Plan B if things go down the drain?

[deleted941485]

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Realistically how low could salaries for various specialties go in a M4A system even?

I think you need to take a broader view of M4A and what it will do.

Conservatively, what ever your median earnings will be in a specialty take off 20% off the bat right there. On top of that, you’ll be seeing more patients but will likely be able to do so especially if your a pcp.

If you are a specialist here, you will probably make even less 25-30% less. Docs will attempt to increase their productivity with mid levels and PAs which may help things even out BUT this will likely mean that the job market will get really very tight for new specialists as is the case with specialists in Canada.

Fees will be set by govt with below inflation raises when also amounts to a put cut sustained every year. Might have a few doctors strikes but the neutered physician representative body will kowtow to govt demands. And of course, bundled payments will put the kabosh on hiringnew attendings.

Long post residency fellowships that add little more than extra years of indentured servitude will be the norm. Think 4-6 years in IM. You will basically function as a PA doing attending level work.

Ofcourse by then the govt will make medical school free, but it will be a Pyrrhic victory for incoming students. It will be used by the govt to justify all sorts of abuse of junior residents and attendings and in the end cost more in time, opportunity costs, and just downright mental anguish than the debt you would have otherwise been expected to pay.

While you might say, at least I get to practice medicine debt free. Let’s be clear that you won’t be practicing medicine by this point, you will be prescribing and recommending treatments in a controlled and highly monitored manner dictated by an algorithm designed by a national health service and administered by a DNP.

In 10-15 years, medicine will be what many post doc PhD positions are currently in the US, just a pathway to citizenship.

 

[GonnaBeADoc2222]

I think you need to take a broader view of M4A and what it will do.

Conservatively, what ever your median earnings will be in a specialty take off 20% off the bat right there. On top of that, you’ll be seeing more patients but will likely be able to do so especially if your a pcp.

If you are a specialist here, you will probably make even less 25-30% less. Docs will attempt to increase their productivity with mid levels and PAs which may help things even out BUT this will likely mean that the job market will get really very tight for new specialists as is the case with specialists in Canada.

Fees will be set by govt with below inflation raises when also amounts to a put cut sustained every year. Might have a few doctors strikes but the neutered physician representative body will kowtow to govt demands. And of course, bundled payments will put the kabosh on hiringnew attendings.

Long post residency fellowships that add little more than extra years of indentured servitude will be the norm. Think 4-6 years in IM. You will basically function as a PA doing attending level work.

Ofcourse by then the govt will make medical school free, but it will be a Pyrrhic victory for incoming students. It will be used by the govt to justify all sorts of abuse of junior residents and attendings and in the end cost more in time, opportunity costs, and just downright mental anguish than the debt you would have otherwise been expected to pay.

While you might say, at least I get to practice medicine debt free. Let’s be clear that you won’t be practicing medicine by this point, you will be prescribing and recommending treatments in a controlled and highly monitored manner dictated by an algorithm designed by a national health service and administered by a DNP.

In 10-15 years, medicine will be what many post doc PhD positions are currently in the US, just a pathway to citizenship.

Shiiiiiiiiiit.

 

[sylvanthus]

They don’t because it doesn’t happen right away. Which is why everyone is on board with it. 5-10 years is too long in the public’s mind and long enough for most of the lawmakers to run out their terms and move on to writing their memoirs and 100K per speech dinners about being brave courageous hero’s for getting this passed.

If the industry fails to block this then the only positive is you have about 5-10 years to find yourself some supplemental income avenues cause your medicine day job just isn’t gonna cover it.

5-10 years? Well, guess Ill at least get my loans paid off and a chunk of change in retirement and emergency funds by then. If this really happens its gonna suck to be a current medical student or someone just starting residency.

 

[deleted941485]

5-10 years? Well, guess Ill at least get my loans paid off and a chunk of change in retirement and emergency funds by then. If this really happens its gonna suck to be a current medical student or someone just starting residency.

If you are early enough in the process of med school, I’d be looking elsewhere. Cut your losses. Seriously.

Even if you play by the rules and do everything the govt asks of you, you will still be getting screwed.

 

[cyanide12345678]

I am not trying to convince anyone to move to Dubai or anything, and those crazy salary numbers sound outdated, but you can easily get by as a doctor without speaking Arabic. Mostly people speak at least some English. Those who don't aren't all Arabic speakers. Most non Arabic speakers are about equally split between Hindi speakers, other Indian subcontinent dialect speakers, and Arabic speakers. You can almost always find someone to interpret from among the nurses or other doctors.

Socially you really don't need any other language except English.

Sounds like i could probably get by since i speak Hindi, Urdu and English. I know my wife would be really excited about moving to Dubai.

Also i second the fact that dubai in particular is extremely progressive, a lot of tourism and ethic diversity. I don't think anyone goes to jail there for drinking alcohol. It's not saudi arabia. Saudi Arabia is essentially the worst place ever as far as human rights go and the exporters of most terrorism in the world, sorry i know this is a very political statement but their ideological exportation of wahabism has only caused issues for the rest of the world.

 

[TooMuchResearch]

I don't think it's particularly political if it's fact.

Sounds like i could probably get by since i speak Hindi, Urdu and English. I know my wife would be really excited about moving to Dubai.

Also i second the fact that dubai in particular is extremely progressive, a lot of tourism and ethic diversity. I don't think anyone goes to jail there for drinking alcohol. It's not saudi arabia. Saudi Arabia is essentially the worst place ever as far as human rights go and the exporters of most terrorism in the world, sorry i know this is a very political statement but their ideological exportation of wahabism has only caused issues for the rest of the world.

 

[deleted941485]

I don't think it's particularly political if it's fact.

Where have you been last 10 years? Facts and fact finding are political.

 

[Angus Avagadro]

This is why the "public option" will be the preferred route. On its face this sounds reasonable as you aren't outlawing insurance companies outright. The completely predictable outcome of any public option will be that in 5-10 years it will replace most insurance plans, including employer sponsored ones. We would be left only with private insurance for the wealthiest segment who choose to pay the massive premiums. This will be Medicare-For-All in everything but name only.

This is the natural history of govt controlled healthcare. We need only look to the Natl Health Service in the UK over the last 50 yrs to see where this goes. Generic capped cost healthcare for the great unwashed and private ins for everyone who can afford it. The NHS caps what it will spend on you. It used to be 250k when my Navy doc buddy was stationed there with NATO. Dont know what the figure is now. If your breast cancer chemo exceeds that cost, you dont get that chemo.

 

[TooMuchResearch]

Not for me.

Where have you been last 10 years? Facts and fact finding are political.

 

[gro2001]

Let’s be clear that you won’t be practicing medicine by this point, you will be prescribing and recommending treatments in a controlled and highly monitored manner dictated by an algorithm designed by a national health service and administered by a DNP.

Most wealthy countries around the world have systems that are similar though. Do you think doctors in all those countries aren't practicing medicine?

 

[deleted941485]

Most wealthy countries around the world have systems that are similar though. Do you think doctors in all those countries aren't practicing medicine?

Similar in what way?

 

[miacomet]

This is the natural history of govt controlled healthcare. We need only look to the Natl Health Service in the UK over the last 50 yrs to see where this goes. Generic capped cost healthcare for the great unwashed and private ins for everyone who can afford it. The NHS caps what it will spend on you. It used to be 250k when my Navy doc buddy was stationed there with NATO. Dont know what the figure is now. If your breast cancer chemo exceeds that cost, you dont get that chemo.

The good news in the NHS is that specialists generally have lucrative private practices and rake it in, in not a few cases to the mid-six figures. EM fares particularly poorly under their system, though, since you can't have a private practice and the slots generally go unfilled.

EM salaries would, I imagine, go down, although Canada and Oz still do quite well, so who knows? Those folks in procedural specialties should do OK, though, as they always do.

 

[gro2001]

Similar in what way?

Similar to your description of a hypothetical medicare for all. The way I understood it, the main characteristics of a potential future medicare for all system that you outlined will be:

1) most/all physicians will make significantly less money than they currently do in the US
2) duration of training will extend by 50-100%
3) medical school will be free
4) medical decision making will be highly controlled by national health service policy, which will be administered by non-physicians

Presumably the decrease in pay will come from all-payer rate setting, which is the most drastic of possible price control mechanisms. That is already present in most developed multi-payer systems (France, Germany, etc) as well as obviously all single payer systems. Physicians do make significantly less money there than in the US. Duration of training in those countries is also typically longer (but duty hours are significantly shorter). Medical school is also typically either free or almost free. And medical decision making is affected by national policies. So basically it seemed to be that your nightmare scenario is very similar to France, Germany, or most other developed countries. Which, I understand, may be an undesirable outcome (especially vis-a-vis making less money) but the comment that one "wouldn't be practicing medicine by that point" seemed over the top to me. So I meant to ask if you thought that physicians in France, Germany, the Netherlands, etc also aren't practicing medicine, since their systems have all the characteristics you describe.

 

[Brigade4Radiant]

Medical training in Europe starts after high school if also you have to include benefits like health insurance and medical coverage in general and no school debt and 40 hour weeks and 8 weeks paid vacation on top of that.

Lol if you think anyone is working long hours in Europe and they don’t worry about lawsuits either.

 

[miacomet]

Medical training in Europe starts after high school if also you have to include benefits like health insurance and medical coverage in general and no school debt and 40 hour weeks and 8 weeks paid vacation on top of that.

Lol if you think anyone is working long hours in Europe and they don’t worry about lawsuits either.

EM is not a thing there, though, and we should consider that.

 

[deleted941485]

The good news in the NHS is that specialists generally have lucrative private practices and rake it in, in not a few cases to the mid-six figures. EM fares particularly poorly under their system, though, since you can't have a private practice and the slots generally go unfilled.

EM salaries would, I imagine, go down, although Canada and Oz still do quite well, so who knows? Those folks in procedural specialties should do OK, though, as they always do.

You do realize that most of these specialists don’t and in many cases prohibited from opening private clinics. Somebody pretty much has to die for you to even get that opportunity because the patient bases are probably not very large to begin with. No one is seeing a cardiologist for their V tach in a private clinic. Sorry, but I would not stake your career on the fantasy that you’ll be different or that you’ll some how weasel your way into PP in a Medicare for all future.

If the system was setup that way, those who can do private would and never have to deal with the public system thus undermining the whole point of setting up such a system.

 

[GeneralVeers]

Most likely there will be opportunities to work in private "American-Style" hospitals that will open along the Mexican border. These clinics will be free of burdensome MC4A requirements, and can take cash pay. It will be an interesting reversal whereby wealthy Americans have to to cross the border to get timely, decent care.

 

[miacomet]

You do realize that most of these specialists don’t and in many cases prohibited from opening private clinics. Somebody pretty much has to die for you to even get that opportunity because the patient bases are probably not very large to begin with. No one is seeing a cardiologist for their V tach in a private clinic. Sorry, but I would not stake your career on the fantasy that you’ll be different or that you’ll some how weasel your way into PP in a Medicare for all future.

If the system was setup that way, those who can do private would and never have to deal with the public system thus undermining the whole point of setting up such a system.

The numbers include a lot of international patients. The training is long and you are correct that it takes awhile to become a consultant in certain fields, but the whole design of the NHS was to allow physicians to make money on the side as a way to get them to buy into National Health. The public system has, rightly or wrongly, been undermined by this, as you state. Sure, people use the public system for childbirth, emergencies, oncology, among other things, but they opt out if they can (many can't- people earn less there and most jobs don't provide private insurance) and get their joint replacements, cataracts, hysterectomies etc done privately if they can afford (many can't).

The NHS actually DEPENDS on private practice to exist.

Here are some links explaining the NHS and private practice: Stuff Their Mouths With Gold! - Gwlad Gwlad News Portal

“Mouths Full of Gold.” Private Practice in Britain’s National Health System

By SAURABH JHA, MD When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in healthcare in the world he...

thehealthcareblog.com

Here are some of the top incomes: Doctors prescribe themselves £1m salaries

Now, an EM doc there (if you can find one) will do quite poorly, as one must work for the NHS and earn a pittance- probably $150k top, even if the schedule is much better. We would have been wise to pick a procedural specialty with a possibility of private practice, and we have only ourselves to blame if this change occurs and we are in the wrong field.

 

[miacomet]

-Weather
-Cities (Sydney and Melbourne are some of the most liveable cities in the world)
-People
-Sane immigration policy
-Doctors are still paid decently, unlike most of the rest of the world

Cons
- Terrible food (and expensive)
- High taxes
- Expensive to get to

What's with the bad food in Oz? I hear they have great coffee and brunch and barbecue. Maybe it's all hype?

 

[GeneralVeers]

What's with the bad food in Oz? I hear they have great coffee and brunch and barbecue. Maybe it's all hype?

I think it stems from the British origins of most of the population. England has some of the worst food in the world, and it translated over to Australia. The only exception is Melbourne which has some decent restaurants. Sydney food is overpriced, bland, and generally terrible service due to the high minimum wage and lack of tips.

 

[GonnaBeADoc2222]

I think it stems from the British origins of most of the population. England has some of the worst food in the world, and it translated over to Australia. The only exception is Melbourne which has some decent restaurants. Sydney food is overpriced, bland, and generally terrible service due to the high minimum wage and lack of tips.

Interesting. I think Ireland used to be the same way but I think recently it's undergone a sort of foodie revolution.

 

[miacomet]

I think it stems from the British origins of most of the population. England has some of the worst food in the world, and it translated over to Australia. The only exception is Melbourne which has some decent restaurants. Sydney food is overpriced, bland, and generally terrible service due to the high minimum wage and lack of tips.

So the Greek, Chinese, Italian etc haven't upped the ante? The weird thing is that food in Britain is generally much better than the US. Weird.

 

[deleted109597]

Lol if you think anyone is working long hours in Europe and they don’t worry about lawsuits either.

Wrong.
Also, the NHS has destroyed the pension system, and some docs are actually paying money out of their checks to go to their mandatory OT.
And lawsuits happen, but they also have criminal charges way, way more often for malpractice.
Thanks but no thanks.

 

[deleted941485]

The numbers include a lot of international patients. The training is long and you are correct that it takes awhile to become a consultant in certain fields, but the whole design of the NHS was to allow physicians to make money on the side as a way to get them to buy into National Health. The public system has, rightly or wrongly, been undermined by this, as you state. Sure, people use the public system for childbirth, emergencies, oncology, among other things, but they opt out if they can (many can't- people earn less there and most jobs don't provide private insurance) and get their joint replacements, cataracts, hysterectomies etc done privately if they can afford (many can't).

The NHS actually DEPENDS on private practice to exist.

Here are some links explaining the NHS and private practice: Stuff Their Mouths With Gold! - Gwlad Gwlad News Portal

“Mouths Full of Gold.” Private Practice in Britain’s National Health System

By SAURABH JHA, MD When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in healthcare in the world he...

thehealthcareblog.com

Here are some of the top incomes: Doctors prescribe themselves £1m salaries

Now, an EM doc there (if you can find one) will do quite poorly, as one must work for the NHS and earn a pittance- probably $150k top, even if the schedule is much better. We would have been wise to pick a procedural specialty with a possibility of private practice, and we have only ourselves to blame if this change occurs and we are in the wrong field.

Yeah...like a side hustle sort of like the gig economy. Yeah totally. Now that I think about it Cuba has a similar system for its doctors. Gotta be a real go getter but you can enlist to travel to another country and provide care in Angola or Namibia. Or if your not a fan of leaving the sunny Caribbean then you can drive a cab or roll cigars for some extra cash.

Liz Warren is leading in the polls btw, hope you registered with uber and lyft.
Good luck trying to nail down those private international patients.

I’m sure all those rich jet setters will be falling over themselves to get on the EuroStar or A private jet for their emergency room visits.

Lip stick on a pig man. Lipstick on a pig

 

[miacomet]

Wrong.
Also, the NHS has destroyed the pension system, and some docs are actually paying money out of their checks to go to their mandatory OT.
And lawsuits happen, but they also have criminal charges way, way more often for malpractice.
Thanks but no thanks.

The criminal charges thing is insane and sadly all too common in the UK. I guess it's cheaper to convict docs (they rarely get locked up) than pay patients and their families. It's truly awful.

Certainly does't incentive systems improvement. Great article on the ridiculousness of these kinds of charges- Europe is backwards in many ways: Medication errors that have led to manslaughter charges and they system has yet to change Medical manslaughter: will the findings of an independent review be a tipping point for change? - The BMJ

 

[miacomet]

Yeah...like a side hustle sort of like the gig economy. Yeah totally. Now that I think about it Cuba has a similar system for its doctors. Gotta be a real go getter but you can enlist to travel to another country and provide care in Angola or Namibia. Or if your not a fan of leaving the sunny Caribbean then you can drive a cab or roll cigars for some extra cash.

Liz Warren is leading in the polls btw, hope you registered with uber and lyft.
Good luck trying to nail down those private international patients.

I’m sure all those rich jet setters will be falling over themselves to get on the EuroStar or A private jet for their emergency room visits.

Lip stick on a pig man. Lipstick on a pig

As I said, EM would be awful under such a system. But private practice really does well, really well. There's a reason no one does EM, IM, or even Paediatrics in the UK. It just doesn't pay.

 

[deleted941485]

As I said, EM would be awful under such a system. But private practice really does well, really well. There's a reason no one does EM, IM, or even Paediatrics in the UK. It just doesn't pay.

OR

Anesthesia
OBGYN
Gen surg
Oncology
GI
Cards
ID
Rheum
NSX
CT surgery
Radiology

Anything that might actually require your expertise to make even a mild impact on someone’s life will be nickel and dimed away.

See that Iowa poll?

 

[miacomet]

OR

Anesthesia
OBGYN
Gen surg
Oncology
GI
Cards
ID
Rheum
NSX
CT surgery
Radiology

Anything that might actually require your expertise to make even a mild impact on someone’s life will be nickel and dimed away.

See that Iowa poll?

So, I would rather not work in the NHS for a variety of reasons, but in the name of accuracy:

-Anesthesia does well there- who do you think staffs private, elective cases?
-Cards sees lots of private patients for pacemakers, elective caths, general management.
-Ob-gyn does well; try getting a myomectomy or hysterectomy on the NHS and you'll see why.
-Same with gen-surg for hernias, fistulas etc. NHS watches and waits way too much.
-Rads can do well with private imaging centers.
-Nsgy does lots of elective spine

The rest, I agree, probably don't do so well, although rheum and ID are pretty poor here, too.

 

[deleted941485]

As I said, EM would be awful under such a system. But private practice really does well, really well. There's a reason no one does EM, IM, or even Paediatrics in the UK. It just doesn't pay.

So, I would rather not work in the NHS for a variety of reasons, but in the name of accuracy:

-Anesthesia does well there- who do you think staffs private, elective cases?
-Cards sees lots of private patients for pacemakers, elective caths, general management.
-Ob-gyn does well; try getting a myomectomy or hysterectomy on the NHS and you'll see why.
-Same with gen-surg for hernias, fistulas etc. NHS watches and waits way too much.
-Rads can do well with private imaging centers.
-Nsgy does lots of elective spine

The rest, I agree, probably don't do so well, although rheum and ID are pretty poor here, too.

I guarantee if he private sector in HC were as prosperous there it would completely undermine the NHS. Imagine waiting weeks for a myomectomy on an NHS list. They will try to force you to work more in NHS time than Private.

I read an interview with a CT surgeon where they asked him point blank if he had a private clinic. I think the last name was bridge water. He was basically ashamed to say that he did run a small one and then called it destructive and divisive (wonder why) All told making 120K as a consultant. What a joke.

Dentists and lawyers probably do better there with less work and less headaches.

And last I checked, they had a junior doctor strike recently which I’m sure was a ringing endorsement while the health officials essentially tried to squeeze free work out of them by taking away extra pay during “unsociable” hours by incorporating it into their base.

 

[miacomet]

Lawyers do much better there. Some lawyers do much better here than docs. Dentists...well, you know the jokes about British teeth. EM would be terrible (although it's OK in Canada and Oz).

If you read my links above you'll see the NHS actually DEPENDS on the private sector to exist and thrive, something most people don't appreciate, even in the UK.

Sure. The junior doctors are on an endless training scheme and abused. But that doesn't change, or relate to, what I said about private practice.

 

[deleted941485]

Lawyers do much better there. Some lawyers do much better here than docs. Dentists...well, you know the jokes about British teeth. EM would be terrible (although it's OK in Canada and Oz).

If you read my links above you'll see the NHS actually DEPENDS on the private sector to exist and thrive, something most people don't appreciate, even in the UK.

Sure. The junior doctors are on an endless training scheme and abused. But that doesn't change, or relate to, what I said about private practice.

Ookie dookie.

 

[KeikoTanaka]

PI is way too strong in America to just evaporate. Sure, maybe in a long long time it'll be phased out, but we're looking probably 20-30 years out. Also, America is very different than these other countries. Even if we adopt a M4A system, it won't necessarily behave like other countries. I think if enough people argue the fact that Physician salaries are extremely important to counteract the horrific medical school debt, they will keep them high. That, or they'll just wipe away our debt. At the end of the day, physician salaries are only 12-15% of the total cost of healthcare. Think about how much money would be saved if half the administration/useless jobs of private hospitals were slashed, and if the government could control the cost of an MRI, pharmaceutical drugs, etc... there are a lot of ways to reduce the burden without directly impacting healthcare provider salaries. But anyways, I truly think the most we'll get out of a democratic president will be a baseline universal primary care coverage which will cover sick visits to your PCP as well as maybe a couple ED visits a year. And hell, they'll probably just cut a deal with insurance companies and make it universally given through private insurance but then subsidized by the gov. Who knows. It's all speculation and doomsday theorizing. But, unless you actively participate in government and work with representative bodies, you'll always get the short end of the stick.

 

[TooMuchResearch]

A couple of ED visits per year is way above average.

PI is way too strong in America to just evaporate. Sure, maybe in a long long time it'll be phased out, but we're looking probably 20-30 years out. Also, America is very different than these other countries. Even if we adopt a M4A system, it won't necessarily behave like other countries. I think if enough people argue the fact that Physician salaries are extremely important to counteract the horrific medical school debt, they will keep them high. That, or they'll just wipe away our debt. At the end of the day, physician salaries are only 12-15% of the total cost of healthcare. Think about how much money would be saved if half the administration/useless jobs of private hospitals were slashed, and if the government could control the cost of an MRI, pharmaceutical drugs, etc... there are a lot of ways to reduce the burden without directly impacting healthcare provider salaries. But anyways, I truly think the most we'll get out of a democratic president will be a baseline universal primary care coverage which will cover sick visits to your PCP as well as maybe a couple ED visits a year. And hell, they'll probably just cut a deal with insurance companies and make it universally given through private insurance but then subsidized by the gov. Who knows. It's all speculation and doomsday theorizing. But, unless you actively participate in government and work with representative bodies, you'll always get the short end of the stick.

 

[KeikoTanaka]

A couple of ED visits per year is way above average.

Literally was throwing random numbers out there.

 

[cyanide12345678]

A couple of ED visits per year is way above average.

I've seen so many frequent flyer folks now that a couple of ED visits a year seem like they never go to the ER.

 

[deleted941485]

PI is way too strong in America to just evaporate. Sure, maybe in a long long time it'll be phased out, but we're looking probably 20-30 years out. Also, America is very different than these other countries. Even if we adopt a M4A system, it won't necessarily behave like other countries. I think if enough people argue the fact that Physician salaries are extremely important to counteract the horrific medical school debt, they will keep them high. That, or they'll just wipe away our debt. At the end of the day, physician salaries are only 12-15% of the total cost of healthcare. Think about how much money would be saved if half the administration/useless jobs of private hospitals were slashed, and if the government could control the cost of an MRI, pharmaceutical drugs, etc... there are a lot of ways to reduce the burden without directly impacting healthcare provider salaries. But anyways, I truly think the most we'll get out of a democratic president will be a baseline universal primary care coverage which will cover sick visits to your PCP as well as maybe a couple ED visits a year. And hell, they'll probably just cut a deal with insurance companies and make it universally given through private insurance but then subsidized by the gov. Who knows. It's all speculation and doomsday theorizing. But, unless you actively participate in government and work with representative bodies, you'll always get the short end of the stick.

The house, 1/3 senate, and the presidency are up for grabs in 13 months. Literally anything is possible and if anything is possible that usually means you’re gonna get screwed.

 

[KeikoTanaka]

The house, 1/3 senate, and the presidency are up for grabs in 13 months. Literally anything is possible and if anything is possible that usually means you’re gonna get screwed.

Don't think insurance companies aren't in the pockets of democrats. Also, imagine if they just removed PI, literally millions would be out of the job. They could cause a massive recession. Things could get messy sooo fast. At most I think we'll see the return of Obamacare with a couple of added benefits

 

[deleted941485]

Don't think insurance companies aren't in the pockets of democrats. Also, imagine if they just removed PI, literally millions would be out of the job. They could cause a massive recession. Things could get messy sooo fast. At most I think we'll see the return of Obamacare with a couple of added benefits

Liz seems pretty dead set on M4A which means she will at least get a public option for Medicare buy in at 50 for “all who want it”. If PI remains, It’ll be the worst of both worlds basically putting everyone on a Medicare advantage plan with PI skimming off the top.

Even if the plans have good reimbursement, repubs will just come in an cut the rates in 4-8yrs anyway. You get screwed on the Democrats plan and then on the backlash.

 

[sylvanthus]

If you are early enough in the process of med school, I’d be looking elsewhere. Cut your losses. Seriously.

Even if you play by the rules and do everything the govt asks of you, you will still be getting screwed.

Ehhh Im an attending now, done with 6 years of IBR in residency/fellowship, work now as an employed physician,; I'm going to shoot for PSLF, save money on the side and if PSLF happens in 4 years, awesome, if it doesn't I pay my loans off.

 

[KeikoTanaka]

Ehhh Im an attending now, done with 6 years of IBR in residency/fellowship, work now as an employed physician,; I'm going to shoot for PSLF, save money on the side and if PSLF happens in 4 years, awesome, if it doesn't I pay my loans off.

IBR? PSLF?

Also, in any of these plans, would Direct Primary Care be illegal?

 

[BoardingDoc]

IBR? PSLF?

Also, in any of these plans, would Direct Primary Care be illegal?

@sylvanthus is responding to a comment from a ~40 posts ago talking about public service loan forgiveness (PSLF) and repaying loans via Income Based Repayment (IBR).

 

[deleted941485]

IBR? PSLF?

Also, in any of these plans, would Direct Primary Care be illegal?

At best they’ll cap what you charge, which is the whole thing behind the new “surprise” billing legislation. Surprise surprise...they want to control what you charge regardless.

 

[GeneralVeers]

IBR? PSLF?

Also, in any of these plans, would Direct Primary Care be illegal?

It would be illegal as it's a "covered service". You would only be able to bill under Medicare. Any extra cash on the side would be illegal.

 

[hundreddaysoff]

So anyone here have a plan B for their lives if our field went down the sh** hole? Let's say the following happens over the next 5 years:

1) The law passes where out of network billing is at 125% of median in network and reimbursement starts to decline

2) 100+ new hca and cmg sponsored new residencies open and the market is flooded with new grads

3) CMGs continue taking over SDG contacts and replacing doctors with MLPs, leading to decreased physician demand.

Let's say our worst possible scenario happens and compensation drops to around 150/hour in most places.

What's next? Anyone with an exit strategy or plan B here? Or would you just suck it up and keep grinding?

My take: what makes $150/h the lowest we can go under this scenario? If the market is really flooded with new grads, why assume most of us would be able to find jobs at all? If corporate or CMS pencil-pushers start managing us all anyway and their only god is the bottom line, then I'd think they'd come up with any excuse to push current attendings out and keep churning in the endless new grads for less and less money in a race to the bottom. Just like HCA does with its RNs right now.

In any case, suppose I work 8 12s/mo under this regime. At 150/h, that's 172K/y gross. If the status quo really holds for 5 years beforehand, then at that time I'll have a house free and clear and no loans, so my family expenses will only be like $50--60k. And my wife has a stable $50K/y job that she loves. So, yeah, in this scenario I'd suck it up and keep lazygrinding for a few years at 8 shifts/mo till we have at least $500k--1M in the bank, then probably call it quits and skinny-FIRE.

Bottom line: in your scenario, still can't think of any more profitable and less risky use of my time than working in the ER, at least until I hit FI. Yes, EPs' situation relative to what we have now would suck in that case, but compared to the average American I'd still think we'd have it pretty good.

 

[deleted941485]

My take: what makes $150/h the lowest we can go under this scenario? If the market is really flooded with new grads, why assume most of us would be able to find jobs at all? If corporate or CMS pencil-pushers start managing us all anyway and their only god is the bottom line, then I'd think they'd come up with any excuse to push current attendings out and keep churning in the endless new grads for less and less money in a race to the bottom. Just like HCA does with its RNs right now.

In any case, suppose I work 8 12s/mo under this regime. At 150/h, that's 172K/y gross. If the status quo really holds for 5 years beforehand, then at that time I'll have a house free and clear and no loans, and my family expenses will only be like $50--60k. And my wife has a stable $50K/y job that she loves. So, yeah, in this scenario I'd suck it up and keep lazygrinding for a few years at 8 shifts/mo till we have at least $500k--1M in the bank, then probably call it quits and skinny-FIRE.

Bottom line: in your scenario, still can't think of any more profitable and less risky use of my time than working in the ER, at least until I hit financial independence. EPs' situation relative to what we have now would suck in that case, but compared to the average American lifestyle I'd still think we'd have it pretty good.

That’s assuming you keep you keep your job at 150/hr and don’t quit early due to burnout or are not replaced with MLP plus AI or the rates don’t get pushed further down.

1M these days maybe gets you 40K tops for retirement. Assuming rates of return will stay where they are which they probably won’t probably more around 3%.

Pretty good is in fact pretty bad.

 

[TooMuchResearch]

4% is too high a withdrawal rate. I can't recall the blog name, but they've modeled the **** out of these things. Safe withdrawal rate is more around 3.2% or something.

That’s assuming you keep you keep your job at 150/hr and don’t quit early due to burnout or are not replaced with MLP plus AI or the rates don’t get pushed further down.

1M these days maybe gets you 40K tops for retirement. Assuming rates of return will stay where they are which they probably won’t probably more around 3%.

Pretty good is in fact pretty bad.

 

[deleted941485]

4% is too high a withdrawal rate. I can't recall the blog name, but they've modeled the **** out of these things. Safe withdrawal rate is more around 3.2% or something.

Yeah people always use the most optimistic numbers like 4% but honestly they are setting themselves up for disappointment. And early bankruptcy

 

[Birdstrike]

That’s assuming you keep you keep your job at 150/hr and don’t quit early due to burnout or are not replaced with MLP plus AI or the rates don’t get pushed further down.

1M these days maybe gets you 40K tops for retirement. Assuming rates of return will stay where they are which they probably won’t probably more around 3%.

Pretty good is in fact pretty bad.

There’s no safe withdrawal percent set in stone. It depends on interest rates during your retirement. In past, higher interest rate climates, 4% was easily sustainable. Now, in a low rate climate, closer to 3% is safer. What will interest rates be in 10, 20 or 40 years? Nobody knows. Prepare for the worst and hope for the best.

 

[deleted941485]

There’s no safe withdrawal percent set in stone. It depends on interest rates during your retirement. In past, higher interest rate climates, 4% was easily sustainable. Now, in a low rate climate, closer to 3% is safer. What will interest rates be in 10, 20 or 40 years? Nobody knows. Prepare for the worst and hope for the best.

Make as much as you can while you still can and have the energy. That way you have the option to slow down later.

 

[EctopicFetus]

Make hay while the sun shines. Smartest thing anyone told me.

In the end the SWR doesnt matter because no one has any earthly clue on returns or inflation. Much of SWR depends on your timeline. Simply 4% is 25 years at 0 return. If you are 70 you are incredibly safe. If you are 25 much more risk. Also, and maybe this is me and my FatFI ideas than even if I withdraw 4% I will leave some contingency. Lastly, if you have $3M in cash you should be able to live well on 120k/yr if you have no loans or mortgage.