There are a lot of factors that will play into what doctor's make in the future so I don't think anyone can give any certain answers, but I'll ramble on for a while with some of my thoughts, i'd kinda like to hear how they bounce off other people. Some of the huge factors that make it so unpredictable are whether or not the government will take over the healthcare system, whether or not we'll make up for the impending doctor shortage with imported foreign trained doctors, to what extent we are willing to give more of the system over to physician assistants and nurse practitioners.
I think with the impending shortage of doctors procedure based specialties will actually fair a little better than other specialties because they can't really replace us with Physician Assistants and nurse practitioners because people won't trust them to operate on them. I guess it'll all come down if medicine acts like a market. If the demand is high and the supply is low, doctors are going to have to get reimbursed more to make it worth their while to work so hard. But then again many doctors will just silently take one for the team and just work harder. Also if they keep lowering reimbursements you'll have to work harder just to be able to make ends meet as a doctor, so it almost could go either way. If reimbursements keep going lower the older physicians will retire and some physicians will leave medicine for greener pastures which will make the shortage happen more acutely. My guess is that if they do have to start upping the reimbursements because of a labor supply issue it will peak out very quickly because they'll realize that it's cheaper to import foreign laborers who are making about half what we do here in the states and are more than willing to come and work in our country. Then if you want you can start trying to figure out if the domestically trained will have a career advantage over the foreign trained.
The thing that scares me the most is that society already thinks doctors are way overpaid as it is. Articles and other news pieces try and point this out all the time. I've seen it in comments on you tube, comments on blogs, comments on message boards, it's pretty wide spread. They don't understand what we go through to get here. They don't understand that you have to ace your way through undergrad and study when other's are out partying. They don't understand that the 9 years more of grueling training that you did as compared to the average college grad have an opportunity cost in and of themselves not to mention that you finish your training in your 30's with 200k of debt that isn't related to a dream home, fancy car, home theater, or exotic vacations. And then after all of that your job doesn't involve sitting at a computer chatting online all day waiting for your next break or the clock to tick the magical number so that you can blow out of there and not have to face those problems till the next day. They just don't get it and they won't get it unless they try it. A couple of friends of mine who are close enough to me to notice that I work on the weekends, am 4 hours into my work day when they start theirs and that I'm still at work when they are in front of their TV at night and have heard me tell stories of my first rectal exam and the rotting SICU patients I have to smell think I'm crazy for wanting to be a doctor. Truth is the same people who think you are overpaid wouldn't maintain your schedule, and do the things you have to do for anywhere near the amount you are paid. They simply wouldn't do it, but they expect you to and to do it with a smile and a good attitude.
Hopefully that's not too depressing. At the ACS conference in New Orleans my father introduced me to a lot of his friends and colleagues and told them that I was applying for general surgery. They all made jokes about getting out while I still could, and ultimately said that if the problems that surgeons are facing discourage you from wanting to be a surgeon, you probably don't belong in surgery.
P.S.
Here is a very depressing power point from a lecture I went to in my second year of medical school that totally shot my motivation for the boards. Very interesting read for anyone considering a career in medicine.
And on a positive note here is news article saying doctors need to be paid more.
news article
