LADoc00

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To summarize the PATHOLOGY RELEVANT points in today's historic burning (and/or crapping upon) of the US Constitution:

In 2011, reimbursement for Medicare from all other speciality physicians, including Pathologists will be reduced and given to primary care doctors.

In 2013, this law will begin bundling payments to hospitals for all services rendered for patients with Medicare. The implication for this is beyond huge.

This is on top of whopping increases on taxes for most of us in the upper income levels.

I would probably not match into Pathology with the bundled payment scenario that is about to occur. I would expect incomes to drop 50-75% and/or all private pathologists to be relegated to salaried hospital employees unless there is some drastic change in the pipelines (like physicians all decide to drop Medicare, 2nd civil war etc).

I hate to say it: The End is Nigh.

 

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All you idiots who voted for or any demoRAT who voted for this abomination should be ashamed of yourselves as you sold out not only the entire field of pathology (and most of medicine) but the entire country.

The not too distant future: Long lines will form to receive quality care and now only the rich and well-connected will receive it.

The rest will have some piece of paper telling them they have "insurance".
 

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I don't want to argue about the immediate implications of the reform on physicians. I do believe though that 'long lines' is a bit of scaremongering. I had opportunities to use both the US healthcare system and British NHS as a patient, and to me the waiting times in the two look comparable.
 

schrute

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It's fairly obvious optimism and partisan ideology trumped rationality and economic reality. Logic was seemingly absent from the entire bill, which I guarantee you no one has read:

We add 32 million people to the insured ranks, we prohibit insurance companies from denying anyone coverage with pre-existing conditions, we mandate everyone purchase insurance or face a fine, et al...and this is magically going to be cheaper? Because the govt has a long track record of sticking to budgetary projections.... .... ... ... ... ... ... ... ...

Ironic that so much of the bill takes effect after the 2010 and 2012 elections... ... ... ... ...

Unprecedented.
 

schrute

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I love crap like this (from longlake's link):

"*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients."

"Free"??? "...little or no cost to patient"? Really?? LMFAO.
 

Thrombus

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I don't want to argue about the immediate implications of the reform on physicians. I do believe though that 'long lines' is a bit of scaremongering. I had opportunities to use both the US healthcare system and British NHS as a patient, and to me the waiting times in the two look comparable.
You are quite naive then young Perry.

Lets see....consider the following.

Physicians lose almost all negotiating power and leverage.

The more efficient and productive a physician becomes, the more he/she gets taxed.

Over-regulated already, we are going to face exceeding regulation and oversight with stupid law after stupid law preventing us from being efficient, cost-effective, and reasonable.

Physicians who can retire....will. They will be taxed more (including dividend income) and regulated more leading to more frustration. If the way this was passed is any example.....you better not voice your opinion against "the system" to loudly!!! The IRS is going to be the muscle behind this bill.

Now you add 32 million to the rolls who have a piece of paper claiming they have access to us at their whim!!! AND YOU THOUGHT PATIENTS HAD A SENSE OF ENTITLEMENT BEFORE?????

With DRG related payment bundles, it will be in the providers' best interest to do AS LITTLE AS POSSIBLE to these entitled patients.

This will lead to increasingly unhappy patients, increasingly unhappy physicians...and as a result.....INCREASINGLY HAPPY LAWYERS!!!!!

You tell me how this trash does not KILL PATIENT ACCESS!!!!!
 

Nilf

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To summarize the PATHOLOGY RELEVANT points in today's historic burning (and/or crapping upon) of the US Constitution:

In 2011, reimbursement for Medicare from all other speciality physicians, including Pathologists will be reduced and given to primary care doctors.

In 2013, this law will begin bundling payments to hospitals for all services rendered for patients with Medicare. The implication for this is beyond huge.

This is on top of whopping increases on taxes for most of us in the upper income levels.

I would probably not match into Pathology with the bundled payment scenario that is about to occur. I would expect incomes to drop 50-75% and/or all private pathologists to be relegated to salaried hospital employees unless there is some drastic change in the pipelines (like physicians all decide to drop Medicare, 2nd civil war etc).

I hate to say it: The End is Nigh.

LA,

Can you explain why bundled payment will have disproportiately worse effect on pathology as compared with other specialties?

I will pre-answer--because pathologists have no leverage against clinicians who feed them cases.
 

Thrombus

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LA,

Can you explain why bundled payment will have disproportiately worse effect on pathology as compared with other specialties?

I will pre-answer--because pathologists have no leverage against clinicians who feed them cases.
Unfortunately, most pathologists have little understanding of this concept.
 

pathstudent

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LA,

Can you explain why bundled payment will have disproportiately worse effect on pathology as compared with other specialties?

I will pre-answer--because pathologists have no leverage against clinicians who feed them cases.
This is bundling of payments to hospitalized patients. You won't be fighting just the radiologists, surgeons and internists for a slice of the pie, you will be fighting the for profit corporations who own your hospital and give you a contract.
 

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Regarding the effect of bundled payments, the medical home concept, coordinated care models, etc, on pathology reimbursement, pathologists (and pathology residents) need to understand that this is not fear mongering. Unless you are near retirement or independently wealthy, we should all be very scared. Bundled payments type programs in particular, if that's the means by which health care is broadly paid for in the future, will disproportionately affect pathology. The reasons have already been alluded to above. We have little or no leverage in most cases. I believe that it will take a concerted effort by the entire profession to become more visible in our contributions to patient care, along with strong support of CAP/ASCP/ACLA advocacy efforts from all of us, in order to avoid outright disaster. Even then I'm not entirely convinced it will be enough...
 

Nilf

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Regarding the effect of bundled payments, the medical home concept, coordinated care models, etc, on pathology reimbursement, pathologists (and pathology residents) need to understand that this is not fear mongering. Unless you are near retirement or independently wealthy, we should all be very scared. Bundled payments type programs in particular, if that's the means by which health care is broadly paid for in the future, will disproportionately affect pathology. The reasons have already been alluded to above. We have little or no leverage in most cases. I believe that it will take a concerted effort by the entire profession to become more visible in our contributions to patient care, along with strong support of CAP/ASCP/ACLA advocacy efforts from all of us, in order to avoid outright disaster. Even then I'm not entirely convinced it will be enough...
That's precisely why I am brainstorming ways to break back into clinical medicine, especially derm aspect thereof... We don't have leverage against clinicians... but the clinicians have the leverage against the patients... Therefore, we have to become a bit more clinical... Let's see...

1. Melanoma/nevi/wart clinic--removal of skin spots and next day diagnosis. Who needs a dermatologist or PCP to remove a mole?
2. Once you have patients coming in, why stop there? Peddle beauty products, laser hair removal, spas, massages, wrinkle products.
3. Whip out that prescription pad... start prescribing.
4. For you hemepaths out there... If you did the fellowship, you should be more proficient in doing bone marrow aspirates than the hem-onc fellows. You know what a good marrow biopsy is... no excuse for not being able to do it. This should give you leverage.
5 GIs/Gyns/GUs... tough task. Any ideas?
 
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levels x3

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If this all comes to pass, perhaps it will finally force the mass retirement of older pathologists we keep hearing about. Jobs will be plentiful!!!

Sorry, I just couldn't help myself.
 

Substance

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LA,

Can you explain why bundled payment will have disproportiately worse effect on pathology as compared with other specialties?

I will pre-answer--because pathologists have no leverage against clinicians who feed them cases.
I don't understand why pathologists don't take time to also practice clinically.

Taking a punch biopsy is about the easiest procedure in the world. Endoscopy is monkey-work - fancy monkey-work - but still fairly simple. Thyroid ultrasound-guided biopsies are the same. Getting biopsy samples should not be hard. I do not see why pathologists have to wait for a derm or a GI endoscopist or interventional radiology to dole out tissue. If the field of pathology was serious about preserving their worth, they'd turn the tables and encroach on this market too.
 

2121115

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Pathologists aren't going to start doing endoscopies. As much as CAP wants to "transform pathology" it turns out that most pathologists are too busy actually being pathologists to start poaching interventional rads work. I give you props for thinking outside the box though.

What pathology has to do is become better at selling what we already actually do (and do quite well). Its fine and well to throw a tantrum and get it out of our system but when the dust settles there is going to be more work to do and we will all be paid less for doing it. Those are the breaks.
 

Perry Mason

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You are quite naive then young Perry.

Lets see....consider the following.

Physicians lose almost all negotiating power and leverage.

The more efficient and productive a physician becomes, the more he/she gets taxed.

Over-regulated already, we are going to face exceeding regulation and oversight with stupid law after stupid law preventing us from being efficient, cost-effective, and reasonable.

Physicians who can retire....will. They will be taxed more (including dividend income) and regulated more leading to more frustration. If the way this was passed is any example.....you better not voice your opinion against "the system" to loudly!!! The IRS is going to be the muscle behind this bill.

Now you add 32 million to the rolls who have a piece of paper claiming they have access to us at their whim!!! AND YOU THOUGHT PATIENTS HAD A SENSE OF ENTITLEMENT BEFORE?????

With DRG related payment bundles, it will be in the providers' best interest to do AS LITTLE AS POSSIBLE to these entitled patients.

This will lead to increasingly unhappy patients, increasingly unhappy physicians...and as a result.....INCREASINGLY HAPPY LAWYERS!!!!!

You tell me how this trash does not KILL PATIENT ACCESS!!!!!
Once again, I am not arguing about the implications of the reform on the physicians. My comment above was exclusively about waiting times.

I would rephrase your sentence I've bolded as "it will be in the providers' best interest to do AS MUCH AS NECESSARY to these entitled patients". Not every case of diarrhea needs scoping from both ends, not every pigmented skin lesion needs to be excised and not every hep C needs a liver biopsy. We'll probably see fewer radical prostatectomies for localized cancer and fewer whipples done on 75-year-olds. This might lead to a few unhappy patients but as a physician (as opposed to accountant) I believe the patients as a group will benefit at the end.

This is just my opinion based on my observations of a socialized health care system that, even though it has its flaws, works about as effectively as the US system without the drawback of overtreatment.
 

Thrombus

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Once again, I am not arguing about the implications of the reform on the physicians. My comment above was exclusively about waiting times.

I would rephrase your sentence I've bolded as "it will be in the providers' best interest to do AS MUCH AS NECESSARY to these entitled patients". Not every case of diarrhea needs scoping from both ends, not every pigmented skin lesion needs to be excised and not every hep C needs a liver biopsy. We'll probably see fewer radical prostatectomies for localized cancer and fewer whipples done on 75-year-olds. This might lead to a few unhappy patients but as a physician (as opposed to accountant) I believe the patients as a group will benefit at the end.

This is just my opinion based on my observations of a socialized health care system that, even though it has its flaws, works about as effectively as the US system without the drawback of overtreatment.
The problems you mention are already side effects of quasi-socialized medicine where the consumer's dollar has no power to limit over-treatment. If it costs 150$ to get my mole excised and analyzed, I am going to think twice about it. If it costs everyone else $150, I won't necessarily object.
 

rockit

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The problems you mention are already side effects of quasi-socialized medicine where the consumer's dollar has no power to limit over-treatment. If it costs 150$ to get my mole excised and analyzed, I am going to think twice about it. If it costs everyone else $150, I won't necessarily object.
Not to mention the physician's still got skin in the game because there was no malpractice reform. Stop doing Whipples on 75 year olds and start getting sued by 75 year olds.
 

pathstudent

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just read a CAP email that specifically said that the increased compensation for primary care and general surgery will not come from decreasing compensation for other specialties.

So maybe the below claim that pathologist reimbursement will be 25% what it is now is just a bunch of fearmongering bull****.

Who know how things will be in the future. Obviously the current administration and democratic majority are all about wealth redistribution. However, currently pathologists do a lot of gratis care for the uninsured. If those people can now at least pay something via their ****ty govt funded insurance, maybe it will make up for the higher taxes and hypothetical decreased reimbursements.

At one point in this health insurance debate I read that the govt was thinking about a govt run plan that would pay 1.2x medicare to hospitals and physicians. For pathologists that wouldn't have been so bad.

To summarize the PATHOLOGY RELEVANT points in today's historic burning (and/or crapping upon) of the US Constitution:

In 2011, reimbursement for Medicare from all other speciality physicians, including Pathologists will be reduced and given to primary care doctors.

In 2013, this law will begin bundling payments to hospitals for all services rendered for patients with Medicare. The implication for this is beyond huge.

This is on top of whopping increases on taxes for most of us in the upper income levels.

I would probably not match into Pathology with the bundled payment scenario that is about to occur. I would expect incomes to drop 50-75% and/or all private pathologists to be relegated to salaried hospital employees unless there is some drastic change in the pipelines (like physicians all decide to drop Medicare, 2nd civil war etc).

I hate to say it: The End is Nigh.

 

RisingSun

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My guess what this will mean for path (take with grain of salt):

1. Clinicians being more judicious about what tests they order - you may not need a CBC w/diff, CMP, etc everyday on stable pts. One way to keep costs w/in a flat fee. That will mean fewer labs per patient. But there will be more patients. Who knows what the bottom line will be, I'm guessing no change here.

2. Surgical pathology is a fundamental component of modern medicine. Nothing will f---ing happen without a tissue diagnosis. Period. Surgeons will demand that their pathologists know what the hell they are talking about, there will be no wiggle room for going back to the OR, etc. unless absolutely necessary because they will want to stay w/in the global fee. A wrong diagnosis from path will cost the hospital serious coin.

3. Surgeons won't make any money for the hospital rounding, doing inane crap. They will need to be in the OR, cutting all the time. There will be more insured patients, and the incentive will be for surgeons to operate. Translation = more work for pathology.

4. No more extraneous immunohistochemistry stains, etc. Pathology will have to be streamlined to keep from bleeding red.

My guess is that pathologists who are well-trained, good diagnosticians, efficient, and interact well with their colleagues in path and other fields, will have good jobs that keep them busy but pay well. Not too unlike the present.
 

LADoc00

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My guess what this will mean for path (take with grain of salt):

1. Clinicians being more judicious about what tests they order - you may not need a CBC w/diff, CMP, etc everyday on stable pts. One way to keep costs w/in a flat fee. That will mean fewer labs per patient. But there will be more patients. Who knows what the bottom line will be, I'm guessing no change here.

2. Surgical pathology is a fundamental component of modern medicine. Nothing will f---ing happen without a tissue diagnosis. Period. Surgeons will demand that their pathologists know what the hell they are talking about, there will be no wiggle room for going back to the OR, etc. unless absolutely necessary because they will want to stay w/in the global fee. A wrong diagnosis from path will cost the hospital serious coin.

3. Surgeons won't make any money for the hospital rounding, doing inane crap. They will need to be in the OR, cutting all the time. There will be more insured patients, and the incentive will be for surgeons to operate. Translation = more work for pathology.

4. No more extraneous immunohistochemistry stains, etc. Pathology will have to be streamlined to keep from bleeding red.

My guess is that pathologists who are well-trained, good diagnosticians, efficient, and interact well with their colleagues in path and other fields, will have good jobs that keep them busy but pay well. Not too unlike the present.
this would typify the example of someone who really doesnt have any experience in pathology and is posting here because they love the sound of their keyboard clicking as they woefully attempt to participate in a big kids discussion.

I dont order extraneous IHC, nor do ANY Pathologists I interact with or employ. You must be at some bottom of the barrel for-profit medical school where is this occurring. Im sorry about that. May you rise above your humble beginnings.

The big issue is when x=amount of money for a Medicare patient with CML is distributed to the hospitals, the chunk for pathology for things like reading the bone marrow, the flow or doing neccessary IHC will be allocated in competition with things like cytogenetics and molecular testing. The last 2 Pathologists at most places including major medical centers and teaching hospitals SEND OUT. Lets say given COB and overhead cost for hospital being .7x and oncologists fees being .2x, we would scrap out perhaps .1x or less.

At the end of the day, for profit corporations with shareholder accountability and massive lobbying dollars like Quest Diagnostics will take whatever pitiful share of the a bundled costs Pathologists might enjoy. That WILL (not maybe) leave many types of Pathology surgical specimens with literally zero income potential for time worked.

The wash argument is idiotic. Obama wants me to make up for a massive income reduction with VOLUME? So work harder, sometimes 2x hard for the same level of pay? What?! Seriously??? Incur 2x the malpractice risk because the POS attorneys made absolutely certain their boy wouldnt put anything in the bill to stop their lawsuits and payouts?

You have to be joking. The whole political process in this sad little country is a joke now.

There is truthfully nothing left to do but steal with both hands ala Jesse James until caught.

 

BrainPathology

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My guess what this will mean for path (take with grain of salt):

1. Clinicians being more judicious about what tests they order - you may not need a CBC w/diff, CMP, etc everyday on stable pts. One way to keep costs w/in a flat fee. That will mean fewer labs per patient. But there will be more patients. Who knows what the bottom line will be, I'm guessing no change here.

2. Surgical pathology is a fundamental component of modern medicine. Nothing will f---ing happen without a tissue diagnosis. Period. Surgeons will demand that their pathologists know what the hell they are talking about, there will be no wiggle room for going back to the OR, etc. unless absolutely necessary because they will want to stay w/in the global fee. A wrong diagnosis from path will cost the hospital serious coin.

3. Surgeons won't make any money for the hospital rounding, doing inane crap. They will need to be in the OR, cutting all the time. There will be more insured patients, and the incentive will be for surgeons to operate. Translation = more work for pathology.

4. No more extraneous immunohistochemistry stains, etc. Pathology will have to be streamlined to keep from bleeding red.

My guess is that pathologists who are well-trained, good diagnosticians, efficient, and interact well with their colleagues in path and other fields, will have good jobs that keep them busy but pay well. Not too unlike the present.

That actually pretty much parrots a couple of the attendings where I trained.. right now they make in the top 5% of all groups in the country and they aren't really worried about what this will do to their practice.

(the caveat is they have all already made so much who would worry anyway? - but they are saying the same for us who have just graduated. It may be a little better, it may be a little worse.. it's very unlikely armageddon.)

There are plenty of just sunny, rainbows out of their ass, care bear vomitty happy pathologists at Mayo and the Cleveland Clinic who follow the kind of model that some people would have us believe will leave us all begging on the street. Not every hospital is going to be as great to work for as these two places but then that's the case already.

It's funny how the radicals come out periodically here. Some of the people who actually offer logical well thought out arguments elsewhere are bringing out terms like "demorats" "raping of the constitution" etc. The constitution has been VERY VERY drunk for the last century or so.. any "raping" of it by this and the last administration would just barely be qualified as rape.

These things always only demonstrate that Democrats and Republicans really do share some common ground and are both right simultaneously as long as they are claiming that the other side is stupid. Listen to everyone here from both sides and you'll have just about 100% chance of knowing exactly what WON'T happen.
 

longlakeboy

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I dont order extraneous IHC, nor do ANY Pathologists I interact with or employ. You must be at some bottom of the barrel for-profit medical school where is this occurring. Im sorry about that. May you rise above your humble beginnings.
Or maybe he's at an academic institution that gets outside consults from community hospitals, where they do things like order 25 immunostains on an ovarian serous tumor, none of them being WT-1 or p53.
 

pathstudent

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Or maybe he's at an academic institution that gets outside consults from community hospitals, where they do things like order 25 immunostains on an ovarian serous tumor, none of them being WT-1 or p53.

That is disgraceful. It is almost always an H&E diagnosis. I only see it done on mets, or when the patient has history of two primaries or some scenario like that.

Things aren't going to be that different anytime soon. There are 30 million more people that can pay at least something on their pathology bills. yes it probably going to bankrupt the country and our taxes will go up. But things aren't going to be that different anytime soon.
 

path24

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This bill pretty much sums up how much power physicians have in DC. Even AMA supported and still no medicare fix or tort reform.

We need to do a better job of organizing and being represented in DC. We treat patients and should have the major/final say on healthcare legislation.....currently we don't have any.
 

tardieu

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Old and busted: "I can't get a job" threads

New hotness: "We're all doomed" threads.
These threads make me appreciate the few upsides of being a humble civil servant who does what he does because he likes to do it and has no ambitions towards getting "rich".

To any other such dreamers out there, I say, come on over to forensics. There's work to be done, jobs to be had, and we really need more good people.

Plus, you carry a badge!
 

LADoc00

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Old and busted: "I can't get a job" threads

New hotness: "We're all doomed" threads.
New plan: Complete loan forgiveness for all providers willing to take Medicaid patients. Step 2, completely run public medical school education system that is FREE.

Cant have the Socialist European model without the free education.
 

Adrian Cocot

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New plan: Complete loan forgiveness for all providers willing to take Medicaid patients. Step 2, completely run public medical school education system that is FREE.

Cant have the Socialist European model without the free education.
And nude beaches. But of the skinny, European socialist kind, not the obese American kind.
 

schrute

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underpants-gnomes.edit.3.JPG

aw man...
image size fail.
 

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New plan: Complete loan forgiveness for all providers willing to take Medicaid patients. Step 2, completely run public medical school education system that is FREE.

Cant have the Socialist European model without the free education.
. . . been saying it for years. couldn't agree more. our country has grown more and more schizo in recent years: the benefits of capitalism inducing claims of entitlement.

we paid good money to be good and offer our best to our patients, now they and democrats want our best and expect us to absorb the cost.

as click and clack may say . . .BOOOO-GUS!!
 

HbyHA

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These threads make me appreciate the few upsides of being a humble civil servant who does what he does because he likes to do it and has no ambitions towards getting "rich".

To any other such dreamers out there, I say, come on over to forensics. There's work to be done, jobs to be had, and we really need more good people.

Plus, you carry a badge!
that's what i've been saying!
 

path24

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Residency is a nice example of what can happen if physicians don't step up to the govt takeover of healthcare. How much real control did/do you have as a resident?...your hours, pay, benefits, workload, location, schedule...etc. I know this is an extreme example of what could happen to physicians, but it does already exist and we allow it.
 

Parts Unknown

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Residency is a nice example of what can happen if physicians don't step up to the govt takeover of healthcare. How much real control did/do you have as a resident?...your hours, pay, benefits, workload, location, schedule...etc. I know this is an extreme example of what could happen to physicians, but it does already exist and we allow it.
Hmmm, prior to Medicare funding of residency positions, residents were only paid enough to buy food and clothing. They lived in whatever housing was provided on the hospital campus. Hence the term "resident." I doubt the hours and benefits were very appealing by modern standards.

Now we get a living wage, paid time off, health insurance, disability insurance, malpractice insurance, and an ostensible work hour restriction. I'd say the situation has gotten better rather than worse.
 

LADoc00

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These threads make me appreciate the few upsides of being a humble civil servant who does what he does because he likes to do it and has no ambitions towards getting "rich".

To any other such dreamers out there, I say, come on over to forensics. There's work to be done, jobs to be had, and we really need more good people.

Plus, you carry a badge!
hehehe. Thank you for not being covetous. Seriously. I wish there were more people like you.

Unfortunately the Obama and Nancy Pelosi are currently vying for the "Most Covetous Person in Galaxy" award atm.
 

yaah

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I don't think there is much in this particular bill that changes things that much (it is mostly stuff dealing with insurance company regulations and expanding medicaid coverage from what I can tell). Expanding medicaid coverage doesn't help pathology. It doesn't help anyone except the patients. It hurts everyone who has to deliver healthcare because medicaid reimbursement is so whack. The problem will be what happens next. The asinine aspect of the bill is that they decided to not fix the medicare SGR formula because to include it in the bill would have increased the cost of the bill. They say they are going to fix it later on, which they likely will, but most likely it will be the same as usual month or two delay. They will keep doing that until at least after the election. What they do at that point will probably depend on the election results. Since the only options are to either raise taxes or cut spending, they are clearly going to cut spending given the current environment. I think drug companies already have their deals locked in, and hospitals have a lot of clout. And medical device makers each have their own personal congressman to throw in a tiny little exception to preserve their payments. So that leaves physicians as the likely screwed ones. The question is how screwed. I am not as pessimistic as others but I do not believe reimbursement is ever going to rise.

I personally do not think the world is ending. By the way, I just came back from USCAP with a senator and a congressman on my plane. I decided not to cause a scene.
 

rirriri

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this thread is the PERFECT example of HYPE WITHOUT SUBSTANCE.

you're just speculating...your guess is as good as a gerbil's. This thread is basically just propaganda.
 

yaah

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this thread is the PERFECT example of HYPE WITHOUT SUBSTANCE.

you're just speculating...your guess is as good as a gerbil's. This thread is basically just propaganda.
lol, great post. So true. While it is important to speculate and consider consequences, work to change bad things, etc, what is not good is taking this speculation as iron-clad fact.
 

Pathwrath

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I think real concern is warranted for all specialists. This bill costs big bucks, and that's coming from Medicare trimming. Since they're not cutting coverage, the cuts are coming out of providers. It will be interesting to see what the all-powerful Medicare IAB orders.

On a related note, what's with the continued tedious dicking with Medicare physician payment rates? I thought that was the quid pro quo to get the AMA on board with this reform.
 

pathstudent

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I think real concern is warranted for all specialists. This bill costs big bucks, and that's coming from Medicare trimming. Since they're not cutting coverage, the cuts are coming out of providers. It will be interesting to see what the all-powerful Medicare IAB orders.

On a related note, what's with the continued tedious dicking with Medicare physician payment rates? I thought that was the quid pro quo to get the AMA on board with this reform.
The bill they passed includes the 21% cut for 2010 and all future cuts in its budget. So either the AMA is going to get duped or the public that voted on it because they believed it expand coverage and decrease the budget. If they reverse the cuts, it will add to the deficit.
 

Pathwrath

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The bill they passed includes the 21% cut for 2010 and all future cuts in its budget. So either the AMA is going to get duped or the public that voted on it because they believed it expand coverage and decrease the budget. If they reverse the cuts, it will add to the deficit.
They had to include the cuts in the budget because the SGR is still law.

You may be right and they'll start screwing docs from the get go, but I don't think that's Obama's or the Democrats' style. I think they'd rather let the Medicare Advisory Board do their dirty work for them. Later, once everything settles down.
 

mikesheree

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I've been in this business since 1977 and all i have heard are prophycies of every form of financial catastrophy. i have been in the military, an associate in a large group, a senior partner in the same group and now an employee since we sold. I have never had it easier and the money continues to roll in. Don't listen to the whiners.
 

yaah

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On a related note, what's with the continued tedious dicking with Medicare physician payment rates? I thought that was the quid pro quo to get the AMA on board with this reform.
I think the quid pro quo is still there, only with tacit assumption that something will be done to fix it. Kind of a big assumption to think that politicians will follow through on promises, but in this case the 21% cut is one of those "drastic" things that politicians are not going to mess with (like funding for Israel or military R&D). The reason they continuously dick with it is because any long term fix is going to be attached to a price tag (even if it is all projection-based). And politicians do not want their name on something with a huge price tag unless it is a military budget or a tax cut.
 

pathstudent

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I've been in this business since 1977 and all i have heard are prophycies of every form of financial catastrophy. i have been in the military, an associate in a large group, a senior partner in the same group and now an employee since we sold. I have never had it easier and the money continues to roll in. Don't listen to the whiners.
Good to hear someone with a long term perspective chime in. However, you stated you sold your practice a number of years ago. Those sale prices typically are set for 4-5 times yearly gross income and the buyer typically expects a break even point of 7 years. So anyone in your group that planned on working more than 7 years was stupid to agree to sell. Also what about all the future young pathologists. People like you hosed them. You reaped the rewards of private practice, and now you sold it and Fed over future young pathologists.

What do you got to say about that?
 

mikesheree

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I did a surgical internship. I attended 6 months of undersea/divng/hyperbaric medicine with the navy. I spent 2 years as an undersea medical officer/GP. I then did the regular ap/cp. I then did FP w/the AFIP. I then spent 2 years as an attending at a major Naval training hospital. Got out and spent 4 years as an associate with a large private florida group. I then paid $230,000 cash buy in to become a partner. We sold about 6 years later. If that is "hosing" someone tough s***.

And we were not "stupid" to sell. We saw the gravy train coming to an end so we picked up about 3M each as long term capital gain rather than ordinary income.

And why retire? I like pathology, am medical director and solo pathologist
( with backing of a large local group) of a 175 bed community hospital, work about 7 hours /d sign out enough surgicals to make things interesting and make $400K+
 

Thrombus

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I did a surgical internship. I attended 6 months of undersea/divng/hyperbaric medicine with the navy. I spent 2 years as an undersea medical officer/GP. I then did the regular ap/cp. I then did FP w/the AFIP. I then spent 2 years as an attending at a major Naval training hospital. Got out and spent 4 years as an associate with a large private florida group. I then paid $230,000 cash buy in to become a partner. We sold about 6 years later. If that is "hosing" someone tough s***.

And we were not "stupid" to sell. We saw the gravy train coming to an end so we picked up about 3M each as long term capital gain rather than ordinary income.

And why retire? I like pathology, am medical director and solo pathologist
( with backing of a large local group) of a 175 bed community hospital, work about 7 hours /d sign out enough surgicals to make things interesting and make $400K+
Yes you did sell us out. Many people no longer have the opportunity to pay 230K cash to become a partner because you ran off with 3 million $.

You made it worse for business savy upcoming pathologists who now have their career reduced to a dead end employee model. Yes thats great right before retirement, but many of us did not go into this to take orders from some business admin.
 

schrute

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Yes you did sell us out. Many people no longer have the opportunity to pay 230K cash to become a partner because you ran off with 3 million $.

You made it worse for business savy upcoming pathologists who now have their career reduced to a dead end employee model. Yes thats great right before retirement, but many of us did not go into this to take orders from some business admin.
I have to agree with Thrombus.

"If that is "hosing" someone tough s***"

+

"We saw the gravy train coming to an end so we picked up about 3M each as long term capital gain rather than ordinary income."

=

"I'll take mine any way I can get it, the field be damned."


Your tough "s****" attitude isn't justified because you're ahead of me in training, and your $3 mil comes from future employees relegated to the lab salary (a la Ameripath).
 

Pathwrath

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I've been in this business since 1977 and all i have heard are prophycies of every form of financial catastrophy. i have been in the military, an associate in a large group, a senior partner in the same group and now an employee since we sold. I have never had it easier and the money continues to roll in. Don't listen to the whiners.
I'll let others address your actions and their impact on future pathologists, but any variant of there's no problem for me, so there's no problem is at best myopic. Believe me, your attitude is not uncommon on this site, so don't feel singled out.

Anyway, I would argue that this current "reform" is something really different, certainly without precedent since before 1977, and extrapolating based on your personal fortunate experience to date is probably not reliable.