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Health care and MD's salaries in 10 years

Discussion in 'Pre-Medical - MD' started by tennisboy93, Feb 29, 2000.

  1. tennisboy93

    tennisboy93 Junior Member 10+ Year Member

    18
    0
    Feb 1, 2000
    Illinois
    Guys and gals:

    Have heard a lot of different things lately, in the news, programs, internet...all talking about doctors' salaries going down, and the changing face of health care, and a possible surplus of doctors in metro areas. Now, I am not wanting to be a doctor here because I want to get rich, but i think we all would be lying if we didn't say, at least to some degree, we want a respectable, noble profession that will provide nicely for our family/ourselves. I mean, come on. So my question is: what do we think health care will look like in 10 years? where will doctors' salaries be? Will there ever be a time when doctors make like, say, $50,000 a year? how are we to pay for school with that? And will there be MD's out there who SERIOUSLY can't find work because of a surplus, or just a "surplus" in certain areas? It honestly frightens me to think of how things might look different from the way they are now. I'm not looking to get rich here, but after all that hard work and competition I'd like to think we can all get at least $80,000 to 90,000 a year, and a stable job? Thanks, Brent )PS: Tim from NYC..you seem to know a lot, what do you think things will look like for us?) [​IMG]
     
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  3. DO Boy

    DO Boy Senior Member 10+ Year Member

    109
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    Jan 23, 2000
    TX
    Points to consider:

    -Salaries will be going down and down and down as managed care companies reduce physician compensation to make up for rising medical costs from law suits, administrative costs, technology, and the aging population.

    -The physician surplus (it is real) will increase supply/reduce demand futher decreasing physician salaries.

    -Supplier-induced demand does not exist in a managed care environment.

    -Physician unions can never go on strike thus reducing their bargaining power.

    So, now is not the right time time to get into medicine for the money b/c it won't be there. It still may not be there even if something dramatic happens to the hlth care system in the future.

    Keep all this in mind and read Learning to Play God and any other book describing the difficulty, irrationality, and lost life time (read: your non-medical friends are outside playing/partying) spent in medicine, internship, and residency (after four trying years of med school). Remember, life is very short.

    So get out while you can! You can make more money in way less time in the stock market and can always buy put options for the occasional 2-3 yr bear markets! Don't say you weren't warned by me or the thousands of currently unhappy physicians warning you too!!!

    BUT if you're crazy enough to believe in helping that one "gomer" that keeps you up all night after not sleeping the night before who all the while constantly puts you down and who prefers to die anyway without the "help" of your meddling procedures and their resulting complications, GO into medicine. That is your "nobility in medicine" that premeds don't really talk about.

    OFFICIALLY, this is probably the most DISMAL and PESSIMISTIC outlook of medicine I've ever read, but it's all in there. And, I love it. I've got my reasons for entering med school. Do you?


    DO Boy
    MPH candidate
    TCOM '04
     
  4. turtleboard

    turtleboard SDN Advisor 10+ Year Member

    1,594
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    Jun 3, 1999
    New York, New York
    I was fortunate enough to have attended a lecture given by a giant in the business of healthcare (who incidentally is also the new president of my med school), and from what was said at the lecture, and based on my own research:

    The predicted surplus may actually turn out to be true. For years there was a projected need for primary care physicians, but less than a year ago a study showed that there was actually a slight surplus in primary care physicians nationwide, slowing that demand.

    Despite there being a surplus, however, a doctor will never not find work. A doctor will never make $50,000 a year. Physician compensation is intimately related to the health of HMOs in this country, and as HMOs are becoming more and more unpopular (You can't even count all the HMOs that have folded on all fingers and toes!) physician salaries may in fact creep up and up.

    Medicine will NEVER go back to the traditional fee-for-service era, but it will also not advance toward more managed care organizations. What we will have is a kind of hybrid that allows maximum choices to the consumer, physician autonomy, and low cost. Capitation plans may not work. Things like IPAs (Independent Practice Associations -- mini-HMOs run by physicians) won't make it big either, because at some point, they'll degenerate to a form of HMO.

    From this same lecture, it was mentioned that socialized medicine will never make it big in America because the healthcare consumer DOES NOT want to wait, and this has been proven by our failed HMO experiment.


    Tim of New York City.
     
  5. Duo Degree

    Duo Degree Member 10+ Year Member

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    Feb 28, 2000
    Ft. Worth, TX, USA
    i feel a need to reply on this topic since i have a pretty strong background in healthcare. currently, i work for the largest integrated healthcare delivery system in texas, and so i think i have a pretty good insight into how medicine works. physician practices have definitely evolved. the solo practices have dissolved while group practices become the "fad." there have been alot of reasons for this change...including the desire for leverage when negotiating managed care contracts. Although physicians have recently entered into many unfavorable contracts which put them at risk(i.e. per member per month capitation), the trend seems to be reversing as providers are aggregating in order to gain an advantage in these contracts.

    now, for most new physicians, i understand that many are going to work for HMOs, or employed with some facility rather than opening their own practice. Yes, there will be less autonomy, but its a small price to pay in order to survive. as i see it, i dont think that less autonomy necessarily means less money or less authority. physicians are definitely still in control(at least within certain facilities) and are learning to work with people in delivering care. Money is decreasing, but not nearly to the extent that you predict. i think the older generation of physicians have voiced the most concern over the dwindling dollars because they are accustomed to certain level of income and living. we, as younger physicians, will hardly notice the difference bc it will certainly be more than we have ever had or need. we can adjust our standard of living and will be alot more comfortable than many other people in our community. yes we will have more work and responsibilities, but its something we should be able to adapt to. and by the way, salaried physicians, or employed physicians, also have negotiating power. there are several unions including PRN(physicians for responsible negotiations, which was derived from AMA). the physicians voice is strong depsite the onset of managed care(which is more than just HMOs). many other types of managed care organizations are being created and the method of healthcare delivery is changing due to creative minds. this is an area which im interested in being a part of due to my background. if anyone has questions about healthcare..please feel free to ask me. if i dont know the answer(which is often the case), im sure i could find out for you!

    your healthcare guru
     
  6. Duo Degree

    Duo Degree Member 10+ Year Member

    52
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    Feb 28, 2000
    Ft. Worth, TX, USA
    and by the way, there is actually NOT a surplus of physicians!!! there have been plenty of reports concerning this topic. the problem is not due to the number of physicians, but due to the distribution of physicians! there are many areas such as urban and rural areas that are needing physicians. since those places arent always the nicest place to live, many physicians have declined offers to go to these underserved areas of our country. lots of these places will actually heavily recruit physicians by enticing them with bonuses and homes and offices. thus far, many FMGs(or whatever its called now) are willing to go to these places and therefore continue to fulfill a certain need here in the US despite the controversy. the types of physicians demanded will go in cycles...though there may be a need for more PCPs, wait a couple of years and the swing will come back around. i certainly dont want to degrade the reasons people have for entering med school, but make sure you know the level of responsibilities you plan to take on. good luck to everyone!
     
  7. Ryebass

    Ryebass Member 10+ Year Member

    33
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    Feb 20, 2000
    Keene, NH
    I agree...this whole 'surplus' of physicians thing is BS...take a stroll through most ER's , for example, and try to find a DOCTOR...the fact is that we have more physicians than the insurance co's are willing to pay for...NOT a surplus of physicians...we don't have docs sitting around twiddling their thumbs desperately hoping for another patient to keep their job viable...the public needs some honest info in this respect because most laypeople I speak to repeat this parrot fashion..."there is a glut of doctors..."etc...simply isn't true.

    Granted in this country we probably have one of the, if not the, highest ration of doctors to patients...but that doesn't mean that doctors don't feel rushed in their approach to the individual patient, if there were truly a glut the insurers wouldn't feel obligated to limit office consultation times to the token 10 minutes or so its at now. Doctors may be ambivalent about this one as they recognize that the surplus refers to the economics of it, and, ultimately, to the fact that the insurers are offering a limited financial pool that they can either share or 'horde'...


    the bottom line is:get the damned middle man out of it!!!

    oh well...probably not going to happen any time soon...but docs could go a long way by playing the role of patient advocate and helping the public understand what is really taking place as opposed to being so darned cautious about losing what they already have...

    any of this make any sense? LOL


    Ryan

    BUSM '04
     
  8. LotusEsprit

    LotusEsprit Junior Member 10+ Year Member

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    Dec 4, 1999
    There is still hope left folks just as long as we 1.) stay away from Ca as a physician or 2.) start unionizing who knows? or 3.) practice in rurals get pay more or 4.) stay away from private practices 5.) perhaps kill the HMOs!! Read on this new article I found in a medical magazine this month.

    The long-term outlook is not good news for any physician, or for those considering medicine as a career. In 1999, medical school applications fell for the third straight year - the result, some say, of flat incomes. "Physicians will always be paid good salary," says one expert. "But if you want a high salary, be a stockbroker or computer scientist. People will have to go into medicine for other reasons."

    The California nightmare: Is this where managed care is taking us?

    If we all had been seers-or perhaps if we'd simply given more thought to the situation-we might have seen this scenario unfolding: Health plans, vying for market share in a state overwhelmed by managed care, squeeze doctors dry so they can charge employers less. Eventually, there's too little money in the system to adequately support the delivery of care.
    So it goes in California, where thousands of doctors are facing personal financial crises as IPAs and PPMs teeters, or collapse, around them. More than 130 of the state's approximately 350 independent practice associations and physician practice management groups have declared bankruptcy or gone out of business in the past three years, according to the California Medical Association. CMA estimates that California doctors are currently owed more than $150 million from these failed groups-including $60 million from FPA medical Management, which went belly-up in mid-1998.
    The personal fallout is dramatic. Some California primary care physicians now make as little as $60,000 a year, 55 percent less than the national average of $134,000 for their peers, according to a PricewaterhouseCoopers report. Some now hold two full-time jobs. One-fifth of those over age 65 have delayed their retirement. Others are retiring early, cutting back on staff, or moving into medical administration, consulting, or other professions entirely. More than 2,000 doctors, the CMA estimates, have simply packed up and left the state. "I can't count the physicians I know personally who have made significant changes over the last year or so," says internist Cynthia A Point, who practices at Pacific Coast Internal Medicine, a group of five internists in San Francisco. Point is also on the board of directors of Brown & Toland Medical Group, a prominent Northern California IPA. "These colleagues have either left the area altogether, retied, or taken a job in which they're not involved in direct patient care. At the least, they've opted to cut all ties to managed care except for the loosest PPO contracting. And we're going to see more of this." Point describes Brown Toland's condition as "sever but not terminal," with doctors' fees being cut by at least 30 percent.
    Ironically, the very size and sophistication of some of California's doctor groups may be part of their problem. In most other states, few groups are big or experienced enough to take on risks formerly managed by the HMOs. "But it could happen anyplace with a high penetration of managed care and relatively sophisticated physician networks," says Kim Ross, vice president for public policy for the Texas Medical Association. Ross cites Illinois, Ohio, and Wisconsin as possible candidates.
    These risks are being shifted to doctor groups through a relatively new generation of HMO contracts. They transfer administrative duties such as physician credentialing to the doctor groups. Risk management responsibilities are transferred, too, including pharmacy risk, the unpredictable devil of health car costs. The plan pay these so-called delegated IPAs primarily by capitation.
    Why did groups agree to these contracts? Some wanted to regain control over medical decisions. But others were drawn to the potentially high reward for accepting risk. They wanted to control a bigger piece of the premium pie, and to profit by managing their patients efficiently.
    The CMA points to another powerful inducement, particularly for small plans: the HMOs' overwhelming bargaining power. The six biggest insurance plans operating in California now control 90 percent of the market. Many small IPAs viewed the plans' contracts as take-it-or leave it propositions, and with good reason.
    Now however, the CMA and the doctors argue that the HMOs' capitation rates become manifestly inadequate. One example CMA cites is the $10 per child per month that some California pediatricians report receiving from their plans-inadequate even to pay for the state mandated vaccines they must provide their small patients, let alone the costs of administering the shots.
    Meanwhile, charges FP Jack C. Lewin, chief executive officer of CMA, the HMOs' remain too high. "When they transfer all that risk to doctors, they should be reducing their administration and profit-taking to give physicians enough money to manage patient care," says Lewin. "But their whole scheme was to delegate the risk and increase their profit with the savings." Many angry physicians also portray the IPAs as too organizationally weak, politically inept, and inexperienced in business to negotiate effectively with the big HMOs.
    Not surprisingly, the HMOs see things differently, "That's not an accurate reflection of reality," says Walter A. Zelman, president and chief executive officer of the California Association of Health Plans. "Plenty of medical groups are very savvy, very experienced, and they bargain very hard with HMOs."
    But some medical groups undoubtedly don't have enough experience to handle this new generation of risk, Zelman agrees. And some got into trouble by underestimating how much it would cost them to deliver medical services. "That doesn't help anybody," says "Zelman, "and I think health plans have to be wary of it. What we're really talking about is bargaining relationships. In some negotiations, the health plan may have a big more leverage; in others, the medical group has the upper hand." "We don't want medical groups to fail," say Jim Harris, spokesman for Cigna Healthcare of California, which contracts with 220 IPAs and has 750,000 members statewide. "It's our interest to have them succeed." Harris doesn't deny that many physician groups are in trouble, but notes that public-sector financing-Medicare and Medi-Cal also pays power rates in California than elsewhere in the United States. "We don't think it's fair to put all the blame on the HMOs" he says.
    Indeed, the PricewaterhouseCoopers study, commissioned by CMA, details a string of events since the mid-1990s that have led inexorably to the current predicament. "The financial crisis for California physicians didn't happen overnight," says Cherise Skeba, a PricewaterhouseCoopers senior manager and actuary.


    ----------------------
    M.D.'02
     
  9. Sara in Canada

    Sara in Canada Member 10+ Year Member

    47
    1
    Feb 26, 2000
    Canada eh?
    TYEBASS,
    Just incase you are curious I remeber reading somewhere that although US and Canada have a fairly good doctor patient ratio, it is certain European countries which have the highest ratios. I dont remeber name or numbers exactly but they had about 2-3 more docs per 500 people or so.....
    anyways no big deal just thought i would pass that info along
     
  10. DO Boy

    DO Boy Senior Member 10+ Year Member

    109
    0
    Jan 23, 2000
    TX
    Don't say you weren't warned!

    It's easy and nice and comfortable to think, we will be ok in the future, salaries will be high, we will always find a job (in remote rural, 300 total population villages w/o even a McDonalds). Sorry folks, until the gov't fixes up the tax code and finally forces the consumer into the market (e.g. fix the fact (1) that corporations can deduct hlth insurance but individuals who buy it for themselves cannot and (2) employees who receive hlth insurance benefits from their employer don't have to pay income taxes on the dollar value of the insurance), we're gonna see more of this "middle man" pressure to decrease compensation while we struggle to reduce our costs below the break even pt.

    These seemingly inert tax laws remove the consumer from the hlth care mkt (Anecdote -- "Patient: How much is this going to cost me? Doctor: "Why? You're not paying for it! Patient: "Ok, fine.")...and costs go on like the energizer bunny.

    These aren't my ideas; they belong to individuals who work in hlth care policy or for presidential candidates, Harvard Business School profs, and administrative gurus that have spoken in my classes or that I have read on my own.

    I think we'll continue our struggle for now (slowly and slowly giving in), but as medical costs continue to grow (from the zillions of reasons) despite managed care and other crazy, sexy, cool efforts, there'll be a breaking point. Hopefully, what will emerge will be a patient oriented hlth care system with patients benefiting first, doctors second, and managed care companies...well who cares? I for one am not too fond of pre-cert, defensive medicine.

    One has to have other mega-personal reasons for entering medicine these days.


    Ready to help revamp the system,
    DO Boy
     
  11. popoman

    popoman Member 10+ Year Member

    46
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    Feb 29, 2000
    nj
    one quick question????
    would this decrease in salary hold true for dentist?????? in 10 years?????
    can u guys tell me how much they would make in 10 years??? i mean like est.
    thanks


    The confused Freshman....=)

    [This message has been edited by popoman (edited 03-10-2000).]
     
  12. futuredo

    futuredo Junior Member 10+ Year Member

    23
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    Nov 13, 1999
    Florida
    Entering medical school for financial reasons is not a good idea.
    At the same time, salaries are quite high comparing to other professions.
    Check out the occupational outlook handbook (available on the web)for outlook on medicine and dentistry.


    [This message has been edited by futuredo (edited 03-28-2000).]
     
  13. KimR

    KimR 10+ Year Member

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    Apr 10, 2001
    Lotus - Where does this article come from???
     
  14. premedicine

    premedicine 2+ Year Member

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    Aug 27, 2009
    *
     
    Last edited: Nov 21, 2012
  15. DrYoda

    DrYoda Space Cowboy Physician 7+ Year Member

    13,806
    96
    Jun 22, 2008
    Dagobah System
    I guess SDN wasn't all that different back in the day. The title fits right in.:laugh:
     
  16. tennisball80

    tennisball80 Banned Banned 2+ Year Member

    GUYS

    THE ORIGINAL POSTER

    tennisboy93 is my brother
     

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