It might be because I live in Texas, but most physicians I've talked to seem to talk crap about Obamacare. Why do most docs seem to be against it, while most premeds on sdn are in favor of it? Is it because I live in Texas? Do premeds have a jaded and overly optimistic view?
Most docs seem to be against Obamacare, while most premeds are in favor of it
- Thread starter rubisco88
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Many of the doctors I've been working with are all for the healthcare bill. One surgeon I talked to was against it because he believes he will end up being reimbursed $5 per bypass surgery. I have a hard time believing this is true, but I can see some parts that could be detrimental. I'm generally a big fan, as it would allow my largely uninsured and medically needy family access to insurance that isn't astronomical in price.
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I'm in Wisconsin, and most of the doctors that I have talked to share a similar view. And we're supposed to be one of the most "socialist" states in the nation!
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To be honest, this is an unavoidable contributing factor. Without discussion the merits or pitfalls of the bill, it has unfortunately become a very politicized issue where people both support and attack it because of its party affiliations rather than its actual content. "Talking" to doctors is never a thorough way to determine what you should think about the bill because you'll get very different based on what hospital you're at, what specialty you're talking to, what state you're in, what level along the healthcare chain they're at, etc etc. Just get informed and learn what's in the bill and what it actually means.
But more importantly, do we really need another thread on this topic? Honestly, what more is there to say that hasn't been said in the hundreds of responses to this.
http://forums.studentdoctor.net/showthread.php?t=752150
http://forums.studentdoctor.net/showthread.php?t=927565
http://forums.studentdoctor.net/showthread.php?t=874213
http://forums.studentdoctor.net/showthread.php?t=867840
http://forums.studentdoctor.net/showthread.php?t=900176
http://forums.studentdoctor.net/showthread.php?t=711803
http://forums.studentdoctor.net/showthread.php?t=715478
http://forums.studentdoctor.net/showthread.php?t=711565
http://forums.studentdoctor.net/showthread.php?t=710880
http://forums.studentdoctor.net/showthread.php?t=655556
http://forums.studentdoctor.net/showthread.php?t=859422
http://forums.studentdoctor.net/showthread.php?t=838553
http://forums.studentdoctor.net/showthread.php?t=815757
http://forums.studentdoctor.net/showthread.php?t=766451
I could go on and on. Let's stop making threads about this.
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Really? interesting... I thought California was the most "progressive" state in the Nation.
@ OP, I think your location has a lot to do with it. I have heard differently from a bunch of primary care doctors in Cali.
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Call it the Affordable Care Act. You'll sound smarter. Luckily for women, they will have some mandates go in effect very soon. Birth control, labor reforms and approved preventative care which doesn't cost an arm, leg or both.
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It's split about 50/50 in the physician community with a large block of physicians saying it doesn't go far enough.
In general, people don't know enough about the ACA. On top of this general ignorance, physicians have the double whammy of not knowing what impact the ACA will have on their practice and so the natural state is to be apprehensive.
In general, people don't know enough about the ACA. On top of this general ignorance, physicians have the double whammy of not knowing what impact the ACA will have on their practice and so the natural state is to be apprehensive.
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I saw my pediatrician recently (laugh all you want), and he told me to not go into medicine when I mentioned that it's my plan post graduation. He told me that the way it's looking, you won't ever work for yourself. You'll always be working for another hospital, another company, or an older physician's office. He also said that we'll be paid less in the future than you see as salaries now. He told me that it just isn't worth all the time and money and that I'd be better off going into genetics and more along the lines of biochemical engineering. Oh, and he said get a masters for that...a PhD is too specific.
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The problem with the term "Obamacare" is that it is too vague. There are about 2,700 pages in the so-called "Affordable Care Act" and many (arguably all) of those pages are totally irrelevant to improvement of healthcare. So, are they opposed to the extension of kids' coverage under their parents' plans until 26, or are they opposed to the random tax hikes included in the bill? Or both?
BTW I have yet to meet an attending who supports the Act. Seriously.
Probably because we premeds haven't worked as doctors yet, and can't really understand the full consequences of such a bill. I can understand how giving lower class access to free health care is very very concerning (because it's really not free), but I won't know for real until I see how it affects my paycheck.
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Most of the people I've talked with (pre-meds and physicians alike) have supported it. The ones who are against it are the ones who think it will lower their paycheck, which ultimately just makes me question their motive for medicine. Also, I'm from the South.
Based on the amount of personal sacrifice you make, level of work you perform, and length of shift you have, I would certainly be opposed to a pay cut. Let's be real here. This is your career, and your paycheck is what supports you and your family.
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The amount of pay cut is still up for debate, though. How large will the cut actually be? If specialists go from making 400k to 300k (pulled numbers out of my a**), what's the big deal? How much of a luxury are you living in when you're b******* about making 300k a year, when the median income in the USA is MUCH MUCH MUCH less than that?
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100k less a year is a big deal. You plan your life based on what you are making, not the bare minimum. Sorry, not everyone wants to live like a poor broke college student. I know I can support myself, with 6 meals a day (of course, 1 meal might only be half a chicken breast), housing, ect. on 18k/year. But do I seriously want to live like that if I'm racking in 400k? And that's not even counting a family. I earned my income, now I will enjoy it.
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Your argument assumes that physician compensation will drop to poverty level. 😕
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My financial example was that's how cheaply I can live (and am living).
Point is: If I'm earning money, I don't want to take a paycut for any real reason. What I do with my money is my business, maybe I donate a good portion of it, maybe I don't. But either way, if I'm making a certain amount of money I'm not too keen on taking a paycut. I will if required, but do not expect me to be happy about or support it.
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The American Hospital Association, the American Medical Association, AAMC, Texas Hospital Association, and more have come out with positive statements showing support for the ACA.
With this being said, most of the nation is still split 50/50 and I imagine that this trend follows doctors as well. While their organizations may publicly go on record displaying positive statement (thereby possibly indicating more doctors in favor than not) it does not follow that unity amongst physicians exist...
With this being said, most of the nation is still split 50/50 and I imagine that this trend follows doctors as well. While their organizations may publicly go on record displaying positive statement (thereby possibly indicating more doctors in favor than not) it does not follow that unity amongst physicians exist...
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To be clear, there is no evidence that the ACA will reduce reimbursements at this point. There's nothing explicitly laid out that reduces physician pay. Furthermore, with greater coverage, physician reimbursement could go up. Primary care, for sure, is getting some added perks in the ACA.
The ACA isn't a cost-controlling bill. It's an insurance reform bill.
The ACA isn't a cost-controlling bill. It's an insurance reform bill.
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I'm happy with getting paid 10 bucks an hour now. Can't wait to be raking in 100k+ lol. Idk why some complain about a pay cut if your making more than 99% of America.
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To me it's weird. I love making money. At no point did I decide that I wanted to be a doctor for money (wasn't until this summer when I realized I loved making money, and by then AMCAS was already submitted). I'll probably donate a lot of money if I ever start making that type of money. Heck, if I'm lucky enough I would love to do MSF. But please understand, I don't ever want to take a paycut. I will to survive, I will because I have to, but I never want to or will ever be happy with a straight up paycut.
Also, I don't like the argument "well you already make more than *insert high percentage*." So what? If I make that type of money, it's up to me how to spend it. Personally, I want to make an honest living. But don't tell others how to spend their money. At least that's how I'd feel in their shoes.
P.S. My posts are rather off topic in hindsight. I'm more or less commenting on the attitude of "well you're making so much money, why would you care if you take a pay cut?" Not ACA in general, because my overall feeling is that no one really knows how this is going to shape out.
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Where in my post did I say how to spend your money? W T F?
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Directly, never.
Personally I feel as if saying "take a pay-cut, you can afford it" is the same as saying "don't spend your entire yearly salary" which is indirectly telling someone how to use his or her money.
Also, the first paragraph is my main reference to your post. Second is my opinion on an attitude.
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I agree 100%. That's the problem with liberals - they have their hand in everyone's pocket and think they can dictate how much everyone should make.
"Doctor, you make enough already. You're to go from 200k to 100k. It's only fair"👎
I think that everyone should be their own free agent. Able to spend their income how they see fit and optimize their earnings for their enjoyment. Say "no" to Obama come Nov 2012! Say "yes" to freedom and prosperity.
"Doctor, you make enough already. You're to go from 200k to 100k. It's only fair"👎
I think that everyone should be their own free agent. Able to spend their income how they see fit and optimize their earnings for their enjoyment. Say "no" to Obama come Nov 2012! Say "yes" to freedom and prosperity.
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I'm really pissed off that insurance companies now have to pay directly, without cost sharing or deductibles, for birth control, prenatal care, preventative medicine for women, etc. rawr rawr rawr.
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The bureaucracies and insurance companies love this Act because its utter chaos and lack of coherence allows them to do more bottom-line padding. Doctors I've spoken with do not like it because most of them (and us) enter the profession to treat patients, not spend vast amounts of time and money complying with endless regulation and paperwork. Also, there's a good case to be made that this will result in drastically lower quality of care.
1) Again, it's not all about the money. The fact is that this bill forces doctors to spend less time on the medicine and more time on bureaucracy.
2) Yeah, it's an insurance reform bill. One that increases cost of insurance and actually reduces quality of care. Think about who has the money to lobby Congress and get theirs. It ain't doctors.
It's actually very sad to see people think of income and wealth in terms of how they compare with other people. It's a mindset that is predicated on envy, and is a recipe for lifelong obsession with materialism. If someone is saving lives every day, there's absolutely no reason for that person to feel guilty about being wealthy.
👍
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Really wish I could do more than just thumbsup here, but these two posts honestly say everything I would be typing.
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It's kind of like 'If you're young and Republican, you have no heart. If you're old and a Democrat, you have no brains.'
Basically, it's easy for a pre-med who hasn't endured 1 day of actual work in the real world as a doctor, or incurred one dollar of debt from school, to want to save the word and provide everything for free. Once you're out there, working your ass off for your paycheck, and you have an other entity telling you how you're going to work / who's going to pay you / how much you're going to be paid, you might get irked.
I'm not going to pretend to have much knowledge on what obamacare means for doctors, but the general consensus I get is that most doctors here don't much care for it, either.
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This isn't about "caring" vs. "non-caring." There are real issues to be discussed with healthcare and insurance reform, and the PPACA isn't all glitter and gold.
In fact, most doctors do not support Obamacare (the PPACA). PPACA is supported by the AMA, yet the AMA is against the IPAB, the 15 member advisory board created by the PPACA to govern Meddicare spending (read: will set healthcare policy guidelines). Just 17% of doctors are members of the AMA.
A Jackson & Coker survey found that 13% of physicians were in full support of the PPACA. A more recent survey from Deloitte found that only 44% of physicians thought the bill was "a step in the right direction."
Primary care practitioners are currently getting underpaid (under-reimbursed) by approximately 20% for their Medicare patients. PPACA/IPAB currently do not have provisions for not cutting physician salaries. Notably, the physician take-home salary contributes only about 10% to national healthcare spending. Yet for some reason (apparently because US docs make more than their global counterparts... even though they pay more for education, overhead, and malpractice...), doctor salaries are painted with bright red targets for PPACA/IPAB.
So why do some people in healthcare have a problem with this bill? Because it targets their salaries after they've worked their whole lives to establish themselves and entrenches them in paper, bureaucracy, and managed care guidelines even though salary is not the barrier to affordable access to healthcare in the US.
Why isn't greater effort being put in to cut the cost of hospital admission (31% of healthcare costs), pharmaceuticals, and biotech? Why is administrative cost 7% of healthcare spending -- not including physician administration. How do we manage care for illegals - who should eat that cost (currently, it's hospitals)? I think these are questions the people who don't support the PPACA would like to see answered before their salaries start getting hacked away.
Considering that the new bill is really pay-for-performance and "streamlined" patient care, yes I would say there is less time with patients and more on bureaucracy. I'd say you should read up on it more. By the numbers alone, if more people have insurance (agree, a good thing), then won't you have more people in your waiting room?
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But does it not not have provisions for not cutting physician salaries?
The PPACA actually does provide for increasing reimbursements for certain specialties, including 10% Medicare bonus payments to certain primary providers, and raising Medicaid payment rates to Medicare levels.
The CAFP has a nice summary.
I will be watching my own collections carefully over the next few years. With any luck my non-payment rate will dwindle as the percentage of uninsured patients we serve declines.
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Sorry, I should have phrased it better. I meant to say that as it stands it does not protect physician salaries across the board. Yes, it does have certain measures to try to encourage greater reimbursement in certain specialties. I agree that lessening the (huge) disparity in income among specialties is an important step, though.
I certainly hope it does go up for you!
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I agree with where you're coming from here, although I wasn't thrilled when I was working 70 hour weeks and pulling in about 33k a year. 😉
I grew up in a family of 3 that had an income of roughly 20k a year, and while I didn't get fancy clothes or shoes, I was a happy kid. So I'm pretty sure I'll be able to support my family on a doctor's salary. Yes, I'll be roughly 200k in debt when I graduate, but there are ways to get rid of most of that debt if you have a good financial adviser, especially if
1) you're going into a long residency or residency+fellowship
or
2) You work in underserved areas. Not all underserved areas are in the middle of nowhere/horrible places. I currently live in one of the nicest areas in Miami and there are clinics and hospitals less than 30 min from my home that count as underserved.
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One of the chief complaints I see is the increasing bureaucracy.
The accountable care organizations are effectively dictating to doctors how to practice medicine.
The checklists and accountability programs are getting so invasive, that doctors are not able to practice how they want to practice. The amount of time and amount of patients doctors have to see are being increasingly mandated.
This is not medicine. This is mass produced factory bull crap. I call a spade a spade, and if we increasingly go in this direction, then we lose the essential part of medicine.
Medicine is an art, it requires a natural bond and intuition between doctor and patient. There is a lot more unknown about the human body than known, and in that VERY large realm of uncertainty, a doctor must be able to have autonomy and ability to use their intuition and skills to pursue both the conventional and unconventional styles of treatment for their patients.
One can argue that factory style medicine will empower more patients and that might be true. But the glory of medicine is in discovery, is in the serendipitous trials that lead to innovative styles of treatments. Think rituximab revealing autoimmunity in CFS patients. Think IVIG now being seen as a possible treatment in Alzheimers. Discoveries like this require going outside the box, going outside the factory, and it is not a huge leap to say that modern discoveries of medicine are made everyday in the clinics. They certainly are, but they are becoming more rare owing to the increased bureaucracy and the subsequent consequence will be reduced innovation, reduced specialized care, and general screwing over of patients with chronic illnesses that do not have current adequate treatments. This factory style medicine will necessarily blunt medical innovation as it has already done by effectively pricing out and litigating risk for medical research.
Affordable Care Act is good if you are a statistical patient with a high statistical disease.
This is what happens when politicians, lawyers, and economists have their input on medicine.
The accountable care organizations are effectively dictating to doctors how to practice medicine.
The checklists and accountability programs are getting so invasive, that doctors are not able to practice how they want to practice. The amount of time and amount of patients doctors have to see are being increasingly mandated.
This is not medicine. This is mass produced factory bull crap. I call a spade a spade, and if we increasingly go in this direction, then we lose the essential part of medicine.
Medicine is an art, it requires a natural bond and intuition between doctor and patient. There is a lot more unknown about the human body than known, and in that VERY large realm of uncertainty, a doctor must be able to have autonomy and ability to use their intuition and skills to pursue both the conventional and unconventional styles of treatment for their patients.
One can argue that factory style medicine will empower more patients and that might be true. But the glory of medicine is in discovery, is in the serendipitous trials that lead to innovative styles of treatments. Think rituximab revealing autoimmunity in CFS patients. Think IVIG now being seen as a possible treatment in Alzheimers. Discoveries like this require going outside the box, going outside the factory, and it is not a huge leap to say that modern discoveries of medicine are made everyday in the clinics. They certainly are, but they are becoming more rare owing to the increased bureaucracy and the subsequent consequence will be reduced innovation, reduced specialized care, and general screwing over of patients with chronic illnesses that do not have current adequate treatments. This factory style medicine will necessarily blunt medical innovation as it has already done by effectively pricing out and litigating risk for medical research.
Affordable Care Act is good if you are a statistical patient with a high statistical disease.
This is what happens when politicians, lawyers, and economists have their input on medicine.
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I am a 4th year student.
I am against King Care solely on legal and Constitutional grounds.
If it ultimately helps patient care (highly unlikely... think of hospital mergers... closing ERs... forcing everyone to go to one place with overworked doctors and then giving patients minimal care due to time constraints...) then I'm for it, but I highly doubt it.
I would prefer if the US and the neocons and neoliberals stopped these unconstitutional wars... they've been saying Iran is "two years away" from nukes since 1984 (yes Orwell's 1984...)
http://rudepundit.blogspot.com/2012/02/yep-media-matters-is-right-iran-has.html
http://mediamatters.org/blog/2012/02/21/for-conservative-media-iran-is-always-a-year-aw/185058
but I digress on politics...
Most medical students are idealistic fools... I know I was once...
Now that I am in my fourth year, I have fully embraced the values of human centered patient care and altruism... not just cold blooded medical knowledge.
However, that kind of care will be compromised under King Care.
so what is the solution?? stop these wars, money creation by the Fed leading to inflation, and get some real tort reform (true malpractice based on negligence, abandonment, etc... and not just bad outcomes)
but nope... not with Washington in its current state
bottom line:
I was against ObamaCare from the start, not because I am money hungry and greedy and want more... but on Constitutional grounds.
P.S. I do not like Romney much either...
I am against King Care solely on legal and Constitutional grounds.
If it ultimately helps patient care (highly unlikely... think of hospital mergers... closing ERs... forcing everyone to go to one place with overworked doctors and then giving patients minimal care due to time constraints...) then I'm for it, but I highly doubt it.
I would prefer if the US and the neocons and neoliberals stopped these unconstitutional wars... they've been saying Iran is "two years away" from nukes since 1984 (yes Orwell's 1984...)
http://rudepundit.blogspot.com/2012/02/yep-media-matters-is-right-iran-has.html
http://mediamatters.org/blog/2012/02/21/for-conservative-media-iran-is-always-a-year-aw/185058
but I digress on politics...
Most medical students are idealistic fools... I know I was once...
Now that I am in my fourth year, I have fully embraced the values of human centered patient care and altruism... not just cold blooded medical knowledge.
However, that kind of care will be compromised under King Care.
so what is the solution?? stop these wars, money creation by the Fed leading to inflation, and get some real tort reform (true malpractice based on negligence, abandonment, etc... and not just bad outcomes)
but nope... not with Washington in its current state
bottom line:
I was against ObamaCare from the start, not because I am money hungry and greedy and want more... but on Constitutional grounds.
P.S. I do not like Romney much either...
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^this 👍
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This is one of the most disturbingly ignorant and stunningly naive quotes I have ever read on SDN. When you're finished gazing at pretty butterflies and searching for unicorns, please read more on the subject.
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Saying pre-meds are dumb as rocks is an ad hominem attack and really adds nothing to your argument. In the end, nothing that either side says will really matter. It's not a pre-med vs. physicians thing. There are the SAME arguments on this thread happening among attendings.
In the end, 90% of it will be politics. It doesn't matter if the ACA is PERFECT. It doesn't matter if it ****s out free beer and gives you $50 for every doctor's visit while somehow not costing a single dime. The same people against it now will still be against it.
In the end, 90% of it will be politics. It doesn't matter if the ACA is PERFECT. It doesn't matter if it ****s out free beer and gives you $50 for every doctor's visit while somehow not costing a single dime. The same people against it now will still be against it.
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That's a rather difficult thing to say, considering that ACOs are in their infancy, and those that exist are being designed and implemented by providers, hospitals, and insurers.
UrshumMurshum said:
Hmmm, let's examine some actual quality measures for, say, an acute heart attack:
- Aspirin within 24 hours of arrival
- Patients given ACEi or ARB for left ventricular systolic dysfunction
- Angioplasty within 90 minutes of arrival
- Aspirin at discharge
- Beta blocker at discharge
So which of these interventions is too check-listy/cookbooky for you?
UrshumMurshum said:
True, but this also isn't 1965. We have come far enough to apply basic protocols in certain situations. This isn't about stifling innovation, it's about applying standard of care. I have no doubt that if your loved one was having an MI and did not receive the above measures, you would be howling bloody murder like the rest of 'em.
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There are a ton of people here making broad statement claims about how this will increase beaurocracy and dictate what doctors can do, turning it into "factory healthcare" or what have you.
And I've seen nothing to back these kinds of claims up.
Sure the increase in patients (although many of them had been getting treatment for serious stuff for free already) will be an issue in the short-term, but it is one that is easily addressable by increasing the number of physicians as well as other health care positions. Is increased employment such a bad thing?
To me the much bigger problem is the sheer volume of uninsured Americans prior to the ACA. And that is one that was unaddressed for a number of years. All I'm saying is that there are a ton of provisions in the bill (like the one that went into effect a few days ago requiring insurance companies to dedicated 80% or more of their spending to actual healthcare) that are very positive. It may cause problems that need addressing (in fact almost certainly will) as any bill as comprehensive as this one would, but if you for a second stop thinking solely about how it will impact a doctor's salary, for me personally, it's easy to see that the ACA is a positive thing.
However, I do sympathize with people who feel that ACA was not a step in the right direction because it may put off our eventual move to a public option or singlepayer system (which should be the end goal) and instead enriches the private insurance industry. There are a lot of tough measures against insurance companies, but I do agree with this position somewhat. I was really hoping for a public option or a move to singlepayer.
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This is just a reminder to keep the thread free of personal attacks towards other users. Attacking ideas vs the users that hold them are very different.
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How many people are still uninsured after the Affordable Care Act goes into full effect? The left sings the praises of this bill, when the vast majority has no idea what is in it. It does not actually provide anything close to universal coverage, which seemed as though it was the express goal of those seeking its passage. There seems to be a pervasive notion that the ACA is going to fix all of health care's problems, and yet it fails to address some of the most important problems facing the field. I thought people with pre-existing conditions were going to receive coverage? My father has CHF and got a new job (finally!) where he was insured. However, because of his heart failure, he could not visit a cardiologist for 6 months after the insurance took effect... So much for how great the bill is...
I think minimizing the problem of a rapidly expanding patient population is disingenuous, at best. The physician population, like the general population, is rapidly aging, and many are approaching retirement. In fact, the present trends in medicine are probably pushing many of them into an early retirement. I would probably be heading that way if I was in a position to do so. There is immense uncertainty associated with this bill, as evidenced by your appealing to its lack of perfection. "It my cause problems that need addressing." I suppose it depends on your definition of the "short-term" as well. It takes quite some time to train a fully functioning physician... So even if you expanded the number of medical schools available, and then expanded the number of spots in residency, and then expanded the number of fellowships/ specialty training program... You see where I am going? It is not as simple as you seem to believe! Increased employment is not a bad thing, so long as we continue producing qualified doctors...
I don't think there are many, if any, doctors and future doctors who feel that people should not have access to affordable health care (they do have access to health care at the moment, by the way... an important distinction)... However, access to everyone should not come to the very serious detriment of those who provide the services that some are claiming is a right. It reminds me of Leon Kass... Talk of rights is fashionable... But health care, in my opinion, is not a right... Who do you hold that right against? Do doctors have to prescribe you medicine? I don't think so!!!
In closing, I am so tired of the argument that the only doctors who oppose the ACA do so because they are greedy and want to take advantage of poor and sick people. That is complete and utter nonsense. There were alternatives that could have been studied more fully. Instead, we choose to violate individual rights in favor of the "collective good" which, in my opinion, will not ultimately improve the situation at all.
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wat?
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Different aspects of the ACA go into effect at different times. You realize this, right? As I'm aware, the "pre-existing conditions" clause doesn't go into effect until 2014. It's unfair to label the "failures" of the act as failures when they haven't even gone into effect yet.
I don't think anybody thinks the act is perfect. When I "sing the praises" for the ACA, I'm not touting its perfection. I'm saying that it's a step in the right direction. We're moving somewhere rather than remaining static, and that in itself is an accomplishment worth praising.
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Of course, I understand that different components of the law are going to be implemented at different times. The point was that the law has been advertised as doing all of these things and results are largely non-existent. The fact that these aspects haven't taken effect yet doesn't change how the bill was advertised. People run around claiming that now the pre-existing conditions that they suffer from are covered and that now health care is so much better. This is wrong!!! The claim is frequently made that people disagree with President Obama because they do not understand what he is trying to do. They don't, and maybe the can't? I think that is the hidden subtext behind that one. That people are too ignorant to understand the grander plans proposed by Obama. There is no doubt that the ACA is a step in a direction... The right direction? Now that is up for debate.
