Physician compensation decreasing?

[Lothric]

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Hey,

Does anyone have a crystal ball and can tell me where they see the future physician salaries go? I'll not be an attending until 10-12 years from now but I do value high compensation alot and if anything points to them taking a nosedive soon it would really drag me down to no end. I feel like I'm at an irreversible point in life right now too, so it would be even more terrible knowing that I'll be heading into a tanking market. That doesn't mean I regret it yet though (today's compensation seems OK), knowing it has sinked a bit...

It would seriously piss me off to no end if the poor med student with 200-500k student loan debt, suffering through the hell that is residency/fellowship only comes out making less than 200k/year when some random idiot DJ called Zedd pulls in 15 millions a year in his 20s, Logan Paul who films cadavers pulls in another 6-10 millions a year or the random peanut brain average NHL player pulls in millions a year. They never had to sacrifice to the same extent as the average doc in his/her late 30s.

Yet somehow people complain about docs being overpaid but never mention individuals like Ricegum, Justin Bieber and what have you.

Either way, what do you guys think? If a compensation decrease is expected, would this affect all specialties or only some?

 

[Raryn]

My bet is that a number of specialties will have compensation decrease, but it's hard to predict which ones.

For example, right now spine surgeons make more than any other doctors - I find it very unlikely that's going to persist when the outcomes for spine surgery are so crappy. But it's also possible new operations or new evidence comes up and/or reimbursement for spine operations doesn't get slashed.

I think the most vulnerable specialties are those that depend on just 1-2 procedures for the lion's share of their reimbursement. Ex: Many people predict that GI salaries will come down in the long run as we get alternatives to screening colonoscopies and there's less scope volume in general.

I also think that primary care, hospitalist work, and the lower paying subspecialties are relatively safe - but then I can easily be wrong. Medicare can easily change the reimbursement rules (see the proposed merger of the 5 complexity levels) in a way that screws us too.

 

[Ironheme]

(see the proposed merger of the 5 complexity levels)

This. If they do this, there is 0 chance I'd go into primary care clinic work. I don't understand the logic in getting paid the same to do 2 - 3 x the work, or doing less work but then getting sued if you miss something...

 

[recycledpaper]

In this life, you are going to come across a lot of people who are less intelligent than you, that make more money than you. A lot of people do not have to sacrifice their 20s and 30s for their job. That is just a way of life. You sitting at your computer, fuming at the idea of someone like Zedd or Justin Bieber making more money than you, is honestly laughable. Stop worrying about others, and focus on what gives you fulfillment.

 

[Shambere]

My bet is that a number of specialties will have compensation decrease, but it's hard to predict which ones.

For example, right now spine surgeons make more than any other doctors - I find it very unlikely that's going to persist when the outcomes for spine surgery are so crappy. But it's also possible new operations or new evidence comes up and/or reimbursement for spine operations doesn't get slashed.

I think the most vulnerable specialties are those that depend on just 1-2 procedures for the lion's share of their reimbursement. Ex: Many people predict that GI salaries will come down in the long run as we get alternatives to screening colonoscopies and there's less scope volume in general.

I also think that primary care, hospitalist work, and the lower paying subspecialties are relatively safe - but then I can easily be wrong. Medicare can easily change the reimbursement rules (see the proposed merger of the 5 complexity levels) in a way that screws us too.

GI wont decrease dramatically, because endoscopy has many useful techniques (therapeutic and diagnostic) that go beyong screening colonoscopies. A well skilled and available GI is a godsend to any hospital and his colleagues.

 

[VA Hopeful Dr]

GI wont decrease dramatically, because endoscopy has many useful techniques (therapeutic and diagnostic) that go beyong screening colonoscopies. A well skilled and available GI is a godsend to any hospital and his colleagues.

Why don't you go find the numbers for screening colonoscopies versus diagnostic endoscopy of every form and report back to the class?

Never mind, I'll do it for you.

Roughly 25% of all GI endoscopy of all types is for colon cancer screening.

If you think a 25% reduction in procedure volume won't hit their bottom line hard, I don't know what to tell you.

 

[Shambere]

Why don't you go find the numbers for screening colonoscopies versus diagnostic endoscopy of every form and report back to the class?

Never mind, I'll do it for you.

Roughly 25% of all GI endoscopy of all types is for colon cancer screening.

If you think a 25% reduction in procedure volume won't hit their bottom line hard, I don't know what to tell you.

To reach a mil i guess every scope counts, fair

 

[Redpancreas]

GI wont decrease dramatically, because endoscopy has many useful techniques (therapeutic and diagnostic) that go beyong screening colonoscopies. A well skilled and available GI is a godsend to any hospital and his colleagues.

This is misinformation. Now, I don’t know if Raryn is correct in predicting that proceduralists with 1-2 procedures will see a big cut, but there is no doubt that a majority of GI physicians and probably the majority aspiring for GI on this forum will be doing diagnostic colonoscopies for the most part. The advanced procedures are for those who do an extra year of GI and even those procedures don’t really bring in much money for hospitals and have very specific indiciations meaning they’re not as commonly performed outside of tertiary/quaternary centers. The outcomes, unless they’re for emergent biliary pathology, from what I’ve been reading
(elective ERCP, stenting for suspected duct leak, etc) are not amazing either.

Not addressing you, but I find it crazy how so many people are gunning for GI and don’t even understand the field that well. Everyone I talk to seems to view it as “the Derm of IM” and pursued it because it affords lifestyle/$$$. In addition, if colonoscopies get cut big time, that’s a major issue. My feeling is that I don’t think they’ll get cut that much because they’re still the best test and provide a means for immediate intervention. It’s also weird how everyone thinks Advanced Endoscopy is the GI version of Interventional Cards where you do another year and your salary goes up a 100K. Advanced Endoscopy won’t increase your salary and may in fact decrease it because you will have restrictions on which hospitals need your skills (unless you want to have it just to make yourself more competitive). Also, GI fellows probably work nearly as hard as Cards fellows with call and at the attending level, if they want to be well compensated, they’re working very hard there too.

 

[Gastrapathy]

We’ll be fine. Worry about the IM subs that already make less than general internists.

 

[Sardonix]

Hey,

Does anyone have a crystal ball and can tell me where they see the future physician salaries go? I'll not be an attending until 10-12 years from now but I do value high compensation alot and if anything points to them taking a nosedive soon it would really drag me down to no end. I feel like I'm at an irreversible point in life right now too, so it would be even more terrible knowing that I'll be heading into a tanking market. That doesn't mean I regret it yet though (today's compensation seems OK), knowing it has sinked a bit...

You're a medical student but you're 10-12 years out from being an attending?

Short of societal collapse or an anti-intellectual peasant revolution similar to Mao Zedong or basically anything Pol Pot did, physicians will be just fine. Unless you're going into something niche and already underpaid like pediatric infectious disease, odds are you'll still make well above the average person's income.

Stop worrying about how much money socialites or youtube stars make and just buckle down and do what you have to do.

 

[rokshana]

You're a medical student but you're 10-12 years out from being an attending?

Short of societal collapse or an anti-intellectual peasant revolution similar to Mao Zedong or basically anything Pol Pot did, physicians will be just fine. Unless you're going into something niche and already underpaid like pediatric infectious disease, odds are you'll still make well above the average person's income.

Stop worrying about how much money socialites or youtube stars make and just buckle down and do what you have to do.

if he is a 1st year, then he is, at a minimum, 7 year before being an attending if he goes into IM, Peds, or FM...if GS or other specialties or if he does a fellowship than it could be more like 10 years, so yeah, 10-12 years sounds appropriate enough...

 

[Raryn]

We’ll be fine. Worry about the IM subs that already make less than general internists.

Unless they totally screw all physicians, I'm actually not too worried about decreases in compensation - my pay can't realistically fall below primary care levels.

 

[Winged Scapula]

You're a medical student but you're 10-12 years out from being an attending?

Short of societal collapse or an anti-intellectual peasant revolution similar to Mao Zedong or basically anything Pol Pot did, physicians will be just fine. Unless you're going into something niche and already underpaid like pediatric infectious disease, odds are you'll still make well above the average person's income.

Stop worrying about how much money socialites or youtube stars make and just buckle down and do what you have to do.

He’s a medical student in Sweden or at least states he is in another post.

Looks like he’s contemplating moving to the US because physicians make more money here than in Sweden. Of course he’s forgotten about our lack of coverage for malpractice, healthcare and other social reform programs that they get in Sweden but I think that’s the point of this thread.

 

[Sardonix]

if he is a 1st year, then he is, at a minimum, 7 year before being an attending if he goes into IM, Peds, or FM...if GS or other specialties or if he does a fellowship than it could be more like 10 years, so yeah, 10-12 years sounds appropriate enough...

I recognize that surgical specialties have 5yr (or 6 if neurosurg) residencies and fellowships add another 1-3 years. My point was that it very much struck me as a cart-before-horse situation... but then again I suppose one is never too early to begin financial planning. I just figure that any specialty that requires 5+ years residency likely won't have too much trouble paying off loans, barring major political changes.

 

[Obnoxious Dad]

He’s a medical student in Sweden or at least states he is in another post.

Looks like he’s contemplating moving to the US because physicians make more money here than in Sweden. Of course he’s forgotten about our lack of coverage for malpractice, healthcare and other social reform programs that they get in Sweden but I think that’s the point of this thread.

And you are forgetting the draconian taxes in Sweden.

I have a Swedish friend who worked in the U.S. for a while in cancer research. I once played golf with him and two of his Swedish doctor buddies here in the states. They whined about the Swedish system for the entire round of golf. They carped about low pay, high taxes and how good the American physicians have it.

 

[Winged Scapula]

And you are forgetting the draconian taxes in Sweden.

I have a Swedish friend who worked in the U.S. for a while in cancer research. I once played golf with him and two of his Swedish doctor buddies here in the states. They whined about the Swedish system for the entire round of golf. They carped about low pay, high taxes and how good the American physicians have it.

Lol I’m not forgetting anything. I’m well aware (as a citizen of the world who knows stuff and someone who’s very close friend moved to Sweden for 20+ years). Ever talk to a Swede that actually moved here to the US? Listen to them start complaining about the lack of lengthy maternity and paternity leave, the cost of college, the lack of other social programs and all of a sudden our exorbitant salary doesn’t seem so great.

It just wasn’t worth mentioning because it’s not on topic; I was just providing context for people who are confused about the op’s goals .

 

[GoSpursGo]

Does anyone have a crystal ball and can tell me where they see the future physician salaries go?

Are you really going to base your career decisions about how random people on the internet peer into a nonexistent crystal ball?

I mean, yes compensation is highly important, but nobody knows what's going to happen 10-12 years from now if that's your timeframe.

 

[Obnoxious Dad]

Lol I’m not forgetting anything. I’m well aware (as a citizen of the world who knows stuff and someone who’s very close friend moved to Sweden for 20+ years). Ever talk to a Swede that actually moved here to the US? Listen to them start complaining about the lack of lengthy maternity and paternity leave, the cost of college, the lack of other social programs and all of a sudden our exorbitant salary doesn’t seem so great.

It just wasn’t worth mentioning because it’s not on topic; I was just providing context for people who are confused about the op’s goals .

We can talk about Sweden's confiscatory tax rates in the abstract but let's have everyone on this board take a look at them. They are nothing to "LOL" about.
Sweden Personal Income Tax Rate | 1995-2018 | Data | Chart | Calendar

The top individual marginal rate is 61%. The sales tax rate is 25%. The total Social Security tax rate, the burden of which ultimately falls on the employee, is 38.42%. I'll pass on the cradle to grave social programs and keep the lion's share of what I earn, thank you very much.

 

[Winged Scapula]

We can talk about Sweden's confiscatory tax rates in the abstract but let's have everyone on this board take a look at them. They are nothing to "LOL" about.
Sweden Personal Income Tax Rate | 1995-2018 | Data | Chart | Calendar

The top individual marginal rate is 61%. The sales tax rate is 25%. The total Social Security tax rate, the burden of which ultimately falls on the employee, is 38.42%. I'll pass on the cradle to grave social programs and keep the lion's share of what I earn, thank you very much.

I am “loling” st your insinuation that I was unaware of Sweden’s notorious tax rates, Not everyone is ignorant of world issues.

However, this is considerably off topic and is not relevant to the OP.

 

[Shufflin]

Hey,
iI
Does anyone have a crystal ball and can tell me where they see the future physician salaries go? I'll not be an attending until 10-12 years from now but I do value high compensation alot and if anything points to them taking a nosedive soon it would really drag me down to no end. I feel like I'm at an irreversible point in life right now too, so it would be even more terrible knowing that I'll be heading into a tanking market. That doesn't mean I regret it yet though (today's compensation seems OK), knowing it has sinked a bit...

It would seriously piss me off to no end if the poor med student with 200-500k student loan debt, suffering through the hell that is residency/fellowship only comes out making less than 200k/year when some random idiot DJ called Zedd pulls in 15 millions a year in his 20s, Logan Paul who films cadavers pulls in another 6-10 millions a year or the random peanut brain average NHL player pulls in millions a year. They never had to sacrifice to the same extent as the average doc in his/her late 30s.

Yet somehow people complain about docs being overpaid but never mention individuals like Ricegum, Justin Bieber and what have you.

Either way, what do you guys think? If a compensation decrease is expected, would this affect all specialties or only some?

I just got off the phone with the president of Medicare and he said they plan to stop paying doctors by 2020. So I don't think the USA is gonna work well for you my friend.

 

[rokshana]

We can talk about Sweden's confiscatory tax rates in the abstract but let's have everyone on this board take a look at them. They are nothing to "LOL" about.
Sweden Personal Income Tax Rate | 1995-2018 | Data | Chart | Calendar

The top individual marginal rate is 61%. The sales tax rate is 25%. The total Social Security tax rate, the burden of which ultimately falls on the employee, is 38.42%. I'll pass on the cradle to grave social programs and keep the lion's share of what I earn, thank you very much.

who cares? This is a general residency forum for those involved in or have been involved in residency programs...i don't think you qualify.

 

[Obnoxious Dad]

who cares? This is a general residency forum for those involved in or have been involved in residency programs...i don't think you qualify.

There are plenty of people who post on these threads who are not, have not and perhaps will not be residents. I could still go to a community college, take the premed courses required and then go to med school in the Caribbean. I'd bet St. Eustatius would take my money.

 

[rokshana]

There are plenty of people who post on these threads who are not, have not and perhaps will not be residents. I could still go to a community college, take the premed courses required and then go to med school in the Caribbean. I'd bet St. Eustatius would take my money.

i wouldn't know since i did not go to that school.

occasionally an SO/spouse or a med student does post here to ask a question that is still related to the topic of the forum...but generally aren't giving advice on what to do said resident...you are giving your opinion about what its like to be a resident/physician in the US as well as what its like to live in Sweden...neither of which you have experience with, other than, maybe, having spent the night at a Holiday Inn...

please stay on topic...and the topic is not to try to think you are the only one here with a world view (WS has probably lived in more countries that you have even thought to visit).

 

[Obnoxious Dad]

i wouldn't know since i did not go to that school.

occasionally an SO/spouse or a med student does post here to ask a question that is still related to the topic of the forum...but generally aren't giving advice on what to do said resident...you are giving your opinion about what its like to be a resident/physician in the US as well as what its like to live in Sweden...neither of which you have experience with, other than, maybe, having spent the night at a Holiday Inn...

please stay on topic...and the topic is not to try to think you are the only one here with a world view (WS has probably lived in more countries that you have even thought to visit).

You don't know a thing about me. I don't have to rationalize my presence on these boards to you but I will anyway.

I post on these boards because healthcare accounts for approximately 18% of the US GDP. Most of the people who post here have never studied logistics, economics, public policy, taxes, or the law. All of these subjects have a bearing on health care and I have studied these issues and worked in those fields. I would bet that you have not. If you don't like to hear a different voice you should go to your safe space and not try to silence others.

 

[VA Hopeful Dr]

You don't know a thing about me. I don't have to rationalize my presence on these boards to you but I will anyway.

I post on these boards because healthcare accounts for approximately 18% of the US GDP. Most of the people who post here have never studied logistics, economics, public policy, taxes, or the law. All of these subjects have a bearing on health care and I have studied these issues and worked in those fields. I would bet that you have not. If you don't like to hear a different voice you should go to your safe space and not try to silence others.

I would bet none of that means anything, but you do you I guess

 

[Winged Scapula]

Let’s get back on topic guys.

 

[rokshana]

You don't know a thing about me. I don't have to rationalize my presence on these boards to you but I will anyway.

I post on these boards because healthcare accounts for approximately 18% of the US GDP. Most of the people who post here have never studied logistics, economics, public policy, taxes, or the law. All of these subjects have a bearing on health care and I have studied these issues and worked in those fields. I would bet that you have not. If you don't like to hear a different voice you should go to your safe space and not try to silence others.

Please that is not why you post...you have a daughter who struggled with getting a residency and you blamed all the Caribbean grads here for “taking” your daughters residency spot.

Hopefully she finally did get something but please, don’t make us sound like you have nothing personal going on here...but even if it was the reason...then, again, what on earth does that have anything to do with the topic of this thread? Nothing.

 

[Winged Scapula]

Closing because we can’t seem to stay on topic and none of us have a crystal ball for the OP.