Obamacare and Physician Salaries

[MissionStanford]

I've looked this question up online before, and different people seem to say different things, and I just can't seem to find a clear, easy-to-understand answer as to how Obamacare will affect physician salaries (I think it's agreed upon that Obamacare will be causing a decrease in physician salaries though). Can anyone give me a simple explanation about this? I'm trying to understand the healthcare system in the US better. I know a lot more than I used to before, but I'm still not nearly as knowledgeable as I'd like to be.

---

Members don't see this ad.

 

[TheWeeIceMan]

The problem is, there is no simple explanation. Lots of factors in play and a tons of things still need to shake out.

 

[deleted357625]

Simply, it expands medicaid to millions of Americans, in order to save money reimbursements for the procedures will be lower, hence the physician gets paid less per procedure.

 

[Syndicate]

which means they'll just perform more procedures, sometimes unnecessary ones that don't cause harm but do minimal good.

 

[MissionStanford]

Simply, it expands medicaid to millions of Americans, in order to save money reimbursements for the procedures will be lower, hence the physician gets paid less per procedure.

But under Obamacare, more people will be getting coverage, right? I guess that doesn't compensate for the lower reimbursement? Also, what will be happening with Medicare?

 

[deleted357625]

But under Obamacare, more people will be getting coverage, right? I guess that doesn't compensate for the lower reimbursement? Also, what will be happening with Medicare?

We're all coerced to pay a tax or penalty to compensate for the low reimbursements (hurting the productive individuals - healthcare professionals/middle class & upperclass). Moreover, the healthcare system was completely inefficient before PPACA was even implemented (so many controls and regulations), the idea to expand something that doesn't work, in which for example 30% of medicaid is reported fraud, not including over-spending, it is inefficient and that's the creation of bureaucracy (more government control).

It would make more sense to fix the healthcare system rather than to expand an atrocious program at the expense of the more productive members of society.

 

[Pacna]

which means they'll just perform more procedures, sometimes unnecessary ones that don't cause harm but do minimal good.

What? Have you worked with any physicians? Nobody's going to do that.

They may qualify more things as procedures (currently not all ultrasounds count as procedures for instance), but no doctor is going to just start sewing up lacerations you don't have.

 

[deleted357625]

What? Have you worked with any physicians? Nobody's going to do that.

They may qualify more things as procedures (currently not all ultrasounds count as procedures for instance), but no doctor is going to just start sewing up lacerations you don't have.

Actually he's right in a sense. Many physicians, even before PPACA, practice what's known as "defensive medicine" for liability reasons (med malpractice)

 

[Syndicate]

What? Have you worked with any physicians? Nobody's going to do that.

They may qualify more things as procedures (currently not all ultrasounds count as procedures for instance), but no doctor is going to just start sewing up lacerations you don't have.

Sorry; didn't mean "procedures" taken literally. What I meant to say is that they will do stuff like performing additional exams on patients that may not necessarily need them, and the like.

 

[CarlosDanger]

Sorry; didn't mean "procedures" taken literally. What I meant to say is that they will do stuff like performing additional exams on patients that may not necessarily need them, and the like.

Yes, this has been happening for quite a long time. It's called fee for service, which is how physicians get paid in the US. Obamacare doesn't do anything to change that, besides encouraging accountable care organization formation.

EDIT: Basically, if we start to move towards a healthcare delivery system more like an ACO that doesn't pay docs directly for each procedure they perform, then you'll see many specialist salaries fall. This would require much more liberal reform than Obamacare, and won't happen for a while at minimum. More generally, with cuts to medicare, doctor fees may or may not fall across the board. They are supposed to be cut each year for the past few years, but it hasn't happened yet (goggle articles about the SGR formula). Regardless, some specialist salaries are already falling a little, and in general salaries aren't rising much.

There are more detailed threads about this in the med student forum, where people are posting this year's medicare reimbursement rates for different specialities and comparing to previous years. You can also google the medscape physician compensation report for salary information and comparisons to previous years.

 

[Jabbed]

And it begins.

The biggest issue that affects physicians' wages (in the short term) is Medicare reimbursement. It is the gold standard by which private insurance companies set their own reimbursement rates and also represents a substantial portion of total healthcare expenditures. Cuts to Medicare reimbursement directly translate into decreased revenue for providers.

 

[Jabbed]

Yes, this has been happening for quite a long time. It's called fee for service, which is how physicians get paid in the US. Obamacare doesn't do anything to change that, besides encouraging accountable care organization formation.

I think that one of the main undercurrents of the ACA is a transition from a fee for service model to a 'pay for performance' one. Granted, it seems very poorly implemented as of now.

 

[deleted357625]

I think that one of the main undercurrents of the ACA is a transition from a fee for service model to a 'pay for performance' one. Granted, it seems very poorly implemented as of now.

Pay for performance is a disaster. Who would dictate a physicians performance? If a patient doesn't listen is it the physician's fault?
Should I get paid more or less depending on how good I cook the steak from time to time?

These strategies put financial pressure on medical providers. In such programs, reimbursement reflects provider performance on quality metrics based on adherence to certain care processes, scores on patient satisfaction surveys, or patient outcomes.
In fact, however, the Medicare pay-for-performance strategy is not market-driven; it is a strategy to replace the function of a market with government management of health care delivery. This approach will not solve the problem of sluggish quality improvement; nor will it drive patients to better value care. It will, however, introduce perverse new incentives into the delivery of health care that direct resources away from real improvement and even harm quality.

 

[Syndicate]

Honestly, I don't understand why policymakers/Obama are trying to get doctors to make less money. Given the amount of education, training, cost and sacrifice that goes into even becoming a doctor in the first place, and then all the hassle with insurance companies that are trying to short-change you on all your reimbursements plus all the malpractice insurance and high tax rates, doctors don't take home that much money. If doctors start making less, we may lose some really good doctors to other work areas like investment banking where the market is more lucrative. Sure, future doctors are not supposed to go into medicine solely for the money, but I'll be the first to admit that while money/stable job is not the only reason I'm going into medicine, it definitely is a big reason why I, like many of my friends who are aspiring physicians, want to go into medicine. Like I said before, if doctors only end up making $100k/year, we'll lose a lot of the best docs to investment banking and other jobs that have better payouts.



"If someone in your family has a brain tumor, do you want the best neurosurgeon to perform the surgery or do you just want an above average neurosurgeon doing the surgery?"

 

[sourdoughllama]

Pay for performance is a disaster. Who would dictate a physicians performance? If a patient doesn't listen is it the physician's fault?
Should I get paid more or less depending on how good I cook the steak from time to time?

These strategies put financial pressure on medical providers. In such programs, reimbursement reflects provider performance on quality metrics based on adherence to certain care processes, scores on patient satisfaction surveys, or patient outcomes.
In fact, however, the Medicare pay-for-performance strategy is not market-driven; it is a strategy to replace the function of a market with government management of health care delivery. This approach will not solve the problem of sluggish quality improvement; nor will it drive patients to better value care. It will, however, introduce perverse new incentives into the delivery of health care that direct resources away from real improvement and even harm quality.

Have your bosses assess your work (much like it already is), but turn in an official report. I think getting rewarded for good work and penalized for bad work seems fair? It's good to put financial pressure on medical providers in return for accountable practice

 

[sourdoughllama]

Honestly, I don't understand why policymakers/Obama are trying to get doctors to make less money. Given the amount of education, training, cost and sacrifice that goes into even becoming a doctor in the first place, and then all the hassle with insurance companies that are trying to short-change you on all your reimbursements plus all the malpractice insurance and high tax rates, doctors don't take home that much money. If doctors start making less, we may lose some really good doctors to other work areas like investment banking where the market is more lucrative. Sure, future doctors are not supposed to go into medicine solely for the money, but I'll be the first to admit that while money/stable job is not the only reason I'm going into medicine, it definitely is a big reason why I, like many of my friends who are aspiring physicians, want to go into medicine. Like I said before, if doctors only end up making $100k/year, we'll lose a lot of the best docs to investment banking and other jobs that have better payouts.



"If someone in your family has a brain tumor, do you want the best neurosurgeon to perform the surgery or do you just want an above average neurosurgeon doing the surgery?"

I don't think they're trying to make doctors make less money per se; I would say it's more that doctors are making tons of money while the poor can't even get proper health care. Health care costs are ridiculously high in my opinion, and of course I agree with you that finances are a big reason why most people are going into this career (including myself). I'm just playing the devil's advocate here by saying that is it better to have people cared for or to have doctors who are sufficiently content with very high salaries? Everyone says doctors don't even make that much money but I know a ton of doctors and they all seem pretty well off (primary care level pay included).

Edit: Yes, I am aware that other fields don't require as much schooling/debt/malpractice to make the same amount, but even with all that, PCPs are still making a ton of money compared to the "average" American house hold. I'm not siding with cutting physician pay, I'm just saying that while it would suck, it's not the end of the world.

 

[TheWeeIceMan]

Have your bosses assess your work (much like it already is), but turn in an official report. I think getting rewarded for good work and penalized for bad work seems fair? It's good to put financial pressure on medical providers in return for accountable practice

How would you like to determine good and bad work?

 

[deleted357625]

Have your bosses assess your work (much like it already is), but turn in an official report. I think getting rewarded for good work and penalized for bad work seems fair? It's good to put financial pressure on medical providers in return for accountable practice

Incentives matter in health care, and subjecting health care providers to financial pressure is necessary to encourage meaningful, widespread, and lasting quality improvement. Real market competition (not pay for performance) can achieve these goals, allowing providers of medical care to secure a larger patient base by offering the best value. With transparency in outcomes and other quality indicators that matter to patients, individuals can take advantage of the best that medical professionals have to offer before an episode of care takes place. Within a system of administrative pricing, pay-for-performance instead offers financial incentives to improve quality through slight alterations to reimbursement after care has already been provided. Rather than making quality improvement imperative to a provider’s existence—building a strong “business case” for quality—this strategy provides a slight slap on the wrist for those who fail to keep up.
The main structural flaw of the federal pay-for-performance approach is that it does not involve patients in the drive for better value. The programs allow patients to continue behaving as they normally would when choosing providers, since patients do not share in any of the savings from finding and using high-value health care providers. The goal of these programs is for the payer—Medicare—to achieve better value by retroactively paying more when, on the whole, high-quality care was received and less when low-quality care was received. A more effective, patient-centered way to promote improved quality is to revamp the financing and delivery of American health care such that each individual experiences incentives to seek out value in the system, and has both the necessary assistance and proper tools to do so.
What do we do about complex, hard-to-monitor tasks where the desired outcome is difficult to measure and subject to influences outside the employee's control — such as educating a child or restoring a patient to health? It is almost impossible to design objective performance metrics that can't be met through illegal or undesirable behavior. In the case of education, it could be falsifying student test scores; in the case of healthcare, it could be controlling blood pressure through medications that make patients feel sick instead of persuading patients to exercise. And when you create a system that inadvertently incentivizes illegal or undesirable behavior, you get more of it.

 

[CarlosDanger]

Honestly, I don't understand why policymakers/Obama are trying to get doctors to make less money. Given the amount of education, training, cost and sacrifice that goes into even becoming a doctor in the first place, and then all the hassle with insurance companies that are trying to short-change you on all your reimbursements plus all the malpractice insurance and high tax rates, doctors don't take home that much money. If doctors start making less, we may lose some really good doctors to other work areas like investment banking where the market is more lucrative. Sure, future doctors are not supposed to go into medicine solely for the money, but I'll be the first to admit that while money/stable job is not the only reason I'm going into medicine, it definitely is a big reason why I, like many of my friends who are aspiring physicians, want to go into medicine. Like I said before, if doctors only end up making $100k/year, we'll lose a lot of the best docs to investment banking and other jobs that have better payouts.



"If someone in your family has a brain tumor, do you want the best neurosurgeon to perform the surgery or do you just want an above average neurosurgeon doing the surgery?"

I wouldn't mind if we took a few smart people from the premed pool and put them in Congress. Your job isn't as hard as being a doctor? Yeah, we could tell.

Despite the fact that there is a ton of hard work and sacrifice involved in becoming a doctor, most DO make a lot of money relative to the general public. Further, if one of your main motivations of going in to medicine is making bank, you can pretty easily organize your career to do so. Those who make less usually choose to do so in order to run a lab, take a government job, etc. Its ok to want to make a comfortable living. I'm just saying that no one is making $100k against their will.

 

[deleted357625]

I don't think they're trying to make doctors make less money per se; I would say it's more that doctors are making tons of money while the poor can't even get proper health care. Health care costs are ridiculously high in my opinion, and of course I agree with you that finances are a big reason why most people are going into this career (including myself). I'm just playing the devil's advocate here by saying that is it better to have people cared for or to have doctors who are sufficiently content with very high salaries? Everyone says doctors don't even make that much money but I know a ton of doctors and they all seem pretty well off (primary care level pay included).

Doctors making more money - Good. Poor are just poor and can't receive healthcare - Tough Luck. What's fair about self-sacrifice on the physicians part? If physicians gave up all their money they would have achieved sainthood in the views of this country, this idea of morality is distorted. There is no such thing or concept as equality. If I want to be on the same level as Michael Jordan, the only way is to break his arms and legs. People are born rich some poor, some with unique talents some not, some intelligent some idiots.

The higher the salaries for not just physicians but anyone is good. They increase our standard of living, they create value, it's a voluntary exchange between free individuals. Our lives are much better off without anyone trying to dictate the healthcare system and destroying the incentive to pursue medicine when there's already a saturation/shortage issue in PC.

 

[sourdoughllama]

How would you like to determine good and bad work?

Death rate? Complication rate? Accountability? I'm sorry, but there is a way to tell good and bad work in every field. I don't run a hospital so I don't know the metrics by which good work is determined but running unnecessary tests or treating patients with disrespect can be assessed.

 

[deleted357625]

Death rate? Complication rate? Accountability? I'm sorry, but there is a way to tell good and bad work in every field. I don't run a hospital so I don't know the metrics by which good work is determined but running unnecessary tests or treating patients with disrespect can be assessed.

And if a physician advises a patient to take his medication, yet fails is the physician to blame? Pay for performance - there is no such thing... As much as a physician tries - he provides a service - it's up to the patient to determine how he lives his life. Do you understand?

How can a physician know how well he does when every time he is reimbursed AFTER surgery or such, and who dictates? Where is an incentive when he doesn't know what the outcome will be?

 

[sourdoughllama]

Doctors making more money - Good. Poor are just poor and can't receive healthcare - Tough Luck. What's fair about self-sacrifice on the physicians part? If physicians gave up all their money they would have achieved sainthood in the views of this country, this idea of morality is distorted. There is no such thing or concept as equality. If I want to be on the same level as Michael Jordan, the only way is to break his arms and legs. People are born rich some poor, some with unique talents some not, some intelligent some idiots.

The higher the salaries for not just physicians but anyone is good. They increase our standard of living, they create value, it's a voluntary exchange between free individuals. Our lives are much better off without anyone trying to dictate the healthcare system and destroying the incentive to pursue medicine when there's already a saturation/shortage issue in PC.

Hey I'm not saying that that concept is what I agree with, but "If physicians gave up all their money" is exactly what I'm pointing out. People in this field make a huge deal when their income gets close to 150K. That's gotta sound silly to everyone else. Even I wouldn't feel bad for me.

 

[sourdoughllama]

And if a physician advises a patient to take his medication, yet fails is the physician to blame? Pay for performance - there is no such thing... As much as a physician tries - he provides a service - it's up to the patient to determine how he lives his life. Do you understand?

Exactly; that is why you have review boards to assess your performance from the health care provider point of view (your boss). I'm sorry, but I cannot buy into you guys' idea that physician performance cannot somehow be at least monitored or assessed. Yes there are many things that are out of your control, but so are all the other jobs out there. So if we go by this logic, then how are we able to assess the performance of any employee anywhere? You can't force customers to do what you want; you assess performance within logical bounds. It's not a perfect system but from the other posts it seems to me that you guys are saying there is no way physicians should be held accountable for performance (outside of literally killing people or blatantly breaking rules)

Some metrics people can go by to assess physician performance:
1- Unnecessary tests? Not enough tests?
2- Are patients treated with respect? (this one can be iffy but if 90% of your patients say no I don't think that's really debatable)
3- Do you follow protocol to your best ability? (Patient compliance is then assessed separately - you can't make them all do the right thing)
4- Do you treat other staff with respect?

Yes these are amateur metrics but to say there is no way to gauge performance I cannot agree with. I am pretty sure these must already be taken into account anyway

 

[deleted357625]

Hey I'm not saying that that concept is what I agree with, but "If physicians gave up all their money" is exactly what I'm pointing out. People in this field make a huge deal when their income gets close to 150K. That's gotta sound silly to everyone else. Even I wouldn't feel bad for me.

It's not silly. Individuals pursue what they value, which is their time, efforts, and goals. This all stems from life in general. This gives humans purpose. If one spends on average 11+ years of their life dedicated to a self-interest of theirs that defines their moral compass, yes they would like to be compensated freely for what they achieved, a value produced that only a handful can provide in a society of 300 million people - part of the reason why their salaries are high. When you have government controls and regulations dictating every step of your life - where's your incentive to truly value life anymore? 150K is worth enough to someone who wants to pursue a field worth that amount that fulfills their goals and interests, for ones who know the value of what they produce is greater (but reduced due to someone looking over your shoulder), and people are willing to pay for something - they obviously value what the producers make and is considered higher than what they pay for or they wouldn't even bother.

 

[deleted357625]

Exactly; that is why you have review boards to assess your performance from the health care provider point of view (your boss). I'm sorry, but I cannot buy into you guys' idea that physician performance cannot somehow be at least monitored or assessed. Yes there are many things that are out of your control, but so are all the other jobs out there. So if we go by this logic, then how are we able to assess the performance of any employee anywhere? You can't force customers to do what you want; you assess performance within logical bounds. It's not a perfect system but from the other posts it seems to me that you guys are saying there is no way physicians should be held accountable for performance (outside of literally killing people or blatantly breaking rules)

Stop saying "your boss," physicians can run their own independent practices.
You still don't comprehend the fallacy behind such a proposal. Not only can such a method lead to immoral behavior, but the incentive is a fallacy that doesn't exist. Apparently you don't understand the free-market. If a value someone produces is bad, patients stop visiting his office. Done Deal. The market can fix itself.
Example of a pay-for performance in education:
35 public school teachers and administrators indicted for allegedly cheating to raise test scores in an Atlanta school district began turning themselves in to authorities. They may be the tip of the iceberg; a state investigation implicates 178 educators in the scandal.
Were these teachers and principals all "bad apples," intrinsically unethical individuals who somehow ended up in the same school district? Not likely. They were ordinary people who allegedly did unethical and dishonest things to achieve the student performance targets needed to keep their jobs and earn their bonuses. The Atlanta cheating scandal illustrates the dangers of the modern infatuation with incentives and what's called "pay for performance."

 

[TheWeeIceMan]

Death rate? Complication rate? Accountability? I'm sorry, but there is a way to tell good and bad work in every field. I don't run a hospital so I don't know the metrics by which good work is determined but running unnecessary tests or treating patients with disrespect can be assessed.

Maybe there is a decent way to evaluate physician performance, but I don't think any of your examples would qualify. Medicine is a field in which you can do everything right and still get a poor outcome. How will you control for that issue or for non-complaint patients?

Also, many of your examples of performance metrics would create a situation that would incentivize physicians to not treat very sick patients or those that may be less likely to follow the physician's treatment plan.

lol, at tracking "disrespect."

 

[sourdoughllama]

Maybe there is a decent way to evaluate physician performance, but I don't think any of your examples would qualify. Medicine is a field in which you can do everything right and still get a poor outcome.
lol, at tracking "disrespect."

Like I said, that can be said for almost every job out there. You and I can agree to disagree on the respect thing. Physicians are the worst offenders when it comes to creating a team environment in hospitals from my observations. Maybe that's not something that also holds true from your experiences.

Stop saying "your boss," physicians can run their own independent practices.
You still don't comprehend the fallacy behind such a proposal. Not only can such a method lead to immoral behavior, but the incentive is a fallacy that doesn't exist. Apparently you don't understand the free-market. If a value someone produces is bad, patients stop visiting his office. Done Deal. The market can fix itself.
Example of a pay-for performance in education:
35 public school teachers and administrators indicted for allegedly cheating to raise test scores in an Atlanta school district began turning themselves in to authorities. They may be the tip of the iceberg; a state investigation implicates 178 educators in the scandal.
Were these teachers and principals all "bad apples," intrinsically unethical individuals who somehow ended up in the same school district? Not likely. They were ordinary people who allegedly did unethical and dishonest things to achieve the student performance targets needed to keep their jobs and earn their bonuses. The Atlanta cheating scandal illustrates the dangers of the modern infatuation with incentives and what's called "pay for performance."

I can see what you're saying about the pay for performance thing, and I agree that it can back fire. But not all medicine is private practice - and your performance does get tracked regardless of private practice or not.

Okay those are all my points, I don't have anymore to argue about
The WeeIceMan: I'd appreciate if you didn't make fun of my posts, but instead just addressed them.

 

[astromfs]

Medicine is far from perfect to be pay per performance.

 

[deleted357625]

I can see what you're saying about the pay for performance thing, and I agree that it can back fire. But not all medicine is private practice - and your performance does get tracked regardless of private practice or not.

Okay those are all my points, I don't have anymore to argue about
The WeeIceMan: I'd appreciate if you didn't make fun of my posts, but instead just addressed them.

"And your performance does get tracked regardless of private practice or not."
You just said it. Hence, no need for pay for performance. In a free market, you have two voluntary consenting individuals who voluntarily exchange products or services, in this case if a physician's value lacks performance he suffers - similar to any business. No need for "pay for performance." The market can sort itself out. Such a method only hurts the healthcare system. If a burger joint cooks bad burgers consistently. I stop going.

 

[sourdoughllama]

"And your performance does get tracked regardless of private practice or not."
You just said it. Hence, no need for pay for performance. In a free market, you have two voluntary consenting individuals who voluntarily exchange products or services, in this case if a physician's value lacks performance he suffers - similar to any business. No need for "pay for performance." The market can sort itself out. Such a method only hurts the healthcare system. If a burger joint cooks bad burgers consistently. I stop going.

Okay sounds good

 

[Pacna]

Sorry; didn't mean "procedures" taken literally. What I meant to say is that they will do stuff like performing additional exams on patients that may not necessarily need them, and the like.

Oh I see. That makes more sense. 🙂

 

[Gauss44]

I've looked this question up online before, and different people seem to say different things, and I just can't seem to find a clear, easy-to-understand answer as to how Obamacare will affect physician salaries (I think it's agreed upon that Obamacare will be causing a decrease in physician salaries though). Can anyone give me a simple explanation about this? I'm trying to understand the healthcare system in the US better. I know a lot more than I used to before, but I'm still not nearly as knowledgeable as I'd like to be.

ObamaCare:

1. More people will be covered by insurance. <-- That probably means more trips to the doctor's office.
2. Insurance companies have always tried to negotiate low reimbursement rates for medical procedures/doctor's office visits. But now, there may be more pressure to accept lower rates (political pressure, etc.). Insurance companies might use ObamaCare as a reason to try to negotiate lower reimbursements (They will use any "reason" they can, any year with or without ObamaCare.).
3. Obama wishes ObamaCare included much more, and that Republicans wished it included much less. What will be included and who will be covered by ObamaCare might change now and then.

In General:

Doctors may need to defend their paycheck.
-They could take politicians on directly.
-Some might get creative with the service they offer to make more money: Examples, offering exceptional hospitality and advertising to wealthy demographics that are self pay. Advertising high tech new procedures.
-They could just ALL (or most) avoid lower paying specialties and say, "If there's a primary care shortage, then offer primary care a paycheck. Don't expect PCP's to work for free!"

 

[lobo.solo]

PCPs are going to make a bit more with the ACA. Specialist (in general) are going to make somewhat less then what they were used to. In reality, it is difficult to predict what exactly will be the magnitude of those changes... I think is cool that PCPs are going to get incentives with this law given the hard and much needed work that they do.

 

[Tommyguns89]

Honestly, I don't understand why policymakers/Obama are trying to get doctors to make less money. Given the amount of education, training, cost and sacrifice that goes into even becoming a doctor in the first place, and then all the hassle with insurance companies that are trying to short-change you on all your reimbursements plus all the malpractice insurance and high tax rates, doctors don't take home that much money. If doctors start making less, we may lose some really good doctors to other work areas like investment banking where the market is more lucrative. Sure, future doctors are not supposed to go into medicine solely for the money, but I'll be the first to admit that while money/stable job is not the only reason I'm going into medicine, it definitely is a big reason why I, like many of my friends who are aspiring physicians, want to go into medicine. Like I said before, if doctors only end up making $100k/year, we'll lose a lot of the best docs to investment banking and other jobs that have better payouts.



"If someone in your family has a brain tumor, do you want the best neurosurgeon to perform the surgery or do you just want an above average neurosurgeon doing the surgery?"

Dont you need to pretty much go to an ivy league college and then get the right internship while there to get an IB job(at least the ones that pay a lot) these days? Honestly, for a lot of people in medical school there probably isnt a more financially rewarding(in the long term assuming a full career) path realistically available to them. The top lawyers and top Finance guys make much more than doctors but its usually feast or famine in those professions and being at the top involves a lot more than doing well in school.

The point where you would see doctors leaving is if they start getting paid less than doctors in other countries. US trained physicians are welcome in a lot of countries, if income decreases by enough I can see some of them saying screw it, especially the current/next generations that are settling down with a family later in life.

 

[knv2u]

Few people, including the lawmakers who voted to pass the bill, have actually read it. (Nancy Pelosi, then Speaker of the House, opined something to the effect that we would need to pass the bill to see what was in it). With all of the delays and administrative red tape and other variables/intangibles that are unknown, I don't think anyone can give you a straight up answer. I do agree with the others, however, that I would be concerned about lower reimbursement costs as has already been pointed out in this thread.

 

[knv2u]

Like I said before, if doctors only end up making $100k/year, we'll lose a lot of the best docs to investment banking and other jobs that have better payouts.

I don't believe that physician salaries will ever be this low for precisely this reason. There are far too many physicians who would leave the medical profession. There would be a shortage of doctors and the so-called "underserved" regions would be even more underserved. The bill, at that point, would help to screw over some of those it supposedly aids. There would be such an enormous political backlash that would likely repeal the law IMO. I mean, come on. The Congressmen/Senators make more than $100k a year. It would be interesting to see if more MDs developed an interest in political office. 😛

 

[Pacna]

I don't believe that physician salaries will ever be this low for precisely this reason. There are far too many physicians who would leave the medical profession. There would be a shortage of doctors and the so-called "underserved" regions would be even more underserved. The bill, at that point, would help to screw over some of those it supposedly aids. There would be such an enormous political backlash that would likely repeal the law IMO. I mean, come on. The Congressmen/Senators make more than $100k a year. It would be interesting to see if more MDs developed an interest in political office. 😛

You mean like 95% of laws?

Physicians will continue to get payed according to their value like most professions (minus government employees). The only way to decrease the cost of docs is to increase the supply or distribute some work to NPs/PAs (which I think is past due).

 

[knv2u]

Physicians will continue to get payed according to their value like most professions (minus government employees). The only way to decrease the cost of docs is to increase the supply or distribute some work to NPs/PAs (which I think is past due).

The increased demand by having more patients and an aging population should counterbalance any small changes in the supply (or at least I would think so); and with regards to the latter, wouldn't that only affect family medicine/pediatrics/internists who practice in primary care? Are you predicting that most other medical specialities will not see a reduction in pay under the ACA?

 

[Pacna]

The increased demand by having more patients and an aging population should counterbalance any small changes in the supply (or at least I would think so); and with regards to the latter, wouldn't that only affect family medicine/pediatrics/internists who practice in primary care? Are you predicting that most other medical specialities will not see a reduction in pay under the ACA?

While I agree with you that the supply of docs isn't likely to increase in a significant way any time soon, I was speaking more principally. More docs = less doc value. I wasn't saying that there was going to be or even could possibly be a necessary increase in new docs.

If anything, I'd expect specialist pay to increase with the increase amount of patients seeking care (and I wouldn't be surprised if PCP salaries fall). Remember: The government is almost always wrong when it attempts to predict economic trends or the effects/costs of its programs.

 

[knv2u]

@Rik1111 - I hope you're right!

 

[Pacna]

@Rik1111 - I hope you're right!

Haha! I don't! I think specialists get paid plenty while PCPs could use a boost.

 

[BlueLabel]

Hey I'm not saying that that concept is what I agree with, but "If physicians gave up all their money" is exactly what I'm pointing out. People in this field make a huge deal when their income gets close to 150K. That's gotta sound silly to everyone else. Even I wouldn't feel bad for me.

Not just referencing the quoted post but your comments in this thread generally, you are very naive and it's almost painful watching you hold forth on some of these issues.

 

[circulus vitios]

I'm not worried about it. I just won't accept Medicaid/Medicare.

 

[rbolt25]

I'm not worried about it. I just won't accept Medicaid/Medicare.

If we end up with a single payer system (which is most likely the goal for all the liberal big government supporters), #1 heathcare is going down the tubes and #2 you may not have a choice on what you accept/dont accept

 

[phunky]

It's going to become a lot more like the European system. Many doctors in places like Spain and England split their time between seeing patients with public healthcare and those who have private insurance or are willing to pay out of pocket.

 

[circulus vitios]

If we end up with a single payer system (which is most likely the goal for all the liberal big government supporters), #1 heathcare is going down the tubes and #2 you may not have a choice on what you accept/dont accept

Not necessarily. NHS and Canadians physicians get a good salary and private practice still exists.

 

[sourdoughllama]

Not just referencing the quoted post but your comments in this thread generally, you are very naive and it's almost painful watching you hold forth on some of these issues.

.

 

[Syndicate]

Dont you need to pretty much go to an ivy league college and then get the right internship while there to get an IB job(at least the ones that pay a lot) these days? Honestly, for a lot of people in medical school there probably isnt a more financially rewarding(in the long term assuming a full career) path realistically available to them. The top lawyers and top Finance guys make much more than doctors but its usually feast or famine in those professions and being at the top involves a lot more than doing well in school.

The point where you would see doctors leaving is if they start getting paid less than doctors in other countries. US trained physicians are welcome in a lot of countries, if income decreases by enough I can see some of them saying screw it, especially the current/next generations that are settling down with a family later in life.

Good point but I would say that there are a lot of future doctors who would be qualified for those IB jobs if they planned for an IB career all the way back in high school. The education, work ethic, training, dedication, cost, and discipline that goes into becoming a doctor is far greater than that of becoming successful in careers like IB. If you can become a successful specialist, chances are you could have become a successful hedge fund manager given your attributes. Of course, I'm speaking generally.

 

[BlueLabel]

Good point but I would say that there are a lot of future doctors who would be qualified for those IB jobs if they planned for an IB career all the way back in high school. The education, work ethic, training, dedication, cost, and discipline that goes into becoming a doctor is far greater than that of becoming successful in careers like IB. If you can become a successful specialist, chances are you could have become a successful hedge fund manager given your attributes. Of course, I'm speaking generally.

Pure speculation