curious monkey

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I've been told my so many physicians to specialize because they believe that IM docs salaries will continue to decrease over time and they believe that the role of an IM doc will continue to decrease due to more and more specialists and they're desire to grow their fields (and increase profit). Is this generally true. Is going into IM without specializing more of a risk than specializing. My problem is that I like the all-arounded nature of medicine and would hate to limit myself to a subspecialty. Any comments or suggestions?
 

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curious monkey said:
I've been told my so many physicians to specialize because they believe that IM docs salaries will continue to decrease over time and they believe that the role of an IM doc will continue to decrease due to more and more specialists and they're desire to grow their fields (and increase profit). Is this generally true. Is going into IM without specializing more of a risk than specializing. My problem is that I like the all-arounded nature of medicine and would hate to limit myself to a subspecialty. Any comments or suggestions?
When socialized medicine strikes, it will be the specialists that are hurt the most.

Take a look at canada. The average canadian primary care doc makes perhaps 10% less than the american primary care doc. However, the canadian specialist makes up to 50% less than an american specialist.

A typical specialist salary in Canada is about 180k, whereas teh primary care salary in Canada is about 110k. Compare that to america, where teh average primary care is about 130k and the average specialist is over 250k.
 

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MacGyver said:
When socialized medicine strikes, it will be the specialists that are hurt the most.

Take a look at canada. The average canadian primary care doc makes perhaps 10% less than the american primary care doc. However, the canadian specialist makes up to 50% less than an american specialist.

A typical specialist salary in Canada is about 180k, whereas teh primary care salary in Canada is about 110k. Compare that to america, where teh average primary care is about 130k and the average specialist is over 250k.
I keep telling everyone but they dont understand. Socialized medicine will not come to the US until War/Abortion/Gay-marriages become lesser topics. The American public might want it... but they vote based on those three issues and thus the status of medicine remains minor. Did you choose between Bush and Kerry based on their status with healthcare? How about Gore vs Bush?

No socialized medicine anytime soon. (I want socialized medicine too btw.)
 

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the original question was not exactly answered, but because of that, i guess you can infer that yes, general medicine will have progressive decreasing salaries.
 

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MacGyver said:
When socialized medicine strikes, it will be the specialists that are hurt the most.

Take a look at canada. The average canadian primary care doc makes perhaps 10% less than the american primary care doc. However, the canadian specialist makes up to 50% less than an american specialist.

A typical specialist salary in Canada is about 180k, whereas teh primary care salary in Canada is about 110k. Compare that to america, where teh average primary care is about 130k and the average specialist is over 250k.
Socialized Medicine is at least 25 years away....if it is coming, that is...
 

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Internal medicine as an outpatient practice is declining, but I imagine when the country realizes that there are not enough "primary care " physicians, the salaries will bounce back. Meanwhile, if you like internal medicine, but are not certain about specializing, consider being a hospitalist.
 

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Annette said:
Internal medicine as an outpatient practice is declining, but I imagine when the country realizes that there are not enough "primary care " physicians, the salaries will bounce back. Meanwhile, if you like internal medicine, but are not certain about specializing, consider being a hospitalist.
Primary care is in flux at the moment. Various orginization such as the ACP and AAFP are attempting to increasing values of RVU's (relative value units), as well as initiating additional ways to bill during an outpatient visit. There is a genuine concern regarding a "crisis" in primary care, at the current time Primary care compensation is significantly lower that subspecialities, however there may be some sort of equilization in the future.
 

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Indeed salaries/reimbursements are falling for internists. The sad thing is that their specialist counterparts are by no means immune from the same trend. In fact, the income gap between specialists and general practitioners has been decreasing for almost a decade now. All in all, the medical profession is not the field to pursue if you want to make money. If you put the same amount of hard work and dedication into any other venture, you're bound to make a lot more money. At the end of the day, if you're not comfortable with being a public servant, which is what doctors are, then you'll be very unhappy no matter what field you're in. Unfortunately with the advent of "evidence-based medicine", the intellectual challenge of the profession is only enjoyed by the elite academicians, albeit patients now have a much greater degree of protection. Most private physicians are just following guidelines and expert panel recommendations. Add to that the declining incomes, the crisis in medicine is no longer a matter of whether or not to specialize but whether one should even bother going to medical school. Many medical schools in the country are already feeling the heat as the number of quality applicants has been dropping. The proposals on the table to rectify this problem range from subsidizing medical education to making it shorter. All hopes rest on those who go into medicine just for the love of it but each year there seems to be less and less of such selfless altruists.
 

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Although it is true that the medical field probably offers its practioners the lowest effort:financial reward ratio compared to other profession, it does have certain outright advantages including for the most part stability and a tremendous amount of social respect and prestige (something stock brokers or ~ahem~ laywers dont get).

As far as the advantage of specialization, I feel that there are significant advantages of doing so. I struggled with decision to do a fellowship vs primary care at the end of my intern year as well. It's about choosing what you are REALLY interested in doing and focusing your efforts on your foremost strength. It's the same argument as choosing a major in college: liberal arts/general studies vs. molecular biology/comparative lit/latin... If you truely feel excited about cardiology or oncology or ID, and not so much the other fields, you should specialize. Given how broad medicine is, there is no way in hell you are equally passionate about every single field. In my experience, a good measure of how much you like a field is to look at the bread and butter diseases in that field (ie. chest pain in cardiology, copd in pulm, esrd on dialysis in nephro) and ask yourself if you mind seeing patients with those problems 7 days a week. Being able to become a specialist in the area that I feel most passionate about is the biggest reason why I chose to specialize.

Other perks to note for specialization is your role in patient care and the degree of knowledge required in your field. In major cities, specialists serve generally as consultants in the hospital and sees referral patients in clinic with one or two focused problem, not the "doc, I have fibermyalgia and I hurt all over" or "i need my dilaudid refilled" patients. In the hospital, your opinion and recommendations serve as a guiding light for other specialties and generalists alike, and you get respect. Although a broad knowledge of medicine is generally necessary, you dont need to stay at the forefront of literature with any field but your own. IN small towns/rural areas in the US, as a specialist, you may be the only one in the particular town or region, and in addition to the above, you have the option to be really busy, and be REALLY RICH really soon.

These are the reason why I think why at least 1/2 of the graduating medicine residents decide to go into fellowships. Primary care is becoming less popular and the American public focuses on "sick care" rather than health care (ie.pouring money into having the state of the art cath lab for acute MI and not spending enough on primary prevention of obesity and hypertension). In addition, it's becoming increasingly encroached upon by NP's and PA's to a point where people spending 1/2 the time (and money) you spent in school do the same job you do. Guess what? NP's can't do what a specialist do.

At the end of the day, if you have done a fellowship and truly hated what you do, you can always go back to primary care. If you graduate from residency primary care all the way, and then 5 years into practice you decide you hate it, you are kinda screwed.
 

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i am still just a lowly pre-med so take this for what it's worth, but i know some PCPs that did fellowships in nephrology. the majority of these guys' practices are primary care, but they are also trained to handle specialty issues as well. this is probably possible with some other subspecialties, too, so if you wanted to do a fellowship it doesnt mean you still cant do primary care or have a diverse practice.
 

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Faebinder said:
I keep telling everyone but they dont understand. Socialized medicine will not come to the US until War/Abortion/Gay-marriages become lesser topics. The American public might want it... but they vote based on those three issues and thus the status of medicine remains minor. Did you choose between Bush and Kerry based on their status with healthcare? How about Gore vs Bush?

No socialized medicine anytime soon. (I want socialized medicine too btw.)

Commie- Have you ever been involved in social med? Hope you have deep pockets. You have to pay to get to the front of the line... Read history before you go voting for those liberals.
 

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Shah_Patel_PT said:
Socialized Medicine is at least 25 years away....if it is coming, that is...
Look at most urban med centers and the clients... There bill is picked up from the govt, and in a sense this is the first step to govt. medicine. I agree we are far off, as long as the dam liberals keep their hands free from our field.
 

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Renovar said:
At the end of the day, if you have done a fellowship and truly hated what you do, you can always go back to primary care. If you graduate from residency primary care all the way, and then 5 years into practice you decide you hate it, you are kinda screwed.
How's that? A specialist who spends several more years in training and decides they hate what they do is far more screwed than a primary care doc who decides they hate what they do. You're assuming that the specialist would enjoy doing primary care more than their original field, which is pretty unlikely. In either case, both doctors would end up doing something they disliked, but the specialist would be far worse off financially than the generalist.
 

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KentW said:
How's that? A specialist who spends several more years in training and decides they hate what they do is far more screwed than a primary care doc who decides they hate what they do. You're assuming that the specialist would enjoy doing primary care more than their original field, which is pretty unlikely. In either case, both doctors would end up doing something they disliked, but the specialist would be far worse off financially than the generalist.
Yes, but the specialist is not screwed financially....in comparision to the FP/IM docs.
 

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endodoc said:
Look at most urban med centers and the clients... There bill is picked up from the govt, and in a sense this is the first step to govt. medicine. I agree we are far off, as long as the dam liberals keep their hands free from our field.

I agree...

..it is unfortunate that some medical students and even residents dont understand political agendas of liberals...
 

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Shah_Patel_PT said:
Yes, but the specialist is not screwed financially....in comparision to the FP/IM docs.
They are if you account for the lost income (opportunity cost) incurred by their additional years of (wasted) training.
 

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KentW said:
They are if you account for the lost income (opportunity cost) incurred by their additional years of (wasted) training.

Inspite of the income lost....specialist can make it up very easily....NOW....

Although 10 years from now...I cant say for sure that will be true...
 

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Shah_Patel_PT said:
If thats the scenario....then of course.....any doc is SCREWED! IM and FP docs cant make it up.....no matter how experienced they may be.
Next time, read the whole thread. ;)
 

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Any FM or IM doc, especially boarded in their specialty can easily exceed $200K a year and even more. Its what is a priority in their lives. yes, they may have to work a few more hours a week or do some weekend coverage for another practice etc, etc. but anyone with some work ethics and a brain can easily make lots of money in medicine. :D
 

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Was at a dinner last night, and one of the cardiologists was complaining that he was paid only $300 a cath instead of the $750 he used to get. He also complained that it took longer than 15 minutes to do the caths because of having to wait if labs weren't done, the previous cath had a complication, etc. Hmmm, in primary care, it would take seeing 8 patients to make $300.
 

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Annette said:
Was at a dinner last night, and one of the cardiologists was complaining that he was paid only $300 a cath instead of the $750 he used to get. He also complained that it took longer than 15 minutes to do the caths because of having to wait if labs weren't done, the previous cath had a complication, etc. Hmmm, in primary care, it would take seeing 8 patients to make $300.

Wow ...that big of a diff in reimbursements.......I wonder how it will be 10 years from now........ :(
 

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APACHE3 said:
Any FM or IM doc, especially boarded in their specialty can easily exceed $200K a year and even more. Its what is a priority in their lives. yes, they may have to work a few more hours a week or do some weekend coverage for another practice etc, etc. but anyone with some work ethics and a brain can easily make lots of money in medicine. :D
"few more hours".....HA....more like running around like a DOG.....don't get me wrong...the nephrologist are starting to have to do this also from what i hear...but for more money
But you're probably right....if you're smart you could make tons of money in primary care...but then again you chose the field of medicine...so how smart of a business man could you be. :)

In the end you should simply do what makes you happy, even if you don't get paid for it. :p
 

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Annette said:
in primary care, it would take seeing 8 patients to make $300.
Medicare currently reimburses $66.28-$101.57 for a 99214 (depending on local rates). Most private payers reimburse in excess of that. Thus, only 3-4 patients would need to be seen in order to make $300, not 8.

Many people are predicting that RVUs for procedural work will soon begin to decrease, and RVUs for cognitive work will increase. The difference in reimbursement between generalists and specialists will narrow. It won't take ten years for this to occur, either.
 

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Once again I will repeat myself.... Did you vote for the president based on healthcare or based on War/Terrorism/Abortion/Gay-Marriage?

Until those issues are put out of the way.... no one will change the healthcare into national mode. I doubt those issues will resolve even in 30 years.

So till then.. best we can hope is to make one side to win over there other.. I am speaking of the Malpractice Lawyers (milking the doctors by making them pay for frivilous suits) (These guys are with the democrats) vs Health Insurance Companies (milking the doctors by paying them little) (These guys are with the republicans).

The only way I can see this crunch stopping is to support larger organizations that represent doctors like AMA. If the AMA gives its support to one side fully, we will see a change in the system.

Personally I rather see them attack health insurance companies (yes hate me for being a liberal) but I wouldn't mind them going after malpractice attornies... either case... one side needs to be crushed fully.

The hidden message: Support large doctor organizations like the AMA whether you like them or not. They are the only thing that defends you.

Flame ahead. :sleep: