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

[Jolie South]

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Thanks KThanksBye. I think I could totally afford that and it would be a great idea!!

I guess I'll just go with a lower deductible plan until my savings become large enough to cover the largest possible deductible.

You said that you shouldn't link the account and the insurance policy. How did you manage that? Did the same broker hook you up or did you get the HSA through the broker and the policy independently?

 

[Kthanksbye]

Thanks KThanksBye. I think I could totally afford that and it would be a great idea!!

I guess I'll just go with a lower deductible plan until my savings become large enough to cover the largest possible deductible.

You said that you shouldn't link the account and the insurance policy. How did you manage that? Did the same broker hook you up or did you get the HSA through the broker and the policy independently?

I went through the broker for the health plan mostly, and he recommended an HSA as well. They can research several plans and find one that works for you a bit easier than you can, and using them doesn't make your insurance any more expensive since they don't charge you (they can actually find a better deal if you get a good one, though there are some very pushy ones who kept calling me with terrible deals and wouldn't stop calling even after I said no, but not with the broker I listed earlier). But you can do it individually if you want to. I got my plan from Assurant health and the HSA is from HSA bank, which allows you to trade the account with Ameritrade (an on-line discount stock broker), which is perfect for me. I can leave it with HSA bank, where it is in an interest bearing savings account, or transfer it to a money market, or transfer it to ameritrade and buy stocks or mutual funds with it. Some accounts don't allow trading, so you have to pay attention to what you are signing up for. The combined HSA with health plans tend to be more expensive, but have less options, in my experience. I was originally with blue cross, and they offer an HSA with a health plan, but it's over a hundred a month and you can't trade with the account. It's just a savings account. 👎 Not doing that. Also, if the insurance plan changes (they change often), you can't change insurers easily since it's linked to your HSA. You would have to cancel both and roll over your account to a new one. Better to have your account in one place and your plan somewhere else. They don't have to be linked. Also, a broker will be able to find a better deal later if your plan changes. My broker will notify me if he finds me a better deal down the road. I think they have an incentive to do this because they get a bonus if they switch you to another company. They work for you but you don't pay them. Not bad.

Also, the laws for HSAs seem to get tweaked a bit every year. They generally make them more attractive, so it's good to be able to change plans as the laws change to get a better deal down the road.

 

[potato head]

i barely read any of these responses, but if i can live off of 30K now, i'm okay with 80K later.

and a 150K loan? pay off 40K per year, living off of 40K (which i can do), and i'm out of debt after four years. sounds okay to me.

Even if your 80K gross was after malpractice insurance was deducted, your student loans can't be paid before taxes. If you want to pay off 40 grand/year in student loans, your remaining take home would be below the poverty line.

If your first contract as a doc is only 80K and you have 150K in loans, a mortgage, and/or a family, you will have a very hard time making ends meet in any part of the country ten years from now.

If you are happy with an 80K salary, you should go look into a career as a PA. The cost and time needed to earn a medical doctorate and become board-certified is not worth 80K.

You may also want to look into the ramifications of the new college cost reduction act.

you write a lot.

just saying i'm okay with dealing with a large loan with an 80K income. i suppose you could say i actually make 24K, post taxes. i know to what extent i can get by on this, and after bills/utilities, i usually have at least 700/mo to pocket into savings. 80K pre-loan payoff is doable, 80K post-loan payoff is rather comfortable. but this is all hypothetical anyways.

 

[lisichka]

you write a lot.

just saying i'm okay with dealing with a large loan with an 80K income. i suppose you could say i actually make 24K, post taxes. i know to what extent i can get by on this, and after bills/utilities, i usually have at least 700/mo to pocket into savings. 80K pre-loan payoff is doable, 80K post-loan payoff is rather comfortable. but this is all hypothetical anyways.

and i assume, you have no dependants yet. when you have kids, 700/per months to pocket savings is hypothetically doable, but just enough to survive, but not live. blue collar workers (no education) earn more. so is it fair? not really, if you ask me.

and when you factor in inflation, and the falling dollar exhange rate, life becomes unbearable. not only you won;t be able to travel, but you'll have to count every penny to afford food.

 

[potato head]

so is it fair? not really, if you ask me.

i know, it's not.

 

[nima123]

Yes, doctors' salaries are indeed going down. The downward trend has already started and will continue with or without Hilary.

Many doctors may get rich these days, but in only 10 years only a few will become rich by practicing medicine. Unfortunately, there's little that doctors can do about this, as it is next to impossible for doctors to go on strike or even unionize.

So if you're in it at least in part for the money, now is a good time to perhaps reconsider and think about more lucrative and easier alternatives such as law or dentistry, etc.

Scary, sad...but true! 🙁

 

[badasshairday]

Good luck.

That was a very good read. It seems old though, 1998?

Man, but that's what I'm talking about... somthing like the "Federation of Physicians" they talk about in there can keep HMO's from screwing physicians.

 

[Funky]

This I don't buy. As long as states own monopolies on government-supported education, they can continue to push tuitoin costs up with no backlash. They merely up the allowed loans from the federal government regardless of whether or not students know what their degree is worth. If you look at lower paying jobs like education, for instance, their salaries are not rising at nearly the rate that their tuition is going up, and that won't catch up to the profession until it is too late.

Regarding specialties, mid-levels have taken over for MD's in many primary care settings (not to mention CRNA's). Cheaper care and lower compensation out-compete doctors.

i'm not saying med schools will be cheaper or tuition will say the same. I'm saying since debt is high, incomes will remain relatively high compared to the rest of the country. Plus doctors are in high demand especially in specialty areas because of the difficulty in earning a degree and going through training.

 

[Chuckwalla]

Life will continually get harder for doctors. As businesses gain more power they will take more of the health care money for themselves, meanwhile insurance companies will constantly try to decrease doctor compensation.

 

[cbrons]

Respect is all that matters to me.

lol, yeah. that attitude will really last after you're hundreds of thousands in debt from school.

 

[nima123]

Guys who got PhDs in Physics and other sciences went through 'training' just like the doctors did.

Bull****. PhD is by far shorter and more laid back than medicine and is nowhere nearly as competitve as medicine.

There's no job that is nearly as hard and as long as medicine in terms of BOTH training and practice.

Why don't you get into med school first before you make comments as to how difficult/easy becoming a doctor is?

 

[Gut Shot]

Bull****. PhD is by far shorter and more laid back than medicine and is nowhere nearly as competitve as medicine.

Factoring in post doc years, the PhD training is comparable in length to MD + residency +/- fellowship. PhDs also deal with lower salary prospects and much, much less job security than MDs. Medicine is an ass kicking, but research/academia as a PhD is soul crushing.

Why don't you get into med school first before you make comments as to how difficult/easy becoming a doctor is?

If you're looking for trouble, you found it.

Sincerely,

Gut Shot
PhD -> MD

 

[Law2Doc]

Please, people need to calm down. 100k is enough to live on, even with $150k in loans. Yes, you may need to add spousal income, but guess what? So does the majority of the country.

And don't give me that BS about the 'time spent in training.' Guys who got PhDs in Physics and other sciences will be making a lot less than physicians make, and they went through 'training' just like the doctors did. You are not God's Gift To The World. And it's still more after you account for the loan payment. Seriously, the loan payment business is such a red-herring. A guy I know with a PhD makes $50k/year. You add the 'backbreaking loans' that a doctor might have, that he doesn't, and you'd only need to be making $75k-$90k/year. And I am living on my own and doing it for four years, working a full time job and paying my own undergrad, while starting my post-bac, so I know full well how it is to 'live in the real world'.

Obviously, I'd like to make as much as possible, but the whining that I hear makes me understand completely why many people believe doctors are a bunch of overpaid cry babies. In the US, doctors get paid more than pretty much any other country, yet being a physician is extremely competitive almost anywhere. So I don't buy the idea that no one will want to be a doctor either.

And for the record, I don't think our salaries will average anything less than $140-$150k for primary care and $170-$200 for specialties, even with universal healthcare.

I think the point is that "enough to live on" has not historically been the income physicians are accustomed to. As debt goes up, reimbursements go down, and healthcare gets reformed to be "cheaper", it seems likely that, as you suggest, physicians will be able to have enough to live on, but become decidedly more middle class. i.e. comfortable but not rich. Which is fine, and won't be the end of the profession. But if you are interested in a certain level of income, it is going to be more appealing to get there in a field without 4 years of professional school and 3+ years of residency, so you will see some folks drift to other fields. There will still be plenty of people who want to become doctors, but some percentage of the best and brightest always gets lost when the perqs go away. This is not unigue to medicine.

Your comparison to doctors in other countries or to folks in other career paths will be pretty meaningless to you when you are working longer hours to live much more modestly than the prior generation of physicians. Expectations are higher. So too any argument that doctors will still earn in the top x% of the world. Nobody cares -- this kind of thing sounds important in eg undergrad, but what really matters is whether you are saving anything or living paycheck to paycheck.

Save your post and come back and look at it once you have completed your 4+ year residency with $200k in educational debt, and income of $150k and a couple of kids (meaning you or your spouse either stays home, or most of his/her salary is paid over to the nanny/daycare). Perceptions always change when you get to reality.

 

[Drogba]

Factoring in post doc years, the PhD training is comparable in length to MD + residency +/- fellowship. PhDs also deal with lower salary prospects and much, much less job security than MDs. Medicine is an ass kicking, but research/academia as a PhD is soul crushing.



If you're looking for trouble, you found it.

Sincerely,

Gut Shot
PhD -> MD

Ohhhhh, SNAP!

 

[hawk126]

This is not an HSA. It's an FSA (flexible spending account). I would not recommend anyone use an FSA. Obviously, the biggest drawback is that if you don't use your contributions within the year, they are gone. With an HSA, the money is yours forever. And it's inheritable, so even if you die, it's not absorbed by your health plan. An HSA is kind of like a retirement account in that you can use it for anything you want without penalty after 65. Before 65, you can only withdraw from it for health care (which is actually pretty broadly defined) or suffer a penalty fee.



Generally, the premiums are less than what most people are paying for their standard insurance plans. You can look into it to find out, but you can get coverage for about $50/month and up, depending on your deductible and coverage. Mine is $47.36. You don't have to contribute to the HSA at all. But it would understandably be wise to at least get it up to the amount of the deductible, which I think is by law is $5100 max, but can also be less. I would actually like to have a higher deductible since it makes the insurance cheaper and I rarely go to the doctor and would rather pay out of pocket for most things. Health insurance is not for every random prescription or visit, it's just for getting hit by a bus or something that no one can reasonably be expected to afford. The reason most people pay so much for insurance is because they are over insured. Your HSA can cover the small stuff. Your insurance picks up the really expensive stuff.



This is a drawback of HSAs. You are limited to a fixed maximum contribution per year, so it can take some time to accumulate a sizable HSA. Although wise investing can make your HSA grow faster. Also, this is less of a problem for young people who are unlikely to experience significant health problems before they can build up their HSA. Although I would not say that HSAs are only for the young and healthy. I think they have something to offer for others as well...control of health care, tax free retirement savings, ability to invest, independence, and it puts the responsibility of personal health on the patient, where it should be. One thing you could do would be to start out with a lower deductible if it makes you feel more comfortable, then raise the deductible as the HSA grows to save money on premiums. Here are some sites that answer some questions:

US treasury department

Kiplinger FAQ

Great Info!!! My wife and I use an FSA thru her employer, but I think we're definitely going to research HSA's now. Thanks a million for the insight!!

 

[Kthanksbye]

Great Info!!! My wife and I use an FSA thru her employer, but I think we're definitely going to research HSA's now. Thanks a million for the insight!!

I think you can roll your FSA into an HSA if you decide to switch. It's a one time allowance. Also, I think you get a one time roll over from your IRA if you want to use that to help build your HSA for the first year.

 

[Gut Shot]

Ohhhhh, SNAP!

Dammit, I left out the best part:

 

[Law2Doc]

But that's a pretty idiotic way to judge things. In prior generations, a lot of people were making more or less. You can't pay a profession based on what they used to make.

I agree with this. But I think you are probably misunderstanding my point and looking back too many generations with your point. 90% of the pre-allo salary threads involve mention of some parent, uncle or neighbor who is now a millionaire physician. People practicing now, not historically. My point is they got in at a different time -- are a different generation and saw a different pay structure and ceiling. Those days are over. This is not your father's oldsmobile.

 

[osli]

exactly correct. i did the math, and my opportunity cost for going to med school (assuming a 5 to 6 year residency) is going to run me, NOT COUNTING time value of $/investing... about $1M. That's with six zeros.

Your math works out to the same tune mine does. 1mil opportunity cost, and that ignores both investing potential/growth during med school/residency and the interest that I will have paid by the time I'm done with the student loans some decades down the road. One million is just student loan principal when I finish residency + lost income during those years.

 

[Kthanksbye]

I love how sure everyone is about this. Baby boomers are about to reach retirement, demand for cosmetic procedures is going to explode, and the number of doctors is going to stay a constatant. Seems to me like salaries are about to go up. Yet somehow every premed is 'sure' that they're going to end up making minimum wage in a few years.

And once again, you haven't read Hilary's health plan. All she wants to do is force people to buy health insurance, the same way we currently force people to buy flood insurance if they live in flood zones, and then to subsiize the lower income families that couldn't afford it. If you've every worked with Grady health care in Atlanta, or with the health care system in New Orleans, you'd know that the masses of uninsured are not helping doctors salaries, rather the exact opposite.

Oh. Is that all? I find this to be frankly quite naive. She actually wants to have a large say in the type of health insurance people are able to choose from when they are forced to buy it. And the definition of "lower income" would be expanded greatly so that it included most Americans. Look at what they tried to do with SCHIP. They wanted to expand coverage to 400% of the poverty level and define "children" as 25 year olds. But somehow, vetoing that terrible bill is "against children".

Wall Street Journal Article

 

[mig26x]

If one day my salary as an MD is 80,000 I will use my MPH in EPidemiology as my source of income which will be fewer hours and a salry of 50k-70k for less much work and less stressful.

 

[badasshairday]

I see Lokhtar's point about how we can live off such a reduced salary. But at the same time, I don't think it is right to say physcians are whining about the salary prospect. EVERYONE else is looking to make sure there income grows; ie. teachers, nurses, politicians, postal workers. So it is okay that physicians look out for there salary as well. Like I said before, if physicians don't protect there turf and their salary, nobody will.

 

[Law2Doc]

Like I said before, if physicians don't protect there turf and their salary, nobody will.

They won't. Physicians are embarrassingly poorly organized, and are easy fodder for the stronger pharmaceutical and insurance lobbies. I think it's pretty clear who is going to be strung up as the bad guys during healthcare reform.

 

[badasshairday]

Law2Doc,

If you get a chance, this is a good article about some frustrated physicians taking some big steps against insurance companies decreasing reimbursement rates. It's a long article, and about 10 years old, but if you have time it is a good read.

Good luck.

I tried to follow up on what happen with the Federation of Physicians and Dentists, and it appears they had to settle in 2005. They can't do the whole messenger thing to get the private physicians together anymore.

 

[batman1983]

Of course, and as I said, I don't think physicians are overpaid. But the reasons provided will sound as complete whining to most people, especially the ludicrous bit about 'training.' Because otherwise, my math PhD friend with post-docs and a bunch of the academic credentials would be making $400k.

In the real world, it doesn't mean squat.

Yeh, but usually your PhD friends or ppl with similar academic creditionals didnt have to pay $30-50k a year for training(most of the time they get paid), as well as those programs are usually not as selective to get into. Furthermore, their occupations are not as demanding in terms of time

 

[Drogba]

This whole argument betrays a lack of basic economic awareness. Incomes are not determined on principle. The price of labor (wage) is determined (more or less) the same as any other price in any other market.

 

[nima123]

Lokhtar, I think if you don't change your attitudes about medicine, you will get your ass kicked real bad during your clinical rotations, if not during your med school interview.

Doctors work hard all their life to get there. The service they give to society is invaluable. They save people's lives. They HAVE TO be the among the best-paid professionals in society merely on the basis of how critical their service is.

You will see how health care will be damaged in the long run once physician compensation starts dropping to near-average levels.

On the other hand, many researchers investigate ridiculously absurd subject and waste public funds during their entire careers only because THEY find their own crap 'interesting'.

 

[batman1983]

I would guarantee you that everyone would trade their income and no debt for a physician's income and debt. It's not even close.

Its a trade off between easier life and greater financial rewards(as is most occupations). On average, a PhD makes 20-30k during school, whereas a doctor pays 30-50K for school. Thus, for the 1st 4 yrs, there is a price differential of $200-320k. I am going to assume the difference between residency and remainder of PhD program is the minuet. Now, taking into account interest costs and the time value of money that range is probably $250-400k. Now, out of school, the avg doctor will probably make $200k vs the avg PhD of $125k. Thus, it can take anywhere from 5-8 years(taking into account taxes) for a PhD and doctor to essentially be equal. Now, during school and after school, I am willing to bet that a PhD has a less stressful environment in terms of classes/studying/work hours vs a doctor. Thus, choosing between the two, is essentially choosing between a less demanding/stressful occupation for less financial reward.

Have you tried applying to CalTech for PhD? I don't think you'd say that. And now we should be paying people based on the selectivity of their school? So a physician from Harvard should make $200k, and your average MD school should make $100k?

Obviously, the statements I made were generalizations based on avgs. Arguing about exceptions will be essentially useless. If you are going to bring up CalTech and MIT, I might as well just contend with Harvard or Johns Hopkins. On average, though, it is more difficult to get into medical vs PhD programs, and that selectivity is partially reflected in the pay of the two. Just look at schools with both PhD and medical programs, to compare their selectivities.
As for your next statement, about avg harvard doctor making more than an avg MD, well yeh, duh. I am willing to bet that an avg Harvard doctor/lawyer/undergrad will make more than the avg tier school doctor/lawyer/undergrad. The selectivity/rigor of a school will be reflected in the pay. Ex. I work in investment banking and making pretty good money. I got my job mostly due to the selectivity/rigor of undergrad school I went to. If I went to another/lower tier school, I probably wouldnt have got the job.

What's that got to do with anything? A dermatologist and a general surgeon generally place wildly different demands on time, and yet which one gets paid more? Again, these excuses do not fly in the real world.

Essentially the current pay structure in the US is reflected on market forces of supply and demand. Now, each factor I listed isnt the sole reason for an occupation's pay, it is the composite of these factors, as well as others, that determine an occupation's pay. Seriously, if you are going to make arguments, you are going to need more common sense. There are extremes to everything.

 

[Kthanksbye]

This whole argument betrays a lack of basic economic awareness. Incomes are not determined on principle. The price of labor (wage) is determined (more or less) the same as any other price in any other market.

While it would be great if this were true, unfortunately, this betrays a lack of basic awareness of the economic forces that determine physician salary. Relatively few physicians can actually use market principles when charging for their services. Incomes are largely determined by what insurance companies will pay, and since medicare/medicaide (i.e. the government) is the primary insurer, with many private insurance companies modeling their pay scales on what the government reimbursement is, what we have is in all practical purposes price fixing which translates to a planned economy in health care. Increasing the size and scope of these programs will only increase the hold government has on health care.

Getting away from this to the type of market forces you describe is what I would like to see, but the country seems to currently be pretty enamored with the tripe Edwards spews forth, which would increase the planned nature of the health care economy to a scary extent.

 

[Drogba]

While it would be great if this were true, unfortunately, this betrays a lack of basic awareness of the economic forces that determine physician salary. Relatively few physicians can actually use market principles when charging for their services. Incomes are largely determined by what insurance companies will pay, and since medicare/medicaide (i.e. the government) is the primary insurer, with many private insurance companies modeling their pay scales on what the government reimbursement is, what we have is in all practical purposes price fixing which translates to a planned economy in health care. Increasing the size and scope of these programs will only increase the hold government has on health care.

Getting away from this to the type of market forces you describe is what I would like to see, but the country seems to currently be pretty enamored with the tripe Edwards spews forth, which would increase the planned nature of the health care economy to a scary extent.

You are certainly right that physician salaries are more distorted from economic equilibrium becuase of the complex interaction of actual markets, government intervention and other third party involvement. My point was that incomes are not assigned based on principle in a capitalistic society. Reimbursement for different professions can conform to economic equilibrium to varying degrees.

Medicine (for better or worse) is one of the more distorted professions from a capitalistic standpoint I guess you could say. Even in medicine though the basic laws of supply and demand can be observed. This is certainly part of the explanation for the difference in specialty compensation and why we ration high paying specialties so carefully.

 

[Kthanksbye]

You are certainly right that physician salaries are more distorted from economic equilibrium becuase of the complex interaction of actual markets, government intervention and other third party involvement. My point was that incomes are not assigned based on principle in a capitalistic society. Reimbursement for different professions can conform to economic equilibrium to varying degrees.

Medicine (for better or worse) is one of the more distorted professions from a capitalistic standpoint I guess you could say. Even in medicine though the basic laws of supply and demand can be observed. This is certainly part of the explanation for the difference in specialty compensation and why we ration high paying specialties so carefully.

Actually, no. The highest paid specialties are currently the ones that do not generally take insurance or have pay scales not dictated by insurance. Supply and demand has little to do with it. Why else would a dermatologist be paid more than a heart surgeon?

 

[Law2Doc]

Actually, no. The highest paid specialties are currently the ones that do not generally take insurance or have pay scales not dictated by insurance. Supply and demand has little to do with it. Why else would a dermatologist be paid more than a heart surgeon?

Agreed. Supply and demand doesn't work in medicine, except to the extent you can avoid taking insurance, which is in a minority of practice areas. Derm actually further also takes advantage of the relatively noncritical nature of its services and keeps the number of residency slots small and the demand high.

Physicians cannot generally set their own prices, which is a basic tenet upon which the law of supply and demand relies. They rely on reimbursements from insurance companies, who benefit keeping prices down. The differences in specialty salaries are largely driven based on what procedures insurance companies have deemed reasonable for their bottom line. So specialties where you can do a lot of expensive but well reimbursed procedures in a relatively short period of time will make more.
Meanwhile, expenses are dictated by supply and demand and inflation, so expenses keep going up, even while reimbursements go down. So salaries in medicine have been decreasing for the last decade notwithstanding that with the aging baby boomers, the demand for medical services has gone up phenomenally.

 

[Drogba]

Actually, no. The highest paid specialties are currently the ones that do not generally take insurance or have pay scales not dictated by insurance. Supply and demand has little to do with it. Why else would a dermatologist be paid more than a heart surgeon?

Aside from cosmetics and elective procedures (which is purely market based medicine) is this accurate? Surgery has a lot of reimbursement issues to my knowledge. In a certain economic sense cosmetic procedures are more in demand than the services of a CT surgeon.

What about rads, optho, ortho etc. If more residencies were opened in these fields than the salaries would decrease, no? Regardless, supply and demand definitely play a major role in determining salaries intraspecialty if not interspecialty. Salaries decrease significantly in saturated markets (major cities, esp NYC, San Fran etc).

Like I said medicine is highly distorted from market equilibrium, and my main point was that salaries have little do with principle and philosophical notions of value.

 

[Law2Doc]

What about rads, optho, ortho etc. If more residencies were opened in these fields than the salaries would decrease, no? Regardless, supply and demand definitely play a major role in determining salaries intraspecialty if not interspecialty. Salaries decrease significantly in saturated markets (major cities, esp NYC, San Fran etc).

I think you are correct in suggesting that supply and demand plays a role intraspecialty in terms of where people aggregate, but not to a huge extent. Salaries may range by a couple of percent. And yes, there is certainly a breaking point at which you would decrease salaries if you kept adding new residencies.

 

[Drogba]

I think you are correct in suggesting that supply and demand plays a role intraspecialty in terms of where people aggregate, but not to a huge extent. Salaries may range by a couple of percent. And yes, there is certainly a breaking point at which you would decrease salaries if you kept adding new residencies.

Really? Received wisdom on SDN seems to be that it can make a huge difference. Probably what is more relavent is practicing in an area with low competion, high demand, and a generally well insured population (with an emphasis on the last factor). Like you said physicians can't set their own prices which vastly complicates a simple supply and demand analysis.

 

[Kthanksbye]

Aside from cosmetics and elective procedures (which is purely market based medicine) is this accurate? Surgery has a lot of reimbursement issues to my knowledge. In a certain economic sense cosmetic procedures are more in demand than the services of a CT surgeon.

What about rads, optho, ortho etc. If more residencies were opened in these fields than the salaries would decrease, no? Regardless, supply and demand definitely play a major role in determining salaries intraspecialty if not interspecialty. Salaries decrease significantly in saturated markets (major cities, esp NYC, San Fran etc).

Like I said medicine is highly distorted from market equilibrium, and my main point was that salaries have little do with principle and philosophical notions of value.

I wasn't arguing with this point. But demand is an assessment of value, and in a true market system, it is half of the equation, supply being the other half. But medicine is far from a true market system. I'm not sure what compensation rates are by city and how they correlate with specialty saturation. I wouldn't even know where to find this information. Do you have data? I'd actually love to see it. I know in my city, it makes little difference what the supply and demand is, because this city, second biggest in the state, has very low reimbursement rates even compared to smaller neighboring cities. These rates are largely determined by insurance companies, which set prices regionally based on their bargaining power in that area. The rates are not something physicians have any control over, and they don't improve with physician scarcity, which is a reality in this city that is created by the low reimbursement rates. It is very difficult for existing groups to recruit new physicians and some hospitals are losing their groups altogether. The hospital I volunteer at has no in house radiology group and no pathology. They farm them both out because these groups just up and left one day. This does not increase the pay scale of the remaining physicians. Why would a new doctor come to this city when he is over $200K in debt and the cost of living is higher than a neighboring city where he can be paid twice as much for the same job and afford more land and a bigger house for the same money? The insurance companies don't consider this to be their problem, even though they create it.

 

[Law2Doc]

Really? Received wisdom on SDN seems to be that it can make a huge difference. Probably what is more relavent is practicing in an area with low competion, high demand, and a generally well insured population (with an emphasis on the last factor). Like you said physicians can't set their own prices which vastly complicates a simple supply and demand analysis.

Insurance can be better or worse, but it's still insurance. Aetna, Hartford, AIG -- they all make money by taking in premiums and not paying stuff out they don't have to. So as I understand it, reimbursements are either bad or worse. Location matters a bit, but quite frequently, the better the region's insurance the worse the volume. I think it pays not to try to look at this as supply and demand. Look at it as a profession with ever decreasing income ceilings and the only way to earn more is to work longer.

 

[Drogba]

I wasn't arguing with this point. But demand is an assessment of value, and in a true market system, it is half of the equation, supply being the other half. But medicine is far from a true market system. I'm not sure what compensation rates are by city and how they correlate with specialty saturation. I wouldn't even know where to find this information. Do you have data? I'd actually love to see it. I know in my city, it makes little difference what the supply and demand is, because this city, second biggest in the state, has very low reimbursement rates even compared to smaller neighboring cities. These rates are largely determined by insurance companies, which set prices regionally based on their bargaining power in that area. The rates are not something physicians have any control over, and they don't improve with physician scarcity, which is a reality in this city that is created by the low reimbursement rates. It is very difficult for existing groups to recruit new physicians and some hospitals are losing their groups altogether. The hospital I volunteer at has no in house radiology group and no pathology. They farm them both out because these groups just up and left one day. This does not increase the pay scale of the remaining physicians. Why would a new doctor come to this city when he is over $200K in debt and the cost of living is higher than a neighboring city where he can be paid twice as much for the same job and afford more land and a bigger house for the same money? The insurance companies don't consider this to be their problem, even though they create it.

http://www.memag.com/memag/article/articleDetail.jsp?id=112482

Is a fairly decent salary survey, though it doesn't make my point for regional variation as strongly as I was hoping. Then again it wasn't meant to compare city to city. I've seen someother data that I can't find now that was more specific. Also, I'm basing this on anecdotes of newly minted attending who talk about the very high offers they get to practice in little towns versus the salaries they are able to find in major cities. Maybe this is a problematic source, but I've never heard anyone contest that practice location can make a world of difference. Perhaps, it's not market saturation that is of primary importance.

 

[Lokhtar]

Lokhtar, I think if you don't change your attitudes about medicine, you will get your ass kicked real bad during your clinical rotations, if not during your med school interview.

Why? Never once did I say or imply that physicians don't work hard. I said, people need to stop thinking they are God's gift to the world and somehow their training should guarantee them something that most people with doctoral level education don't get.

Doctors work hard all their life to get there. The service they give to society is invaluable. They save people's lives. They HAVE TO be the among the best-paid professionals in society merely on the basis of how critical their service is.

I don't know about have to - they aren't in most countries. Police and firefighters aren't among the best paid professionals. But doctors should be - I never disagreed with that.

On the other hand, many researchers investigate ridiculously absurd subject and waste public funds during their entire careers only because THEY find their own crap 'interesting'.

Just FYI - when statistics was 'discovered', they thought it would be the most useless of all Math. See how that turned out? It is impossible to predict what new uses various discoveries have long term, and ludicrous to assume they won't be of any benefit.

 

[nima123]

I don't know about have to - they aren't in most countries. Police and firefighters aren't among the best paid professionals. But doctors should be - I never disagreed with that.

The US has the most advanced medical system (I'm talking about the medicine here, not health care policies) for a reason. The best and the brightest go into med over here, but that could easily change if the compensation is lowered. Those countries are suffering partly because of their stinginess.

I am sick and tired of the analogies between doctors and firefighters. It is absurd. Firefighters don't SAVE people's lives, they just take them out of the burning zone and get them to the nearest hospital where a DOCTOR saves their lives.

As long as you agree that doctors deserve to be very well-compensated and bitch about the downward trend in their salaries, we have nothing to argue about. 😎

 

[Drogba]

The US has the most advanced medical system (I'm talking about the medicine here, not health care policies) for a reason. The best and the brightest go into med over here, but that could easily change if the compensation is lowered. Those countries are suffering partly because of their stinginess.

I am sick and tired of the analogies between doctors and firefighters. It is absurd. Firefighters don't SAVE people's lives, they just take them out of the burning zone and get them to the nearest hospital where a DOCTOR saves their lives.

As long as you agree that doctors deserve to be very well-compensated and bitch about the downward trend in their salaries, we have nothing to argue about. 😎

Unless they prevent them from being burned in the first place.

What a ridiculous comment.

 

[nima123]

Unless they prevent them from being burned in the first place.

You're missing the point, dude. They don't save their lives in the sense that they don't treat them. They do not intervene to stop what will eventually kill them. A person who suffers from major burns would die within hours if not treated even if he/she has been taken out of the fire.

 

[Lokhtar]

The US has the most advanced medical system (I'm talking about the medicine here, not health care policies) for a reason. The best and the brightest go into med over here, but that could easily change if the compensation is lowered. Those countries are suffering partly because of their stinginess.

Err, I would disagree about the best and the brightest, to be honest. A lot of fellow students in my major (math) probably kick my ass in terms of intelligence, I would bet . In any case, it is obviously the most competitive. But even in countries like India, where doctors make virtually nothing, it is still very competitive. Look at Canada, their schools require ridiculous combinations of MCAT/GPA to get in, even though their healthcare is universal and specialists generally get paid less.

I am sick and tired of the analogies between doctors and firefighters. It is absurd. Firefighters don't SAVE people's lives, they just take them out of the burning zone and get them to the nearest hospital where a DOCTOR saves their lives.

Haha.

As long as you agree that doctors deserve to be very well-compensated and bitch about the downward trend in their salaries, we have nothing to argue about. 😎

I agree that doctors should be very well compensated, but I disagree with the bitching. I would try to make an articulate case for keeping physician salaries relatively high, and not inane excuses like 'training' or 'because we're smarter than you, thus we deserve more'. Both of which are patently false, and that is what I read most of the time, and which is why doctors get little sympathy while nurses get loads of it. A little less arrogance would go a long way.

 

[Drogba]

You're missing the point, dude. They don't save their lives in the sense that they don't treat them. They do not intervene to stop what will eventually kill them. A person who suffers from major burns would die within hours if not treated even if he/she has been taken out of the fire.

If by "what" you mean the fire then it certainly seems like an intervention to me to remove them before they get burned or stop the fire before it gets to them. A person who suffers major burns will die regardless of whether they are treated or not unless they are removed before they get burned that badly. Firefighters intervene directly to prevent death in some circumstances, and a much greater risk to themselves than your average doctor might I add. I don't know what kind of messed up logic you have and I think you are the one missing the point.

 

[8744]

The US has the most advanced medical system (I'm talking about the medicine here, not health care policies) for a reason. The best and the brightest go into med over here, but that could easily change if the compensation is lowered. Those countries are suffering partly because of their stinginess.

I am sick and tired of the analogies between doctors and firefighters. It is absurd. Firefighters don't SAVE people's lives, they just take them out of the burning zone and get them to the nearest hospital where a DOCTOR saves their lives.

As long as you agree that doctors deserve to be very well-compensated and bitch about the downward trend in their salaries, we have nothing to argue about. 😎

Whoa. I just want to point out that on many occasions, our city's most excellent paramedic/firefighters secure airways, cardiovert, give protocol drugs, run ACLS and pretty much do what we are going to do once they get the patient in. The difference, sometimes, between a patient making it or not is the quality of the pre-hospital care they receive.

 

[nima123]

Lokhtar, remember what I said about getting your ass kicked in the wards? I'll bet on it...seriously.

Drogba, son, major burns COULD kill people, not "will".

If you guys have any doubt that doctors kick ass and medicine is the best profession, then I suggest you change your status from pre-medical to pre-firefighter?

'Cause there ain't much money left for doctors by the time you guys (and we) start practicing, and firefighters certainly save more lives single-handedly than doctors ever will!

 

[Drogba]

Lokhtar, remember what I said about getting your ass kicked in the wards? I'll bet on it...seriously.

Drogba, son, major burns COULD kill people, not "will".

If you guys have any doubt that doctors kick ass and medicine is the best profession, then I suggest you change your status from pre-medical to pre-firefighter?

'Cause there ain't much money left for doctors by the time you guys (and we) start practicing, and firefighters certainly save more lives single-handedly than doctors ever will!

And here I thought if you had extensive enough full thickness burns there was pretty much nothing medicine could do to save you. What do I know, you are the med student. Oh and call your unfortunate offspring "son", not me.

 

[MelnaisLacis]

Would you rather he call you "boy?"


This thread is the 😴

 

[Lokhtar]

Lokhtar, remember what I said about getting your ass kicked in the wards? I'll bet on it...seriously.

Haha, what? Because I don't consider myself the second coming of Isaac Newton? Or think that every person in the profession is the genius incarnate?

If you guys have any doubt that doctors kick ass and medicine is the best profession

Nah, medicine is pretty cool, but I'd give it to Astronauts as the best profession. And if you can get tenure, I have a soft spot for physicists and mathematicians too.

'Cause there ain't much money left for doctors by the time you guys (and we) start practicing, and firefighters certainly save more lives single-handedly than doctors ever will!

Yea, Astronauts don't make much money, so no one wants to be one, right?

 

[premedrod]

Yay for unfounded generalizations and vague analysis! 👍

this has to be the funniest response i have ever read on here....
such a burn...and i seriously hope you arent going to med school ronaldo23...