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what would be the consequences? Graduate rads 2023...by all accounts this seems very bad
Medicare for all and radiology
- Thread starter brandnewcolony
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Considering a significant portion of what physicians bill goes down the toilet I would welcome national insurance that guaranteed payment. Particularly if we could eliminate private insurance leeches and couple it with litigation protection. Would probably be a boost initially until the government turned the screws. I’m sure someone will come along and call me Fidel Castro.
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I would agree with this. There may very well be a 5-10 year period where guaranteed payments and increased volume could make compensation of all specialties stable or go up. However, I have little doubt that the government would put the clamps down after that to cut cost.
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I agree with both of you. We have accounts where as many as 3/10 studies we read are charity care. Getting any remuneration out of those patients would be a financial boon, but it would be short-lived. Long term, I suspect physician salaries would go down. It's too bad, too, because conceptually, the idea has the chance to eliminate administrative bloat and remove 3rd-party leeches, but I'm skeptical that any of those improvements will make their way to physicians' paychecks.
D
deleted941485
I really think We’re gonna get single payor in 5-10 years. Just look at the Dem candidates. It could play out a few ways for docs. Spoiler alert it’s mostly bad.
Scenario 1: it passes. initially pretty generous national healthcare scheme overall maybe some specialties get hit hard particularly the ones other docs love to hate on like Rad Onc, Derm, maybe Rads (maybe not Rads anymore). Then repubs sound the alarm about national debt cost control socialism taking over America etc and get back in power. Then before you know it, they’re slashing reimbursements like Edward scissor hands and passing laws that essentially make it impossible to raise extra funds. Turning it into essentially another zero sum game like it was pre-Medicare forall only now they have total control. Docs lose but over a longer time frame as the politics unfold.
Scenario 2: it passes. All fees go to Medicare rates except for some favored classes. Private insurance all but disappears. Few win but most lose. Most Docs get screwed immediately. Even in this scenario, Unlikely to provoke a physician strike but if they do it’ll just make the docs look worse and essentially seal their fate as the most hated class of people in the US. From my experience, Docs are essentially doormats anyway. Republicans will fight it and try to dismantle it but will ultimately fail as they did with Obamacare. Over time, republicans will learn to love it just like old Medicare. Hell, they may even open the floodgates for more Med schools and FMGs to push those salaries down even further!
Scenario 3: Medicare for all fails but Medicare Rates become the facto standard regardless of payor. Lowers healthcare spending. Keeps the illusion of market based private insurance (minus the good reimbursement). Docs try to get out of network and but only some very select specialties are able to do this with any success. Then New laws get passed that essentially force you to be in network wheather you want to or not threatening to take liscence away, revoke hospital privileges etc.
Scenario 4: Public Option (Medicare for Most) allowed to enter the market. This public option is allowed to “compete” with other plans in the healthcare “marketplace”. It might be unusually generous in the very initial introduction period with low premiums for customers and good payments. That quickly changes over time as they put 90% of private plans out of bussiness as it is subsidized by the taxpayer. To hasten private insurance demise, they might even introduce a tax on private health plans to help pay for it. At this point they’ll basically have Medicare for Most which is close enough for govt work. Docs lose over time as the reimbursements fail to keep up with inflation. The tempo of the loss will be dictated by who is is in power in Washington.
Students at the start of the long and arduous journey should take note and be proactive but gaining non clinical skills that can be useful outside of healthcare. Nobody really knows which way this will go but only a fool would think physicians will gain from any of it. Good luck making a 30 year career out of this.
Scenario 1: it passes. initially pretty generous national healthcare scheme overall maybe some specialties get hit hard particularly the ones other docs love to hate on like Rad Onc, Derm, maybe Rads (maybe not Rads anymore). Then repubs sound the alarm about national debt cost control socialism taking over America etc and get back in power. Then before you know it, they’re slashing reimbursements like Edward scissor hands and passing laws that essentially make it impossible to raise extra funds. Turning it into essentially another zero sum game like it was pre-Medicare forall only now they have total control. Docs lose but over a longer time frame as the politics unfold.
Scenario 2: it passes. All fees go to Medicare rates except for some favored classes. Private insurance all but disappears. Few win but most lose. Most Docs get screwed immediately. Even in this scenario, Unlikely to provoke a physician strike but if they do it’ll just make the docs look worse and essentially seal their fate as the most hated class of people in the US. From my experience, Docs are essentially doormats anyway. Republicans will fight it and try to dismantle it but will ultimately fail as they did with Obamacare. Over time, republicans will learn to love it just like old Medicare. Hell, they may even open the floodgates for more Med schools and FMGs to push those salaries down even further!
Scenario 3: Medicare for all fails but Medicare Rates become the facto standard regardless of payor. Lowers healthcare spending. Keeps the illusion of market based private insurance (minus the good reimbursement). Docs try to get out of network and but only some very select specialties are able to do this with any success. Then New laws get passed that essentially force you to be in network wheather you want to or not threatening to take liscence away, revoke hospital privileges etc.
Scenario 4: Public Option (Medicare for Most) allowed to enter the market. This public option is allowed to “compete” with other plans in the healthcare “marketplace”. It might be unusually generous in the very initial introduction period with low premiums for customers and good payments. That quickly changes over time as they put 90% of private plans out of bussiness as it is subsidized by the taxpayer. To hasten private insurance demise, they might even introduce a tax on private health plans to help pay for it. At this point they’ll basically have Medicare for Most which is close enough for govt work. Docs lose over time as the reimbursements fail to keep up with inflation. The tempo of the loss will be dictated by who is is in power in Washington.
Students at the start of the long and arduous journey should take note and be proactive but gaining non clinical skills that can be useful outside of healthcare. Nobody really knows which way this will go but only a fool would think physicians will gain from any of it. Good luck making a 30 year career out of this.
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what can we do about this other than vote in our self-interest? nobody that has private insurance wants this.
There is nothing you can do about this. Nothing. Physicians don't matter in the current system. MBAs an Admin matter. Rads1900 mentioned a strike but I think even they know that it is futile. In The new system the only people that will matter with be the new govt admin that HHS will need to hire to administer the single payer program.
Making yourself scarce by not training new residents is probably the best policy for now until the govt decides to open the floodgates. Med students, as naive as they are, will finally get the message and I think were gonna see substantially more "interest" in the non-clinical route for MDs and DOs. Once they realize that truly the whole of medicine has been completely screwed and they dropped an ungodly sum to get this far, the students will get even more desperate to trying to re-coup their investment. I knew 2 people who quit residency to join a freaking start-up company and 1 who quit med school for the same reason. While these risks seem ridiculous today, I think that in a few years and the prospect of a crappy clinical career either from low pay or midlevel encroachment taking these risks will be more and more appealing. The writing is on the wall. There are no "good" specialties anymore. In the next few years, the truly bright students (Not the memorize and regurgitate types) will finally say "screw it". Clinical excellence will suffer as people just mindlessly follow algorithms (designed for the sole purpose of saving money) and we wont have the collective intelligence or will to change it because all of the desirable candidates are working for tech companies or finance.
The way you voice your disdain is to vote with your feet. Also, save as much as you can for this inevitable showdown.
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is the future really this bleak? I kind of surmised this myself...I want at least a 20-30 year career doing DR making at least300+k/year.....
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Live with the assumption that the future is at least this bleak, because there's a good chance it will be. If it's not, then it will be a pleasant surprise.
D
deleted941485
So if you adjust those numbers for inflationary changes over your career that number needed will need to be higher to maintain buying power. And guess what? it won’t be. That’s the problem. Effectively by the time you graduate that 300K which is what is pretty commonly posted today will effectively be about 240-260 optimistically by the time you graduate and dip lower as govt tightens the belt and Productivity goes up. Sure you salary might go up as an attending but the truth is the raises will be minscle and you will be lucky it covers inflation in any given year. Even salaries out in the sticks are just not even close to what they were even 5 years ago.
Future isn’t necessarily so bleak.
Canadian radiologists on average make more than American radiologists in the northeast.
People have been predicting the end of medicine and radiology for years. Things have changed, but the compensation hasn’t really
Canadian radiologists on average make more than American radiologists in the northeast.
People have been predicting the end of medicine and radiology for years. Things have changed, but the compensation hasn’t really
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Couldn’t one argue that the reason Canadian docs get decent $$$ is because...they sit right next to America, land of the highest paid physicians in the world? Otherwise their docs can hop the border to chase better pay.
Now if US physicians were across the board suddenly paid 50% less, Canada will 100% have downward pressure on their compensation too.
D
deleted941485
Their govt goons probably salivate at the prospect of a 30-50% pay cut for rads just as much as any bean counter and beureaucrat State side if not more so. And with the number of Med schools and residencies that are now proliferating it ain’t looking good.
People seem to ignore the fact that physicians are intelligent, highly skilled professionals who work long hours, and devote 10-15 years of their lives towards post-graduate training. Many, if not all, physicians could have chosen to follow the path of law school or delved into the financial sector where the compensation is well beyond a doctor's salary. Instead, as doctors or medical students we have chosen a strenuous career where much is sacrificed in quality of life and personal relationships, all in the name of improving the health of the general population.
I fear that as physician compensation falls, the bright, motivated individuals who choose medicine will instead opt to get an MBA and pursue private equity, VC, or become a hedge fund analyst; and subsequently, the quality of health care will steadily deteriorate. I understand, money is not everything. I would argue the large majority of physicians choose to become a doctor because they are genuinely interested in helping others and are truly interested in the science/pathophysiology of medicine. But at what point does pursuing a passion become unrealistic in the setting of low wages and rising debt?
I fear that as physician compensation falls, the bright, motivated individuals who choose medicine will instead opt to get an MBA and pursue private equity, VC, or become a hedge fund analyst; and subsequently, the quality of health care will steadily deteriorate. I understand, money is not everything. I would argue the large majority of physicians choose to become a doctor because they are genuinely interested in helping others and are truly interested in the science/pathophysiology of medicine. But at what point does pursuing a passion become unrealistic in the setting of low wages and rising debt?
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What on earth are you talking about
You can’t just “hop the border” and start practicing medicine in America. Canada is a different country than America.
Our reimbursement schedules have absolutely nothing to do with each other.
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Sorry but you are totally wrong on this.
Canadian physician pay is relatively decent precisely because American pay is good and canadian docs can definitely hop the border with ease (unlike true FMGs).
Physicians in canada who have LMCC (canadian accreditation of med school/training) credentials are accepted in 44 US states. They do not need to train in residency in the US to be a practicing attending here unlike true FMGs.
See also: Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis
“In Canada, a perceived surplus of physicians in the 1980s led to recommendations to limit the number of physicians by lowering medical school enrolment and reducing dependency on foreign trained physicians while also looking for other means of delivering health care [10]. As a result, there was a 10% reduction in medical school positions and immigrant physicians coming to Canada fell from a peak of 525 in 1993 to 243 in 1999 [11]... The movement of physicians from Canada to the US at this time was described as a ‘brain drain’ or ‘major exit ramp’ that contributed to physician shortages [16]...The Canadian dialogue then shifted from physician surplus to physician shortages, and many of the initiatives that were aimed at reducing physician numbers in the 1990s were reversed... Efforts at primary care reform were undertaken in most provinces and, though differing in detail, were aimed at improving primary care physician income and providing infrastructure funding. There were initiatives to improve hospital funding intended to reduce surgical wait times for select procedures [21].”
