BLADEMDA

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http://nypost.com/2013/12/07/the-medicaid-time-bomb/

Obama is well aware of the Medicaid/Medicare/SS time bomb issue. His "master plan" is to completely socialize medicine so the time bomb is there on purpose. As for SS Obama wants a massive tax hike on all those "wealthy" citizens earning more than $250K plus increase the SS taxable limit to $180K.
 

Spikebd

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I get more and more excited about paying back the 450K in student loans I will owe in a few years.
I'm feeling the same way. I'm still about a decade away from really paying off these high interest loans I'm taking out. I hope there is still light at the end of the tunnel.
 

cincincyreds

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This Obama is a real piece of garbage. Lets look at how taxes have increased this year alone. For single/married, you pay an extra 0.9% for the medicaid surcharge in income over 200k/250k. So if income is 400k, this year you get to pay an extra $1800 if you are single and $1350 married. So over a 40 year career, $72,000 for a single person and $54,000 for a married couple. Imagine if you invested that money in an index fund at 7%.

Get the point, that is a big tax increase Mr. Obama, how dare you.

And what about the 3.8% medicare surcharge on outside investments, if 0.9% if a lot, 3.8% is like 4 times the pain.

This is what you are up against guys. You are being blamed for the high cost of medicine. Have a day's work in people living in California go to the tax man so the politicians can buy votes. As this continues, there will be no talent in medicine.

And you guys get NOTHING back on your high interest student loans. I'm not really sure why poor people go into medicine anymore. If you have rich parents it is one thing.
 

cincincyreds

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Mr. GoodmanBrown, I can't wait until you have to pay taxes with your 8.5% student loans at a principal of 500,000 dollars making 75,000 per year under the great Obama. Obama thinks $200k per year is as wealthy as Warren Buffet as he taxes both those parties accordingly.

Wake up.
 

emd123

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I get more and more excited about paying back the 450K in student loans I will owe in a few years.
Especially considering the massive Medicare cuts that just came to Pain, Pathology and other specialists a few weeks ago, this may reach crisis proportions. Plan on taking a pay cut every year for your career, regardless of how good or bad of a job you do.

Obama plans on crushing specialists by cutting what Medicare pays each year so that we make as little as what doctors do in countries with socialized medicine. That's his goal. But they won't do a damn thing about the cost of medical school, the cost of running a practice or the cost of insuring ourselves against predatory and frivolous medical malpractice suits.

Nope, just an Rx for one can of US Government Suck-it-up.

What socialist country pays it's doctors pennies, and forces medical student to run up debts in the hundreds of thousands for tuition yet cuts every year, your salary, so that you can never pay it back? I know of only one.

Obama sees doctors as the problem.

We've known Obama had plans to kill medicine, crush doctor pay, put us out of business and force us under the Obama puppet string-hospital umbrella, and now his plan is in action.

See Medicare cuts 2014. (Specialists cut across the board, and non-physician payments all up, including chiropractors getting a 12% raise).

Think before racking up debt, think before you pick your specialty, think before you choose Medicine as a career, and think before you vote.

We're under assault.


Obama says doctors are greedy and just amputate legs unnecessarily just to make $50,000:


Obama says doctors are greedy and just resect tonsils unnecessarily to make money:


He's not placed ANYTHING in the system to change fee for service. He's just cutting specialist pay across the board.

He's cutting it for the ones who are unethical AND cutting it for those who practice with the utmost ethics, AND for those just entering the workforce who had no hand in creating any of this debacle.

Obamacare has caused more patients to LOSE healthcare coverage than it's helped to get insurance.

Obamacare is a travesty; a modern day calamity.

It's bad for patients and it's bad for doctors.
 
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seinfeld

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anyone who feels we should all pay more in taxes is more than welcome to send a check to the IRS on my behalf. Personally I would rather spend my earned money than give it to a dysfunctional government.
 

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Obama is a true scumbag. I would turn away care for him any day and hope i have the opportunity too one day
 

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Explain your math, GoodmanBrown.....$16 million?! Where the hell do you come up with that number? At $300k per year, working for 30 years, that's only $9 million. In this era of medicine, you'd be extremely fortunate to pull down that salary too. You must be one of the doofuses feeding the Obama administration their "information."
 

GoodmanBrown

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Cinceyreds gave $400K x 40 years. I simply used his assumptions. Re: taxes, I'm not going to be sending any extra money Uncle Sam's way, but for the most part, we (those in the overall medical profession) get decent pay for our work. A stable, adequately-funded government helps create an environment from which we all benefit. Medicare pays for ~60% of all healthcare in America, so we're also getting directly paid by the government for our work. Yeah, anesthesiologists get a bit of a finger from Medicare/Medicaid, but I'm not overly upset as your general annual reimbursement is hardly putting you in the poor house.

The (presumably) older docs always talk about how big a burden loans are, but I have to scratch my head when we also have posts by attendings 2 years out who have paid off their entire loan debt already. (Sevo had a post awhile ago about him and his wife paying off their student loan debt in 1 year and making $500K each in Nebraska or somewhere in the Midwest.) Please give me another field (law?, business?) where you can essentially be guaranteed a wage of >200K for simply passing your classes at any old school. Yeah, law & business can be more lucrative, but you have to get to a top 20 school and be the best in your class for those jobs. Median lawyer salary is $113K (that's all lawyers, not just new ones). A study looked at the top MBA programs and how much their graduates earned over 20 years. Harvard MBAs earned $3,639,643 over 20 years. That's an average of $182K/yr. PCPs are matching MBA money from a top school! So, you see why I'm a bit skeptical about all this concern over physician pay and people leaving medicine for greener pastures.

The deficit's coming down, and the natural gas boom in America (& the world) will fund cheap energy for decades to come. Overall, the economic recovery is slow, but steady. This should really be an optimistic time for those of us who's incomes put us in the 90+%. Income inequality is honestly my main concern and one of the biggest impediments to a robust economic recovery.

Re: my paying off loans, please don't worry on my account. ;) I'm a non-traditional student, and I'm easily as old as some younger attendings. I've paid taxes before. My loans & taxes will not cause me to not buy a house or have kids when I want them.
 

VA Hopeful Dr

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Cinceyreds gave $400K x 40 years. I simply used his assumptions. Re: taxes, I'm not going to be sending any extra money Uncle Sam's way, but for the most part, we (those in the overall medical profession) get decent pay for our work. A stable, adequately-funded government helps create an environment from which we all benefit. Medicare pays for ~60% of all healthcare in America, so we're also getting directly paid by the government for our work. Yeah, anesthesiologists get a bit of a finger from Medicare/Medicaid, but I'm not overly upset as your general annual reimbursement is hardly putting you in the poor house.

The (presumably) older docs always talk about how big a burden loans are, but I have to scratch my head when we also have posts by attendings 2 years out who have paid off their entire loan debt already. (Sevo had a post awhile ago about him and his wife paying off their student loan debt in 1 year and making $500K each in Nebraska or somewhere in the Midwest.) Please give me another field (law?, business?) where you can essentially be guaranteed a wage of >200K for simply passing your classes at any old school. Yeah, law & business can be more lucrative, but you have to get to a top 20 school and be the best in your class for those jobs. Median lawyer salary is $113K (that's all lawyers, not just new ones). A study looked at the top MBA programs and how much their graduates earned over 20 years. Harvard MBAs earned $3,639,643 over 20 years. That's an average of $182K/yr. PCPs are matching MBA money from a top school! So, you see why I'm a bit skeptical about all this concern over physician pay and people leaving medicine for greener pastures.

The deficit's coming down, and the natural gas boom in America (& the world) will fund cheap energy for decades to come. Overall, the economic recovery is slow, but steady. This should really be an optimistic time for those of us who's incomes put us in the 90+%. Income inequality is honestly my main concern and one of the biggest impediments to a robust economic recovery.

Re: my paying off loans, please don't worry on my account. ;) I'm a non-traditional student, and I'm easily as old as some younger attendings. I've paid taxes before. My loans & taxes will not cause me to not buy a house or have kids when I want them.
Find me a job that you are training for until, minimum, age 30 with a steadily increasing loan burden, delayed retirement/family, increasingly expensive MOC requirements, threats of lawsuits, long hours where you're responsible for life/death decisions no matter the hour or how tired you are.
 

pgg

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Find me a job that you are training for until, minimum, age 30 with a steadily increasing loan burden, delayed retirement/family, increasingly expensive MOC requirements, threats of lawsuits, long hours where you're responsible for life/death decisions no matter the hour or how tired you are.
I don't think he's arguing that physicians don't deserve high pay, we sure as hell do, just that

1) medicine as a whole has been, is, and will continue to be at a minimum an upper middle class life that is recession-proof and totally immune to the unemployment fears so many other Americans face

2) there simply aren't any other non-medical fields that offer comparable recession-proof pay

and so some perspective is in order. We have this thread almost as often as we have midlevel encroachment threads. Someone will always bring up i-banking or various entrepreneurial options, but it's simply fantasy to think that anyone who can be a doctor automatically by-default has the qualities and ability and luck and connections to succeed at those careers. Which, incidentally, are absolutely saturated with risk and also involve obscene work hours.


Where I disagree with GoodmanBrown is in his faith in the longevity of this American petroleum boom and rosy economy / energy outlook. But when that sputters out, whether it's in 5 or 10 or 20 years, I'll be even more glad to be in this well-paid extremely secure job.
 

GoodmanBrown

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Find me a job that you are training for until, minimum, age 30 with a steadily increasing loan burden, delayed retirement/family, increasingly expensive MOC requirements, threats of lawsuits, long hours where you're responsible for life/death decisions no matter the hour or how tired you are.
I'm not sure where you're getting a minimum of 30. Most people start college at ~18. Add 4 for med school, and 4 for an anesthesiology residency, and boom, you're 26. Do a combined BA/MD or a 3 year residency and you're even younger. It is a longer road than a lawyer or MBA, but with the additional, practically guaranteed income, I think it is still worth it. As stated above, loan burden doesn't seem to be crushing the anesthesiologists of this forum... Physicians also seem to feel we've got a lockdown on stressful work conditions; however, I've heard much worse horror stories from I-banking interns. There are no work hour restrictions for lawyers or MBAs. Good luck getting a golden weekend ever in those careers if you want to make partner at a top firm.

I don't think he's arguing that physicians don't deserve high pay, we sure as hell do, just that.

1) medicine as a whole has been, is, and will continue to be at a minimum an upper middle class life that is recession-proof and totally immune to the unemployment fears so many other Americans face

2) there simply aren't any other non-medical fields that offer comparable recession-proof pay

and so some perspective is in order. We have this thread almost as often as we have midlevel encroachment threads. Someone will always bring up i-banking or various entrepreneurial options, but it's simply fantasy to think that anyone who can be a doctor automatically by-default has the qualities and ability and luck and connections to succeed at those careers. Which, incidentally, are absolutely saturated with risk and also involve obscene work hours.

Where I disagree with GoodmanBrown is in his faith in the longevity of this American petroleum boom and rosy economy / energy outlook. But when that sputters out, whether it's in 5 or 10 or 20 years, I'll be even more glad to be in this well-paid extremely secure job.
In general +1 to pgg's statement. (+2 to the fact that this discussion comes up every few weeks).

First off, I won't say whether physicians as a whole deserve more or less money. I think deserve is the wrong question (especially in a forum full of libertarians). The real question is what will the market of individuals, private insurers, and the government pay for our services. Thus far, the order seems to me to be private insurance > government > individuals. Can you imagine anyone but the most affluent Americans paying out-of-pocket for a CABG? (Average cost: $20.7K) I have to think that many Americans would just live on a few generics and hope the "big one" was postponed as long as possible. As such, I think physicians are fairly well reimbursed for what we do and that the market compensates us about as well as we could hope for.

To pgg's point 1), I think it's a stretch to call most physicians "upper middle class." Earning $200K/yr puts you in the 5%. $400K puts you in the dreaded 1%. I know that wealth is relative and many physicians don't feel rich. But objectively, being in the 5-1% in America makes you really close to being rich.

As to your final point, we must agree to shake hands and disagree. My understanding of the geology (which is admittedly minimal) is that we have several decades worth of natural gas in America and that China has even larger shale deposits to tap. Climate change is no joke, and I can't predict what effect it will have on the economy. However, average household debt is falling, unemployment is falling, we have a budget, consumer sentiment is up, and there many other signs of recovery. We'll have to see how the whole thing turns out. But I share pgg's sentiment that it's a great profession to be in for stability and a comfortable lifestyle.
 

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I'm not sure where you're getting a minimum of 30. Most people start college at ~18. Add 4 for med school, and 4 for an anesthesiology residency, and boom, you're 26. Do a combined BA/MD or a 3 year residency and you're even younger. It is a longer road than a lawyer or MBA, but with the additional, practically guaranteed income, I think it is still worth it. As stated above, loan burden doesn't seem to be crushing the anesthesiologists of this forum... Physicians also seem to feel we've got a lockdown on stressful work conditions; however, I've heard much worse horror stories from I-banking interns. There are no work hour restrictions for lawyers or MBAs. Good luck getting a golden weekend ever in those careers if you want to make partner at a top firm.
You forgot that 4 years of college which puts you at the 30 I stated. 18+4+4+4=30. Try to keep up. Combined BA/MD programs are pretty rare in the US, especially in terms of percent of medical school graduates so I'm excluding them.

I'm not saying that medicine has the lock on worst work schedule (although the only hour restrictions are on residents, attendings especially in the busier fields routinely work longer hours than residents). What I am saying is that those bankers and lawyers don't literally have another human being's life in their hands while working that 35th straight hour like so many in medicine do.

Also, as I stated, the loan burden is getting worse every year. While it isn't a huge problem, it is a problem. One of many we face that I think merits our increased compensation.

I've often thought, and know many doctors who agree with me, that I would gladly take less money if you erased our loans, gave us liability protection, and let us work the hours of our socialized brethren in other countries. However, until that happens, don't try to cut our pay too much.
 
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chocomorsel

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I agree with what a lot of Goodman's Brown post (Definitely not the math LOL). And I agree with the idea of Universal Healthcare. And that Obama is well intentioned but with poor planning.
The fact is, no one one has addressed MALPRACTICE at all in this 2000 page Obamacare ACT.
Also, the cost of attending medical school/professional school in this country is a bit exorbitant.

Europe taxes its citizens much higher taxes in order for people to have "free" healthcare. Not just the rich people. So to pay for universal healthcare, all taxes must go up, period. And we as Americans need to stop whining about getting taxed so much, because we still get taxed much less than Europe. I am not saying taxes are fun, but they are an unnecessary evil. We spend way too much GDP in this country on healthcare costs and much of that I don't believe is physician cost, but due to futile care mostly at end of life and ordering unnecessary tests due to fear of missing something and being sued. Lawyers have us by the balls. We know it and they know it.

EVERYONE needs to participate FAIRLY and EQUALLY percentage wise when it comes to taxation. The super rich and cooperate America shouldn't have tax loopholes and the poor shouldn't be taxed any less than average, percentage wise. Period, full-stop end of story. The graded system is not fair. I was born in a very poor continent and know that one can do essentially anything they want to do as far as career choices in this country. People who work hard to achieve a higher standard of living should not be penalized any more than the high school drop out or graduate who for whatever reason did not go to college. Of course, college these days has become exorbitantly expensive so that's one thing that higher taxes could certainly help; funding of a higher education; better schools in the country and inner cities.

I was discussing this with an ENT colleague at work. As a first world country we should be able to have universal healthcare available to everyone, rich or poor. Fantastic idea. But, what about the greedy lawyers and their crazy awards? The government should really come down hard on them and step in by either making new rules on malpractice caps on a national level or giving individual states a time limit to come up with tort reform of their own. I am from Texas and remember back in 2004 when I voted for tort reform and how Texas has seen a steady increase in docs trying to move there since then. Doctors need protection. We are human and when we make honest mistakes we should not have our lives turned upside down. Normal people don't have that issue at work when they screw up.

And before anyone starts complaining about a capitalistic economy and blah, blah, blah, think about the happiness index in Europe where the Scandinavian countries always come out on top. Money, does not buy happiness, is all I am saying.
 

VA Hopeful Dr

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I agree with what a lot of Goodman's Brown post (Definitely not the math LOL). And I agree with the idea of Universal Healthcare. And that Obama is well intentioned but with poor planning.
The fact is, no one one has addressed MALPRACTICE at all in this 2000 page Obamacare ACT.
Also, the cost of attending medical school/professional school in this country is a bit exorbitant.

Europe taxes its citizens much higher taxes in order for people to have "free" healthcare. Not just the rich people. So to pay for universal healthcare, all taxes must go up, period. And we as Americans need to stop whining about getting taxed so much, because we still get taxed much less than Europe. I am not saying taxes are fun, but they are an unnecessary evil. We spend way too much GDP in this country on healthcare costs and much of that I don't believe is physician cost, but due to futile care mostly at end of life and ordering unnecessary tests due to fear of missing something and being sued. Lawyers have us by the balls. We know it and they know it.

EVERYONE needs to participate FAIRLY and EQUALLY percentage wise when it comes to taxation. The super rich and cooperate America shouldn't have tax loopholes and the poor shouldn't be taxed any less than average, percentage wise. Period, full-stop end of story. The graded system is not fair. I was born in a very poor continent and know that one can do essentially anything they want to do as far as career choices in this country. People who work hard to achieve a higher standard of living should not be penalized any more than the high school drop out or graduate who for whatever reason did not go to college. Of course, college these days has become exorbitantly expensive so that's one thing that higher taxes could certainly help; funding of a higher education; better schools in the country and inner cities.

I was discussing this with an ENT colleague at work. As a first world country we should be able to have universal healthcare available to everyone, rich or poor. Fantastic idea. But, what about the greedy lawyers and their crazy awards? The government should really come down hard on them and step in by either making new rules on malpractice caps on a national level or giving individual states a time limit to come up with tort reform of their own. I am from Texas and remember back in 2004 when I voted for tort reform and how Texas has seen a steady increase in docs trying to move there since then. Doctors need protection. We are human and when we make honest mistakes we should not have our lives turned upside down. Normal people don't have that issue at work when they screw up.

And before anyone starts complaining about a capitalistic economy and blah, blah, blah, think about the happiness index in Europe where the Scandinavian countries always come out on top. Money, does not buy happiness, is all I am saying.
Well, up to a certain point it definitely does.

That aside, you're more eloquently stated the point I was trying to make. If we actually went to a full socialized model - free training, no lawsuit worries, easier hours, government benefits... well, I'm not sure that I'd hate it. Plus, we would get the rationing that we very much need especially at end of life as you mentioned.
 

pgg

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I've often thought, and know many doctors who agree with me, that I would gladly take less money if you erased our loans, gave us liability protection, and let us work the hours of our socialized brethren in other countries. However, until that happens, don't try to cut our pay too much.
http://www.navy.mil/

less money, check
no loans, check
liability protection, check check check you better believe it check
work hours of socialized medicine, check



First off, I won't say whether physicians as a whole deserve more or less money. I think deserve is the wrong question (especially in a forum full of libertarians). The real question is what will the market of individuals, private insurers, and the government pay for our services. Thus far, the order seems to me to be private insurance > government > individuals.
That would be an interesting line of debate, if there actually was a free market for healthcare in the US. But there isn't, and I don't think any of us really want that anyway. There's room for, and a need for, government to provide a welfare safety net, of which health care ought to be a part.


More and more I think the whole healthcare debate is just being framed wrong, maybe deliberately so. We keep talking about health insurance. Insurance. What a ridiculous use of the word. Insurance is something you pay for to limit the out-of-pocket and life-altering cost of an unlikely but catastrophic event.

We buy fire or flood insurance in case our house burns or floods. But fires and floods are rare events; they certainly don't happen every year.

We buy life insurance in case we drop dead and leave a family behind. But dropping dead is a rare event; we certainly don't die every year.

We buy auto insurance in case we plow into a farmer's market and injure someone while driving & posting on SDN. But we don't cause accidents every year.

We buy umbrella insurance in case some clown trips on the curb in front of our house and sues us. But getting sued by scamming scum doesn't happen every year.

But we buy health insurance, and somehow expect that a premium of $X should cover PLANNED annual doctor visits and a SCHEDULED colonoscopy at 50 and some number of 2-day stays on L&D which should've been predictable after the first 10 minutes of 7th grade health class, all of which might cost $50X. And then, THE fundamental underpinning of all solvent insurance schemes - the ability to set premiums or deny coverage based on assessed risk - is yanked away by law. And we still call it "insurance" ...

When did we start imagining that "insurance" was something for planned or predictable expenses? We should be talking about paying for preventive care packages and leave the insurance for things like broken bones and cancer.



To pgg's point 1), I think it's a stretch to call most physicians "upper middle class."
I live in the 'burbs and my 3 closest neighbors include a retired widow, a cheese factory worker, and a teacher. I imagine they struggle more than I to cover the mortgage payment, but we live comparable lives.

Rich people don't get up at 5 or 6 in the morning and go to work like my middle class neighbors and I do. Rich people get up when they feel like it, and every once in a while their 'work' involves trying to remember the password to login to the Goldman Sachs web site make sure their investments are paying enough interest or dividends to keep the yacht fueled. And good for them; they earned or inherited the money and it's theirs.

You listed 'income inequality' as a major concern ... but I didn't get the impression you were worried about the "poor" people making $30K paying no income tax while "rich" people making $300K pay 50% income tax ... rather that group making $10,000K or $100,000K paying 20% income tax.
 
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1) medicine as a whole has been, is, and will continue to be at a minimum an upper middle class life that is recession-proof and totally immune to the unemployment fears so many other Americans face.
Good luck with that. If nurses (in general, not only CRNA's) have their way, you will be the sucker taking care of tough cases for the same money as them. You will work harder for almost the same hourly pay as what we call today midlevels, and will call tomorrow "bosses".

When I look at American healthcare nowadays, I feel like I am witnessing the bolshevik revolution. The same hatred for smart, highly-educated people (doctors) from the general population and the blue-collar workers (nurses) who are taking over the factories (hospitals) and either firing the capitalist element or making them live as badly as everyone else (and be very grateful for just having a job, you arrogant, good for nothing doctor!). I am affiliated with a large academic hospital and I have just heard that we have some important committees that have no physician members anymore. It's typical class warfare; only the ignorant who did not grow up in a socialist/communist country don't see it. (Do yourself a favor and read the "Animal Farm", at least.)

We are the dinosaurs. Welcome to the Ice Age!

P.S.
This entire BS with caring for patients in "teams" reminds me of when the poor American factory workers had to train their foreign replacements. That's exactly what we are doing every day we explain our thinking to nurses and midlevels. It might take a decade or two, but it will happen, unless there is a significant change at governmental level. Right now, Washington and their lobbyists are interested in paying big bucks only to Big Pharma and the healthcare-industrial complex, not to physicians. We are already making too little and contributing even less to PACs, to be/stay interesting for the lawmakers.

We are just another bunch of blue-collar workers; only those of us who are partners can still call themselves "professionals". When was the last time in history a hospital executive made many times the salary of the average doctor?
 
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VA Hopeful Dr

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http://www.navy.mil/

less money, check
no loans, check
liability protection, check check check you better believe it check
work hours of socialized medicine, check





That would be an interesting line of debate, if there actually was a free market for healthcare in the US. But there isn't, and I don't think any of us really want that anyway. There's room for, and a need for, government to provide a welfare safety net, of which health care ought to be a part.
Many of us have made a similar deal when it comes to being employed by a hospital system. Usually offer loan repayment, cover your malpractice (still get sued but you don't pay for it), usually easier schedule, and less money then PP though not to the same extent as military med.

You want to see free market at work, google AtlasMD. Its a relatively new model called Direct Primary Care. Now obviously this doesn't work quite as well for OR-driven specialties, but its an interesting start.
 

pgg

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When I look at American healthcare nowadays, I feel like I am witnessing the bolshevik revolution. The same hatred for smart, highly-educated people (doctors) from the general population and the blue-collar workers (nurses) who are taking over the factories (hospitals) and either firing the capitalist element or making them live as badly as everyone else (and be very grateful for just having a job, you arrogant, good for nothing doctor!).
I like that analogy, actually, and think there's some truth to it. It does sort of remind me of the Republican party's contempt for science and the smart, highly educated people who do it. At least, the wing of the party that had Sarah Palin as their idol.


I am affiliated with a large academic hospital and I have just heard that we have some important committees that have no physician members anymore. It's typical class warfare; only the ignorant who did not grow up in a socialist/communist country don't see it. (Do yourself a favor and read the "Animal Farm", at least.)
I've read the book, I suspect everyone here has.

Why aren't there physician members of those committees? Is it because no physicians WANT to be there? We have that problem in the military. There's a heavy slant on major hospital committees and director boards toward non-physicians ... mainly because physicians work really hard to avoid those jobs. As a group we want to practice medicine, not chase paper. Many nurses on the other hand view mid- and upper- management as the natural progression of their careers. And who can blame them? A lot of the in-the-trenches nursing is pretty menial and dirty work, much better to move on to be a charge nurse, and then an office away from the smell of melena on the ward.

Recently I applied for a vacant seat at my hospital's board of directors table. No other physicians applied. At least one specifically declined to be considered. I imagine that phenomenon is even worse out in the civilian world - I don't get paid any less to start 4 out of 5 days in a conference room instead of the OR, but you PP guys probably lose money every minute you spend in a meeting and not the OR.

But having doctors on those committees and boards is important. So much so, that when the post-military day comes that I'm looking for a full time PP group to join, one of my criteria will be a group that has members on those committees and boards, with no financial hit to the guy who goes to those meetings.


We are just another bunch of blue-collar workers; only those of us who are partners can still call themselves "professionals". When was the last time in history a hospital executive made many times the salary of the average doctor?
Admin'ing is hard work and when it's done poorly the entire hospital suffers. Badly. I don't mind seeing good managers get paid well.
 
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chocomorsel

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Well, up to a certain point it definitely does.

That aside, you're more eloquently stated the point I was trying to make. If we actually went to a full socialized model - free training, no lawsuit worries, easier hours, government benefits... well, I'm not sure that I'd hate it. Plus, we would get the rationing that we very much need especially at end of life as you mentioned.
Yes, to a point yes, having money does certainly assist in happiness. But I bet the cutoff is much lower than we give credit for. Many european docs earn less and Europe is more expensive in General than US. I have family there so I know at least in some if not most areas this is true. I would like some Canadian or European docs to weigh in though.
 

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I personally hate all the 1%, or 5%'er arguments. Why does working your way up to be a %er make u a target? Isn't this America? Founded on hard work and merit? If physicians as a whole have a skill/knowledge base that less than 1% of the country can do then we deserve to be compensated as such. Period. And that's ignoring the lost years of income, the debt, and the liability.

Of course, the argument to this would be the obvious truth that a lot of people in the country, gov included, aren't so sure our skill ISN'T able to be performed at least adequately well by any number of "similarly trained" groups..... We are losing the PR battle, BADLY, in both realms, as members of "the rich" that should be subsidizing the have nots, as well as being seen as the greedy healthcare overlords that overestimate their worth/importance.
 

bedrock

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I like that analogy, actually, and think there's some truth to it. It does sort of remind me of the Republican party's contempt for science and the smart, highly educated people who do it.
??? The democrats have [email protected]#$#cked the healthcare system like no politicians before them and you're using the Bolshevik example analogy to refer to Republicans?

Sorry, but plenty of ******* working unionized democrats out there that hate all educated professionals with graduate degrees.
 

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??? The democrats have [email protected]#$#cked the healthcare system like no politicians before them and you're using the Bolshevik example analogy to refer to Republicans?

Sorry, but plenty of ******* working unionized democrats out there that hate all educated professionals with graduate degrees.
Could you point out exactly where I mentioned Democrats?

I referred to the Republican party's hate affair with science and education because FFP's comment reminded me of those clowns. Mostly the religious right.
 

bedrock

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Could you point out exactly where I mentioned Democrats?

I referred to the Republican party's hate affair with science and education because FFP's comment reminded me of those clowns. Mostly the religious right.
Your example was incorrect because it focused on one party. Both the far right and the far left hate educated people, scientists etc. And the Bolsheviks are far left. Ever heard of what the Khymer Rouge did to physicians and all educated people in Cambodia? They massacred them. Again they were far left.

My point is that the far left and far right in both parties are comprised of absolute idiots. So your comment that compared the bolshevik reference only to the Republicans and not to the Democrats seems incongruous.
 
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Yes, to a point yes, having money does certainly assist in happiness. But I bet the cutoff is much lower than we give credit for. Many european docs earn less and Europe is more expensive in General than US. I have family there so I know at least in some if not most areas this is true. I would like some Canadian or European docs to weigh in though.
I can weigh in for you. 40-60 hour work-week, tops. Basically no malpractice (unless egregious). Much better social standing (worse than in the past, but better than US). More paternalistic medicine; less about patients' "rights" and satisfaction, more about getting them better, where the doctor is the expert and the patient is the layperson. No midlevels, much less power to nurses, techs etc.

There's your recipe for happiness.

P.S.
Do not compare incomes. If you take the net income and divide it per hour of work (including a much better paid over-/call-time in Europe), the difference will not be that shocking anymore, especially if you consider that there are no educational loans to pay, no private schools needed for the proper education of your kids, no monstrous malpractice (insurance), no enormous healthcare costs, no need for a parent to stay at home to raise kids because of poor/expensive kindergarten/K-12 etc. Generally, there is a much better social net to catch you in case you need it. (I am not a leftist, and even I appreciate it when in moderate amounts.)

Oh, and one has a better healthcare market in most European countries than in the US. Even in the so-called single-payer systems, there is a significant direct-pay private healthcare market (if you want something better), which in the US is disappearing.
 
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countingdays

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The religious right aren't right, but they are idiots.

The far left mean well but ignore human nature so their policies are doomed to fail.

Obamacare isn't well intentioned. It is a handout to insurance companies and hospitals while expanding the welfare state, which is a government power grab that won't benefit the majority of people it's supposedly designed to help, it just overcharges them for a product they mostly don't need, at least at that price.
 

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Your example was incorrect because it focused on one party. Both the far right and the far left hate educated people, scientists etc. And the Bolsheviks are far left. Ever heard of what the Khymer Rouge did to physicians and all educated people in Cambodia? They massacred them. Again they were far left.

My point is that the far left and far right in both parties are comprised of absolute idiots. So your comment that compared the bolshevik reference only to the Republicans and not to the Democrats seems incongruous.
For all their faults, I don't recall any lefties in the US gargling about "teaching the controversy" of creationism in schools, telling their House Committee on Science brethren about the 9000 year old earth, disregarding and distorting climate scientists' objective findings, calling physics embryology and evolution "lies straight from the pit of hell", presidenting around with gut feelings and hunches and eye-looking truthiness, handwringing about HPV vaccine induced brain damage on the presidential campaign trail, or telling us that "legitimate rape" has a birth control side effect.

What happened to Republican Jon Huntsman's presidential bid about 45 seconds after he dared to admit evolution was more than just a crackpot theory? Yeah. Democrat campaigns don't implode when they demonstrate their acceptance of 8th grade biology.

I could fill volumes with the faults of Democrats, really with any party :), but let's not pretend there's some kind of scientific equilibrium between the Ds and Rs. This is not an area where both parties are equally bad. It is a sadly common Republican tactic to hurl baseless and ignorant attacks at the scientific underpinnings of opposing ideas. It's their MO and their base eats it up.

And FSM help me I still usually hold my nose and vote R because the Ds are worse in different ways. I self-identify as mostly libertarian and flirt with being a single-issue 2nd Amendment voter. The average Republican candidate overlaps with my views more than the average Democrat. Being a resident of a swing state I'm reluctant to vote 3rd party.
 

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I can weigh in for you. 40-60 hour work-week, tops. Basically no malpractice (unless egregious). Much better social standing (worse than in the past, but better than US). More paternalistic medicine; less about patients' "rights" and satisfaction, more about getting them better, where the doctor is the expert and the patient is the layperson. No midlevels, much less power to nurses, techs etc.

There's your recipe for happiness.

P.S.
Do not compare incomes. If you take the net income and divide it per hour of work (including a much better paid over-/call-time in Europe), the difference will not be that shocking anymore, especially if you consider that there are no educational loans to pay, no private schools needed for the proper education of your kids, no monstrous malpractice (insurance), no enormous healthcare costs, no need for a parent to stay at home to raise kids because of poor/expensive kindergarten/K-12 etc. Generally, there is a much better social net to catch you in case you need it. (I am not a leftist, and even I appreciate it when in moderate amounts.)

Oh, and one has a better healthcare market in most European countries than in the US. Even in the so-called single-payer systems, there is a significant direct-pay private healthcare market (if you want something better), which in the US is disappearing.
Very helpful information, yet very depressing at the same time...........

Two thoughts. There are still many very good public schools in america, just parents have to research this and ensure their kids go there.
Social standing of physicians is still quite high in America compared with other professions. #4 the last time I saw this ranked, however this mainly applies to dinner parties and bank loans, not patient interactions.

There is much to admire about the lifestyle of european physicians.
 

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i hope you docs grab life by the balls and win this battle...i agree with the dystopian views in this thread. PGG, don't you think PP already know the importance of docs being on committee's and boards and maybe not cut their pay for attending the meetings? I am curious about that..

the current administration is even worse than socialized..at least in socialized med, tuition is dirt cheap!
 

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Philip Greenspun said:
I’m wondering why Americans are so confident that they need health insurance and that, indeed, health insurance is such a good idea that people who don’t want it should be forced to buy it. Food is more important than medical care since without food a person will surely die. Yet we don’t force people to carry “food insurance” and then have the food insurance company authorize particular food providers to serve meals at times and places of the provider’s choice. If people are poor we give them a debit card (SNAP or “food stamps”) that they can use at the supermarket of their choice, with roughly the same shopping experience as a customer using cash. Poor people are lifted up to enjoy a middle-class shopping experience. In health care, it is the opposite. Middle class people are dragged down to endure the same customer service experience as a poor person dependent on Medicaid. If we hadn’t been forced by convention and now law to hand over $20,000 per year to insurers for our family’s medical care we would have been delighted to pay $160 for an appointment with a doctor who could spend a calm 30 minutes with us, rather than $83 for a rushed 15-minute appointment. And the $45 bill for the prescription wouldn’t have bothered me at all if I hadn’t already paid for prescription drug insurance that, I thought, paid for prescriptions.

The pharmacist put it in terms of dollars and cents: “People think that they can save money by buying insurance. They never wonder how it is that all of the people who own insurance companies got to be billionaires.”
http://blogs.law.harvard.edu/philg/2013/12/14/an-insured-day-in-the-american-health-care-system/
 

chocomorsel

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I can weigh in for you. 40-60 hour work-week, tops. Basically no malpractice (unless egregious). Much better social standing (worse than in the past, but better than US). More paternalistic medicine; less about patients' "rights" and satisfaction, more about getting them better, where the doctor is the expert and the patient is the layperson. No midlevels, much less power to nurses, techs etc.

There's your recipe for happiness.

P.S.
Do not compare incomes. If you take the net income and divide it per hour of work (including a much better paid over-/call-time in Europe), the difference will not be that shocking anymore, especially if you consider that there are no educational loans to pay, no private schools needed for the proper education of your kids, no monstrous malpractice (insurance), no enormous healthcare costs, no need for a parent to stay at home to raise kids because of poor/expensive kindergarten/K-12 etc. Generally, there is a much better social net to catch you in case you need it. (I am not a leftist, and even I appreciate it when in moderate amounts.)

Oh, and one has a better healthcare market in most European countries than in the US. Even in the so-called single-payer systems, there is a significant direct-pay private healthcare market (if you want something better), which in the US is disappearing.
I like the European recipe for happiness. Seems to work better.
 

countingdays

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I like the European recipe for happiness. Seems to work better.
It's good in the short term. Whether long term decline prevents future happiness is a big question. Absent Asian slave labor, the European model would work better.
 

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Remember that most EU countries have a 34-38 hour workweek BY LAW, with serious penalties for overtime. The EU itself has a 48 hour limit. Imagine that in the US, for doctors. :p

Oh, and don't forget the 8-12 weeks of paid vacation time.

P.S. Plus doctors have no interdiction to unionize, and can better defend their interests. Here it's divide and conquer; the professional societies are a joke compared to the unions.
Easy there budy, France has a 35h limit for employees this does not apply to independant contractors (all PP docs) those jobs don't have 8-12 weeks vacation and pay significantly less. I almost took a job in PP in France 12 week vacation 400k€/y but you work hard for this 8am-6:30 7pm everyday + call 1/8, supervising several rooms sometimes running 2 rooms by yourself. And at the end you get hit hard by the tax man.
We do have unions but they don't have all that much power since all docs are not affiliated and for politicians it's always easy to hit the rich and greedy physicians.
 

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But do you agree that malpractice there does not hold a candle to the American version of destroying your career and life?
 

pgg

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PGG, don't you think PP already know the importance of docs being on committee's and boards and maybe not cut their pay for attending the meetings? I am curious about that..
I don't know what the norm is - I'm still only a few years out of residency and haven't spent enough time in enough different places to judge how common it is. It's certainly not universal though. One of the groups where I moonlight has an older anesthesiologist who spends most of his time out of the OR admin'ing around. It's good for the group but there's a fair bit of resentment from some of the worker bee anesthesiologists.
 

dr doze

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I don't know what the norm is - I'm still only a few years out of residency and haven't spent enough time in enough different places to judge how common it is. It's certainly not universal though. One of the groups where I moonlight has an older anesthesiologist who spends most of his time out of the OR admin'ing around. It's good for the group but there's a fair bit of resentment from some of the worker bee anesthesiologists.
It is good for the group…when the guy going to the meetings is an advocate for the group and not just an advocate for himself, Or enjoys going to meetings more than going to the OR. I have seen both situations. Works best when the guy going to the meetings is elected to the position by the group. Not appointed by administration. Ideally several people have administrative and leadership skills within the group so if somebody isn't doing the job satisfactorily, he can be replaced. Of course, I have also seen worker bee docs who were too dumb to see how valuable this can be.
 

dhb

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But do you agree that malpractice there does not hold a candle to the American version of destroying your career and life?
Depends as well if you are PP or academic but lets be real a malpractice suite however unpleasant does not ruin your career if you've not committed gross negligence
 

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It does. Every time you will interview, get a license or privileges anywhere you will have to explain yourself. And that's just for having been sued. Just read the advice from people who have been through something like this. They recommend avoiding the experience at all costs.

As somebody who's practiced in a European country, I can tell you that the malpractice environment does not come close to the US (because of specialized healthcare courts that shield you from frivolous lawsuits, absence of multimillion dollar moral damages, court fees that are proportional with the damages requested, and last, but not least, patients that are much less litigious). It's like comparing ants with elephants. We have a cancer-like legal system that makes everything much more expensive and risky, not just healthcare. In what other country can a burglar sue you for damages from injuries sustained during burglarizing your house? (The list of legal absurdities is incredibly long.)
 
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dhb

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As somebody who's practiced in a European country, I can tell you that the malpractice environment does not come close to the US (because of specialized healthcare courts that shield you from frivolous lawsuits, absence of multimillion dollar punitive damages, court fees that are proportional with the damages requested, and last, but not least, patients that are much less litigious). It's like comparing ants with elephants. We have a cancer-like legal system that makes everything much more expensive and risky, not just healthcare.
I'd say it's catching up quickly.
Reg. specialized courts they don't exist, multimillion dollar settlements: i've seen some data and they're not uncommon...
 

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Europe taxes its citizens much higher taxes in order for people to have "free" healthcare. Not just the rich people. So to pay for universal healthcare, all taxes must go up, period. And we as Americans need to stop whining about getting taxed so much, because we still get taxed much less than Europe. I am not saying taxes are fun, but they are an unnecessary evil. We spend way too much GDP in this country on healthcare costs and much of that I don't believe is physician cost, but due to futile care mostly at end of life and ordering unnecessary tests due to fear of missing something and being sued. Lawyers have us by the balls. We know it and they know it.

EVERYONE needs to participate FAIRLY and EQUALLY percentage wise when it comes to taxation. The super rich and cooperate America shouldn't have tax loopholes and the poor shouldn't be taxed any less than average, percentage wise. Period, full-stop end of story. The graded system is not fair. I was born in a very poor continent and know that one can do essentially anything they want to do as far as career choices in this country. People who work hard to achieve a higher standard of living should not be penalized any more than the high school drop out or graduate who for whatever reason did not go to college. Of course, college these days has become exorbitantly expensive so that's one thing that higher taxes could certainly help; funding of a higher education; better schools in the country and inner cities.

1) Just because people pay higher taxes in Europe, doesn't mean taxes in the US can't also be too high. Taxes in Europe are horrendously high and they'd be better served by lowering them.

2) While on one hand you talk about why taxes are necessary and why we shouldn't whine about them, in the very next paragraph you essentially argue for a flat tax which would mean drastically lower relative rates for anybody in a higher tax bracket. Bring it on. I agree everybody should contribute the same share of their income. I'd even go one step farther and make the first bit, say up to the poverty level, completely tax free. Above and beyond that everybody pays the same. So if we exempt 25K per year and tax at 20%, a person making 50K pays 5K per year (50K-25K then x 20%) while a person making 225K pays 40K per year. Then everybody has skin in the game.
 

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Well, MMan, seems like you understood what I was trying to say. I do mean a flat tax for everyone. (Ok, maybe the ones at poverty level should maybe pay less, haven't figured that out yet). But everyone needs to pay as equally as possible and people who've busted their tail to earn a higher income shouldn't have to pay more because to me that is essentially penalizing someone's hard work. Unless of course you are born into wealth, and are a lucky bastard. And the cooperations/super rich get no tax breaks through loopholes.
Of course I don't know what the right tax rate should be but in my world it would be around 30-35% for everyone.
 

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You are describing the Fair Tax except the tax exemption is up to 50k snd is provided as a pre-bate. It's something like: Everyone gets a check for 10k then pays 20% taxes on all income. People making less than 50k receive more than they pay. 100K pays a 10% effective rate. Increasing income move closer and closer to 20% effective tax rate as the pre-bate 10k is a smaller portion of income taxes.
 

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Of course I don't know what the right tax rate should be but in my world it would be around 30-35% for everyone.
I don't remember the actual numbers on it, but a flat tax of something like 17-20% would provide more tax revenue to the government than our current system does. 30-35% for everyone would actually be more than the Democrats could find a way to legitimately spend. You probably don't want a rate that high. Even with 25 ish % you'd still make the debt go bye bye in not too long.
 

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So, why aren't we implementing the Flat/Fair tax?