If Obama's healthcare plan occurs, which specialties will be affected the most?

anoncurious

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Assuming that Obama's healthcare plan goes through (or goes through with some revisions,etc.), what are your thoughts on which medical specialty will be affected the most?
 

Law2Doc

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Assuming that Obama's healthcare plan goes through (or goes through with some revisions,etc.), what are your thoughts on which medical specialty will be affected the most?
I think you have to wait and see what bill actually makes it out of Congress before you can speculate on this. The broad brush proposals made during campaigning rarely have any resemblance to what comes out of committee after mark-up sessions. As of now I don't know that there's even a bill.
 

doc20

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Obama doesnt really have a plan, its just vague general ideas on how american health care utopia should be!!!
he wouldnt be taking ideas and holding meetings from public if he knew how to fix it himself!!!!
it would take few years before we all truly would know what impact he has on medicine if any
 
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Law2Doc

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Will primary care compensation rise, specialty pay fall, or both?
I think it's a safe bet that all compensation will decline; it has been losing ground to inflation for a while now, and no reason to expect a reverse of trend given the out of control healthcare costs the administration is going to battle. When something is too expensive, it's unlikely anyone is interested in paying doctors more -- that would be impossible to sell to voters. They want to pay less, not more.
 

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I agree.

What will happen is by-and-large necessary:
1) health professionals' incomes will fall, unless in a purely private system outside of the national one (i.e. BUPA in Britain)
2) less care will be provided per capita
3) costs will dramatically fall
4) The US will lose its place as the premier nation for cutting-edge medical technology, research and practice, since market forces, private/gvt money for research, and incentive will be eroded.
5) the "lows" and holes in our system-- including those without any coverage and therefore access to primary/preventive care-- will be patched.
6) Our health care system, for good and for bad, will look more like those of Western Europe, in terms of physician compensation & lifestyle, coverage, and rationing.
 

Faebinder

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He should start being doing things to cut the adminstrative costs. No more needing 75 people just to collect the medical bills of 1 hospital. That's crazy when you compare it to a canadian hospital that only has 5 people for billing.

He could also follow that by easing up on EMTALA rules and make it harder to sue ER for discharging... but who wants to make that hard decision and suffer the consequences of "less" care for the people who truly dont deserve it.. (no we are not doing lab work for you mister well known to us heroine addict here asking for pain meds again).
 

Pir8DeacDoc

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I'll continue to look at doing as much work as possible for people who pay out of pocket. More and more we continue to get screwed and luckily I am in a surgical field and can refuse to see patients who aren't willing to pay. I don't plan to be forced to suckle from the teet of the federal government for my salary.
 

HCE

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Assuming that Obama's healthcare plan goes through (or goes through with some revisions,etc.), what are your thoughts on which medical specialty will be affected the most?

I would think the pimary care fields are most affected. There is no way everyone in the country can be insured and receive medical care without an enormous increase in prmary care physicians. I suppose the flip side of the coin would be that if the need for primary care positions is massively increased, we'll either need scores of new primary care spots, or we will have to move current specialty positions over to the primary care side of the ledger.
 
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HCE

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I'll continue to look at doing as much work as possible for people who pay out of pocket. More and more we continue to get screwed and luckily I am in a surgical field and can refuse to see patients who aren't willing to pay. I don't plan to be forced to suckle from the teet of the federal government for my salary.
Treating "out of pocket" people may work out for you, and it may not..it certainly won't work for the medical profession as a whole. Seems to me right now the choice is to "suckle from the teet of the federal government", or continue to be the insurance companies' b&%tches....the medical community has got to some how get back control of medical treatment in this country, big government and big insurance be damned...
 
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Pir8DeacDoc

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I don't disagree with you. But seeing as there appears to be no movement in that direction currently I'll stick to my thoughts on primarily self pay only.
 

Llenroc

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It's like robbing a bank, you go where the money is.

In countries where healthcare is socialized, most doctors make about the same amount of money, or at least the gap isn't as big as it is here.

So if they start cutting salaries they will probably start with Radiology, Surgery, etc.
 

turkeyjerky

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I'll continue to look at doing as much work as possible for people who pay out of pocket. More and more we continue to get screwed and luckily I am in a surgical field and can refuse to see patients who aren't willing to pay. I don't plan to be forced to suckle from the teet of the federal government for my salary.
hmm...I didn't realize there were that many people who can afford to pay out of pocket for a 50,000 dollar operation. Oh well, have fun suckling from the teet of the other half of the top-one percent (they might even be kind enough to give you a big tip around the holidays).


My guess for what happens under Obama-care is that most primary care will be provided by DNPs and PAs, under the loose supervision of physicians who will handle the hard stuff. Hospital-based practice will become more common. Specialists will take a hit, but not as bad as many expect.
 

Pir8DeacDoc

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hmm...I didn't realize there were that many people who can afford to pay out of pocket for a 50,000 dollar operation. Oh well, have fun suckling from the teet of the other half of the top-one percent (they might even be kind enough to give you a big tip around the holidays).
.

Ever heard of cosmetic surgery?
 

sirus_virus

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Obamas healthcare plan is simple. Primary care first, specialist care last. This is also Tom daschle's healthcare doctrine. Both have teamed up so you can imagine how this is going to play out. I expect primary care physicians, PAs and NPs to see a pay increase, while specialists take a hit.
 

drfunktacular

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Obamas healthcare plan is simple. Primary care first, specialist care last. This is also Tom daschle's healthcare doctrine. Both have teamed up so you can imagine how this is going to play out. I expect primary care physicians, PAs and NPs to see a pay increase, while specialists take a hit.
It's about time for that to happen anyway. If the ortho spine folks go from $1mil to $500k, well, boo hoo. If we can use that money to pay 5 PCP's an extra $100k, or $50k to 20, etc, fine with me. Hopefully that would decrease the disincentives to primary care enough to tamp down the midlevels, too.
 

gasping81

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I wonder what actually we can save if the following is done:

1. Deductibles of 1000-4000 dollars per year based on the size of your family. And don't give me some BS about how people can't save up at least 1000 for their health care per year. At least this would force responsibility upon people and then costs would be much more transparent.

2. Kill administrators. Well not kill, but fire. Let them work on the fields somewhere actually producing something for the US rather than being middlemen. You always need some, but like 10, not 100s per hospital.
 

EUA

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I wonder what actually we can save if the following is done:

1. Deductibles of 1000-4000 dollars per year based on the size of your family. And don't give me some BS about how people can't save up at least 1000 for their health care per year. At least this would force responsibility upon people and then costs would be much more transparent.
True dat. Plus, if they actually had to *pay* (gasp!) for that much up front out of pocket, the average person probably wouldn't go to the doctor for frivolous reasons (e.g., upper respiratory infection) that typically result in expensive, unnecessary diagnostics/medicines (e.g., the latest and greatest antibiotic Patient X saw in Newsweek, when said patient's URI is viral). I can't even imagine how many millions would be saved only by eradicating unnecessary antibiotics alone, especially if you also include side effects and cost of treating said side effects.
 

NotAProgDirector

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1. Deductibles of 1000-4000 dollars per year based on the size of your family. And don't give me some BS about how people can't save up at least 1000 for their health care per year. At least this would force responsibility upon people and then costs would be much more transparent.
Many, many americans live paycheck to paycheck. I'm not defending this, and I expect that some of the reason for this is poor choices. For example, I have a patient who (amongst other problems like alcoholism) has financial issues. When I tried to help review her basic "cash flow", I discovered that she was paying >$100/month for cable -- all of the movie channels, etc. When I pointed out that if she dropped that she would have the extra $100 per month that she needed, she looked at me like I had 3 heads.

But, bottom line is that many americans will not save for a deductible.

2. Kill administrators. Well not kill, but fire. Let them work on the fields somewhere actually producing something for the US rather than being middlemen. You always need some, but like 10, not 100s per hospital.
Amen to that, but perhaps instead of killing them we should turn them into biodiesel.
 

RussianJoo

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I personally don't see how private insurance companies are simply going to give up their client base. Insurance companies are major lobbyists and they will use all their resources to prevent that from happening i.e. will not let national health care go through to the point where everyone will have a national insurance and private insurance companies are out of business. I think once Obama steps into office he'll have a meeting with the rest of the staff and will realize that about 70% of what he promised in the elections simply can't be done. That's what happens all the time presidents promise all sorts of stuff in order to be elected, once elected they don't deliver on most of what they said they would do.
Since private insurances will still be around and since majority of the people can afford private health insurance, even if some kind of national plan does become available, only a very limited number of doctors will see those patients because most will continue to see only privately insured patients like they do now. Wait lists will become huge and people will have to schedule months in advance to see their doctor, those who can afford health care but wanted to save money by having the government insurance will quickly switch back to private insurance just so they can see a physician in a timely manner, and most MDs will not be affected, sure some might make more, some might make less but on average physician salaries will stay the same.

You people are forgetting that most Americans want things now, that's why we invented fast food. Anyone who can afford private health insurance will still have it just so they don't have to wait a month or two to have surgery that's not an emergency but is still needed. Since most specialists don't take Medicaid and Medicare anyway, they'll continue to not accept the national insurance, and since their original client base was composed of people who can afford private insurance their salaries will not decrees.

That's just my take on things, the private insurance companies will lose too much money if we have a nationalized health care, also pharm companies will lose money because the national insurance will not pay them $600 for a month supply of medication like private insurance companies do. All these people have the government in check and won't let anything drastic to occur.


If salaries do drop then we'll see an increase in the physician shortage. Most people will not be able to afford to take out loans to go to med school if they're only going to be making $120K a year after med school. So most will choose some other profession to go into. Yes we all want to be doctors and help people but most of us are not willing to go into bankruptcy to do so.
 
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Llenroc

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hmm...I didn't realize there were that many people who can afford to pay out of pocket for a 50,000 dollar operation. Oh well, have fun suckling from the teet of the other half of the top-one percent (they might even be kind enough to give you a big tip around the holidays).


My guess for what happens under Obama-care is that most primary care will be provided by DNPs and PAs, under the loose supervision of physicians who will handle the hard stuff. Hospital-based practice will become more common. Specialists will take a hit, but not as bad as many expect.
Why would hospital based practice become more common? This is - again - one of the things that's bankrupting the system. One day of hospitalization costs $2000. In the past ten years, there's been an explosion in the size and number of hospitals added.

If they want to cut healthcare costs, they're going to put the money into outpatient, primary care. I'm not a primary care guy myself so I have no reason to advocate for this, other than that on a population level with cost/benefit analysis it actually works.

OTOH, the catastrophic care stuff that America is famous for (and which are bankrupting our system while making no difference to population health) like the helicopters that go out to fetch mangled car accident victims with their brains spilling out of their skulls, or the double and triple liver transplants for alcoholics, or even the fact that everyone with failing kidneys here gets unlimited dialysis will have to go. Society just can't afford to keep paying for those things.

Things in the middle like excessive referrals to specialists and long inpatient hospitalizations for folks that really don't need to be there, will also end up being curtailed.
 
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