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yea neurosuergery is ****ed. No ones gonna want to do a 7 year residency or whatever it is, when they can do 3 years for similar pay.
Medicare plans to cut specialists' payments
- Thread starter Charles_Carmichael
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yea neurosuergery is ****ed. No ones gonna want to do a 7 year residency or whatever it is, when they can do 3 years for similar pay.
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Being a year away from practicing independently, I can certainly appreciate your sentiments. However, there are several inescapable realities that make some painful reforms necessary. The most important is that the current "system" is simply not sustainable. If Medicare were to collapse, a 20% cut in specialist reimbursement would look like a picnic by comparison. The longer we keep our heads in the sand the worse it will be.
More to point, the reality is also that there are too many specialists in this country performing too many procedures, and too few primary care physicians doing necessary non-procedural medicine. The extraordinary gap between procedure reimbursement and non-procedure reimbursement has no inherent justification, it is an artifact of a rather arbitrary set of decisions made long ago.
Still, I wholeheartedly agree that more cuts are unfortunate, and may even backfire as they sometimes have in the past. But, with our system like an old train, slowly creaking towards the edge of a cliff, and limited resources at our disposal, I am struggling to find a better course of action.
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What are physicians and physician organizations planning on doing about this? What I get from reading all the threads on here is that physicians and groups like the AMA have done really nothing these past two decades or so to protect themselves. How can we unify physicians to prevent something like this from happening?
I mean, I understand that after a long day at work, you just want to come home and relax for a bit before going to bed and doing it all the next day, but like someone mentioned, no other profession would take things like this without a good fight. So, what can physicians do?
What can I do as a premed? I already sent emails to my Senators opposing a Medicare-based public plan (through the link in the Anesthesiology forum). What more can I do?
I mean, I understand that after a long day at work, you just want to come home and relax for a bit before going to bed and doing it all the next day, but like someone mentioned, no other profession would take things like this without a good fight. So, what can physicians do?
What can I do as a premed? I already sent emails to my Senators opposing a Medicare-based public plan (through the link in the Anesthesiology forum). What more can I do?
The thing that concerns me is that in addition to advocating higher pay for PCPs, the Obama administration is trying to undermine PCPs by openly advocating and offering funding for increasing the roles of NPs and PAs. He is offering higher pay to PCPs but then bringining in cheaper and less skilled competition at the same time. This makes me think, 1.) the increase in PCP pay will not last, and 2.) this is a divide and conquer strategy. Obama cannot take on the entire physician establishment. If medical professionals start bickering among themselves, it is much easier for him to push through his reform.
20% ?!That's hardcore. Show me another field where this is ok. Try to make a blanket cut this large to a large group of highly trained/educated professionals.
No. It's not 20% cut. It's MUCH MORE THAN THAT in terms of you NET income.
Let's say you Medicare pays you $100 to remove appendix. Let's say that from this $100, you take home $50, and the other $50 are overhead costs. So your NET income for appendectomy is 50$.
Now think what happens when Medicare reimbursements are cut by 20%. All of a sudden you get paid $80 instead of $100. HOWEVER, YOUR OVERHEAD STAYS THE SAME. This means that you are taking home only $30 ($80-$50 = $30) instead of $50. In other words, you just got hit by 40% decrease in your NET income. ($50-$30 = $20 decrease, which is 40% of $50.)
So a 20% cut in Medicare rate means A 40% DECREASE OF YOUR NET INCOME, DEPENDING ON YOUR OVERHEAD. The higher your ovehead, the harder you are hit.
Read, understand, and weep. Only a sucker and a fool would go to medschool at that point.
You can vote with your feet and withdraw your application. That's it.
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We think alike...I posted this in 10/08.
Default
Quote:
Originally Posted by bananamed View Post
If medicare is being slashed left and right, you think it doesn't affect the salaries of hospital employees?
I'd rather be a small business owner in this economic environment than slaving away for a big institution (filled with all sorts of rules/regulations btw) for a salary that won't climb.
""Good point, but hospitals collect a lot more for procedures/surgeries than a physician in private practice. They get a massive facility fee, which of course may decrease as well with cuts, but there is more of a buffer compared with physicians in private practice. Lets say a private practioner is collecting $500,000 per year and the overhead is 50%. A 10% medicare cut does not come out of the total collections, it comes out of the profits after overhead is paid (obviously your overhead doesn't decrease). So the practioner actually decreases his or her profit from $250,000 to 200,000 (which is more than 10%). I am sure this is not new to any of you guys. In a hospital setting, this doesn't apply because of the massive facility fee, in addition to the physician's fee. Again, cuts will likley trickle down to physicians, but it will not be as acute as in the private practice setting. Another issue in private practice is what will actually happen to overhead in the future. I hate to tell you this, but is is going to go up.... a lot. Our country is in more and more debt (bailout etc...) and this will lead to INFLATION as the government prints more $$....everything will cost more (electricity, cleaning supplies for the patient bathroom etc...). Employess will demand higher salaries to pay for the increased cost of their commute to your office, increasing food prices etc.... Even if insurance rates stay the same for physicians, physicians take home pay and operating costs will be outpaced by inflation. The likelihood is that medicare rates will stay the same or will go down (both presedential candidates want to "cut spending" and surely this will come out of doctor's pockets) and this will be disastrous for the private practioner who is essentially a small business owner. That tax cut for small businesses making less than $250,000 that Obama is talking about will not apply to a plastic surgery office.
I think the bottom line is that physicians need to pool together to proctect themselves from all of this crap. We need to think ahead, anticipate these future issues in advance and not merely react to insurance cuts just when they are about to happen (like a few months ago). We provide an essential service and need to be compensated appropriately for it. We shouldn't have to fight to keep our doors open, we need to focus on the PATIENT. Sad but true.""
Default
Quote:
Originally Posted by bananamed View Post
If medicare is being slashed left and right, you think it doesn't affect the salaries of hospital employees?
I'd rather be a small business owner in this economic environment than slaving away for a big institution (filled with all sorts of rules/regulations btw) for a salary that won't climb.
""Good point, but hospitals collect a lot more for procedures/surgeries than a physician in private practice. They get a massive facility fee, which of course may decrease as well with cuts, but there is more of a buffer compared with physicians in private practice. Lets say a private practioner is collecting $500,000 per year and the overhead is 50%. A 10% medicare cut does not come out of the total collections, it comes out of the profits after overhead is paid (obviously your overhead doesn't decrease). So the practioner actually decreases his or her profit from $250,000 to 200,000 (which is more than 10%). I am sure this is not new to any of you guys. In a hospital setting, this doesn't apply because of the massive facility fee, in addition to the physician's fee. Again, cuts will likley trickle down to physicians, but it will not be as acute as in the private practice setting. Another issue in private practice is what will actually happen to overhead in the future. I hate to tell you this, but is is going to go up.... a lot. Our country is in more and more debt (bailout etc...) and this will lead to INFLATION as the government prints more $$....everything will cost more (electricity, cleaning supplies for the patient bathroom etc...). Employess will demand higher salaries to pay for the increased cost of their commute to your office, increasing food prices etc.... Even if insurance rates stay the same for physicians, physicians take home pay and operating costs will be outpaced by inflation. The likelihood is that medicare rates will stay the same or will go down (both presedential candidates want to "cut spending" and surely this will come out of doctor's pockets) and this will be disastrous for the private practioner who is essentially a small business owner. That tax cut for small businesses making less than $250,000 that Obama is talking about will not apply to a plastic surgery office.
I think the bottom line is that physicians need to pool together to proctect themselves from all of this crap. We need to think ahead, anticipate these future issues in advance and not merely react to insurance cuts just when they are about to happen (like a few months ago). We provide an essential service and need to be compensated appropriately for it. We shouldn't have to fight to keep our doors open, we need to focus on the PATIENT. Sad but true.""
