Lifeman

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What do you guys think the most lucrative specialty will be 10 years from now? Will ortho stay on top? Will cardiology recover?
 

DubVille

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It is impossible to say. I agree that hospital admin is the best way to go for money. My random guess is that ortho and NSGY are still going to be at the top. Whoever lays claim to the newest/bestest procedure will see the big increases. I think 10 years from now specialists will make less and primary about the same relative to inflation.
 

DubVille

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this is a crazy guess but i think rheumatology may see a huge increase in salary in the future
Im curious about your reasoning. I think its an exciting time with all the biologic options, but ultrasound guidance for joint injection has been slashed and infusion centers arent as profitable.
 

Mjolner

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I think family medicine goes up and specialties come down. They won't equal out, but I think they'll be a heck of a lot closer. FM will probably be a little less than EM and Gas are now and those two will drop or stagnate. Some places are already seeing FM in the mid to high 200s
Plus ACA will have its say.
 

bashwell

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A good friend's dad had never gone to college. Started off as a janitor in a small community hospital. He moved up the ranks over the years. He eventually did go back to college (while working and which the hospital helped pay for) and got a bachelor's in business at the University of Phoenix. He's now the COO of the same small community hospital. Makes about $200-$250k/year. Works about 40 hrs per week. He apparently has a big say in employing doctors, etc.
 

ChiTownBHawks

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A good friend's dad had never gone to college. Started off as a janitor in a small community hospital. He moved up the ranks over the years. He eventually did go back to college (while working and which the hospital helped pay for) and got a bachelor's in business at the University of Phoenix. He's now the COO of the same small community hospital. Makes about $200-$250k/year. Works about 40 hrs per week. He apparently has a big say in employing doctors, etc.
Sounds qualified to me.
 

Crayola227

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A good friend's dad had never gone to college. Started off as a janitor in a small community hospital. He moved up the ranks over the years. He eventually did go back to college (while working and which the hospital helped pay for) and got a bachelor's in business at the University of Phoenix. He's now the COO of the same small community hospital. Makes about $200-$250k/year. Works about 40 hrs per week. He apparently has a big say in employing doctors, etc.
Back in the day....

If I had a dollar for every one of these stories....

I wish I remembered what I had read about why starting a business or bootstrapping or even working at Wendy's with a Bachelor's has gotten progressively more difficult in the US since the late 1800s.... it made sense and basically explained that you either get a lot of degrees or it's playing the lottery

Great anecdote though.

I see my problem was getting my MD and not staying in garbage collecting or dishwashing in my youth
 

Cpt Ahab

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Back in the day....

If I had a dollar for every one of these stories....

I wish I remembered what I had read about why starting a business or bootstrapping or even working at Wendy's with a Bachelor's has gotten progressively more difficult in the US since the late 1800s.... it made sense and basically explained that you either get a lot of degrees or it's playing the lottery

Great anecdote though.

I see my problem was getting my MD and not staying in garbage collecting or dishwashing in my youth
If only you stuck to dishwashing you would have owned that whole franchise.
 

bashwell

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Back in the day....

If I had a dollar for every one of these stories....

I wish I remembered what I had read about why starting a business or bootstrapping or even working at Wendy's with a Bachelor's has gotten progressively more difficult in the US since the late 1800s.... it made sense and basically explained that you either get a lot of degrees or it's playing the lottery

Great anecdote though.

I see my problem was getting my MD and not staying in garbage collecting or dishwashing in my youth
Thanks, Crayola, and great point! Totally agree with what you're saying here. :)

While we're on the topic of these sorts of stories, I also have a friend who made tons of money crab fishing in Alaska over a summer and had a once in a lifetime adventure they'll never forget, a smart friend with an Ivy league degree who is a plumber probably making about as much money as a pediatrician now, a friend in the video game industry who makes $100k+ doing very cool and fun stuff all day, and the list goes on.

At the same time I have a friend who almost drowned while crab fishing and would never ever do it again, a friend who doesn't enjoy his job much at all and wishes he could trade it for being a pediatrician, and a friend who gets to look for a new job in the video game industry every year or so because video game companies apparently turn over very quickly.

Point of my stories is, despite all that's happening in healthcare to marginalize and devalue physicians, and despite all the horrible things that med students and residents have to endure to become an attending, even the least paid medical specialty like a pediatrician for example is at the end of a day still a good job which can be very fulfilling and wonderfully rewarding in ways beyond money.

In fact, I don't know that I should compare, but if we had to compare I think many (maybe most?) people in other fields would likely trade their jobs any day to become a doctor if they had the opportunity to do so. I even suspect my friend's COO dad often looks somewhat enviously at the doctors at his hospital, given the way he talks about doctors, not for the pay, per se, but for the simple fact that they're doctors.

Speaking for myself, I was a computer scientist for a big famous tech company prior to med school, and even started a PhD at an equally great school (but dropped out after less than a year), and I sometimes look fondly back at all this and regret the decision I made to go to med school. But then I come to my senses and remember why I left, remember things aren't exactly picture perfect in IT or computers either, and I'm content again. It's not for everyone, of course, but for those for whom it is, it's still a privilege to be a doctor, still a privilege to care for patients, even if there are dark and angry storm clouds on the horizon.
 
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Lifeman

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Thanks, Crayola, and great point! Totally agree with what you're saying here. :)

While we're on the topic of these sorts of stories, I also have a friend who made tons of money crab fishing in Alaska over a summer and had a once in a lifetime adventure they'll never forget, a smart friend with an Ivy league degree who is a plumber probably making about as much money as a pediatrician now, a friend in the video game industry who makes $100k+ doing very cool and fun stuff all day, and the list goes on.

At the same time I have a friend who almost drowned while crab fishing and would never ever do it again, a friend who doesn't enjoy his job much at all and wishes he could trade it for being a pediatrician, and a friend who gets to look for a new job in the video game industry every year or so because video game companies apparently turn over very quickly.

Point of my stories is, despite all that's happening in healthcare to marginalize and devalue physicians, and despite all the horrible things that med students and residents have to endure to become an attending, even the least paid medical specialty like a pediatrician for example is at the end of a day still a good job which can be very fulfilling and wonderfully rewarding in ways beyond money.

In fact, I don't know that I should compare, but if we had to compare I think many (maybe most?) people in other fields would likely trade their jobs any day to become a doctor if they had the opportunity to do so. I even suspect my friend's COO dad often looks somewhat enviously at the doctors at his hospital, given the way he talks about doctors, not for the pay, per se, but for the simple fact that they're doctors.

Speaking for myself, I was a computer scientist for a big famous tech company prior to med school, and even started a PhD at an equally great school (but dropped out after less than a year), and I sometimes look fondly back at all this and regret the decision I made to go to med school. But then I come to my senses and remember why I left, remember things aren't exactly picture perfect in IT or computers either, and I'm content again. It's not for everyone, of course, but for those for whom it is, it's still a privilege to be a doctor, still a privilege to care for patients, even if there are dark and angry storm clouds on the horizon.
I was on an airplane to one of my medical school interviews about a year ago and happened to sit next to an older guy who said he was an engineer who designed some pretty cool stuff, I think for nuclear reactors or something? I told him how I was always interested in engineering and how he must love his job. He said, "It's neat, but...it's no saving lives."
 

PatsyStone

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I was on an airplane to one of my medical school interviews about a year ago and happened to sit next to an older guy who said he was an engineer who designed some pretty cool stuff, I think for nuclear reactors or something? I told him how I was always interested in engineering and how he must love his job. He said, "It's neat, but...it's no saving lives."
I hate to be that gal, but in medicine, oftentimes we hurt people more than we help them. Once you take care of your 50th person with dementia whose family wants you to put in a peg tube you'll realize engineers probably do more good in this world
 
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Lifeman

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I hate to be that gal, but in medicine, oftentimes we hurt people more than we help them. Once you take care of your 50th person with dementia whose family wants you to put in a peg tube you'll realize engineers probably do more good in this world
Good point, but I took as being able to see the impact you're making. I think often times with engineering, you might see yourself as just another cog in the wheel of massive corporations, where as a doctor, you are the effector. Whether or not you save the patient, you had a direct hand in the result.
 
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witzelsucht

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Yeah I mean the dude who invented crumple zones or autopilot or AICDs probably "saved more lives" but at the same time, those things would have been invented at some point anyway. If you are the doctor who convinces demented-family-member #51 to not do the PEG and put them in hospice, that's a great thing that only YOU can do.
 
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My guess is primary care docs especially family med and IM will see salaries increasing maybe from 150K-200K right now to about 225K to 275K?...I know in rural areas family med docs makes around 200-250K while hospitalists make around 250-300K...That is a salary I can't complain about:)

Obviously, cardiologists, ortho, pain specialists like anesthesia and neurosurgeons make like 500K-700K and above so I don't think their salaries will decline that much...

My bet for highest earners will be ortho still because of the aging population, everyone wants a knee or hip replacement!
 
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Crayola227

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Good point, but I took as being able to see the impact you're making. I think often times with engineering, you might see yourself as just another cog in the wheel of massive corporations, where as a doctor, you are the effector. Whether or not you save the patient, you had a direct hand in the result.
Yeah I mean the dude who invented crumple zones or autopilot or AICDs probably "saved more lives" but at the same time, those things would have been invented at some point anyway. If you are the doctor who convinces demented-family-member #51 to not do the PEG and put them in hospice, that's a great thing that only YOU can do.
But it's not a great thing only you can do.

Other doctors could do it.

Or, to be fair, yes, of course there are those wonderful moments you know it's the special knack you have for communicating your unique experiences that does the trick.

Dr. Pamela Wible has a youtube video interview with a FP with a blurred out face talking about how disheartening and stressful it is to know what good care is and to continually shortchange patients to keep them going in and out of the meatgrinder fast enough. Average face to face time with patient = 8 min. Average time Rx'ing new drug and educating patient on what it's for, a bit on how it works, safety, side effects, and clear directions on how to take it = 80s.

You don't really feel this pressure as a med student, and as a med student you are responsible for less stuff pertaining to the patient, less patients, in a given timeframe, and generally encouraged to be complete and spend time with patients.

It's easy to imagine at the attending level the increased efficiency they have means they are still providing good care under the time constraints, and I think the happiest docs have a pretty firm denial or overexaggerated sense of how much of their communication sinks in to the patient.

If you are more aware of what quality care is, which definitely requires at least twice the time being spent with patient, you will go to sleep at night tossing and turning about how much better things would be for 75% of your patients if you'd just had a bit more time or the system would actually apply the science we know is good, but doesn't.

The triumphs achieved IN SPITE of a system designed for profit at yours and the patient's expense, are hardly pat yourself on the back worthy. This is compounded by the sense of perfectionism and expectation of excellence that is inherent in the profession. We are never praised for doing a good job or saving lives, that isn't remarkable in our line of work.

You don't walk away feeling great because you managed your basic job requirement of standard of care leading to good outcome, not in the face of whatever went wrong because of a ****ed up system, which likely was out of your control.

People don't have medical knowledge and see the good done as something almost mystically wonderful, once you see the Wizard behind the Curtain, you are mostly just applying science and it's all in a day's work.

Like anyone's job, 80% of it will just being the same thing over and over again.

You think because it's someone's life it will have special meaning, but actually because it's someone's life is why the bad haunts you in a way the good doesn't really comfort you.

Wow! I held a care conference with a patient family for 2 hours and finally got the patient on hospice, spent an hour on the phone getting little Timmy's chemo approved by the insurance company, the social worker got a hold of dad finally after 3 days so I could finally advance this kid's care, there's 10 patients I did the bare minimum before moving on to the next and they're all tucked in until the insanity begins tomorrow! Ah, but one of them died basically due to parent neglect (nothing they can get in legal trouble for), another one I couldn't talk parents into hospice so I can watch them suffer needlessly for another 2 weeks until they die, and another one I made a reasonable choice for care and now they are having a horrific side effect, in hindsight I see that I picked too high a starting dose because I forgot to factor in X. Another kid's parents are miserable scared bedside, but they couldn't come in to talk until 7 pm and I was already home when they showed up. Another pair are miserable bedside because I didn't have time to educate them on what went wrong and they think it's my fault. Another patient I forgot/didn't put in some order so now they'll be stuck here another couple days.

But I feel great about the 10 kids that got the care they deserved.

I can't imagine a world where spine isn't at the top of the reimbursement list.
Seems to me more and more a lot of the most common procedures, like fusions, injections, are falling out of favor with EBM, and if standard of practice continues to be more and more observation and not doing surgery on a number of those herniated disks, plus with slashing of procedure reimbursement in general, may not be a gold mine any more.

Brain surgery will likely still command big money.
 

Cubsfan10

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1. All specialties = less
2. Primary care = stable/maybe slightly more (this depends on what autonomy is granted to NPs)
3. Interventional/Procedural will always make the most
4. Surgical fields still strong in 10 years but many will decline over long-term as most things move non-invasive
5. Likely will have the same fields near the top in 10 years: NSG, Ortho, interventional cards, interventional rads, Plastics
6. Fields that could decline: Cards (non-interventional), Rads (non-interventional), Dermatology, Pathology, EM, CT surgery, Anesthesia
7. Fields that could rise: PM&R, IM/FM

Whomever said hospital admin = truth. Administrative costs and salaries have grown at many multiples of the growth of physicians. Physicians do not have public opinion, insurance companies, politicians, lobbyists, or basically anyone on their side.
Sucks hard to be a highly trained physician and have your care dictated by someone with a Bachelors in Business admin from Univ of Phoenix Online ;)
 
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It's absolutely ridiculous that hospital execs and insurance execs with less education than a doctor have salaries above 500K with benefits and stock options adding up to millions....absolutely ridiculous...I'm not saying doctors are not paid well, because they have good salaries after years of education/training but these execs are making insane amounts of money and no one is saying anything or doing anything about it....why do they profit after we go through all the hard work?

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html
 
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Giovanotto

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But it's not a great thing only you can do.

Other doctors could do it.

Or, to be fair, yes, of course there are those wonderful moments you know it's the special knack you have for communicating your unique experiences that does the trick.

Dr. Pamela Wible has a youtube video interview with a FP with a blurred out face talking about how disheartening and stressful it is to know what good care is and to continually shortchange patients to keep them going in and out of the meatgrinder fast enough. Average face to face time with patient = 8 min. Average time Rx'ing new drug and educating patient on what it's for, a bit on how it works, safety, side effects, and clear directions on how to take it = 80s.

You don't really feel this pressure as a med student, and as a med student you are responsible for less stuff pertaining to the patient, less patients, in a given timeframe, and generally encouraged to be complete and spend time with patients.

It's easy to imagine at the attending level the increased efficiency they have means they are still providing good care under the time constraints, and I think the happiest docs have a pretty firm denial or overexaggerated sense of how much of their communication sinks in to the patient.

If you are more aware of what quality care is, which definitely requires at least twice the time being spent with patient, you will go to sleep at night tossing and turning about how much better things would be for 75% of your patients if you'd just had a bit more time or the system would actually apply the science we know is good, but doesn't.

The triumphs achieved IN SPITE of a system designed for profit at yours and the patient's expense, are hardly pat yourself on the back worthy. This is compounded by the sense of perfectionism and expectation of excellence that is inherent in the profession. We are never praised for doing a good job or saving lives, that isn't remarkable in our line of work.

You don't walk away feeling great because you managed your basic job requirement of standard of care leading to good outcome, not in the face of whatever went wrong because of a ****ed up system, which likely was out of your control.

People don't have medical knowledge and see the good done as something almost mystically wonderful, once you see the Wizard behind the Curtain, you are mostly just applying science and it's all in a day's work.

Like anyone's job, 80% of it will just being the same thing over and over again.

You think because it's someone's life it will have special meaning, but actually because it's someone's life is why the bad haunts you in a way the good doesn't really comfort you.

Wow! I held a care conference with a patient family for 2 hours and finally got the patient on hospice, spent an hour on the phone getting little Timmy's chemo approved by the insurance company, the social worker got a hold of dad finally after 3 days so I could finally advance this kid's care, there's 10 patients I did the bare minimum before moving on to the next and they're all tucked in until the insanity begins tomorrow! Ah, but one of them died basically due to parent neglect (nothing they can get in legal trouble for), another one I couldn't talk parents into hospice so I can watch them suffer needlessly for another 2 weeks until they die, and another one I made a reasonable choice for care and now they are having a horrific side effect, in hindsight I see that I picked too high a starting dose because I forgot to factor in X. Another kid's parents are miserable scared bedside, but they couldn't come in to talk until 7 pm and I was already home when they showed up. Another pair are miserable bedside because I didn't have time to educate them on what went wrong and they think it's my fault. Another patient I forgot/didn't put in some order so now they'll be stuck here another couple days.

But I feel great about the 10 kids that got the care they deserved.



Seems to me more and more a lot of the most common procedures, like fusions, injections, are falling out of favor with EBM, and if standard of practice continues to be more and more observation and not doing surgery on a number of those herniated disks, plus with slashing of procedure reimbursement in general, may not be a gold mine any more.

Brain surgery will likely still command big money.
So, during interviews when they asked you, "Why do you want to be a doctor?", what did you say? What did you believe? I know this before going in and it sure isn't comforting because I believe you and mostly find your logic sound.
 

DubVille

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So, during interviews when they asked you, "Why do you want to be a doctor?", what did you say? What did you believe? I know this before going in and it sure isn't comforting because I believe you and mostly find your logic sound.
Just having realistic expectations will help you in your career. I've said many times on these forums that alot of the people who come in expecting to save the world become very bitter when seeing reality. Those who come in knowing of the suckiness aspects but weighing it against the pro's of thr field are usually unphazed.
 

DubVille

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I can't imagine a world where spine isn't at the top of the reimbursement list.
I agree to some extent but the outcomes for spine surgery are pretty poor, and alot of people get the surgeries when not indicated. EBM may change that and bring volumes way down or slash reimbursements. Same can be said for interventional pain (more my area). Alot of borderline results that the payors no longer want to cover or are slashing reimbursements. I certainly believe in what I do, but selecting appropriate patients for interventions is key. Too many needle jockeys out there.

The other problem with spine surgery is it sometimes is used as a last resort. My therapy/shots/meds/etc dont work and now the "only option" left is surgery, despite the patient having axial lbp without radiation.

Bottom line is I expect it to drop along with most other specialties while primary stays about the same and admin sees exponential gains.

/rant
 
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Shinobiz11

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^ Did you say podiatry?
Yes, though a different path from MD/DO, you can make a lot of money from people who care about their feet and have money to fix every little problem.
 

wjs010

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But it will make them feel bad. Imaging making $300k less than you used to and working the same. Still blows even if you are rich.
 
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Psai

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Im confused why everyone keeps saying primary care will increase. Just because theres a mandate? Between midlevels and the majority of new residencies being in primary care, I dont see it / get it.
Because primary care people keep saying it as if it's true. I don't know what the future holds but what I do know is that the powers that be are trying to replace physicians with mid-levels and they're making the most inroads into primary care and anesthesiology. It's a shame because the care is noticeably inferior which you can tell just by reading the notes and the plans. People like to denigrate family medicine, probably because it's not competitive, but I think that doing it well is difficult and that you need to have a strong command of a broad knowledge base. Otherwise you'll have people being put on synthroid for one marginally high tsh level.
 

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Because primary care people keep saying it as if it's true. I don't know what the future holds but what I do know is that the powers that be are trying to replace physicians with mid-levels and they're making the most inroads into primary care and anesthesiology. It's a shame because the care is noticeably inferior which you can tell just by reading the notes and the plans. People like to denigrate family medicine, probably because it's not competitive, but I think that doing it well is difficult and that you need to have a strong command of a broad knowledge base. Otherwise you'll have people being put on synthroid for one marginally high tsh level.
Can you elaborate on the bolded part?
 
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I feel like the old-boy surgeon lobbies won't allow things to get hacked down to pieces too far...


but I could be wrong.
Surgeons barely have enough time to see their kids or remember what their faces look like. Think they have the time or will to lobby? They just sit around between OR cases complaining about the state of medicine just like every other doctor.

I love the sarcasm (I think it's sarcasm).

But probably Ortho spine. My reason? crossfit.
Pretty soon spine is going to get slashed. There's little evidence for most of it and there are crappy outcomes. It's a golden goose that's about to get slain.
 
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Everything will be cut to approximately 50% of current reimbursements. Majority of good doctors will exit the insurance based system creating a grossly unfair and inequitable two-tiered system (a la Britain). If you want to see what will happen, just look at Europe. The process is empirically modeled for you already. Doctors in the cash only business will make what current doctors make now. Doctors employed by national health will make 50k-100k. I don't get how medical students and doctors do not understand this very simple process. As the country moves left, private enterprise and market-based reimbursements disappear. We get controlled health-care spending growth, true, but no innovative or ground-breaking research comparatively. It is not going to be pretty. EBM is mostly contrived crap used by the gov and insurance companies to assert their influence on doctor and patient choice, as we all know.
 
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KP2AZ

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@FiveOClock , I've heard this same sentiment before from many MANY attendings over the past few years. At first I thought it sounded a little outlandish, but as time has gone on, we seem to be getting closer and closer to what you have been describing. I wish the media and politicians didn't simplify the issue and make physicians into the bad guy just like I also wish I could be batman. Neither are going to happen.
 
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@FiveOClock , I've heard this same sentiment before from many MANY attendings over the past few years. At first I thought it sounded a little outlandish, but as time has gone on, we seem to be getting closer and closer to what you have been describing. I wish the media and politicians didn't simplify the issue and make physicians into the bad guy just like I also wish I could be batman. Neither are going to happen.
There is nothing outlandish about it at all. People on this forum repeatedly refuse to acknowledge reality for some reason. The only questions is what the timeline for the transition will look like. If Republicans take the WH with someone who will reform healthcare with market based solutions (i.e. not Trump) then it will probably slow the trend. If a Democrat is elected, I would expect it w/i 10-20 years.
 
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PL198

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I can't imagine a world where spine isn't at the top of the reimbursement list.
I can. ortho is going to be on the chopping block soon. nothing stays at the top of reimbursements forever. they see what is costing big money and then slash it.