nearly 1/3 of Doctors could leave medicine if health-care reform bill passes

thamsenman

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http://www.cnsnews.com/news/article/62812


Originally from the NEJM:

(CNSNews.com) - Nearly one-third of all practicing physicians may leave the medical profession if President Obama signs current versions of health-care reform legislation into law, according to a survey published in the latest issue of the New England Journal of Medicine.

The survey, which was conducted by the Medicus Firm, a leading physician search and consulting firm based in Atlanta and Dallas, found that a majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.

More than 29 percent (29.2) percent of the nearly 1,200 doctors who responded to the survey said they would quit the profession or retire early if health reform legislation becomes law. If a public option were included in the legislation, as several liberal Senators have indicated they would like, the number would jump to 45.7 percent.

The medical journal published the results in its March and April edition, saying: “While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.”

Kevin Perpetua, managing partner for the Medicus Firm, reported that a reform bill could be “the final straw” in an already financially precarious industry.

“Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases,” Perpetua said in the study. “The overwhelming prediction from physicians is that health reform, if implemented inappropriately, could create a detrimental combination of circumstances, and result in an environment in which it is not possible for most physicians to continue practicing medicine.”

“With an average debt of $140,000, and many graduates approaching a quarter of a million dollars in school loans, being a doctor is becoming less and less feasible,” Perpetua said. “Health-care reform and increasing government control of medicine may be the final straw that causes the physician workforce to break down.”

The survey shows that many doctors already find their situations difficult:

-- 36 percent said that they would not recommend medicine as a profession to others, regardless of whether health-care reform passes;
-- another 27 percent would still recommend medicine as a career, but not if the current reform proposal passes.

In total, 63 percent of doctors would not recommend the profession after health-care reform passes. Just 12 percent do not recommend becoming a physician now but think they would if current reform proposals pass.

Primary-care physicians, those who work in the critical fields of family and internal medicine, not only feel that they would want to quit but that they might be cast out of medicine. 46.3 percent of those physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system.

Despite all the opposition to the bill as it stands, only a little more than 3 percent of respondents said the status quo was best, with the vast majority (62.7 percent) saying they believe changes are needed.

The same 62.7 percent said they wanted reforms made, but that they “should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in (the) legislation.”

Andrea Santiago, a spokeswoman for the Medicus Firm, said those numbers were the most striking.

“Please allow me to emphasize that 96 percent of the physicians surveyed in our report are in favor of health reform, in some form or fashion,” she told CNSNews.com in an e-mail. “To me, the fact that so many physicians surveyed want health reform, but relatively few are in favor of the current legislation, was one of the most significant, telling results.”

Congressional Democratic leaders, meanwhile, have said that doctors favor the bill and are part of an “unprecedented coalition” of doctors rooting for its passage. The claim is based on the American Medical Association’s endorsement of the legislation in Congress.

According to the Bureau of Labor Statistics, in 2008 there were 661,400 physicians and surgeons within the United States. Of that number, 250,000 are members of the American Medical Association (AMA) -- and nearly 100,000 of those are medical students.

Santiago explained the AMA could not claim to represent all doctors, nor perhaps could any other group, and said the potentially massive shortage of physicians has stayed largely out of the debate because public figures have been trying to speak for doctors instead of speaking to them.

“I think the reason it hasn’t become a big issue in the political debate is maybe because no one else has really thought about the effects of health reform on the physician workforce. Or, maybe people didn’t want to think about it, but as recruiters we can’t help but think about it and take notice,” she said.

“If you are not talking to physicians every day about their career plans, it may not occur to someone that it would even be an issue. Plus, many public figures, media, and organizations are speaking for doctors in professional associations and groups, proclaiming ‘doctors want this.’ Without surveying each and every doctor, no one can claim that all doctors want this particular version of health reform, including us.”

Santiago said one problem with a comprehensive bill was all the uncertainty about its effects that comes along with it.

“When you’re on the phone with doctors each and every day, discussing their career plans, like we are as recruiters, you start to notice hot-buttons that are related to their career decisions, and health reform was increasingly and repeatedly coming up as an issue that was causing doctors apprehension when making career plans,” Santiago explained.

“Many seemed frustrated by it. Part of it, I think, is fear of the unknown -- the current health reform bill is so large and all-encompassing, no one really knows for sure what will happen when/if this bill passes, so how does a physician make major career decisions when so much is hanging in the balance?”

The key findings of the survey can be found here
 

Morsetlis

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God I hope it passes so Congress says oh **** and doubles the residency funding/spots 4 years down the line.
 

morning

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I sincerely doubt it happens on a large scale. It is easy to say it, not easy to do it.
 

she woolf

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God I hope it passes so Congress says oh **** and doubles the residency funding/spots 4 years down the line.
^^me thinks the same thoughts ^_^'

I also hope this means that they increase med school spots thus increasing my chances of getting in futher down the line :laugh:
 

Drrrrrr. Celty

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^^me thinks the same thoughts ^_^'

I also hope this means that they increase med school spots thus increasing my chances of getting in futher down the line :laugh:
= over saturation of the medical field. There are tons of residencies not taken every year. If congress goes and makes more residency spots that's a flipping 150k a spot. They could spend that money to reduce the costs of getting a MD/DO. I have to admit these media impulses are beginning to take a toll on us all, but lets all remember, just because I say i'll quit medicine does not mean that I actually will quit.
Though, if medicine does get to the point where it's so bad then PhD here I come.
 

thamsenman

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From CNS Article:

If a public option were included in the legislation, as several liberal Senators have indicated they would like, the number would jump to 45.7 percent.
Almost 1/2 would leave medicine if a public option was there!!!! :(
 
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Honestly, I wouldn't mind not having an astronomical salary in the future...as long as med school was under 50 grand (TOTAL tuition) and residencies weren't such a pain. Well...at least the tuition thing. I doubt residencies will change.
 

Drrrrrr. Celty

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more like pulse and application fee....:laugh:
So we'll start using the Ross model of medical education then :laugh:? The end result is that most pre-meds are smart enough to succeed and make if different fields which require less of a investment and sacrifice. If you take away the monetary aspects of medicine, and we all know that 90% of us will be engineers or PhD's or in your case cocaine smugglers.... I mean pharmacists :D.
 

Bernoull

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Firstly the source of the report is hardly impartial or unbiased. By their own account:

"The Cybercast News Service was launched on June 16, 1998 as a news source for individuals, news organizations and broadcasters who put a higher premium on balance than spin and seek news that’s ignored or under-reported as a result of media bias by omission. Study after study by the Media Research Center, the parent organization of CNSNews.com, clearly demonstrate a liberal bias in many news outlets – bias by commission and bias by omission – that results in a frequent double-standard in editorial decisions on what constitutes "news."
In response to these shortcomings, MRC Chairman L. Brent Bozell III
CNSNews.com in an effort to provide an alternative news source that would cover stories that are subject to the bias of omission and report on other news subject to bias by commission."
founded




The original survey as posted on NEJM says:


Physician Survey: Health Reforms Potential Impact on Physician Supply and Quality of Medical Care

Mar. – Apr. 2010
[SIZE=+1]Key Findings[/SIZE]
Physician Support of Health Reform in General
• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.
Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.
Health Reform, Public Option, and Practice Revenue/Physician Income
• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option. • 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.
Health Reform, Public Option, and Physician Supply
• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career
• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.




Looking at the survey without the slanted commentary gives a more nuanced picture. Also CNSNews is clearly misleading its readers by saying
"In total, 63 percent of doctors would not recommend the profession after health-care reform passes."

The truth is the majority of doctors in that 63% (36%) WOULD NOT recommended medicine irrespective of healthcare reform and they conveniently left that out in their commentary.

For me it makes me wonder why 36% of docs won't recommend medicine as it currently is.
 

Drrrrrr. Celty

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Honestly, I wouldn't mind not having an astronomical salary in the future...as long as med school was under 50 grand (TOTAL tuition) and residencies weren't such a pain. Well...at least the tuition thing. I doubt residencies will change.
Unlikely, there's no way to actually reduce costs by that much. Personally I have a hard time rationalizing the struggle of going through step 1-3 and residency for anything less then 150k a year starting pay. I mean maybe I'm a bit frivolous, but I really don't want to live a frugal life.
Neh change.... gotta love it..
 
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Nice find Bernoull.

Even looking at the statistics from the actual survey, though, makes me seriously doubt whether or not I really want to embark on this path.
 

Tutmos

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Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Holy cow! It didn't seem so bad when the first post claimed the 46% was only if a public option was included. Now Bernouli is posting that the accurate number was 46% if health reform is passed, regardless of a public option being in it. Thanks for letting us know how much physicians oppose Obamacare Bernoull.
 

skiddoc

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Seriously? 1/3 of doctors would just throw 7+ years of schooling away just so that they could leave medicine for some other career not guaranteed to make them nearly as much money?
 

CaliSurferDoc

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Seriously? 1/3 of doctors would just throw 7+ years of schooling away just so that they could leave medicine for some other career not guaranteed to make them nearly as much money?
No, more along the lines of retiring early or leaving their private practice for other lines of MD work.

I know 3 physicians who would actually leave the profession in this respect
 

Drrrrrr. Celty

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Seriously? 1/3 of doctors would just throw 7+ years of schooling away just so that they could leave medicine for some other career not guaranteed to make them nearly as much money?
A lot of Ob/gyn's and IM doctors are beginning to leave medicine in great numbers due to intense malpractice. When your making at most 80k and dealing with managing a business and working with people and all of those stresses. Eventually you'll reach a point where you would rather do something less high maintenance and more full of me time.
 

skiddoc

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A lot of Ob/gyn's and IM doctors are beginning to leave medicine in great numbers due to intense malpractice. When your making at most 80k and dealing with managing a business and working with people and all of those stresses. Eventually you'll reach a point where you would rather do something less high maintenance and more full of me time.
Do you know what they go into? I've always thought about this scenario, but I can't imagine myself doing anything but medicine. Then again, there's no way I'm going into Primary Care because I know a lot of docs hate it.

No, more along the lines of retiring early or leaving their private practice for other lines of MD work.

I know 3 physicians who would actually leave the profession in this respect
I'd imagine they might have to do a different residency to re-specialize, no?
 

Bernoull

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Holy cow! It didn't seem so bad when the first post claimed the 46% was only if a public option was included. Now Bernouli is posting that the accurate number was 46% if health reform is passed, regardless of a public option being in it. Thanks for letting us know how much physicians oppose Obamacare Bernoull.

Don't you guys just love polls.. :laugh::laugh:

Keep in mind the 46% is for primary care docs who as of now, as underpaid AND there's a acute shortage. Naturally many PCPs fear that expanding coverage without increasing PCPs and their pay will only exacerbate their problems. Their position does make sense.

Now another NEJM survey, done 6mos ago, with a much larger sample size found:

"A Robert Wood Johnson Foundation (RWJF) study published in today's New England Journal of Medicine shows that a majority of physicians (63%) support a health reform proposal that includes both a public option and traditional private insurance."

http://www.rwjf.org/healthreform/product.jsp?id=48428

Choose your favorite poll i guess....


There are 3 critical things with surveys:
1. The pollster
2. The specific questions
3. The responders (sample composition)
and ur usual statistics...

The point is no-one should make a career decision based on polls.. Also read a poll critically otherwise its import may be lost...
 

Drrrrrr. Celty

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Do you know what they go into? I've always thought about this scenario, but I can't imagine myself doing anything but medicine. Then again, there's no way I'm going into Primary Care because I know a lot of docs hate it.
You're either lying or a very dull boy if you can't imagine yourself doing anything by medicine. It's probably a complex of which you have likely developed to rationalize medicine most likely.
Ob/gyn's are the most sued doctors in the world. Up to 200k in some states. Doctors who've been practiced for over 30 years are left screwed over because they actually liked that field and now can not continue lest they begin to hemorrhage money.
 

morning

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No, more along the lines of retiring early or leaving their private practice for other lines of MD work.

I know 3 physicians who would actually leave the profession in this respect
That is not the same as "leaving medicine."
 

JeetKuneDo

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Do you know what they go into? I've always thought about this scenario, but I can't imagine myself doing anything but medicine. Then again, there's no way I'm going into Primary Care because I know a lot of docs hate it.

I only have my observations to back me on this one, but it seems that a lot of people have this same feeling towards primary care. Looks like the primary care shortage problem will never be solved.
 

JaggerPlate

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Laugh ... 1/3 would leave my arse. It's easy to be tough on some survey. It would never happen. Doctors are too disorganized to ever leave in a large group (and it's technically illegal due to anti-union jazz), and 90% of them have sat around getting kicked in the groin over and over with reimbursement cuts, mid-levels stepping up and making more and more cash, etc - so saying they would suddenly stick up for themselves now is just untrue (unfortunately). Also, you could probably pass the worse BS bill tomorrow and still have 10 new "3.8/40T - Am I doomed?" threads tomorrow. No risk of docs leaving - no matter how bad it gets. No risk of med school classes struggling to fill quota - no matter how bad it gets.
 

Morsetlis

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If you want to see an example of a country where physicians make jack ****, look at Germany.

And there are still physicians in Germany.

I'm willing to take a pay cut to become a physician.

I just want this process to... hurt... less...

ow ow ow ow ow
 

Slowpoke

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Laugh ... 1/3 would leave my arse. It's easy to be tough on some survey. It would never happen. Doctors are too disorganized to ever leave in a large group (and it's technically illegal due to anti-union jazz), and 90% of them have sat around getting kicked in the groin over and over with reimbursement cuts, mid-levels stepping up and making more and more cash, etc - so saying they would suddenly stick up for themselves now is just untrue (unfortunately). Also, you could probably pass the worse BS bill tomorrow and still have 10 new "3.8/40T - Am I doomed?" threads tomorrow. No risk of docs leaving - no matter how bad it gets. No risk of med school classes struggling to fill quota - no matter how bad it gets.

Truth
 

skiddoc

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serenade said:
You're either lying or a very dull boy if you can't imagine yourself doing anything by medicine. It's probably a complex of which you have likely developed to rationalize medicine most likely.
Ob/gyn's are the most sued doctors in the world. Up to 200k in some states. Doctors who've been practiced for over 30 years are left screwed over because they actually liked that field and now can not continue lest they begin to hemorrhage money.
Let me rephrase that... I've imagined doing stuff other than medicine, but I haven't imagined me happy doing it. Like I said, primary care is not for me. I feel much more comfortable doing surgery, and yes, I know what I am getting into.
 

JaggerPlate

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If you want to see an example of a country where physicians make jack ****, look at Germany.

And there are still physicians in Germany.

I'm willing to take a pay cut to become a physician.

I just want this process to... hurt... less...

ow ow ow ow ow
If uncle sam wants to pay for med school, I'd be much more open to a pay cut. I don't know if that's how they do it in Germany, but I work with a girl who is like ... 2 years(ish) out of France (born and raised there), and she said docs make less, but go to school completely free or, in some cases, are paid to go to school. This or a decent, hiked up via medicare salary during residency. However, until med school doesn't cost 200k, residencies don't pay 45k a year for 80 (wink wink) hour work weeks, and interest doesn't start during residency ... I'll take the 'pain of the process - especially the pre-med part' and a decent, fair salary.
 

JaggerPlate

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Let me rephrase that... I've imagined doing stuff other than medicine, but I haven't imagined me happy doing it. Like I said, primary care is not for me. I feel much more comfortable doing surgery, and yes, I know what I am getting into.
You're too early in the game to know that. I don't know the exact percent, but I think very, very few people go into medical school set on one thing and don't change their mind. Wait until you see that g-surg residency/lifestyle. I also find it kind of hard to imagine that you know what you're getting into??? I don't think anyone truly does until they are in residency.
 
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I am not sure anyone KNOWS what they are getting themself into (prior to residency), but I am sure that most of us have general idea of what specialty they want in to and that is good for direction and motivation. Not to metion most of us are pretty bright and have done some homework. I am hoping anyway.....
I say to those doctors that want to leave or take retirement.... CIAO! I would say they are cutting thier noses off to spite their faces????
 

VPDcurt

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For me it makes me wonder why 36% of docs won't recommend medicine as it currently is.
Doctors work 2x as hard as they did 20 yrs ago and make half the salary.
 

Drrrrrr. Celty

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this is why i vote republican.
Because the Republicans are going to do something better? Face it, both parties suck majorly and its come to the point that they no longer function to help us the people. They are more inclined to help themselves to bribes and enjoy the power which comes with having lobby's. It's long since ended, the time when the government was for the people, by the people.
 

hobbes23

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Reform happens and docs generally keep working:

http://en.wikipedia.org/wiki/Saskatchewan_Doctors'_Strike

The 1962 Saskatchewan Doctors' Strike was a 23-day labour action exercised by medical doctors in the Canadian province of Saskatchewan in an attempt to force the Co-operative Commonwealth Federation government of Saskatchewan to rescind its program of universal medical insurance. The strike began on July 1, 1962, the day the Saskatchewan Medical Care Insurance Act took force, and ended July 23, 1962.http://en.wikipedia.org/wiki/Saskatchewan_Doctors%27_Strike#cite_note-ce-0
US docs make a lot. They will continue to make a lot. Maybe not as much for some specialists. Hopefully more pay for primary care and Medicaid.
http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/
 

Drrrrrr. Celty

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Doctors work 2x as hard as they did 20 yrs ago and make half the salary.
It's a funny reality, but I wonder what will happen in 20 years when the baby boomers retire? Will doctors be expected to work 4x as hard and get paid 4x less?
 
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If you want to see an example of a country where physicians make jack ****, look at Germany.

And there are still physicians in Germany.

I'm willing to take a pay cut to become a physician.

I just want this process to... hurt... less...

ow ow ow ow ow
germans dont pay for med school i dont think. not even college. free living and at the end you make money. vs the US. pay for college, pay for med school. get over worked. i dont have to crunch numbers. but i can tell you this. if US don't pay their physicians as high as we are now, there is going to be a hell lot less physicians around, not to mention they will have to try and cover rest of this country which is already deficit for physicians. this will not be pretty.
 

Bernoull

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Because the Republicans are going to do something better? Face it, both parties suck majorly and its come to the point that they no longer function to help us the people. They are more inclined to help themselves to bribes and enjoy the power which comes with having lobby's. It's long since ended, the time when the government was for the people, by the people.
we are going for medcine no? lets just say republicans do the same thing except to other professions of people, which needless to say, we are not trying to be a part of, this is the Student DOCTOR form after all. thus, it is not so much of our concern. i dont know exactly how republican is going to do about health care, if mccain had been elected. although i do know its not going to be like what democrats are trying to pull. which is going to suck, big time.
 

Ultimeaciax

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Reading this, I don't know what exactly the cons of the current bill...can someone elaborate on it for me, as to why so my physicians oppose this bill? I understand that the patients load will increase and the government will restrict and possibly refuse to pay the cost. Are there any medical aspects that this bill might hinder?
 

Dr Oops

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If you want to see an example of a country where physicians make jack ****, look at Germany.

And there are still physicians in Germany.

I'm willing to take a pay cut to become a physician.

I just want this process to... hurt... less...

ow ow ow ow ow
german physicians are very unhappy w practicing medicine and have gone on strike and try to move to britian. Irish resident were also on strike a few years ago.

Let me rephrase that... I've imagined doing stuff other than medicine, but I haven't imagined me happy doing it. Like I said, primary care is not for me. I feel much more comfortable doing surgery, and yes, I know what I am getting into.
u don't know what's it's like until u r there in it.

The problem when youre a premed is it such a process to go through and such a big desicion to make that we put the blinders On to help us get through it. The prolem w medicine is you don't get out w patients and find out if you love it or hate it until 2 years and thousands of dollars.

I've been watching the house reconcillation and senate hearings recently and it's clear neither side has the answer. Repubs don't want to do anything but the dems want us to be ok with passing a gigantic bill without knowing wuts in it and increasing the already huge debt of the country.

Afte watching the hearings I think this bill would be bad for the climate of healthcare. There are some great things in the bill, but there's even more garbage.
 
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cliffhuxtableDO

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I agree with the blinders comment. The more and more things become/stay uncertain with the health care bill the more I try to reason going into medicine. I have a passion for it, but am I going to get screwed in the end: enter: blinders.
 

Dr Oops

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Reading this, I don't know what exactly the cons of the current bill...can someone elaborate on it for me, as to why so my physicians oppose this bill? I understand that the patients load will increase and the government will restrict and possibly refuse to pay the cost. Are there any medical aspects that this bill might hinder?
It's hard to say exactly but from what I gather, again from watching the hearings, the house side of the bill is aimed at providing alot mor entitlements, to pay for his though they plan on takin a 500 billion from Medicare to help pay for this. However Medicare is planning on reducing costs every year 3 ways: 1 eliminate waste and fraud(which if it was so easy should have been done by now) 2 reduce payments to providers 3 eliminate "wasteful care" basically a way of rationing. This combined wit money being taken from them will be disatserous. Medicare is already projected to be insolvent by 2017. And orzag even testified that the president administration does not have a plan to pay for new entitlements.

Some of the good things in the bill. They are looking to end lifetime caps by insurance companies and prevent insurance companies from excluding people win pre existing conditions.

From what I gathered though parts of the bill wi end up limiting peoples choice of provider.
 

hobbes23

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It's hard to say exactly but from what I gather, again from watching the hearings, the house side of the bill is aimed at providing alot mor entitlements, to pay for his though they plan on takin a 500 billion from Medicare to help pay for this. However Medicare is planning on reducing costs every year 3 ways: 1 eliminate waste and fraud(which if it was so easy should have been done by now) 2 reduce payments to providers 3 eliminate "wasteful care" basically a way of rationing. This combined wit money being taken from them will be disatserous. Medicare is already projected to be insolvent by 2017. And orzag even testified that the president administration does not have a plan to pay for new entitlements.

Some of the good things in the bill. They are looking to end lifetime caps by insurance companies and prevent insurance companies from excluding people win pre existing conditions.

From what I gathered though parts of the bill wi end up limiting peoples choice of provider.
Here are two highly respected sites:
http://www.commonwealthfund.org/Health-Reform.aspx
http://www.iom.edu/Global/Topics/Health-Services-Coverage-Access.aspx

http://www.ihi.org/IHI/Programs/StrategicInitiatives/TripleAim.htm
(addressed how to reduce cost AND improve quality)
 

Geekchick921

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If uncle sam wants to pay for med school, I'd be much more open to a pay cut. I don't know if that's how they do it in Germany, but I work with a girl who is like ... 2 years(ish) out of France (born and raised there), and she said docs make less, but go to school completely free or, in some cases, are paid to go to school. This or a decent, hiked up via medicare salary during residency. However, until med school doesn't cost 200k, residencies don't pay 45k a year for 80 (wink wink) hour work weeks, and interest doesn't start during residency ... I'll take the 'pain of the process - especially the pre-med part' and a decent, fair salary.
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this is possibily the one thread i look forward to read comments from, and it didn't even make past a page. :(