is it inevitable that doctors incomes are going to drastically drop?

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Don't really care. As long as I have a place to stay and food to survive 🙂
 
Nope. The cost of training isn't going down anytime soon. If I was told correctly, this past year was the first time that multiple schools increased their # of seats in a long time - but not by a lot. The highly medically-served population (read: gomers) has been growing like crazy and will continue at a faster rate than med schools grow for a while longer.

'05 saw an average increase of 6% in physician salary, much is attributed to increases in patient volume.
 
ronaldo23 said:
to the 80-120K region, with hilary clintons impending plans, and even without that, universal health care seems like its coming.
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If that ever comes I'll only take patients paying out of pocket. You know...I gotta pay my debts and have to live decently too after years of sacrifice. However, I don't think it'll ever come to that. Think about when Hillary needs a doctor...you don't want to have doctors mad at you when you're sick!
 
Canada's got it, but while incomes are slightly lower, they are NOT in the 80-120 range. 150-200 for most specialties is more like it, and then your malpractice is basically nothing.
 
ronaldo23 said:
to the 80-120K region, with hilary clintons impending plans, and even without that, universal health care seems like its coming.
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that type of salary is enough to live more than comfortably. also, if you get married you can add your spouse's income
 
Respect is all that matters to me.
 
pakbabydoll said:
Respect is all that matters to me.
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Good luck with that. 😉
From the general public, it's likely. From many of your patients, it's likely. From many of your drug-dependent/-abusing Axis-II'ers, it's not likely.

Guess which one's you'll probably remember most. 😉
 
milliya said:
that type of salary is enough to live more than comfortably. also, if you get married you can add your spouse's income
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No, it's not if your spouse does not work. It's enough to live, but not comfortably with a family of 4. Plus your loans....it may seem like a lot to you now if you never had a mortgage and stuff like that.
 
RA1987 said:
unless she doesn't work...

cue the "omg you are such a sexist" comments.

bite me.

I can live on 80,000... My parents TOGETHER don't make that much...
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lol no you're right on both fronts! 80k is livable.
 
pakbabydoll said:
Respect is all that matters to me.
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Very true. However, respect comes also from what you are paid "in respect" to the other professions. If people see you drive a nice car people think you must be a good doctor to make that kind of money and respect you more. Do I agree with it? Not necessarily. But that's how it works.
 
How is $80K "good enough" when you're paying back $150K+ in loans? And with loan deferment for residents now being in jeopardy? Seriously folks, put the idealism aside a little bit.

Though I have serious doubts about salaries coming down to this level in the first place...
 
Personally I don't think the Insurance companies would let unversial health care happen. They will try to fight it, because it means they lose money. The universal health care plan was floated during Bill Clinton's terms as president and it failed. I would expect the same now as well. If doctors salaries fall to those levels I think medicine will then become less competative. Students will pick an easier road to make the same money.
 
ah, the "please allow me to bend over" attitude that's so common among pre-meds/med students til they realize the economic realities of it all. 80k may be "enough to live on" but not when you've racked up 200k in debt.

Furthermore, I could make 80k a lot easier than 4 years of grad school plus 3-5 years of residency plus 2 years of fellowship. I'm sure some college sophomore will chime in about how "uncompassionate" that is, but I would prefer that my colleagues and my own doctor are intelligent enough to not drown in their own naivety.

As for the original question though... no it won't happen. "universal" care will likely end up dealt with on the private end. Though salaries will indeed go down.
 
se2131 said:
How is $80K "good enough" when you're paying back $150K+ in loans? And with loan deferment for residents now being in jeopardy? Seriously folks, put the idealism aside a little bit.

Though I have serious doubts about salaries coming down to this level in the first place...
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Add malpractice insurance in as well.
 
Quix said:
Good luck with that. 😉
From many of your drug-dependent/-abusing Axis-II'ers, it's not likely.

Guess which one's you'll probably remember most. 😉
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Seen them in the ER during volunteer hours. They yell at me when I tell them they can't go home because the doctor hasn't come yet. Then they get all fired up and demand to leave. At that time I summon the nurse and she either convinces them to stay or gets the paperwork. Oh well, they'll be back in a few days anyway.
 
to the 80-120K region, with hilary clintons impending plans, and even without that, universal health care seems like its coming.
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What exactly about her plan would lead to compensation in the 80-120k range? Or did you just completely make that up?

maybe I am missing something but how is it that people assume that because MORE people have insurance doctors will make less? doesn't MORE insurance mean MORE visits to the doctor per year?
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They assume that because most of the uninsured can't afford average premiums, and further, they might draw more resources as they may be more unhealthy as a group. People are afraid that they might have to "subsidize" their health care. Personally, I'd rather live in a country where if you work and play by the rules, you get health care, even if that means I make 175,000 and not 185,000 (concern for the common good, wow imagine that).

Just as we "subsidize" public education for ALL students, we should do the same with health care. It really is our responsibility as a modern nation.
 
RA1987 said:
maybe I am missing something but how is it that people assume that because MORE people have insurance doctors will make less? doesn't MORE insurance mean MORE visits to the doctor per year?
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I'm also guessing lower payouts to counteract that.
 
I doubt that there will be lower payouts, and I suspect volume will make up the difference. Under the current system, hospitals and private practices receive pennies on the dollar from the insurance companies (the biggest source of hospital income tends to be Medicare/Medicaid), so hospitals/practitioners inflate their costs in an effort to get back something approximating the actual cost of treatment. In a system in which everyone is covered, there is no reason for bill inflation to compensate for poor payouts, which will probably produce price stabilization around the actual cost of treatment + fees.
 
RA1987 said:
maybe I am missing something but how is it that people assume that because MORE people have insurance doctors will make less? doesn't MORE insurance mean MORE visits to the doctor per year?
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The assumption is that doctors would become salaried, so the number of patients or visits wouldn't matter, or there would be lower payouts. That's unlikely to happen anytime soon, as I doubt anyone wants to deal with the health care economy collapsing on itself like a falling star.

All in all, I'm not terribly worried about a decline in physician salaries. Private insurance companies aren't going anywhere anytime soon, no matter what happens in DC.
 
brianmartin said:
What exactly about her plan would lead to compensation in the 80-120k range? Or did you just completely make that up?

They assume that because most of the uninsured can't afford average premiums, and further, they might draw more resources as they may be more unhealthy as a group. People are afraid that they might have to "subsidize" their health care. Personally, I'd rather live in a country where if you work and play by the rules, you get health care, even if that means I make 175,000 and not 185,000 (concern for the common good, wow imagine that).

Just as we "subsidize" public education for ALL students, we should do the same with health care. It really is our responsibility as a modern nation.
Click to expand...

I'd just hope we do a better job with healthcare than we do with public education.
 
if compensation ever gets that low, it will be SOOOO much easier to get into med school
 
.
 
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RA1987 said:
maybe I am missing something but how is it that people assume that because MORE people have insurance doctors will make less? doesn't MORE insurance mean MORE visits to the doctor per year?
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Doctors are already overworked and overbook - from primary care to specialty outpatient care. Almost any major hospitals are always full or near critical capacity.


So more "demand" won't necessarily mean more income unless you see more patients in your day/night.

The amount that insurance reimburse physicians varies depending on insurance ... some medicaid HMO plans are notorious for very poor reimbursement (in effect, you lose money by seeing their patients because your total overhead cost is more than the reimbursement). The end results is medicaid HMO patients are having a difficult time finding physicians who 1. accept their insurance and 2. are accepting new patients. The same can be said of Medicaid.


If you were a primary care doctor in an outpatient setting, and your overhead cost comes to around $40 per 15 minutes (rent, salary of office clerk, nurse/MA, billing/insurance clerk, utilities, and all insurance) ... who would you rather see in your 15 minute time slot

Patient A with Insurance A, which reimburse you $60 (and patient will pay $15 copay) for level-3 (CPT code 99213) office visit

Patient B with Insurance B, a medicaid HMO, which reimburse you $43 for a level-3 visit (patient with no copay)


Now you see 4 patients an hour, and you see patients for 7-8 hrs and you see a monetary difference between having 0% of your patients with Insurance B, versus having 60-70% of your patients with Insurance B



For you pre-meds out there who are shadowing physicians, ask which insurance pays well, and which insurance does not pay well (or if a doc does not accept some insurance, ask why)
 
Omyss said:
http://www.payscale.com/research/ca/People_with_Jobs_as_Physicians_/_Doctors/Salary

Goes as low as 85K for ER docs... family docs make about 100K.
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A significant # of doctors in Canada work less than 40 hours a week.

If you find an actual doc-by-doc annual billing breakdowns (don't have a link handy, but I vividly recall seeing one for British Columbia a while ago, so I'm sure you could find one reasonably quickly), you will see the # of hours, and while figures like 60K may seem strikingly low first, you will realize these doctors work 20-25 hours a week.
 
From an ER resident:

"actually in Manitoba they renegotiated the ER contracts a couple of months ago and the article they sent us in the mail reads as follows:

Average annual full time salary at a teaching hospital: $275,000 with a possibility of a $30,000 bonus

Community hospital ER hourly wages:
weekday daytime: $113.64
weekday evening and weekend days: $159.09
weekend evening: $170.45
overnight shift: $181.82"


Hardly 85K.
 
Just throwing another one in there that shows that Canadian docs aren't standing in line at their local food bank.





Canadian MD earnings inch upward

NRM survey shows practice revenue remains healthy


Gross and net earnings rose in 2005
Gross Net
Dermatologists $360,000 $240,000
Internists $310,000 $200,000
Ob/gyns $320,000 $195,000
Pediatricians $250,000 $160,000
Psychiatrists $190.000 $160.000
GPs $260,000 $155,000

"Things seemed pretty steady to me, money-wise" says a Montreal GP. Her view is in keeping with the majority of respondents in NRM's latest Practice Management Survey, which revealed that most doctors' earnings held steady in 2005. But when you closely look at the numbers, there's actually much to happy about. For instance, physicians were more likely to see a wage increase and less likely see their pay decline last year compared the year before.

Overall, 41%* of Canadian doctors said their gross practice revenue increased during last year. This is up from 33% in 2004. Also, fewer doctors complained of a drop in gross revenue in last year (14%) compared to the previous year (21%).

The past year's numbers were similarly pleasant for Canadian MDs after practice expenses. In 2005, 34% reported a higher take-home pay, compared to 27% in 2004. After taxes too, MDs were farther ahead of the game in 2005 than 2004; in 2005 18% of doctors reported a drop in net income compared to 28% in 2004.

NRM Practice Management Survey Results 2006
Gross practice revenue for GP/FPs and selected specialties

click here for pdf chart

DOLLARS & CENTS
Primary care physicians had a pretty good year in 2006. An equal number of respondents (43%) earned a higher practice revenue compared to the previous year; only 13% had a lower gross income. After-tax earnings weren't quite so good for Canada's GPs. While 34% saw their net salary rise, 51% saw it hold steady, and for 18% of respondents, after-tax revenue was down in 2005.

According to the survey, 2005 saw a jump in the number of physicians in the top-tier income bracket of $300,000 or higher. All-in-all 27% of respondents grossed more than $300,000 in 2005 — that's an eight percent jump from the previous year. Also, in 2005, 37% of respondents earned a gross income between of $200,000-$300,000 — a 1% gain from last year's survey. Not surprisingly, a higher proportion of specialists (31%) surpassed the 300K mark than GPs (20%). Nine percent of GPs found themselves in the lowest MD income bracket — less than $100,000. Surprisingly, an even greater percentage of specialist respondents (10%) reported earning less than 100K.

GRASS NOT GREENER
Things haven't been so rosy of late for doctors south of the border. A survey published in Medical Economics found that net earnings for both the average primary care doctor and the average specialist remained unchanged over a one-year — and when inflation was added to the picture, their wages actually declined. Canadian doctors, despite the problems with our system, might want to thank their lucky stars that the tort environment here is nowhere near as poisonous as it is in the United States. In fact, extortionate American malpractice insurance premiums — which shot up 18% in a year — were the biggest factor in holding back growth in US doctor compensation.
US MDs gross more, net less
Gross Net*
Dermatologists $560,000 $282,000
Ob/gyns $569,300 $215,000
Pediatricians $380,000 $147,900
Internists $350,000 $150,000
GPs/FPs $320,900 $134,000
(*2004 median income, after tax-deductible expenses, but before income taxes, in US funds. Source: Medical Economics)
 
Quix said:
I doubt that there will be lower payouts, and I suspect volume will make up the difference. Under the current system, hospitals and private practices receive pennies on the dollar from the insurance companies (the biggest source of hospital income tends to be Medicare/Medicaid), so hospitals/practitioners inflate their costs in an effort to get back something approximating the actual cost of treatment. In a system in which everyone is covered, there is no reason for bill inflation to compensate for poor payouts, which will probably produce price stabilization around the actual cost of treatment + fees.
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Just the equipment used for some of the procedures are pretty alarming.
 
ryandote said:
You realize this is a matter of opinion? Ask Oliver Wendell Holmes where his right to swing his fist ends.

Is healthcare a constitutional right?
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Should it be? I think on this sometimes: when the constitution was written, modern healthcare as we know it did not exist. When a soldier got shot in the American Revolution, they cut his leg off and tarred it. When a sailor got scurvy, someone gave him lemon juice. When an infant was born with a disability (if it got that far), survival was almost impossible. That was "medicine" then. No huge hospitals, surgery, etc...virtually none of the modern aspects of our healthcare delivery system existed at the time of the founding fathers. If it had, would the right to healthcare have been incorporated in our constitution?
 
So basically, your average American doc makes about 15% more than a Canadian, but for many, the slight decrease in income is worth the decrease in paperwork with a single reimbursement agency and a greater extent of freedom when it comes to choosing treatment options. Not to mention, Canadian medical school graduates pay about 30% of the American med school tuition, so we have fewer loans to pay back.
 
hmmm, if i continue on my current job, in a year or two i'd be making 80k. so i sure hope the med school investment would yield a bit more than that? esp with debt and all...
 
jochi1543 said:
So basically, your average American doc makes about 15% more than a Canadian, but for many, the slight decrease in income is worth the decrease in paperwork with a single reimbursement agency and a greater extent of freedom when it comes to choosing treatment options. Not to mention, Canadian medical school graduates pay about 30% of the American med school tuition, so we have fewer loans to pay back.
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So while us in America make more, you guys keep more of you money because malpractice and med school loans aren't as high.
 
narretgrez said:
hmmm, if i continue on my current job, in a year or two i'd be making 80k. so i sure hope the med school investment would yield a bit more than that? esp with debt and all...
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Word.
 
"AMG! Medicine is going to collapse and I won't be able to survive on my pay!"

Calm down people. I thought economics was a mandatory part of the university level curriculum. What kind of crack are you people smoking where you think physician's salaries are going to leave them in the poor house? Physicians salaries will never be low.

Simple supply and demand tells you that physicians will always make enough to convince people going through everything it takes to become an MD or DO it is worth it.

An $80k a year salary? Yea, maybe if the length and cost of medical education to the student were both drastically reduced. There's only so much **** people are willing to eat in the name of "helping others"; especially if there are other options...
 
Arc said:
So while us in America make more, you guys keep more of you money because malpractice and med school loans aren't as high.
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Well, the 15% I gave as an approximation refers to the NET income, but as far as gross - yes, you are right.
 
less money for being a doctor is a possibility for the future?????....:barf:
 
group_theory said:
If you were a primary care doctor in an outpatient setting, and your overhead cost comes to around $40 per 15 minutes (rent, salary of office clerk, nurse/MA, billing/insurance clerk, utilities, and all insurance) ... who would you rather see in your 15 minute time slot

Patient A with Insurance A, which reimburse you $60 (and patient will pay $15 copay) for level-3 (CPT code 99213) office visit

Patient B with Insurance B, a medicaid HMO, which reimburse you $43 for a level-3 visit (patient with no copay)


Now you see 4 patients an hour, and you see patients for 7-8 hrs and you see a monetary difference between having 0% of your patients with Insurance B, versus having 60-70% of your patients with Insurance B



For you pre-meds out there who are shadowing physicians, ask which insurance pays well, and which insurance does not pay well (or if a doc does not accept some insurance, ask why)
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good point, but on the flip side some doctors might prefer medicare or medicaid, because often times it can pay out more with less hassle. even in an outpatient setting, say you bump up that 99213 to a 99215 you're looking at a $150 rather than $50 with medicare. also it's easier to pull a fast one of the gov't versus private insurance companies. for example, doctors and companies that provide nursing care, electric wheel chairs, and medical supplies can easily work together to abuse medicare and medicaid. nursing companies provide doctors with a good supply of medicare clients as long as they make sure to once in a while prescribe nursing care and maybe an expensive wheel chair which is entirely covered my medicare. many doctors probably wouldnt even consider this immoral, since we are all trying to make a living right? should medicine be a business or is it a basic human right? with the amount of time and money doctors spend to get to where they are, they are highly motivated to make it a business. spend 10+ years of your life racking up hundreds of thousands of dollars in debt to take the high road when it comes to making a judgment involving getting paid? doctors are good people, but no one is going to want to bust their butt and waste their youth for a poorly compensated profession, you better believe doctors will do what they have to in order to get paid, even if it means making a small moral compromise. and im sure there are many idealists out there who will disagree and say they will always do what is right, but i suggest that they wait until after med school and interning and then reconsider what they feel they deserve. medicine cannot be moral enterprise as long as the current medical education system is in place.

in addition with inpatient care medicare/medicaid is probably much preferred because you can be hospitalized for days to weeks with little restriction under one of the govt plans, but under an average private insurance company, there is no way you're staying there for days unless there is an extremely compelling reason.
 
milliya said:
lol no you're right on both fronts! 80k is livable.
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80k is just fine is we were normal people with normal jobs. But look what we have to go through. Look at this web site we're on. Do you think there is a student-real estate agent web site that people obsess over? We deserve more money and more respect. There has to be a better way to give everyone health care than to take our money away.
 
I cannot imagine anything more frusterating than not being able to treat patinents and/or apply new treatments because their insurance company or HMO refuses to pay for it. What is the point of research if it can't be applied?

I understand this is a very complex issue... but believe the system is flawed and would take a ~15% paycut to have more freedom in treating my future patients.
 
barto123 said:
good point, but on the flip side some doctors might prefer medicare or medicaid, because often times it can pay out more with less hassle. even in an outpatient setting, say you bump up that 99213 to a 99215 you're looking at a $150 rather than $50 with medicare. also it's easier to pull a fast one of the gov't versus private insurance companies. for example, doctors and companies that provide nursing care, electric wheel chairs, and medical supplies can easily work together to abuse medicare and medicaid. nursing companies provide doctors with a good supply of medicare clients as long as they make sure to once in a while prescribe nursing care and maybe an expensive wheel chair which is entirely covered my medicare. many doctors probably wouldnt even consider this immoral, since we are all trying to make a living right?
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there are plenty of levels of being audited via the chart though. medicare and medicaid have offices/space in many hospitals to just track that. they also do it in private office settings as well... so, the history and physical on a 99215 better be documented appropriately, or it'll get kicked back down to a 99213, and payments may be held, or you'll ahve to repay the money.

add to that, the expensive wheelchair isn't entirely covered by medicare when you look at the paperwork. the patient still has to pay a fee up front to the company which may or may not be reimbursed to the patient. and of course, the paperwork fro the patient needs to state that there indeed is a need for the wheelchair in the first place... and if it doesn't match up during an audit, you'll be in trouble- and being that medicare fraud is a felony, it's not something that some people would do. i'll agree with you, some people do it.

should medicine be a business or is it a basic human right? with the amount of time and money doctors spend to get to where they are, they are highly motivated to make it a business. spend 10+ years of your life racking up hundreds of thousands of dollars in debt to take the high road when it comes to making a judgment involving getting paid? doctors are good people, but no one is going to want to bust their butt and waste their youth for a poorly compensated profession, you better believe doctors will do what they have to in order to get paid, even if it means making a small moral compromise. and im sure there are many idealists out there who will disagree and say they will always do what is right, but i suggest that they wait until after med school and interning and then reconsider what they feel they deserve. medicine cannot be moral enterprise as long as the current medical education system is in place.
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to add, we need to decide if healthcare and medical care are one in the same thing, or if they're two different entities. either way, it will have many implications/ramifications.

someone pointed out in another thread, that there are plenty of things that we need i this life in order that are not guaranteed- food, shelter, and clothing. these are not provided to everyone, yet most people would say that you can't live without them. so, what makes healthcare/medical care different that they should be provided to everyone?

in addition with inpatient care medicare/medicaid is probably much preferred because you can be hospitalized for days to weeks with little restriction under one of the govt plans, but under an average private insurance company, there is no way you're staying there for days unless there is an extremely compelling reason.
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actually, medicare and medicaid pay differently... and the perspective of the hospital and the doctor is different.

for example, a 68 year old smoker comes to the er with cough, fever... chest x ray shows a left lower lob pneumonia. he has medicare insurance. he's admitted for pneumonia. medicare will pay the hospital a d.r.g. (diagnosis related group) based on the pneumonia and history of smoking... and pretty much give the hospital a lump sum which rightly or wrongly will be based on the assumption that the entire hospital course will take 3 days.

same patient, but he has medicaid. medicaid doesn't do things based on drg's. they pay the hospital for the bed day. so, whether the patient is there for 3 days, or 7 days, the hospital will be paid for the bed day.

so, what have some hospitals done? they've skewed some of the powers that be to concentrate on the medicare patients. i.e. make sure the doctor is doing everything he/she can, that ancillary services are doing everything that they can in order to get the patient out in time... so that the hospital doesn't lose money.
insurance companies are then next in level of priority.
they do this at the expense of medicaid patients... because the hospital's getting paid for a bed day, the hospital isn't incentivized to get these patients out.

this is all done without thought of how the physician will get reimbursed for his/her services. in other words, the hospital has their priorities, and physician reimbursement is not number one.
 
Magnolia85 said:
I cannot imagine anything more frusterating than not being able to treat patinents and/or apply new treatments because their insurance company or HMO refuses to pay for it. What is the point of research if it can't be applied?
Click to expand...

there are a few ways to see this situation, and depends on whether you're referring to outpatient or inpatient practice.

say you want treatment y for your patient with disease a. you prescribe it. patient goes to the pharmacy, and their told that your insurance company doesn't cover it. patient comes back to you and says "hey, i have to pay out of pocket for treatment y." you call the insurance company, and are told "you didn't try treatment x 1st."

the patient could decide to believe you, and pay for treatment y out of pocket... but most patients won't, and would rather have whatever is free/cheapest/on formulary.

and in some ways, therein lies the rub. the decision is between the patient and physician. but the patient's and physician's interests are not necessarily aligned with those of the 3rd party payor.

so, if your patients are in a good financial position, you can prescribe what you want to. or, alternatively, if you didn't care, you could let your patient duke it out with the insurance company and stick to your guns as to what you want the patient to take/receive. but, many doctors care and thus change their recommendations to fit the bill for the insurance company.
 
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