Or our communities, MD's and DO's, specialists and generalists can squabble amongst ourselves and watch NP's create the AANP with one year residency programs in outpatient GI (scopes), Cards (EKG's/stress tests), Pain (injections), Cosmetics, Anesthesia (oh wait, CRNA's already exist...their first residency program!!) etc. Their argument might be that you dont need a physician to do simple procedures. Physicians are only needed for interpretations and more complex, hospital based procedures or to handle complications.
Last edited:
