physician salaries in the next decade? less than 100K?

[Vaseline]

i frequent the kevinmd blog site. recently, i read an article ( http://www.kevinmd.com/blog/2014/09/hard-truths-dispelling-10-health-care-myths.html ) that speculated - quite confidently i must add - that physicians' salaries will reduce significantly in the next decade. it projected PCP salaries to dip to $90,000 and sub-specialty salaries to drop to $150,000.

those figures look a little scary... now i'm just as altruistic as the next pre-med, but the prospect of making a $200,000 investment to earn less than $100k/ year sounds like financial suicide. i understand medicine isn't the best financial decision in the first place, but earning that salary already 200k in the hole... man, that is a deep hole. unless the drops in salary are accommodated by propionate drops in medical tuition, or perhaps proportionate increases in resident salary, newly minted doctors may be in trouble

am i being unreasonable? or does that scare anyone else?

is it possible to see such a drastic drop in salary in such a short period of time?

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[Lucca]

While reimbursement will certainly decline in the future, I see no reason why it would drop so precipitously in a very short period of time. What are the arguments behind this Sub-100k future?

Also, it is interesting that in the similar threads section at the bottom of this page we see a thread titled "Physician Salaries - below 100K" from '09.

Highly conservative demographic ---> constant paranoia

 

[Aerus]

i frequent the kevinmd blog site. recently, i read an article ( http://www.kevinmd.com/blog/2014/09/hard-truths-dispelling-10-health-care-myths.html ) that speculated - quite confidently i must add - that physicians' salaries will reduce significantly in the next decade. it projected PCP salaries to dip to $90,000 and sub-specialty salaries to drop to $150,000.

those figures look a little scary... now i'm just as altruistic as the next pre-med, but the prospect of making a $200,000 investment to earn less than $100k/ year sounds like financial suicide. i understand medicine isn't the best financial decision in the first place, but earning that salary already 200k in the hole... man, that is a deep hole. unless the drops in salary are accommodated by propionate drops in medical tuition, or perhaps proportionate increases in resident salary, newly minted doctors may be in trouble

am i being unreasonable? or does that scare anyone else?

is it possible to see such a drastic drop in salary in such a short period of time?

Exactly what is yours or the article's reasoning that PCP salaries will drop below 100k? They mentioned a bad economy, but a bad economy negatively affects all careers, not just Physicians.

Specialist salaries have been cut recently, but all the way down to 150k? That doesn't seem realistic.

 

[EMDO2018]

You kids are paranoid, go to sleep. If salaries did drop that low, with the price of tuition nowadays, no one would go into medicine. It wouldn't make logical sense.

 

[TooMuchResearch]

i frequent the kevinmd blog site. recently, i read an article ( http://www.kevinmd.com/blog/2014/09/hard-truths-dispelling-10-health-care-myths.html ) that speculated - quite confidently i must add - that physicians' salaries will reduce significantly in the next decade. it projected PCP salaries to dip to $90,000 and sub-specialty salaries to drop to $150,000.

those figures look a little scary... now i'm just as altruistic as the next pre-med, but the prospect of making a $200,000 investment to earn less than $100k/ year sounds like financial suicide. i understand medicine isn't the best financial decision in the first place, but earning that salary already 200k in the hole... man, that is a deep hole. unless the drops in salary are accommodated by propionate drops in medical tuition, or perhaps proportionate increases in resident salary, newly minted doctors may be in trouble

am i being unreasonable? or does that scare anyone else?

is it possible to see such a drastic drop in salary in such a short period of time?

There are a lot of bad articles on kevinmd. This is probably one of them.

 

[Law2Doc]

Doubtful the average will drop that low. However, earnings/reimbursements continue to go down slowly and average student debt certainly continues to climb. So, if you factor in the "time value of money" (post-residency earnings a decade from now aren't worth as much when you adjust them to today's dollars), and high debt many people accumulate in this field, it's totally reasonable to think that the RELATIVE income will be less than that of someone earning just under six figures in another field. That's just the reality of the job --- you have to wait a long time and incur lots of debt before you get to start banking anything. anyone with any finance background will tell you it's just a bad financial move for someone with other good career options. Hopefully people are choosing medicine for reasons other than money.

 

[FrozenWilly701]

Deleted

 

[Flashfan]

Yes but look at Canadian physician salaries, which is the model that most believe will be emulated in a single-payer system:

http://www.cihi.ca/CIHI-ext-portal/...orkforce/workforce/physicians/RELEASE_22JAN13

 

[sazerac]

You kids are paranoid, go to sleep. If salaries did drop that low, with the price of tuition nowadays, no one would go into medicine. It wouldn't make logical sense.

By that logic, veterinary medicine schools would be empty by now. Yet people compete for a slot every year.

 

[ridethecliche]

Yes but look at Canadian physician salaries, which is the model that most believe will be emulated in a single-payer system:

http://www.cihi.ca/CIHI-ext-portal/internet/en/Document/spending and health workforce/workforce/physicians/RELEASE_22JAN13

Yeah, but those are canadian dollars. Isn't that like monopoly money?

By that logic, veterinary medicine schools would be empty by now. Yet people compete for a slot every year.

Those places can refuse care and refuse insurance though, right? So if most people are paying out of pocket then things are 'easier'. It's the reason that dentists are pretty happy with things right now.

Side note: have you looked at the DRG's for reimbursements from medicare? They are FAR lower than hospital costs in some cases and barely break-even in others.

 

[gettheleadout]

No.

 

[MrChance2]

0% this will happen. Seriously 0%, quit worrying.

 

[styphon]

A more realistic worry is that physician salary increases will not match or exceed inflation rates.

 

[HoboCommander]

More likely physician salary goes up, as demand further outstrips supply. I'm not convinced that Obamacare is going to change the laws of economics. The invisible hand always has the final say.

 

[darklabel]

By that logic, veterinary medicine schools would be empty by now. Yet people compete for a slot every year.

Well there aren't many vet schools (30 schools vs 141 MD schools and 30 DO schools) so it isn't easy comparing the two. If salaries were to fall that low, the low tier MD schools and DO schools would face issues with recruitment (at least of students with current stat averages). It would probably be similar to what pharmacy is today. It is relatively easy for an average medical school applicant to get into a good pharmacy program.

 

[Aerus]

Well there aren't many vet schools (30 schools vs 141 MD schools and 30 DO schools) so it isn't easy comparing the two. If salaries were to fall that low, the low tier MD schools and DO schools would face issues with recruitment (at least of students with current stat averages). It would probably be similar to what pharmacy is today. It is relatively easy for an average medical school applicant to get into a good pharmacy program.

I know a few people who were weeded out earlier on by the premed track who got into top 10 pharmacy schools.

 

[Law2Doc]

More likely physician salary goes up, as demand further outstrips supply. I'm not convinced that Obamacare is going to change the laws of economics. The invisible hand always has the final say.

The law of economics isn't relevant here. It applies, but in the opposite direction you are thinking. There is really one giant customer, and they decide each year what they want to pay. Thats why they can continue cutting reimbursements and why doctors have to just bite their tongue and tighten their belts. So what we are starting to see is a big decline in private practice and increases in hospital based employees in many fields, and the ever increasing specter of capitation -- where hospitals will get a lump sum from a single payor to allocate to various specialties based on net value added. The vet analogy is irrelevant because you don't have a government payor as the essentially lone big customer that matters.

 

[FindMeOnTheLinks]

The law of economics isn't relevant here. It applies, but in the opposite direction you are thinking. There is really one giant customer, and they decide each year what they want to pay. Thats why they can continue cutting reimbursements and why doctors have to just bite their tongue and tighten their belts. So what we are starting to see is a big decline in private practice and increases in hospital based employees in many fields, and the ever increasing specter of capitation -- where hospitals will get a lump sum from a single payor to allocate to various specialties based on net value added. The vet analogy is irrelevant because you don't have a government payor as the essentially lone big customer that matters.

I think you are looking at this from the wrong angle. If the reimbursement were to decline as you (rightfully) predict, it will absolutely not be economically feasible to pursue a career as a physician. Eventually there will be a greater shortage of physicians (primary care especially) than even now. That will throw a wrench in the plans of ACA supporters everywhere. It is possible to have a single-payer marketplace be successful, but physicians will need to be compensated fairly. This can be accomplished in a variety of ways (decrease debt burden, restrict the ease of malpractice litigation, streamline the education process, and many more).

 

[ridethecliche]

I think you are looking at this from the wrong angle. If the reimbursement were to decline as you (rightfully) predict, it will absolutely not be economically feasible to pursue a career as a physician. Eventually there will be a greater shortage of physicians (primary care especially) than even now. That will throw a wrench in the plans of ACA supporters everywhere. It is possible to have a single-payer marketplace be successful, but physicians will need to be compensated fairly. This can be accomplished in a variety of ways (decrease debt burden, restrict the ease of malpractice litigation, streamline the education process, and many more).

What you are not factoring in is that PA's and NP's have been vying for more independence, especially at the primary care level. This is starting to become the case in many states and will probably continue as more physicians move to specialties for higher compensation for their time.

The issue in the US is that it wants to move to a single payer system and act in the way countries with 'socialized' medicine do (with regards to medicare) however, those countries also have the same systems at play for education and that burden is much lower. You're more likely to specialize in what you love doing if you're not drowning in debt from undergrad already.

 

[Law2Doc]

I think you are looking at this from the wrong angle. If the reimbursement were to decline as you (rightfully) predict, it will absolutely not be economically feasible to pursue a career as a physician. Eventually there will be a greater shortage of physicians (primary care especially) than even now. That will throw a wrench in the plans of ACA supporters everywhere. It is possible to have a single-payer marketplace be successful, but physicians will need to be compensated fairly. This can be accomplished in a variety of ways (decrease debt burden, restrict the ease of malpractice litigation, streamline the education process, and many more).

It's easy to say people will stop becoming doctors, but doubtful it will happen. We have a glut of FMGs waiting in the wings, and lots of NPs and PAs happy to put on white coats and lessen the need. OBGYNs have been threatening for generations to get out of the business because of liability costs and it's never happened, so they will call this bluff too.

 

[Mad Jack]

From the author's profile on Amazon.com:

"Dr. Luis Collar is a physician and author with training in both internal medicine and pathology. After working in the fields of finance and technology for over a decade, he returned to school and earned degrees in molecular biology and medicine. His goal is to write compelling fiction that not only entertains but also forces one to think about the society we live in. He currently lives in New Jersey with his wife and daughter."

By his own measure, he is quite the success.

 

[Mad Jack]

It's easy to say people will stop becoming doctors, but doubtful it will happen. We have a glut of FMGs waiting in the wings, and lots of NPs and PAs happy to put on white coats and lessen the need. OBGYNs have been threatening for generations to get out of the business because of liability costs and it's never happened, so they will call this bluff too.

The biggest problem is more the issue of current physicians leaving the field. It's hard to bitch about "only" making 200k, but once you get down into the lower six figures, a great deal of bright physicians could work less to make as much money or more. Hell, at my old job I could clock 110k per year working 60 hours a week, all without the liability or responsibility of a physician. New people will certainly sign up for residencies and medical school, but the number of exiting physicians would implode the system for quite some time. 90k is simply an impossible salary to work with as a physician, and 150k is damn near impossible with liability, CME, licensing, and everything else factored in.

It's far more likely (and politically tenable) that salaries will simply stay stagnant until inflation levels them out over a 10-20 year period.

 

[Aerus]

What you are not factoring in is that PA's and NP's have been vying for more independence, especially at the primary care level. This is starting to become the case in many states and will probably continue as more physicians move to specialties for higher compensation for their time.

The issue in the US is that it wants to move to a single payer system and act in the way countries with 'socialized' medicine do (with regards to medicare) however, those countries also have the same systems at play for education and that burden is much lower. You're more likely to specialize in what you love doing if you're not drowning in debt from undergrad already.

All fields have to deal with the threat of mid-levels. It shouldn't come as a surprise that they follow wherever the money is at.

 

[freemontie]

More likely physician salary goes up, as demand further outstrips supply. I'm not convinced that Obamacare is going to change the laws of economics. The invisible hand always has the final say.

Doctor pay isn't ruled by free market economics. Like...at all.
Politics, not economics, will decide the future of physician compensation.

 

[gettheleadout]

All fields have to deal with the threat of mid-levels. It shouldn't come as a surprise that they follow wherever the money is at.

Neurosurgery? lol

 

[Aerus]

Neurosurgery? lol

Perhaps not practice rights, but they're there!

 

[ridethecliche]

All fields have to deal with the threat of mid-levels. It shouldn't come as a surprise that they follow wherever the money is at.

I don't think it's a bad thing necessarily. Notice, I made no judgement claim. 2/3 ortho spine surgeons I work with have PA's. They do the pre-ops and see patients, as well as assist during surgeries if no residents/fellows are able. The surgeons love it. It lets them operate more without sacrificing patient interaction.

 

[Aerus]

I don't think it's a bad thing necessarily. Notice, I made no judgement claim. 2/3 ortho spine surgeons I work with have PA's. They do the pre-ops and see patients, as well as assist during surgeries if no residents/fellows are able. The surgeons love it. It lets them operate more without sacrificing patient interaction.

I know many PCP's who were able to take on significantly larger patient bases with the help of mid-levels, so the rising mid-levels aren't a bad thing necessarily, but I don't agree with increasing their practice rights.

 

[Law2Doc]

I know many PCP's who were able to take on significantly larger patient bases with the help of mid-levels, so the rising mid-levels aren't a bad thing necessarily...

Yes they are. Its the killing of the golden goose, plain and simple. The PCPs inevitably get greedy and decide they can make even more money opening facilities run by midlevels without any direct supervision, and that leads to the midlevels saying "why do I have to give a cut to someone who is never even here" and the government, who is also in cost cutting mode agrees. And now theres an unsupervised NP playing doctor at every CVS and Walmart in the country, with no supervision. So yes, this was a very very bad thing and a few idiots got a Ferrari at the expense of the field having a monopoly on primary care. and now you couldn't set up a group staffed by NPs if you wanted to because frankly they don't need you and will cut you out and steal your patient base first chance they get.

 

[Lucca]

All the mid-levels I have met have understood their role in relation to the physician and the physicians were highly appreciative of their mid-levels. Outside of primary care I have not seen the phenomena SDN likes to paint as an ongoing war between Mid-levels and physicians. Maybe it's because I live in Texas.

 

[freemontie]

All the mid-levels I have met have understood their role in relation to the physician and the physicians were highly appreciative of their mid-levels. Outside of primary care I have not seen the phenomena SDN likes to paint as an ongoing war between Mid-levels and physicians. Maybe it's because I live in Texas.

Let me guess: based on your years of pre-med experience, where you eavesdrop on private conversations between mid-levels/mid-level's friends?

 

[Lucca]

Let me guess: based on your years of pre-med experience, where you eavesdrop on private conversations between mid-levels/mid-level's friends?

? No, based on 100 hours of shadowing this past summer.

 

[freemontie]

? No, based on 100 hours of shadowing this past summer.

You're a little dense, aren't you? i.e. hours<<<<years, pre-med <<<real experience, outsider <<<< insider

 

[Lucca]

You're a little dense, aren't you? i.e. hours<<<<years

I understand, but I havent seen the paranoia associated with mid-level creep anywhere but here. Anywhere.

 

[ridethecliche]

Let me guess: based on your years of pre-med experience, where you eavesdrop on private conversations between mid-levels/mid-level's friends?

I can echo this except I work in a practice very closely with surgeons and PAs/NP's. They're all very appreciative of the other and happy to have each other on the team.

 

[Lucca]

There's a neurosurgery PA at my institution that basically handles most of the peds neurosurg stuff, especially seeing consults, rounding on patients and definitely scrubs in to surgeries. No one is safe my friends.

It's a very small step to say "Well I've been acting as a resident all these years so why I can't be just like the attendings?".

While thats a small psychological step (although erronious) it is a far diff thing for that PA to think they can do surgery. PAs are human beings people, they are not totally irrational job thieves trying to undermine the medical establishment. They are people who trained for a job they like to do and need to support their families - just like we did. I'm not saying there arent irrational mid levels who think they can be docs, but I am saying they are the minority.

 

[freemontie]

Not irrational job thieves. Just rational opportunists.
The case for NP autonomy is a constant thing. Especially in the case of FNPs and CRNAs. The former wants to be addressed as doctor and the latter constantly downplays the role of their supervising physician on forums like nurse-anesthesia dot org. How many times in how many contexts have we heard of a nurse practitioner claiming to be equal in knowledge/skill to a physician?
The case is a little harder to be made for PAs, though. But I for one have heard *more than one* use words like 'evolve' (i.e. after years of experience their role should evolve) and 'partner' (not 'assistant', and in fact upset by the term). And I've personally heard members of both groups (in real life) claim to do some aspect of medicine better than a real doctor.

That said as people who aren't even accepted to med school yet, this is all above our pay grade. But its good to be cognizant of office politics and have no delusions about what mid-levels are and what they want. Not all of course, but many.

 

[occams_razor]

not trying to scare you further OP, but going to med school is much more than just a $200,000 investment. according to AAMC data, the median 4 year COA for Class of 2014 is $218,898 (public med schools) and $286,806 (private med schools). then when you factor in loan interest rates, the total repayment is much higher..

 

[Aerus]

Yes they are. Its the killing of the golden goose, plain and simple. The PCPs inevitably get greedy and decide they can make even more money opening facilities run by midlevels without any direct supervision, and that leads to the midlevels saying "why do I have to give a cut to someone who is never even here" and the government, who is also in cost cutting mode agrees. And now theres an unsupervised NP playing doctor at every CVS and Walmart in the country, with no supervision. So yes, this was a very very bad thing and a few idiots got a Ferrari at the expense of the field having a monopoly on primary care. and now you couldn't set up a group staffed by NPs if you wanted to because frankly they don't need you and will cut you out and steal your patient base first chance they get.

Perhaps I should have been more clear. I meant rising level as in number of mid-levels. Obviously having them rise through the ranks is something I'm 100% against. I acknowledge that mid-levels play an important role in our healthcare system. I am however firmly against giving them a "wider scope of practice" and "greater independence". They don't have nearly enough training and there's a lot that they don't know that they don't know that it's the patients who will be the biggest losers in this, not the physicians.

 

[Vaseline]

not trying to scare you further OP, but going to med school is much more than just a $200,000 investment. according to AAMC data, the median 4 year COA for Class of 2014 is $218,898 (public med schools) and $286,806 (private med schools). then when you factor in loan interest rates, the total repayment is much higher..

yes, that $200k was a modest figure i threw out. it is unfortunate how exorbitantly expensive a medical education is. that is why i found that article to be so scary, lol.

i believe i'm entering medicine for the right reasons, and i am genuinely excited about the prospect of becoming a physician. i just hope i can do that while raising a family and living a reasonably comfortable lifestyle. ie not suffocating in debt.

 

[Vaseline]

it is unfortunate there hasn't been more resistance to rising tuition costs. at several schools i have interviewed at, they told us to expect rises in tuition for 2015

 

[occams_razor]

it is unfortunate there hasn't been more resistance to rising tuition costs. at several schools i have interviewed at, they told us to expect rises in tuition for 2015

Agreed. This is a major problem with all forms of higher ed tho. There's a great documentary I just saw called ivory tower that is pretty much all about this issue

 

[JoyKim456]

It is very hard to determine. Athletics continues to play a huge part of educational institutions, baby boomers are retiring, and we already have a physician shortage. If the salary decreases, less people go into medicine. In turn, more people will suffer. Doctors are already retiring and threaten to end their career if Obamacare goes into effect.

 

[Law2Doc]

? No, based on 100 hours of shadowing this past summer.

You do realize 100 hours isn't even a week and a half to many of the residents on here.

 

[Law2Doc]

I can echo this except I work in a practice very closely with surgeons and PAs/NP's. They're all very appreciative of the other and happy to have each other on the team.

1. Surgery is different than primary care.
2. This isn't exactly the kind of stuff you speak openly about at work. Particularly if you work in a doctor - midlevel dynamic. That's just silly to expect to see this.

 

[Law2Doc]

...I am however firmly against giving them a "wider scope of practice" and "greater independence". They don't have nearly enough training and there's a lot that they don't know that they don't know that it's the patients who will be the biggest losers in this, not the physicians.

This cat is already out of the bag.

 

[ridethecliche]

1. Surgery is different than primary care.
2. This isn't exactly the kind of stuff you speak openly about at work. Particularly if you work in a doctor - midlevel dynamic. That's just silly to expect to see this.

1. I didn't say it was the same.
2. You'd be surprised what you hear about when you're a fly on the wall and people forget about you.

This is my fourth year at the same hospital.

 

[Lucca]

You do realize 100 hours isn't even a week and a half to many of the residents on here.

I realize it's a hardly a week to many of the surgeons on here. However, it's not like im pulling these opinions out of my ass, they are based on some level of observation. No one was stepping on anyone's toes, I heard docs complain about nurses frequently and never a word about midlevels.

Im not saying this is not a worthwhile issue, because it is certainly very serious.

But the sky isnt falling and we arent going to be paid sub 100k, I mean c'mon.

 

[Strudel19]

Sub 100K? No.

 

[TooMuchResearch]

I understand, but I havent seen the paranoia associated with mid-level creep anywhere but here. Anywhere.

Hint: No one talks about it at work with the mid-levels around.