Future of Medicine

[DrAwsome]

So now that we know Obama has won, I'm conflicted about the future. Part of me wants to think that this issue with reduced reimbursement and stuff is just a temporary bump in the road given the crappy economy. But part of me fears the long term viability/stability of medicine. I think one of the reasons many of us go into medicine in addition to wanting to be a doctor is because of the stability that medicine is supposed to provide.

But now, with the constant cuts, we don't even have that.

For those of you who may have been in medicine for some time, I'm trying to get your thoughts on the future of medicine. I'm personally very concerned. While I don't think we need to make millions to be well compensated, I do feel that we should be well compensated financially given the huge investment, time committment, opportunity cost, etc that it takes to become a doctor.

More and more, it seems we have to work harder for less money, with more regulations, less autonomy, and I see other professions that easily match or supersede our salaries, with more flexibility and with far less training and work. Is this the future of the field-making 200k and working like dogs?

Anyone care to comment on this?

And while I realize this is not "residency related" per se, it would be nice if this post/thread was not moved to a different forum as I think it makes discussion easier here for one, and I think a lot of us are concerned about this. Thanks.

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[cowme]

More and more, it seems we have to work harder for less money, with more regulations, less autonomy, and I see other professions that easily match or supersede our salaries, with more flexibility and with far less training and work. Is this the future of the field-making 200k and working like dogs?

Pretty much

 

[DrAwsome]

Pretty much

Do you see a problem with that, or feel the need to do something or do you feel ok with that?

 

[GOINGDUMB]

.

 

[Smurfette]

Moving thread to Topics in Healthcare forum as this is a topic of interest to many on SDN, not just residents.

 

[quimicosoy]

I think, not only physicians will feel the punch, but all the health care workers. The problem, the way I see it, is that we are not getting significantly better in terms of results for the way we provide health care. For the amount of money paid to health care workers, results are expected to be much much better than other countries but that is not the case. For instance, I was born in south America, and my family stills live there so I travel a lot. The health care system down there is not as good as it is in here, but they still manage to get comparable results as the results we get here, AT A FRACTION, of the money spent here in the U.S.. THAT IS THE PROBLEM…when the higher ups compare , they don’t see the SIGNIFICANT extra benefit added. For instance, when I have to get some serious dental work, I just travel down there, and I do get the same service at a fraction of the price here.

The truth is this, if you go into health care for money, good luck lol. I am in pharmacy, and things look baaad…but still do it because I like what I learn. I can live with 40.000 a year. If I get paid more than that, then awesome, if not, well, thanks health care reform u screwed me bad…

The sense of entitlement of a health care worker should not be the compensation; it does not matter if you spent 25 years in training, or 2. It is more about the service you provide. Yes, it is easy to say, but with some people racking 300.000 in student loans, that is another dimension, however, it is a trade off...Many people WILL NEVER EVER be able to become an optometrist/pharmacist/physician/dentist/nurse, not because they can not, or they do not want to, it is because they will never get the money to have the privilage to pay for higher education. Here in the US, is all about making it happen, working hard, and boom you are in, and the money flows to pay for your training. You will become what you dreamed of, yea indebt for ever till you DIE! lol , but you are what you are, and that, will not be taken from you.

The health care delivery will change, reimbursment will get lower, and results will be comparable, other countries have done it, have learnt it, and U.S. will follow, now or in 20 years.

 

[thedrjojo]

I think, not only physicians will feel the punch, but all the health care workers. The problem, the way I see it, is that we are not getting significantly better in terms of results for the way we provide health care. For the amount of money paid to health care workers, results are expected to be much much better than other countries but that is not the case. For instance, I was born in south America, and my family stills live there so I travel a lot. The health care system down there is not as good as it is in here, but they still manage to get comparable results as the results we get here, AT A FRACTION, of the money spent here in the U.S.. THAT IS THE PROBLEM…when the higher ups compare , they don’t see the SIGNIFICANT extra benefit added. For instance, when I have to get some serious dental work, I just travel down there, and I do get the same service at a fraction of the price here.

The truth is this, if you go into health care for money, good luck lol. I am in pharmacy, and things look baaad…but still do it because I like what I learn. I can live with 40.000 a year. If I get paid more than that, then awesome, if not, well, thanks health care reform u screwed me bad…

The sense of entitlement of a health care worker should not be the compensation; it does not matter if you spent 25 years in training, or 2. It is more about the service you provide. Yes, it is easy to say, but with some people racking 300.000 in student loans, that is another dimension, however, it is a trade off...Many people WILL NEVER EVER be able to become an optometrist/pharmacist/physician/dentist/nurse, not because they can not, or they do not want to, it is because they will never get the money to have the privilage to pay for higher education. Here in the US, is all about making it happen, working hard, and boom you are in, and the money flows to pay for your training. You will become what you dreamed of, yea indebt for ever till you DIE! lol , but you are what you are, and that, will not be taken from you.

The health care delivery will change, reimbursment will get lower, and results will be comparable, other countries have done it, have learnt it, and U.S. will follow, now or in 20 years.

Bull****.

Most the measures of outcomes the WHO use are hardly reliable comparable between the various nations. Plus, most of these other countries also benefit from the ability of these companies from doing the R&D and make money here. Make us just like everyone else, and all of medicine, everywhere, will stagnate. It's like herd immunity...

Our cancer and surgical outcomes are much better than other areas of the world. Chronic diseases, prenatal care, on aggregate, yeah we could do better, but for those getting treatment, we are still cream of the crop.

You want the best and the brightest people in medicine? Then we need to have top line reimbursement. We need to streamline the training process, making it quicker, easier, and in general cheaper, or medicine will be something that is performed not by the best minds in the country, but by your average joe, and outcomes will suffer. For simple, minor, uncomplicated things, your midlevel providers are fine. Anything more complex though, and the system will suffer with them.

Am I going to leave medicine? No. If I don't see a reward for working more than 40hrs a week, am I going to do so? Not if I don't have to. You make me salaried, and I will earn my salary, fulfill my contractual duty. You need me to pull in a certain number of RVU's, I will meet that quota. But if I can't get extra compensation for extra work, then I would just be a chump for going above and beyond. And thats the problem with decoupling compensation from production.

 

[DrAwsome]

Bull****.

Most the measures of outcomes the WHO use are hardly reliable comparable between the various nations. Plus, most of these other countries also benefit from the ability of these companies from doing the R&D and make money here. Make us just like everyone else, and all of medicine, everywhere, will stagnate. It's like herd immunity...

Our cancer and surgical outcomes are much better than other areas of the world. Chronic diseases, prenatal care, on aggregate, yeah we could do better, but for those getting treatment, we are still cream of the crop.

You want the best and the brightest people in medicine? Then we need to have top line reimbursement. We need to streamline the training process, making it quicker, easier, and in general cheaper, or medicine will be something that is performed not by the best minds in the country, but by your average joe, and outcomes will suffer. For simple, minor, uncomplicated things, your midlevel providers are fine. Anything more complex though, and the system will suffer with them.

Am I going to leave medicine? No. If I don't see a reward for working more than 40hrs a week, am I going to do so? Not if I don't have to. You make me salaried, and I will earn my salary, fulfill my contractual duty. You need me to pull in a certain number of RVU's, I will meet that quota. But if I can't get extra compensation for extra work, then I would just be a chump for going above and beyond. And thats the problem with decoupling compensation from production.

Yep. Not to mention that if salaries continue to drop fewer people will go into medicine. As I've said before, why go into medicine if you can make 150-200k as a consultant, as an actuary, in finance, etc? It's ridiculous. If they don't want doctors well drop salaries and you'll see a current shortage become a crisis.

 

[MOHS_01]

Yep. Not to mention that if salaries continue to drop fewer people will go into medicine. As I've said before, why go into medicine if you can make 150-200k as a consultant, as an actuary, in finance, etc? It's ridiculous. If they don't want doctors well drop salaries and you'll see a current shortage become a crisis.

I don't know if fewer people will go in, but the caliber will likely be lower (granted, that has a lot to do with their potential alternative career paths). I postulate that it will not be readily apparent in our scholastic ratings that this dilution of quality is occurring due to the whay in which grades and scores are calculated. Either way, not good.

 

[DrAwsome]

I don't know if fewer people will go in, but the caliber will likely be lower (granted, that has a lot to do with their potential alternative career paths). I postulate that it will not be readily apparent in our scholastic ratings that this dilution of quality is occurring due to the whay in which grades and scores are calculated. Either way, not good.

I guess I just don't understand what it is that the gov wants. there are tons of money to pay congress, and police, and firemen, and teachers. Why is there no $ to pay doctors? I don't get it. Teachers strike and boom they get a huge raise. Police and firemen make the same that many docs make. What's the deal?

And I think they believe that doctors are important, so why is there a crappy reimbursement?

Again, I would say doctors in 1/2 of specialties make the same or less than many professions out there. that's pretty scary to think about when it requires over a decade to become a doctor vs. a 4-6 year degree for many other professions.

It's hard to believe that a consultant or an engineer makes the same or more as your avg IM/FM/Peds/psych/neuro, etc doc.

I don't know why we are not putting any pressure on the gov to pay what's right. I guess I don't get it.

What will happen when the doctor shortage is so extreme that people die right and left?

 

[MOHS_01]

I guess I just don't understand what it is that the gov wants. there are tons of money to pay congress, and police, and firemen, and teachers. Why is there no $ to pay doctors? I don't get it. Teachers strike and boom they get a huge raise. Police and firemen make the same that many docs make. What's the deal?

And I think they believe that doctors are important, so why is there a crappy reimbursement?

Again, I would say doctors in 1/2 of specialties make the same or less than many professions out there. that's pretty scary to think about when it requires over a decade to become a doctor vs. a 4-6 year degree for many other professions.

It's hard to believe that a consultant or an engineer makes the same or more as your avg IM/FM/Peds/psych/neuro, etc doc.

I don't know why we are not putting any pressure on the gov to pay what's right. I guess I don't get it.

What will happen when the doctor shortage is so extreme that people die right and left?

More FMG visas

 

[DrAwsome]

More FMG visas

That still doesn't answer the question. Even foreign docs don't work for pennies for one. For two, why doesn't the same apply to trying to reduce police, teacher, nurse, firemen, congress salary, etc?


Why trying to reduce physician salary?

 

[MOHS_01]

That still doesn't answer the question. Even foreign docs don't work for pennies for one. For two, why doesn't the same apply to trying to reduce police, teacher, nurse, firemen, congress salary, etc?


Why trying to reduce physician salary?

You don't think foreign docs would stand in line for $150-200k/yr? Really? Besides that, they expand scope of practice laws for midlevels, grant new authorities to other providers, etc. Quality dilution is the way to kick the can a little bit further...

Unions.

 

[DrAwsome]

You don't think foreign docs would stand in line for $150-200k/yr? Really? Besides that, they expand scope of practice laws for midlevels, grant new authorities to other providers, etc. Quality dilution is the way to kick the can a little bit further...

Unions.

Again you are not addressing the question. WHY try to reduce physician salary? WHY?
They INCREASE police, firemen, teacher, congress, etc. salaries all the time.

WHY would you reduce the salaries of doctors?

You can have nurses try to practice all you want, but I doubt the US as a super power wants to have nurses vs. physicians.

I think we should stand united- maybe one day a week everyone decides to not work. See how things work. No one has a backbone in medicine, it's kind of sickening.

And no, even foreign docs want to be compensated that's why they come here. You think they do all they do because they just admire the US so much? No it's bc of $$$$$$.

For 150-200k, I think I'd rather be a consultant and be home on the weekends.

 

[MOHS_01]

Again you are not addressing the question. WHY try to reduce physician salary? WHY?
They INCREASE police, firemen, teacher, congress, etc. salaries all the time.

WHY would you reduce the salaries of doctors?

You can have nurses try to practice all you want, but I doubt the US as a super power wants to have nurses vs. physicians.

I think we should stand united- maybe one day a week everyone decides to not work. See how things work. No one has a backbone in medicine, it's kind of sickening.

And no, even foreign docs want to be compensated that's why they come here. You think they do all they do because they just admire the US so much? No it's bc of $$$$$$.

For 150-200k, I think I'd rather be a consultant and be home on the weekends.

Okay -- here it goes, doc: no one gives two pints of monkey piss what you think you have earned or deserve based upon your education. It's not as personal for them as it is for you. You are not as important to them as you are to you. You are not as valued by them as you value yourself. Payers don't give a damn. Patients don't really give a damn. Politicians surely don't give a damn. Now ask yourself -- why would they "want to cut doctor pay"? Well... think about it for a second. There is a common belief that we spend too much on healthcare. There are but two or three ways to decrease the number of dollars being spent on healthcare; you can decrease the number of services provided, decrease the amount paid out per service, or decrease the need for services. Given that the first is rationing and politically untenable (DEATH PANELS!!:1! OMG!@!!), that's not going to happen (overtly and at first). The latter is impossible... which only leaves price controls. That's it. The politicos "must" do something. Sorry, junior, but we're on the wrong end of this screwing.

You cannot stand united. It's illegal. They have us over a barrel.

How well do you think docs do in purely socialized and poor countries? They don't have to love 'merica, they just have to be able to do better than they can do back home. Do you have any idea how low of a bar that is?

 

[thedrjojo]

Okay -- here it goes, doc: no one gives two pints of monkey piss what you think you have earned or deserve based upon your education. It's not as personal for them as it is for you. You are not as important to them as you are to you. You are not as valued by them as you value yourself. Payers don't give a damn. Patients don't really give a damn. Politicians surely don't give a damn. Now ask yourself -- why would they "want to cut doctor pay"? Well... think about it for a second. There is a common belief that we spend too much on healthcare. There are but two or three ways to decrease the number of dollars being spent on healthcare; you can decrease the number of services provided, decrease the amount paid out per service, or decrease the need for services. Given that the first is rationing and politically untenable (DEATH PANELS!!:1! OMG!@!!), that's not going to happen (overtly and at first). The latter is impossible... which only leaves price controls. That's it. The politicos "must" do something. Sorry, junior, but we're on the wrong end of this screwing.

You cannot stand united. It's illegal. They have us over a barrel.

How well do you think docs do in purely socialized and poor countries? They don't have to love 'merica, they just have to be able to do better than they can do back home. Do you have any idea how low of a bar that is?

I have been in kind of a rut.. Do you think they will call me tomorrow?

 

[lightfire22000]

I think one of the reasons many of us go into medicine in addition to wanting to be a doctor is because of the stability that medicine is supposed to provide.

California longshoreman was my first choice.

More and more, it seems we have to work harder for less money, with more regulations, less autonomy, and I see other professions that easily match or supersede our salaries, with more flexibility and with far less training and work. Is this the future of the field-making 200k and working like dogs?

What you don't point out is that some other professions and physicians in other countries also have high opportunity costs, declining wages, and much less stability and they've usually managed to grow in spite of gov't regulations. From family experiences, wall-street workers working to get into the high-end in I-Banking sometimes even end up working more than medical residents and students and the failure rate is much higher. They're expected to put in 12 hour days at least and their workload depends on their specific job. Engineers and mathematicians usually are expected to do all of their best work in their twenties. If it isn't good, they're often tossed aside at forty, so they too know 20 hour work days in the prime of their lives. There's no place to run from the increasing leviathan of gov't. In Canada with socialized medicine, primary care physicians tend to earn more than they would in America. Salaries aren't drivers of healthcare costs, unlike administration and malpractice.


That being said, I see universal coverage as the only long-term solution to public anxiety over healthcare costs. The simple reason is that mid-levels are slowly going to eat away at the practices of medicine until primary care is gone unless physicians' services can be afforded by the majority of the populace.

Relative to most other professions, medicine is a great one to be in for the upper-middle class lifestyle with upper-class potential. The only one that's got it beat is California Lonshoreman, but if you think getting into medical school is hard, try getting that job. I don't see salaries dropping too much because that hasn't happened elsewhere.

 

[thedrjojo]

California longshoreman was my first choice.




What you don't point out is that some other professions and physicians in other countries also have high opportunity costs, declining wages, and much less stability and they've usually managed to grow in spite of gov't regulations. From family experiences, wall-street workers working to get into the high-end in I-Banking sometimes even end up working more than medical residents and students and the failure rate is much higher. They're expected to put in 12 hour days at least and their workload depends on their specific job. Engineers and mathematicians usually are expected to do all of their best work in their twenties. If it isn't good, they're often tossed aside at forty, so they too know 20 hour work days in the prime of their lives. There's no place to run from the increasing leviathan of gov't. In Canada with socialized medicine, primary care physicians tend to earn more than they would in America. Salaries aren't drivers of healthcare costs, unlike administration and malpractice.


That being said, I see universal coverage as the only long-term solution to public anxiety over healthcare costs. The simple reason is that mid-levels are slowly going to eat away at the practices of medicine until primary care is gone unless physicians' services can be afforded by the majority of the populace.

Relative to most other professions, medicine is a great one to be in for the upper-middle class lifestyle with upper-class potential. The only one that's got it beat is California Lonshoreman, but if you think getting into medical school is hard, try getting that job. I don't see salaries dropping too much because that hasn't happened elsewhere.

"Universal coverage..."

The problem is that people want health insurance to pay for everything because people don't want to consider their health as an expense of living. We have car insurance, and while we pay a lot for it, do we expect car insurance to pay every time we fill up a tank of gas? what about if we take the car in for an oil change, or even a regular tune-up/inspection? No, we use the car insurance only when the costs are astronomical (like my wife's car accident last feb where it turned out to be an $8000 bill, +$1000 car rental cost, all covered under our $500 deductible). I read somewhere (can't find the exact source) that the average american utilizes slightly less than $3000 a year for actual health care costs. Now, most people are spending significantly more than that for insurance premiums, cause when you do use it, a 45 minute ER visit will run you a couple grand nowadays. If the insurance model became more like that of the automobile industry, where everyone had a catastrophic plan with a really high deductible for the year (like 2-3K, so all health care costs up to that point were the responsibility of the person, after that, the insurance covers it), then a HSA where you can shelter from taxes whatever that deductible is, and if you don't use it one year, you can roll it over into the next year. Insurance premiums go way down because it has become catastrophic coverage instead of oil change coverage, more people can get the catastrophic coverage, and people don't have to worry about the concerns of not being able to fund healthcare. People would then shop around more, question the need for defensive medicine, and the world would be a happier place. But no, people want the government to give them everything, and its disgusting.

 

[Gfliptastic]

I've seen the auto insurance metaphor used before, and I really think it is something to be considered. Heaven forbid your car blows up cuz you neglect to get a $50 oil change. Yet, I'm sure a few of us know people who won't go to the doctor because they didn't hit their deductible yet. Basically they care about preventive measures for their car, but NOT for themselves. How disconnected Americans have become!!