New Florida bill will allow foreign doctors as well as American graduates who have not completed residency to practice

[lolthroaway]

This is exactly what they will do.

Lowering salaries is a feature of these bills rather than a bug

Flooding the market in underserved areas will be hard due to the difficulty of getting the visas (though it is possible) and transitioning to GC/citizenship with the caps. Even then it's one state or two if you want to count Tennessee. And again, underserved areas. To lower salaries across the board, they'd have to figure out a way bring in hundreds of thousands of foreign doctors in a short amount of time. We'd have warning signs before then, so I think it's smart to watch what happens in Florida but I'm not sure there's anything to freak out about right now.

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[voxveritatisetlucis]

Flooding the market in underserved areas will be hard due to the difficulty of getting the visas (though it is possible) and transitioning to GC/citizenship with the caps. Even then it's one state or two if you want to count Tennessee. And again, underserved areas. To lower salaries across the board, they'd have to figure out a way bring in hundreds of thousands of foreign doctors in a short amount of time. We'd have warning signs before then, so I think it's smart to watch what happens in Florida but I'm not sure there's anything to freak out about right now.

Many states have bills like this drafted. The bipartisan support (39-0 passage) indicates it will pass in more states.

Even states like Massachusetts with a surplus of physicians

 

[lolthroaway]

Many states have bills like this drafted. The bipartisan support (39-0 passage) indicates it will pass in more states.

Even states like Massachusetts with a surplus of physicians

Even if every single state passed this, there are still the immigration barriers. Not to mention billing and insurance issues that would likely come up. To flood the U.S. market enough to substantially lower wages you'd need hundreds of thousands of doctors coming in. And it would need to happen very quickly as to not set off alarm bells.

 

[Ho0v-man]

Doubt it would need to happen quickly at all. I think by now it’s pretty clear that physicians and their professional societies won’t even start to do anything about major issues until it’s way too late.

Just look at how we buried our heads in the sand about midlevels and corporate medicine.

 

[VA Hopeful Dr]

Doubt it would need to happen quickly at all. I think by now it’s pretty clear that physicians and their professional societies won’t even start to do anything about major issues until it’s way too late.

Just look at how we buried our heads in the sand about midlevels and corporate medicine.

Yeah it would. We've just begun to see what the baby boomer retirements are going to do to workforce numbers.

In FM as of 2 years ago fully 1/3rd of practicing FPs are boomers. I haven't looked into other fields but I bet its similar. This means in the next 10 years we're going to lose a huge chunk of our practicing doctors while the US population continues to grow.

In my town we don't have any physical room for more doctors and we're still all booked out a minimum of 6 weeks for new patients. Most longer than that.

 

[lolthroaway]

Doubt it would need to happen quickly at all. I think by now it’s pretty clear that physicians and their professional societies won’t even start to do anything about major issues until it’s way too late.

Just look at how we buried our heads in the sand about midlevels and corporate medicine.

I think heads were buried because doctors could make money off of midlevels or they made things easier. Even now, they're not a big threat to most specialties; they seem to range from being a major headache to helpful depending on the specialty and clinical environment.

If we start seeing foreign docs coming in at the rate needed to depress wages in a major way (which I have my doubts about after seeing so many people struggle with the immigration process for this) that will (or should) set off alarm bells for the profession.

Plus ironically midlevels will be opposed to this. If you can can get all this foreign labor and substantially reduce what you need to pay doctors, what's the need for them? So even if we did nothing, they'd go bonkers.

And the education system has a lot to lose as well. Paying 90k or more year in cost of attendance is a bitter pill to swallow, but we have the prospect of making 200k a year at minimum, and that's still kind of low without loan forgiveness. That cost of attendance will be hard to justify without high wages. Especially if people can just get cheap education in another country before coming back to practice in the States.

But if we somehow get to the point that wages are diminishing substantially and don't act on the warning signs, we deserve to take the L.

 

[voxveritatisetlucis]

But if we somehow get to the point that wages are diminishing substantially and don't act on the warning signs, we deserve to take the L

This will likely happen since the most powerful physicians (department heads, practice owners etc.) also serve to gain the most by these bills. Imagine a dermatologist who can now hire 10 physicians for 150k each and not give up any equity in the practice

 

[collegestud2013]

Can’t immediately find this, but I suspect that in practice this doesn’t do much. You can’t take step 3 without being in residency, and it’s hard to get malpractice without being board certified in something. And FL in particular is a very litigious state.

Can't find any details on that, but a restricted license basically = a resident.

A state that passes a law that essentially allows unmatched med students to become permanent "resident physicians" - at more reasonable hours but also at similar pay grades - would probably reap significant benefits, and I personally wouldn't be surprised if unmatched MD/DOs flock to such an opportunity.

These unmatched MDs/DOs will effectively become PAs/NPs if they practice with restricted license (and require attendings to co-sign all their notes and take on their liability). Though I suspect they, on average, will get get paid slightly less than PAs/NPs for the same amount of work since employers know that they have will have less employment opportunities than a typical PA or NP and use that to lowball them.

Also, malpractice insurance is not required in Florida (and in quite a few states). A good percentage of physicians in Florida have been practicing "bare" instead of paying high malpractice insurance premiums. They will often require all their patients to sign waivers as a condition of treating them, saying they won't sue the physician or their practice (though it's debatable how well these waivers are legally enforced). Besides, attorneys are much less likely to go after physicians without malpractice insurance since it's a lot harder to get money from the physician or their practice directly (assuming the physician has been very smart about structuring their assets to maximize asset protection).

 

[lolthroaway]

These unmatched MDs/DOs will effectively become PAs/NPs if they practice with restricted license (and require attendings to co-sign all their notes and take on their liability). Though I suspect they, on average, will get get paid slightly less than PAs/NPs for the same amount of work since employers know that they have will have less employment opportunities than a typical PA or NP and use that to lowball them.

Also, malpractice insurance is not required in Florida (and in quite a few states). A good percentage of physicians in Florida have been practicing "bare" instead of paying high malpractice insurance premiums. They will often require all their patients to sign waivers as a condition of treating them, saying they won't sue the physician or their practice (though it's debatable how well these waivers are legally enforced). Besides, attorneys are much less likely to go after physicians without malpractice insurance since it's a lot harder to get money from the physician or their practice directly (assuming the physician has been very smart about structuring their assets to maximize asset protection).

Interesting. Sorry if this is a naive question, I'm not very familiar with litigation, but why is it so difficult to go after physicians directly? Aren't physical assets such as property fair game? Or a judge order deductions from a salary? I ask because the only people I know who got sued had the latter happen to them. I also wonder why all physicians don't just forgo malpractice (if legally possible) if they can just hide assets or lawyers will be less likely to go after them.

 

[collegestud2013]

Can't find any details on that, but a restricted license basically = a resident.

A state that passes a law that essentially allows unmatched med students to become permanent "resident physicians" - at more reasonable hours but also at similar pay grades - would probably reap significant benefits, and I personally wouldn't be surprised if unmatched MD/DOs flock to such an opportunity.

This, they will essentially be somewhere in between a resident and a PA/NP. My guess would be market pay would also fall in between as well (ie higher than a resident but lower than pa PA/NP). For most, I suspect this would also be relatively short-term position for most, and will have very high turnover once many of the unmatched applicants find residencies after reapplying through the Match. For USMDs one common reason to go unmatched is someone going for a very competitive specialty, even though they have strong credentials. For example, an unmatched dermatology applicant could work at a level similar to a dermatology PA/NP under the supervision of a dermatologist for a year or two until they reapply and get into a dermatology residency (or maybe switch to a less competitive specialty if they still go unmatched).

 

[collegestud2013]

Interesting. Sorry if this is a naive question, I'm not very familiar with litigation, but why is it so difficult to go after physicians directly? Aren't physical assets such as property fair game? Or a judge order deductions from a salary? I ask because the only people I know who got sued had the latter happen to them. I also wonder why all physicians don't just forgo malpractice (if legally possible) if they can just hide assets or lawyers will be less likely to go after them.

Most physicians are relatively risk-adverse, and practicing without malpractice insurance is still risky; your chances of getting sued are generally lower but still not zero. Also, only some states allow practice without insurance. And even in states that do, nearly all hospitals will require malpractice insurance to get privileges, so this would only be limited to the private practice setting. The cases where physicians practice without insurance are usually in areas where malpractice insurance is insanely expensive (eg a lot of Ob/gyn private practices in South Florida don't carry insurance since it would cost over $200k per year per physician).

Hiding assets is complex and requires a lot of structuring of assets based federal and state-specific laws; it's not something every physician wants to get into. Laws in some states make it easier than others. Some assets are also exempt from legal judgements; for example 401K retirement accounts. And in some states such as Florida, an unlimited amount of home equity is also exempt if it's your primary residence. Also there are other technically legal ways such as setting up trusts, or putting money in offshore accounts. In most cases, filing for bankruptcy discharges debt from legal judgments; this is what most physicians i've heard of do when they are faced with a large judgement that is well beyond the limits of their malpractice insurance (though statistically speaking, the chances of this happening are very low for most physicians if they have reasonable malpractice insurance).

 

[Doc mu]

https://www.flsenate.gov/Session/Bill/2024/7016/BillText/er/PDF

I think current med students should start to swallow the pill that they just might not even break six figures if this trend spreads to all states, 4 down 50 to go!

 

[MDMechEngr]

only states with lots of HCA centric sweat shops.

 

[DarkBluMage]

Allowing foreign physicians to practice without any oversight at least for a period of time or training for how to properly go about treating our population is insane. Places patient safety in danger and you don’t know what attitudes or cultural practices they're bringing that can negatively affect patient care and interaction.

 

[Splenda88]

Allowing foreign physicians to practice without any oversight at least for a period of time or training for how to properly go about treating our population is insane. Places patient safety in danger and you don’t know what attitudes or cultural practices they're bringing that can negatively affect patient care and interaction.

We already have that. Hello NP.

 

[DarkBluMage]

We already have that. Hello NP.

NPs aren’t physicians. I don’t think anyone thinks they should be practicing with no oversight either, but they’re not the topic of conversation right now.

 

[voxveritatisetlucis]

We already have that. Hello NP.

At least NPs can’t replace surgeons or other procedure intensive specialties. All bets seem off now with this however

 

[GoSpursGo]

Merging with existing thread.