McCain vs Obama vs Clinton on mental health

[Faebinder]

Hmm.. I thought it might be interesting. I was watching cnn on the stand point on all three candidates on mental health. This is what I understood.

McCain: Feels that we need to cut medicare costs first before we can cover mental health. (I guess he didn't benefit much from mental health after his POW experience?)

Obama: Feels there needs to be more specialists and better private sector coverage. (mmm, neutral here.)

Clinton: Feels that mental health should be covered as part of the health insurance plan and she wants every citizen to have health insurance (pretty ambitious?).

Thoughts?

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[mgdsh]

Hmm.. I thought it might be interesting. I was watching cnn on the stand point on all three candidates on mental health. This is what I understood.

McCain: Feels that we need to cut medicare costs first before we can cover mental health. (I guess he didn't benefit much from mental health after his POW experience?)

Obama: Feels there needs to be more specialists and better private sector coverage. (mmm, neutral here.)

Clinton: Feels that mental health should be covered as part of the health insurance plan and she wants every citizen to have health insurance (pretty ambitious?).

Thoughts?

Random thoughts:
- Cutting medicare costs can't really be good.
- Every citizen having health insurance is overly ambitious and probably pretty costly, which would only result in attempted cuts later.
- From what I understand, better private sector coverage would be better for better care coverage & better hospital reimbursements, while making the health care system less reliant on medicare.

 

[Anasazi23]

There's no free lunch anywhere you turn.

Things sound good, such as requiring plans to cover mental health more comprehensively. What you won't hear is that this will cause some employers to stop offering insurance due to the cost this will put on consumers of health care and employers. In the end, more people may wind up without insurance in any form, than in an attenuated form.

I don't claim to have the answer. It's far too complicated for me to consider the myriad ramifications on the economy etc.

What I find most interesting nowadays are the successful lawsuits against HMO companies which have consistenly defrauded doctors on reimbursement. We all knew this was happening, but the verdicts are finally starting to roll in. Funny how the HMOs were borne out of doctors' liberties in billing, and now the reverse is true, but you just don't hear about it.

 

[marie337]

Since the topic was brought up...

Unfortunately, cutting Medicare spending is a necessary evil. If we don't cut these costs the Medicare system is headed for bankruptcy by 2018. But, I'm not aware of McCain's campaign ever mentioning medicare cuts.

A big portion of John McCain's plan involves reducing medical costs. It doesn't matter who is funding medical care. If costs aren't controlled there will never be enough money to adequately provide for everyone. Additionally, he wants to promote prevention and early intervention to lower costs of chronic disease, which includes all chronic illnesses. Also McCain has a separate page about his focus on autism. I think this speaks well for his stance on mental health care.

http://www.johnmccain.com/content/?guid=24dc9c37-e739-4aa3-8a88-ebae650a2f11

But, I agree that there is no perfect system. I just don't see how the current democratic proposals will work.

 

[whopper]

I'm not really impressed by anyone's plans.

Every system has its problems. Michael Moore's Sicko polished universal care as a cure-all and did not show the problems several countries are having with universal care.

The US however does have a pretty lousy system considering our (seemingly decreasing) place as #1 in the world but having a health care system nowhere near #1.

 

[Therapist4Chnge]

I'm not really impressed by anyone's plans.

Every system has its problems. Michael Moore's Sicko polished universal care as a cure-all and did not show the problems several countries are having with universal care.

The US however does have a pretty lousy system considering our (seemingly decreasing) place as #1 in the world but having a health care system nowhere near #1.

Agreed.

I don't think any of the candidates have a realistic solution, and frankly I think none will serve in the best interest of the healthcare professional. Affordable "Universal Healthcare" is a pipe dream, at least in the currently proposed structures. Though some of the administrative overhead %'s seem attractive for a gov't run program, I'm not sure if that will scale to what they need, particularly when you take into account the glut of paperwork and procedure that would need to be in place to make it function even remotely efficiently. (Delay in service is another whole issue, which many countries with 'universal' programs often talk about).

I think having a 2 tiered system is the best approach (have minimal coverage available for all, while offering the option for people to purchase additional private coverage), though this isn't without pitfalls. I think if utilization can be tweaked, it can work. For instance, utilization of the ER by some populations is far more costly than if they were treated in a different setting. The research I've seen, particularly in regard to ER utilization by illegal immigrants suggests that our dollars are being used inefficiently. There are political/legal reasons why this happens (fear of deportation, lack of documentation, easy access, etc), and those won't be answered by a healthcare bill. Stronger illegal immigration enforcement of current laws would greatly reduce the #'s, but there would still be additional work done to really address the issue.

One of my biggest pet peeves is the lack of quality prevention and early intervention programs. The amount of dollars we spend on the back-end are exponentially greater than dollars that could be spent on the front-end more effectively. I am a big believer in prevention and early detection education, and there are still some large gaps in our communities. We need smart programming too.....as we've seen abstinence programs and the D.A.R.E. program fail miserably. One area of improvement I've seen on the private side are financial incentives provided by insurance companies for subscribers who work out, quit smoking, etc. Those are the kind of programs we really need to push.

One of the advantages of a "universal" system is the hopeful streamlining of billing/reimbursing, though I'm concerned that although it may be 'easier', that the final reimbursable amounts will be lessened and the required numbers to make a decent living will go even higher. Having the 2nd tier private system can help those professionals who fill the need, but will not help your 'average' professional trying to help the community. I think there will always be a place for the niche person, but by definition they are not the majority.

The 'cost/overhead' side is out of control, and unless insurance premiums are addressed and medical tort reform enacted, the cost/overhead is going to make everything else a moot point. I have always been a big supporter of capping medical damages and limiting lawyer fee gouging.....but it still happens in most torts out there.

I rarely am in favor of any government involvement in corporate regulation, but I think insurance companies are out of control and they have taken advantage of an already broken system. None of the candidates are in the ballpark for reasonable changes, and even though it is a scary thought...it can still get worse.

 

[futuredo32]

Since the topic was brought up...

Unfortunately, cutting Medicare spending is a necessary evil. If we don't cut these costs the Medicare system is headed for bankruptcy by 2018. But, I'm not aware of McCain's campaign ever mentioning medicare cuts.

A big portion of John McCain's plan involves reducing medical costs. It doesn't matter who is funding medical care. If costs aren't controlled there will never be enough money to adequately provide for everyone. Additionally, he wants to promote prevention and early intervention to lower costs of chronic disease, which includes all chronic illnesses. Also McCain has a separate page about his focus on autism. I think this speaks well for his stance on mental health care.

http://www.johnmccain.com/content/?guid=24dc9c37-e739-4aa3-8a88-ebae650a2f11

But, I agree that there is no perfect system. I just don't see how the current democratic proposals will work.

Someone in the FP forum posted about McCain wanting to push seniors on Medicare into managed care programs (I don't like that idea ). He does mention "coordinated care" on his website, but I didn't understand what he meant by coordinated care. I did think that McCain was better for healthcare (including mental health care), but I'm definitely going to look into it deeper before I cast my ballot.

 

[1viking]

The US however does have a pretty lousy system considering our (seemingly decreasing) place as #1 in the world but having a health care system nowhere near #1.

The WHO data is flawed. For instance, they look at infant mortality and talk about US failures here. Comparing outcomes that have much less to do with medicine and more to do with lifestyle and genetics is truly wrong. Anybody spending time in the NICU knows what the whimpy white male means.

 

[Therapist4Chnge]

I did think that McCain was better for healthcare (including mental health care), but I'm definitely going to look into it deeper before I cast my ballot.

Obama wants to hug away the pain.
Hillary wants to buy off the pain.
McCain wants to blow up the pain.

More seriously though, I admittedly haven't looked as much into McCain's plan (I was really holding out hope Dr. Paul would make a stronger push a few months ago).

 

[futuredo32]

(I was really holding out hope Dr. Paul would make a stronger push a few months ago).

Me too.

 

[TexPre-Med]

From what I have gathered, McCain seems to benefit physicians the most.

 

[Doc Samson]

From what I have gathered, McCain seems to benefit physicians the most.

Damn that super-ego that makes me think about who'd benefit my patients the most!

 

[OldPsychDoc]

Damn that super-ego that makes me think about who'd benefit my patients the most!

Love your liberal Massachusetts superego...

 

[mgdsh]

More seriously though, I admittedly haven't looked as much into McCain's plan (I was really holding out hope Dr. Paul would make a stronger push a few months ago).

That's all we need, an openly racist president.

From what I have gathered, McCain seems to benefit physicians the most.

Interesting observation, care to share a bit more about that?

 

[futuredo32]

That's all we need, an openly racist president.

I think one could make a strong/stronger case for Obama being a racist than RP, but there's no need to go there.

 

[kumar28]

he's half white half black..who's he racist towards...asians??

 

[futuredo32]

he's half white half black..who's he racist towards...asians??

I think a pretty strong case could be made that his close association with Wright, his continued donations to a church that expressed some pretty extreme anti-semetic, anti-Caucasian, anti-Italian thoughts could be deemed racist. But, I really don't think that we need to delve into that discussion here. Let's get back to the topic of which candidate best supports mental health.

 

[whopper]

No matter what anyone suggests, I don't think anyone's really going to have to cajones to change anything.

There's too much money going around with several people willing to spend millions to fight any changes.

I have a feeling the politicians are just going to do a little smoke & mirror trick.

 

[MBK2003]

Damn that super-ego that makes me think about who'd benefit my patients the most!

I think that this is where I get caught up and feel that few of the proposals will make much of a difference for mental health. No one is talking about things from the broader perspective...
- Like home visits from specially trained nurses for the first 2 years with at-risk mother-infant dyads to improve attachment and the quality of parenting. This has been shown to be effective on the mental health side and the educational side, but is certainly not "Medicaid reimbursible."
- How about outcomes based assessment of mental health providers and support services? We all know of at least one homeless frequent flyer who has had the same supportive case manager for the past 3 years and yet remains a homeless frequent flyer. Or the psychiatrist who we all know is just a benzo dispenser and who has patients that are chronically in the emergency room for refills.
- Finally, how about a continuum of care that makes outpatient care more accessible and really acknowleges that inpatient care is the last resort (and not just the cash cow).

In my area we just had two major agencies providing significant amounts of child psychiatry services just close shop and send patients out with a one (or three) month supply of meds. There is not enough capacity in the system to absorb the cases and seriously impaired kids are falling through the cracks. Sadly, it's easier for these kids to get an inpatient bed than to get an outpatient provider after discharge.

Sorry for the rant, but I think the system needs more help than just universal insurance coverage (since many of the most important support services aren't reimbursible by insurance).

 

[Faebinder]

I think that this is where I get caught up and feel that few of the proposals will make much of a difference for mental health. No one is talking about things from the broader perspective...
- Like home visits from specially trained nurses for the first 2 years with at-risk mother-infant dyads to improve attachment and the quality of parenting. This has been shown to be effective on the mental health side and the educational side, but is certainly not "Medicaid reimbursible."
- How about outcomes based assessment of mental health providers and support services? We all know of at least one homeless frequent flyer who has had the same supportive case manager for the past 3 years and yet remains a homeless frequent flyer. Or the psychiatrist who we all know is just a benzo dispenser and who has patients that are chronically in the emergency room for refills.
- Finally, how about a continuum of care that makes outpatient care more accessible and really acknowleges that inpatient care is the last resort (and not just the cash cow).

In my area we just had two major agencies providing significant amounts of child psychiatry services just close shop and send patients out with a one (or three) month supply of meds. There is not enough capacity in the system to absorb the cases and seriously impaired kids are falling through the cracks. Sadly, it's easier for these kids to get an inpatient bed than to get an outpatient provider after discharge.

Sorry for the rant, but I think the system needs more help than just universal insurance coverage (since many of the most important support services aren't reimbursible by insurance).

As someone who publishes way too much, that has been the hardest thing for me to publish. It seems that medical journals have very little interest in discussing the outcome of clinical supportive groups. They would much rather discuss the seratonin effect on a certain receptor. I don't basic science (infact I have a couple of good articles in basic science) but clinical outcomes of support groups is important to stop the medicare drain.

 

[notdeadyet]

From what I have gathered, McCain seems to benefit physicians the most.

The Republican candidate benefits those in the top 2% pay bracket? No great shock there.

 

[OldPsychDoc]

Anyone have a problem with this?

 

[Faebinder]

The Republican candidate benefits those in the top 2% pay bracket? No great shock there.

Mmm... physicians are in the top 2% pay bracket? That's a bit extreme no? Sides, the top 5% earners in the country pay 50% of the taxes.

Physicians are in top 20% not 2%. Top 2% is in the millions.

 

[Faebinder]

Anyone have a problem with this?

Hahahah.. as if the costs of healthcare were due to the provider.

If walmart wants to kick healthcare cost's ass they better start taking over hospitals and squeezing nurse unions, insurance providers, pharm companies and what not. It wont do them any good to squeeze those who only cost the system 5% of the total pie (aka physicians).

 

[OldPsychDoc]

Mmm... physicians are in the top 2% pay bracket? That's a bit extreme no? Sides, the top 5% earners in the country pay 50% of the taxes.

Physicians are in top 20% not 2%. Top 2% is in the millions.

According to this site, I'm in the top 0.01% globally. I'd like to see a breakdown nationally, but let's suffice it to say that we are all well "above average", eh?

Ahh--here's some figures: 95th percentile for US household income is around $160K--so most physicians will be in the top 5% or so.

 

[HCE]

Anyone have a problem with this?

My gag reflex kicks in at the thought of Wal-Mart providing health services. Isn't this the company that wouldn't provide coverage to their part-time employees? I have to admit that I didn't read past the title of the article and the first paragraph, so I am in no position to give a logical critique of the suggestion at this moment. I'll contribute after the nausea settle down a tad.

I'm just getting visions of things like blue-light specials on colonoscopies...

 

[Faebinder]

According to this site, I'm in the top 0.01% globally. I'd like to see a breakdown nationally, but let's suffice it to say that we are all well "above average", eh?

Ahh--here's some figures: 95th percentile for US household income is around $160K--so most physicians will be in the top 5% or so.

ahh, that one is more up to date. Thanks for the link. Damn, we're in the top 5%? really? where is LaDoc00 with his list of people who make over $200k a year... people like the chief of a fire department or some high school principals.

 

[PeeWee137]

No matter what anyone suggests, I don't think anyone's really going to have to cajones to change anything.

There's too much money going around with several people willing to spend millions to fight any changes.

I have a feeling the politicians are just going to do a little smoke & mirror trick.

people talk big games during an election year. im not holding my breath for anything spectacular to happen. although i do enjoy hearing non-medical people debate universal health care when they have no idea what they are talking about, thats always entertaining. and my mom is CONVINCED that voting doesnt count for anything, because some super-secret government club called the "electoral college" decides the election anyway...

 

[whopper]

According to this site, I'm in the top 0.01% globally. I'd like to see a breakdown nationally, but let's suffice it to say that we are all well "above average", eh?

Personally (& of course I'm biased), I got nothing against docs making this much money.

1-docs usually are in the top of their class throughout school
2-premed is difficult & probably expensive depending on which college you graduated.
3-medical school is extremely expensive
4-its also extremely difficult
5-residency-same as the above, we practically spend 3+ years depending on the specialty as indentured servants
6-malpractice costs are through the roof.
7-a good doctor will stay on top of the current data & will study at least a few hours a week that they don't get paid for.

All in all, docs spend approximately 12+ years working extremely hard, doing top level work before they become an attending. Then even as an attending, you're going to have to work about 2 years to pay off all the debt you accumulated. That's 14+ years of extremely hard work before you actually are in the positive zone in terms of fiscal payback. that's about 1/4 to 1/2 of your professional life expectancy. That's also under the assumptions that you'll make it through. I have known several good people that got kicked out of medschool because they couldn't cut in with over 6 figures in debt. That's quite a scare to go through that most people can't handle.

A buddy of mine is an engineer that worked straight out of college, earning a middle class salary. We worked it out. That guy's actually earning the same lifetime amount as I do hour per hour.

Now this is all taken as if the docs actually doing their job. I have seen bad doctors out there, and IMHO, if a doc isn't doing their job properly, they ought to suffer more penalties than they are now. Malpractice doesn't really IMHO take out bad docs because the factors that cause patients to sue isn't the quality of the doc, but simply how much they like their doc on a personable level.

If people want docs to earn less, I suggest that a new type of payment method for pre-med & medschool be offered-a type of program where premed & medschool are free, malpractice is completely covered & then the doc earns less, and should the doc fail out of medschool, they don't have to pay anything back.

 

[notdeadyet]

Ahh--here's some figures: 95th percentile for US household income is around $160K--so most physicians will be in the top 5% or so.

Actually, keep in mind that you're looking at household income there.

Here's the same link for individuals. According to this, if you earn anything $100K or more, you're in the top 5.63% bracket. So depending on specialty, I'd reckon most physicians are in the 3-4% bracket.

Sorry. Didn't mean for this thread to devolve into "How much do physicians make?" (much less, "But boy we deserve it!"). Just meant to point out that Republicans being Republicans and Democrats being Democrats, the Republican candidate's policies will usually be the one to favor physicians. It's an income thing.

 

[notdeadyet]

Physicians are in top 20% not 2%.

Actually, you're in the top 20% if you're pulling in over $65K/yr (link). Most people in this country don't earn as much as you might think.

Top 2% is in the millions.

You're in the top 1% if you're earning over $365K (some data). The truly wealthy are more rare than you might think too.

I woudln't presume a physician is in the top 1%. Though you might hazard a guess after you find out his/her specialty.

 

[Faebinder]

Actually, you're in the top 20% if you're pulling in over $65K/yr (link). Most people in this country don't earn as much as you might think.

You're in the top 1% if you're earning over $365K (some data). The truly wealthy are more rare than you might think too.

I woudln't presume a physician is in the top 1%. Though you might hazard a guess after you find out his/her specialty.

Read my post afterwards.. i stand corrected.

 

[notdeadyet]

Read my post afterwards.. i stand corrected.

No sweat. I was just pointing out where the top 20% actually falls. I was pretty suprised at the $65K/yr figure. I know quite a few recent graduates on this. Coming from a crowd that mostly went to college, I guess it's easy for me to forget that a heck of a lot of people don't, and most of those folks are going to be getting pretty horrible wages for life.

 

[OldPsychDoc]

No sweat. I was just pointing out where the top 20% actually falls. I was pretty suprised at the $65K/yr figure. I know quite a few recent graduates on this. Coming from a crowd that mostly went to college, I guess it's easy for me to forget that a heck of a lot of people don't, and most of those folks are going to be getting pretty horrible wages for life.

And in psychiatry, the downward mobility of our patients puts them even further down the ladder. So for some of us doctors who can't shake our bleeding-heart liberalism, we might be inclined to consider a candidate more for how they would benefit our patients than ourselves.

 

[nancysinatra]

Anyone have a problem with this?

I couldn't read much past the first line--my blood starts boiling at even the mention of Walmart these days, and I'm on call today and it's hot out already so I closed the link after a quick look. But I did write a public health paper last year about Walmart and their in-store clinics. I am convinced that company opened the clinics partly so that their employees would be encouraged to go there for their own health care, instead of to hospitals or ERs or real doctors' offices. That's scary, since Walmart employees are already less healthy than the general population--they have much higher rates of diabetes and heart disease, for example. They let a memo leak a couple years ago where they were trying to lower those rates, not by providing better insurance, but by encouraging managers not to hire anyone who was older or obese or seemed to have a health problem.

It's interesting when people talk about which political parties "benefit physicians." To me, "benefit" doesn't just mean how much money I will earn or get to keep with a particular party in office. It also has to take into account whether their policies help me do my job effectively. I am going into medicine because I want to help patients and help make our society healthier, after all. If the patients can't even get to the doctor, then how can I achieve those professional goals of mine? I don't think a big salary would ever make up for failing the people I set out to help.

Whopper's comment about how awful it must be to have to leave training while owing 6 figures is funny. I was talking the other day to this guy who's an investment banker and makes a boatload of money. He was complaining about how he hates his job but can't quit because of all the money he's making. That's the OPPOSITE of what med students go through! Even if I hated medicine and wanted to quit, I couldn't, because I already owe so much. I'm trapped. (Luckily I love psych and know it will make me happy.)

 

[Anasazi23]

I'm just getting visions of things like blue-light specials on colonoscopies...

Don't be ridiculous.....blue-light specials are at K-Mart.

 

[mgdsh]

I couldn't read much past the first line--my blood starts boiling at even the mention of Walmart these days, and I'm on call today and it's hot out already so I closed the link after a quick look. But I did write a public health paper last year about Walmart and their in-store clinics. I am convinced that company opened the clinics partly so that their employees would be encouraged to go there for their own health care, instead of to hospitals or ERs or real doctors' offices. That's scary, since Walmart employees are already less healthy than the general population--they have much higher rates of diabetes and heart disease, for example. They let a memo leak a couple years ago where they were trying to lower those rates, not by providing better insurance, but by encouraging managers not to hire anyone who was older or obese or seemed to have a health problem.

Yep.... Yep.... Interesting...

It's interesting when people talk about which political parties "benefit physicians."

For the record I think physicians are grossly underpaid for the amount of schooling, and overall combination of intelligence/compassion/hardwork it takes to get through the process.

I know some people would disagree, but I guess it's all about perspective (including where you live and what other professions make after similar training).

Some random stats come to mind:

• The average salary here in the San Francisco Bay Area is ~$65k.
• A driver for DHL, UPS, Fedex, etc makes ~$80-90k a year & doesn't need much education or training to get there.
• I have more than a handful of friends who have nothing more than 4 year degrees making ~$100k+ and some as high as $150-175k, @ 25-27.
• I won't even begin to mention the potential salary for someone with equivocal training on Wall St or in Law.

Back to the politics of it. McCain may help a physician keep more of his income, like Bush did, but I have substantial reason to believe the value of those dollars you hold on to and their purchasing power will be substantially less. I'm also guessing McCain's economic policies (or lack there of) will only continue to widen the gap between the ultra-rich (top <0.5%) & everyone else.

My heart really goes out to all those people on fixed income, like our seniors, veterans and those on disability, etc. Our economic policies (monetary, political, fiscal, & the American consumer) of recent have done nothing to help their situations. If you think we have inflation now, you haven't seen @$!%. Thankfully, our government under reports inflation statistics, which helps pad our GDP numbers and limits the increases of fixed incomes.

Finally, I'd love to see a candidate come out and do more about controlling the real costs in medical care:

• Some type of reasonable cap on malpractice lawsuits
• Over use of tests/imaging
• Lack of prevention efforts by patients themselves.
• End of life care costs
• Insurance companies pandering to investors/Wall St

Those were just a few things that I could think of off the top of my head, I'm sure there's a ton more.

 

[notdeadyet]

For the record I think physicians are grossly underpaid for the amount of schooling, and overall combination of intelligence/compassion/hardwork it takes to get through the process.

I've yet to see a compelling argument for how physicians are so terribly underpaid when you bring actual numbers into it.

It's a huge time commitment for training. It's incredibly competitive. It's a challenging job for the span of your career. You acquire a huge amount of debt.

Once you factor in debt and ours worked, there are definitely more lucrative career paths out there. But not many. I think the folks most disappointed are the ones who had visions of it being something it isn't. But for a lot of us, once we've crunched the numbers, the math has still worked out in medicine's favor, even when it meant leaving pretty sweet six figure careers. It's not the career path for everyone, but I'd find it extremely hard to make the argument that physicians are underpaid.

Back to the politics of it. McCain may help a physician keep more of his income, like Bush did, but I have substantial reason to believe the value of those dollars you hold on to and their purchasing power will be substantially less.

Good point. I think folks lose sight of that.

 

[Faebinder]

I've yet to see a compelling argument for how physicians are so terribly underpaid when you bring actual numbers into it.

It's a huge time commitment for training. It's incredibly competitive. It's a challenging job for the span of your career. You acquire a huge amount of debt.

Once you factor in debt and ours worked, there are definitely more lucrative career paths out there. But not many. I think the folks most disappointed are the ones who had visions of it being something it isn't. But for a lot of us, once we've crunched the numbers, the math has still worked out in medicine's favor, even when it meant leaving pretty sweet six figure careers. It's not the career path for everyone, but I'd find it extremely hard to make the argument that physicians are underpaid.

Good point. I think folks lose sight of that.

You get done with residency/fellowship in your thirties.. you have another 30 years to practice and pay off a 250k+ debit. Not to mention buy your house, save for retirement, kids and what not. An average income of 165k? Most physicians work around 55 hours per week and many work a lot more (and i am not even counting being on call). If you take those 15 hours to that 165k it becomes 70k cause you need to think of that 15 as one and a half time (unless you feel 55 is a normal human being working hours in the week) Is that realistic? Cause if you drop your hours to 40, your income will drop believe me.

I am not even counting the risk factor.. what if you lose your license for some reason or cant work in your field of training anymore like getting HIV as a surgeon or stabbed in the back as a psychiatrist?

Tell us how you changed your mind after you start your first month of residency.

 

[nancysinatra]

You know, not everyone has the same financial expectations in life. If I wanted to make tons of money, I'd go into something more lucrative. A lot of people in those lucrative professions hate their jobs though. I'd personally rather do something I like and feel like I'm making a contribution to the world. I don't need to be in the top 1% or 5% of Americans income-wise. I'm in my 30s NOW, and I'm perfectly happy not being rich now, so why would that change when I become a resident? Maybe for some people it will, but not for everyone. To each his own.

It also depends where and how you grew up. I will be way, way, way above the people I grew up with financially if I end up making 70k. I doubt I'll spend my residency years complaining about that!

 

[OldPsychDoc]

You get done with residency/fellowship in your thirties.. you have another 30 years to practice and pay off a 250k+ debit. Not to mention buy your house, save for retirement, kids and what not. An average income of 165k? Most physicians work around 55 hours per week and many work a lot more (and i am not even counting being on call). If you take those 15 hours to that 165k it becomes 70k cause you need to think of that 15 as one and a half time (unless you feel 55 is a normal human being working hours in the week) Is that realistic? Cause if you drop your hours to 40, your income will drop believe me.

I am not even counting the risk factor.. what if you lose your license for some reason or cant work in your field of training anymore like getting HIV as a surgeon or stabbed in the back as a psychiatrist?

Tell us how you changed your mind after you start your first month of residency.

The benefit to risk ratio is STILL orders of magnitude better for us than for our patients. How great do you think it is to be working nights in a convenience store (how's your physical security there?) to supplement your wages as a teacher's aide because your abusive ex is in prison and couldn't cough up the child support he owes you, even if he wanted to, but he doesn't...

And yes, I think that working 50 + hours a week IS normal for someone making a six figure income. And frankly, most of the other liberal arts majors I went to undergrad with took until their 30s to get settled in a career, too.

I'm getting sick to death of hearing how awful it is to be practicing medicine when most of my inpatients don't have a stable home, have limited, if any, job prospects, and, through choice or predisposition, are hanging out in social circles that practically guarantee further downward social mobility.

Have some fricking gratitude, people--you live in a country that allows you to achieve a standard of living that is light-years beyond the reach of 90%+ of your fellow humans on this planet. If you don't like it then PLEASE go where you think the grass is greener. I know plenty of compentent FMGs who are lining up to take your place.

 

[Solideliquid]

This may be a little short-sighted, but going from an overworked resident making 40-45k/year to around 150k (psychiatry) after graduation...isn't...that...bad, it's pretty amazing to me.

Considering most people don't get a jump that high from internship to graduation in terms of salary (except lawyers if they make a firm).

EDIT: oh and to the topic at hand, I think the shrinking compensation from Medicare alone is going to lower our bottom line enough. I hate to think what changes in current policy the democrats are thinking will do to our earning capacity. However with that comment I welcome new changes that make it health care more accessible and reasonable in terms of price for our mentally ill patients.

 

[Faebinder]

The benefit to risk ratio is STILL orders of magnitude better for us than for our patients. How great do you think it is to be working nights in a convenience store (how's your physical security there?) to supplement your wages as a teacher's aide because your abusive ex is in prison and couldn't cough up the child support he owes you, even if he wanted to, but he doesn't...

And yes, I think that working 50 + hours a week IS normal for someone making a six figure income. And frankly, most of the other liberal arts majors I went to undergrad with took until their 30s to get settled in a career, too.

I'm getting sick to death of hearing how awful it is to be practicing medicine when most of my inpatients don't have a stable home, have limited, if any, job prospects, and, through choice or predisposition, are hanging out in social circles that practically guarantee further downward social mobility.

Have some fricking gratitude, people--you live in a country that allows you to achieve a standard of living that is light-years beyond the reach of 90%+ of your fellow humans on this planet. If you don't like it then PLEASE go where you think the grass is greener. I know plenty of compentent FMGs who are lining up to take your place.

(PS: I did do the gas station thing for a long time while in undergrad and grad). And yes I agree the word grossly by mgdsh should not have been used but he is not far from being correct and I think this is what he was referring to.

 

[OldPsychDoc]

(PS: I did do the gas station thing for a long time while in undergrad and grad). And yes I agree the word grossly by mgdsh should not have been used but he is not far from being correct and I think this is what he was referring to.

Oh well--the word for that is frankly, "corruption". That and "entitlement" begotten out of years of overpowered public employees' union contracts. To use those figures to set reasonable physician compensation would be almost like recalculating minimum hourly wages in Cleveland to keep pace with LeBron James' salary as a function of playing time.

 

[Therapist4Chnge]

-The SF article shows why many unions are screwing the average American.
-If you want a pay disparage for education....look no farther than psych-ology...7 years of education, and crap money.
-There are many that get 'stuck' in high-paying jobs because of the lifestyle. Been there, done that....then I left.

 

[sunlioness]

This may be a little short-sighted, but going from an overworked resident making 40-45k/year to around 150k (psychiatry) after graduation...isn't...that...bad, it's pretty amazing to me.

Where are people making 150k? I would have been making around 135k if I weren't doing any psychotherapy. Since I am, it will be less than that. But still when I got over being whiny about that and freaking out about my debt, I realized that I am still doing pretty darn well.

 

[TheWowEffect]

Where are people making 150k?

Most everywhere....and more than that at a lot of places.

 

[mgdsh]

Wow, let me just correct myself and say I'm not complaining. All I'm trying to say is that if you take a look at how well other fields/professions can be compensated, then yes physicians are *grossly* underpaid.

Call me crazy, assume I'm disenchanted, etc... But I'm not. I'm happy with the route I've chosen, and if it really makes you feel better to wake up in the morning and say hey look at how great I'm getting paid, then so be it. But please take a look around at various pay & bonus scales for everything we've put into where we are, and you'll realize that yes we are grossly underpaid.

I know pharmacists around 26-27 (when we'd start residency) getting paid $120-130k a year (and that's working about 55-60 hours a week, or the average physician work week).

Heck, I know bartenders that make $100k+ a year.

Take the examples I've provided above as well. Take the examples Faebinder has listed. The examples are really endless.

I'm guessing a lot of it also has to do with where you live. I would love to see MDs working in New York City or the San Francisco / LA areas, and say that they're overpaid.

I love where I am in life right now, and I couldn't really be happier. I also realized along time ago that medicine isn't the field to be in if you want to get rich. As mentioned by others, if you really do want to be better compensated, there are better fields to be in.

There are plenty of other great things about our jobs that you won't easily find in other fields, and no it's obviously not all about the money, but our side discussion of this thread was about compensation.

Forgive me if I come off as a realist.

 

[nancysinatra]

Wow, let me just correct myself and say I'm not complaining. All I'm trying to say is that if you take a look at how well other fields/professions can be compensated, then yes physicians are *grossly* underpaid.

Why don't you look in the other direction, and compare physician salaries to those of journalists, professors, artists, scientists, musicians, human rights laywers and other members of the educated class, who make far less than doctors, and whose contribution to society is often as or more long-lasting than ours?

It's odd, but the people I hear complaining about their incomes are usually the ones in the most well paid fields, who just don't happen to be at the TOP.

 

[notdeadyet]

You get done with residency/fellowship in your thirties.. you have another 30 years to practice and pay off a 250k+ debit.

This is where people get thrown. Get a spreadsheet out and forecast income. A $250K debt, with interest is a massive payback, especially if you aren't agressive with it. But crunch the numbers and you'll see that bigger paycheck + bigger debt beats smaller paycheck + no debt every time.

Not to mention buy your house, save for retirement, kids and what not.

Ignore that. These debits affect everyone, so it's a moot point when comparing.

An average income of 165k? Most physicians work around 55 hours per week and many work a lot more (and i am not even counting being on call).

Professional careers are not 40 hours per week. Tossing out the 40 hours per week thing is a red herring. I don't know anyone in a professional field (banking, technology, law, etc.) who works 40 hours per week. You can (as you can in medicine) but most don't. I think that this is why non-trads seem happier wth the financial aspect than traditional folks; we've walked on the other side and know that 9-5 exists for very few jobs of any sizable income.

I am not even counting the risk factor..

I'd be curious to see this data of what percentage of physicians this happens to. Then compare it to other jobs. It would be interesting. For all I know, medicine is a higher risk occupation than fireman or 7-11 cashier. Or it could be safer than attorney. I haven't seen any comparative data, but I'd be interested.

Tell us how you changed your mind after you start your first month of residency.

Don't need to. I don't consider residency part of the career, I consider it part of the training. I don't worry about making $8/hour in residency any more than I worry about making $0/hour in med school. This is part of the investment.


If folks are very debt averse, medicine is definitely a pretty dismal career path. but if you're a long-term investment type, there aren't many paths as safe as this one.