Sep 8, 2009
26
0
Houston, Texas
Status
Pre-Medical
I've tried searching SDN for related Forums, nothing truly answered my question.
Heres my sitch: Applying this coming summer, trying to figure out what the future of the career of physicians are. I am worried about what salaries are going to look like for physicians, from pcps to specialists. I am not in this for the money whatsoever, I have my own personal motivations, I don't believe money is worth going through 14 years of hell, plenty of other careers I could do if that was my goal.
However I want to be sure the hell I will go through is going to be compensated for when I finish in almost 10 years down the road. What is projected to happen with the new reform? Will doctors salaries be cut? If so, how much?
I'm sure there are plenty other pre meds/ med students wondering the same thing. Does anyone have any idea, or even know of a news article that addresses this topic?
any help and feedback is appreciated.
and please, do not turn this into a political debate.
 

ronaldo23

The Truth
10+ Year Member
7+ Year Member
Jul 28, 2007
994
0
Status
Medical Student
I've tried searching SDN for related Forums, nothing truly answered my question.
Heres my sitch: Applying this coming summer, trying to figure out what the future of the career of physicians are. I am worried about what salaries are going to look like for physicians, from pcps to specialists. I am not in this for the money whatsoever, I have my own personal motivations, I don't believe money is worth going through 14 years of hell, plenty of other careers I could do if that was my goal.
However I want to be sure the hell I will go through is going to be compensated for when I finish in almost 10 years down the road. What is projected to happen with the new reform? Will doctors salaries be cut? If so, how much?
I'm sure there are plenty other pre meds/ med students wondering the same thing. Does anyone have any idea, or even know of a news article that addresses this topic?
any help and feedback is appreciated.
and please, do not turn this into a political debate.
about tree fitty
 

Morzh

SDN Lifetime Donor
Lifetime Donor
7+ Year Member
Sep 20, 2010
1,000
229
Status
Resident [Any Field]
The truth is that aside from a handful of specifics nobody really knows. Even soon-to-be-former speaker of the house Nancy Pelosi said that we'll just have to wait and see what the healthcare "reform" law actually does. According to the democrats, it was important just to get "something" passed while they still had a chance and then they could tweak it later as needed.

The uncertainty is further compounded by the fact that in all likelihood several parts of the bill (if not the entire thing) may end up never seeing the light of day due to repeal, court challenges, or because they are simply economically unfeasible in practice.

The general idea as I understand it is that they want procedure-based compensation to be a thing of the past and instead salaries to be based on performance/patient outcome. For example, insurance companies/the government would set a standard saying "We will compensate doctors X amount of money for treating a breast cancer." That money would then be divided up between oncologist, radiologist, surgeon, etc. based on the individual treatment needs of the patient, instead of physicians tallying up each scan/procedure/follow-up visit and submitting that as a bill.

While some of that sounds good on paper, there are obviously going to be challenges in actually getting a system that works like that to be effective. I'm not condoning either the current or proposed systems. I think they both have serious problems.

Anyway, if something like that ends up happening, you could expect procedure-heavy specialty salaries to drop. Some wishful thinkers like to believe there will be a reciprocal rise in primary-care doctors' salaries, but I wouldn't hold my breath... the general consensus politically is that *all* doctors are overpaid and under-worked. They probably want to use the money taken away from physician compensation and use it to train more DNPs.
 

mfrizzo3

10+ Year Member
7+ Year Member
Nov 11, 2007
939
8
Status
Medical Student
Good news! You will be compensated.
 

gettheleadout

MS-4
Moderator Emeritus
7+ Year Member
Jun 23, 2010
11,814
2,783
Status
Medical Student
Anyway, if something like that ends up happening, you could expect procedure-heavy specialty salaries to drop. Some wishful thinkers like to believe there will be a reciprocal rise in primary-care doctors' salaries, but I wouldn't hold my breath... the general consensus politically is that *all* doctors are overpaid and under-worked. They probably want to use the money taken away from physician compensation and use it to train more DNPs.
I hate the public.
 

Parts Unknown

Fork tender
Jun 26, 2009
1,515
3
Status
Attending Physician
The general idea as I understand it is that they want procedure-based compensation to be a thing of the past and instead salaries to be based on performance/patient outcome. For example, insurance companies/the government would set a standard saying "We will compensate doctors X amount of money for treating a breast cancer." That money would then be divided up between oncologist, radiologist, surgeon, etc. based on the individual treatment needs of the patient, instead of physicians tallying up each scan/procedure/follow-up visit and submitting that as a bill.
You are confusing procedural reimbursement with fee for service (FFS). And outcome initiatives (aka pay for performance) are not the same as bundling, which you allude to in your breast cancer example.

In short, you are somewhat confused on this issue.

FFS is going to hang around for now, but it is going to undergo some changes and take on some challenges. Reimbursement for procedures is going to decline, and payment for non-procedural care will increase (albeit after a rocky transition).

Pay for performance has been an ongoing project with Medicare, and it has been very difficult to implement, measure, and justify. I would be somewhat surprised if it continues, although I'm sure some fights will be had.

Bundling is going to be the next big thing that gets tried, but not all bundling is created equal. The idea is that if a patient presents with condition X, and one knows how much X costs to treat in thousands of other patients with X, you pay the caregivers a set amount of money. If said caregivers follow best practices they net a profit (ostensibly more that they would have through FFS). If they do not follow best practices the patient suffers non-reimbursed complications and the caregivers risk a financial loss.

That's the idea, anyways.

Projects to examine different payment systems have been bubbling along for some time. An example would be Prometheus (see here and here).

Of course, another important consideration is that reform will (presumably) decrease the percentage of uninsured patients, and thus reduce the amount of uncompensated care that is administered. For example, say you work in an urban ER and see 100 patients. Of those, 50 have insurance and 50 do not. That's a lot of money down the drain. But, after reform, you see 100 patients and 95 of them are insured. That's less money down the drain. Even if they cut per patient reimbursement you can still end up ahead in this scenario.

In summary, there is a lot of uncertainty, but there is also no reason to assume that all physicians are going to have their pay cut by _%.
 

Morzh

SDN Lifetime Donor
Lifetime Donor
7+ Year Member
Sep 20, 2010
1,000
229
Status
Resident [Any Field]
parts unknown: Thanks for clarifying that somewhat for me. It will be interesting to watch, but I'm still not holding my breath about things getting better anytime soon. Heavy federal govt intervention in the healthcare sector = heavy politicization of healthcare (more than it already is). And getting politics involved NEVER makes anything better.
 

eablackwell

It Wasn't Me
Moderator Emeritus
7+ Year Member
Nov 17, 2009
1,791
132
The Land of Sleepless Nights
Status
Resident [Any Field]
parts unknown: Thanks for clarifying that somewhat for me. It will be interesting to watch, but I'm still not holding my breath about things getting better anytime soon. Heavy federal govt intervention in the healthcare sector = heavy politicization of healthcare (more than it already is). And getting politics involved NEVER makes anything better.
Meh, it worked for revising the Articles of Confederation. :p
 

Parts Unknown

Fork tender
Jun 26, 2009
1,515
3
Status
Attending Physician
Heavy federal govt intervention in the healthcare sector
Well, if you boil down the entire reform act as much as possible, it does three things:

1. Expands Medicaid (State-administered).
2. Cuts Medicare payments to Advantage programs (revises existing Federal program).
3. Subsidizes the purchase of private insurance (done at the State level).

So yes, while the Federal government is handing down new mandates and new money, how this thing flies is going to depend more directly on the actions of private health insurers and individual State governments.

The basic idea of an individual mandate with subsidies to purchase private insurance is essentially what has happened in Massachusetts, and what the Republican opposition offered as an alternative to Hillarycare back in 1992-1993. So it's not exactly tantamount to the NHS brand of socialized medicine, despite what the critics say.

Here is a good article on the interesting dynamic that will unfold as newly Republican State governments are handed "considerable leeway" to implement reform. Enjoy.
 

Playa

Removed
Jul 15, 2010
291
0
Status
I've tried searching SDN for related Forums, nothing truly answered my question.
Heres my sitch: Applying this coming summer, trying to figure out what the future of the career of physicians are. I am worried about what salaries are going to look like for physicians, from pcps to specialists. I am not in this for the money whatsoever, I have my own personal motivations, I don't believe money is worth going through 14 years of hell, plenty of other careers I could do if that was my goal.
However I want to be sure the hell I will go through is going to be compensated for when I finish in almost 10 years down the road. What is projected to happen with the new reform? Will doctors salaries be cut? If so, how much?
I'm sure there are plenty other pre meds/ med students wondering the same thing. Does anyone have any idea, or even know of a news article that addresses this topic?
any help and feedback is appreciated.
and please, do not turn this into a political debate.
You'll still be able to afford that ferrari.