Post health care reform: What if it is no longer your dream job?

[TexasFight]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick
- Whatever else comes to mind.

Suppose you just finished your first year of residency. What do you do now? You can't stand medicine. State what would no longer make medicine your dream job, and what you would do afterwards.


Personally, I am afraid of having the government dictate what I can and can't do as a physician, to the point where I am just a technician at their disposal. I would be working unfair hours for the salary (unfair for me would be 70 - 80 hours a week for 150k). Hah, sounds like primary care right now...

So instead, I would love to do research with a PhD at a medical center. I feel like I would be making a difference with patients and I would have a decent salary for decent hours (40 hours a week for 120k?). I would also have a lot of that autonomy brought back.


What would you all do?

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[cliffhuxtableDO]

Leave the country.

 

[txprodigal]

.

 

[kimdoc]

What a scary prospect! The thought of it all gives me a severe existential crisis. I have to say though, leaving the country would be preferred over research for me

Ha!

Kim

 

[Arzt67]

I'd take over a small island country and rule as physician-dictator - it would certainly solve the autonomy problem.

 

[LiveUninhibited]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick
- Whatever else comes to mind.

I would think if these things deter you, it might not be the best career choice, as they are already problems even without further reform. Managed care took away most of the physician autonomy you allude to. Ditto on medical malpractice, as that necessitated joining a larger group of physicians or hospitals and eroded autonomy in that way.

The context in which physicians operate will likely not stay the same, what is important is if the career is inherently rewarding compared to alternatives. If you want to make money, I'm not sure if becoming a physician is the path of least resistance.

Personally, I am afraid of having the government dictate what I can and can't do as a physician, to the point where I am just a technician at their disposal. I would be working unfair hours for the salary (unfair for me would be 70 - 80 hours a week for 150k). Hah, sounds like primary care right now...

Again this ship already sailed. Say hello to the DEA and utilization review.

 

[Parts Unknown]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick

That's how things are now. In my mind the worst case scenario is that nothing will change.

 

[kami333]

So instead, I would love to do research with a PhD at a medical center. I feel like I would be making a difference with patients and I would have a decent salary for decent hours (40 hours a week for 120k?). I would also have a lot of that autonomy brought back.

I agree with the autonomy but you should reevaluate your view of the research life style...

 

[DrYoda]

Quit and get a new job.

 

[vokey588]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick
- Whatever else comes to mind.

Suppose you just finished your first year of residency. What do you do now? You can't stand medicine. State what would no longer make medicine your dream job, and what you would do afterwards.


Personally, I am afraid of having the government dictate what I can and can't do as a physician, to the point where I am just a technician at their disposal. I would be working unfair hours for the salary (unfair for me would be 70 - 80 hours a week for 150k). Hah, sounds like primary care right now...

So instead, I would love to do research with a PhD at a medical center. I feel like I would be making a difference with patients and I would have a decent salary for decent hours (40 hours a week for 120k?). I would also have a lot of that autonomy brought back.


What would you all do?

Not that this makes the worst-case scenario less scary, but if physician autonomy is constricted because of Federal guidelines to treatment then malpractice lawsuits will be drastically reduced. How can a doctor be sued for following evidence-based medicine as endorsed by the Federal government itself?

The Supreme Court recently ruled that medical device makers can NOT be sued over a product that was approved by the FDA. I don't see why some variant of that wouldn't apply to doctors in your worst-case scenario.

 

[NickNaylor]

Leave the country.

I will jump ship before I deal with this stuff that, in reality, will probably not happen. I personally have no problem going overseas and practicing. An American MD is like gold.

 

[PremedIowa]

All the successful professors I know work physician hours and still make <120k. Very few people in the real world with successful careers work 40 hours/wk.

And autonomy? You mean only being able to do what you get grant funding for? Have you worked in a real research lab?

 

[TexasFight]

There is one MD in the lab I am working in. I don't work directly with him, so I guess I wouldn't know how much he gets paid. I do know the PhD's get 90 - 100k. And maybe it's just my lab... but all everyone in the lab all just reads articles and maybe do an experiment every week. They all go home at 4. I think it's very possible to work 40 hours a week doing research. The 120k a year I'm not so sure about. Hence the question mark.

 

[SteinUmStein]

There is one MD in the lab I am working in. I don't work directly with him, so I guess I wouldn't know how much he gets paid. I do know the PhD's get 90 - 100k. And maybe it's just my lab... but all everyone in the lab all just reads articles and maybe do an experiment every week. They all go home at 4. I think it's very possible to work 40 hours a week doing research. The 120k a year I'm not so sure about. Hence the question mark.

Maybe, but at some point you need to get actual data to show significance of your results, and you won't publish doing "an experiment every week." I know a lot of grad students, post-docs, and even PI's who come in on weekends to run stuff. Plus, hard as med school may be, at least you know it will last 4 years, whereas grad school can drag on for 6... 7 years.

 

[pharaoh88]

All the successful professors I know work physician hours and still make <120k. Very few people in the real world with successful careers work 40 hours/wk.

And autonomy? You mean only being able to do what you get grant funding for? Have you worked in a real research lab?

ditto.

 

[NoMoreAMCAS]

I will likely always live in the country with highest physician salaries (take home), as long as it isn't a dump. But, if the US is only slightly behind the next country, i'll stay in the US.

 

[TexasFight]

Maybe, but at some point you need to get actual data to show significance of your results, and you won't publish doing "an experiment every week." I know a lot of grad students, post-docs, and even PI's who come in on weekends to run stuff. Plus, hard as med school may be, at least you know it will last 4 years, whereas grad school can drag on for 6... 7 years.

We are probably just imagining two different lab settings. This summer I am working in a clinical lab where we bring in patients one day a week for experiments and just mess with the data the rest of the work. They definitely are happy with the amount of publications they get. During the academic year I do molecular biology research where I actually do have to go in during the weekends sometimes, so I think I understand what you are envisioning. Now that I've experienced some clinical research, I could definitely say I enjoy it a lot more than bench research.

 

[CD4helpCD8]

So instead, I would love to do research with a PhD at a medical center. I feel like I would be making a difference with patients and I would have a decent salary for decent hours (40 hours a week for 120k?).

If you can find a research job that pays a PhD 120k for 40 hours/week, please let me know.

 

[movax]

I would return to my old job at Siemens (or switch to GE) and work on medical tech. (Undergrad = Electrical/Computer Engineering).

 

[ChenMary]

Wow.... you are pathetic

 

[NoMoreAMCAS]

Wow.... you are pathetic

Who? Why?

 

[ChenMary]

Not really going to have a discussion with you losers..

 

[spyderracing32]

Not that this makes the worst-case scenario less scary, but if physician autonomy is constricted because of Federal guidelines to treatment then malpractice lawsuits will be drastically reduced. How can a doctor be sued for following evidence-based medicine as endorsed by the Federal government itself?

The Supreme Court recently ruled that medical device makers can NOT be sued over a product that was approved by the FDA. I don't see why some variant of that wouldn't apply to doctors in your worst-case scenario.

The difference is at the point of care and in the human element. They're not going to be bringing suit against the gov't for the methods by which medicine is practiced. They're going to be bringing suit against the physician who administered the care (and it is then the court's job to decide whether it was done so inappropriately). You may not be able to bring suit against a corporation producing an FDA approved pace-maker, but you sure can bring suit against the physician who put that pace-maker in your chest. There's no mention of tort reform in any of this, and a public health system is not going to achieve the same affect. I'm just waiting for Obama to exhibit some real saavy and hedge gov't health insurance against gov't malpractice insurance. Then we can all just hold hands in the bread line and share vodka while wearing our snazzy new red scrubs.

 

[TexasFight]

Not really going to have a discussion with you losers..

Based on your posting history you, my friend, are going to be the first person on SDN that I call a troll.

Have a nice day.

 

[RogueUnicorn]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick
- Whatever else comes to mind.

wait, this is your post-reform scenario?

 

[ChenMary]

No, my friend here is why i am mad at you:

You believe that 150K for 70 hours of work a week is horrible? And you are letting a small paycut determine your career?!

We need compassionate doctors, not money chasers, as Obama said to his cabinet. Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

 

[spyderracing32]

We need compassionate doctors, not money chasers, as Obama said to his cabinet. Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

I would hardly call ordering extraneous (although possibly relevant) tests greedy when the risk of being sued into ruin (read: not being able to afford macaroni and cheese for dinner) persists as a risk of the profession.

 

[TexasFight]

wait, this is your post-reform scenario?

I sincerely and truly hope not. I want health care reform to happen, but I made this thread after reading some articles in certain publications (I'm looking at you NY Times!) who seem to believe slashing doctor salaries and forcing them to practice in certain ways is the solution. The comments that follow don't help. I really wouldn't mind a single payor solution if they paid at private insurer rates. There are too many institutions in medicine that profit at the expense of patients without contributing at all to patient care.

 

[TexasFight]

No, my friend here is why i am mad at you:

You believe that 150K for 70 hours of work a week is horrible? And you are letting a small paycut determine your career?!

We need compassionate doctors, not money chasers, as Obama said to his cabinet. Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

There are medical students, residents, and attendings on this forum that could tear apart your statement way better than I ever could. You should go read some threads in Topics in Healthcare or in General Residency Issues. Don't post if you don't want to be yelled at.

 

[Exalya]

If I really just hated my job as a physician, I would go into research. Probably genetics. I find that plenty interesting, and since money is not my motivator, I'd be cool with the lower pay.

 

[Charles_Carmichael]

No, my friend here is why i am mad at you:

You believe that 150K for 70 hours of work a week is horrible? And you are letting a small paycut determine your career?!

We need compassionate doctors, not money chasers, as Obama said to his cabinet. Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

If you got rid of everyone who had taken money into account before entering medicine, I doubt there would be enough doctors out there. Worrying about your income doesn't make you uncompassionate. Medicine isn't the only profession that helps people; nearly every other profession out there helps others in some way. But when they get worked up over possible pay cuts, you don't see anyone calling them pathetic, uncompassionate, and unwilling to help others do you?

Also, a small cut can actually turn out to be a big cut. Think of the overhead cost that's required to maintain a practice. All those costs, salaries of people working there, etc. remain the same while you take a small cut; this effectively turns this small cut into an even bigger cut. I'll try to explain it in a very simplified way so don't count it against me for being inaccurate with numbers, etc. Let's say you make $100 per year and your overhead cost is $50. So your take home pay for that year would be $50. Now, if you had a 10% cut in what you make per year, you now make $90 per year. But overhead stays constant because the people you have hired don't want pay cuts and the equipment, building, etc. all have to still be paid for. Now, your take home pay is 90 - 50 = $40. So, that initial 10% cut actually turned out to be a 20% cut.

 

[RogueUnicorn]

I sincerely and truly hope not. I want health care reform to happen, but I made this thread after reading some articles in certain publications (I'm looking at you NY Times!) who seem to believe slashing doctor salaries and forcing them to practice in certain ways is the solution. The comments that follow don't help. I really wouldn't mind a single payor solution if they paid at private insurer rates. There are too many institutions in medicine that profit at the expense of patients without contributing at all to patient care.

the reason for my post is everything you put up as a "hypothetical" is exactly reason tons of doctors are feeling disillusioned with the whole system to start with.

 

[spyderracing32]

I really wouldn't mind a single payor solution if they paid at private insurer rates.

Medicare already reimburses at a lower rate than private insurers. Expanding an already ailing program to the masses isn't going to promote more reasonable reimbursement without massive taxation to make up the extra expense. Since everyone hates taxes, I imagine that reimbursements would stay low or go lower.

 

[Charles_Carmichael]

Medicare already reimburses at a lower rate than private insurers. Expanding an already ailing program to the masses isn't going to promote more reasonable reimbursement without massive taxation to make up the extra expense. Since everyone hates taxes, I imagine that reimbursements would stay low or go lower.

Also, as an example, Medicare reimburses anesthesiology at 33% of the rate of private insurers. If reimbursements with a government program were lowered to Medicare levels, anesthesiologists would take huge cuts (greater than 50%) and the field could potentially die. You can read about this stuff in the Anesthesiology forum; it's pretty scary. Who would want to keep paying higher amounts for private insurance if the government offers the same thing at a lower price by decreasing reimbursements?

 

[Mashizhao]

No, my friend here is why i am mad at you:

You believe that 150K for 70 hours of work a week is horrible? And you are letting a small paycut determine your career?!

We need compassionate doctors, not money chasers, as Obama said to his cabinet. Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

I'm sure there are other passionate doctors out there who would devote themselves entirely to their cause - and sacrificing family, free time etc. I've seen a few and I will be one.

But most people just view medicine as a job and want to make a decent living. That's why we need to find an empirical format that would work for everyone.

 

[RogueUnicorn]

I'm sure there are other passionate doctors out there who would devote themselves entirely to their cause - and sacrificing family, free time etc. I've seen a few and I will be one.

But most people just view medicine as a job and want to make a decent living. That's why we need to find an empirical format that would work for everyone.

please don't start a family then

 

[spyderracing32]

What we should be asking is what happens when healthcare costs become unsustainable and the government imposes some nasty and draconian measures in the coming years.

I believe that's what we are asking...

Also, as an example, Medicare reimburses anesthesiology at 33% of the rate of private insurers. If reimbursements with a government program were lowered to Medicare levels, anesthesiologists would take huge cuts (greater than 50%) and the field could potentially die. You can read about this stuff in the Anesthesiology forum; it's pretty scary. Who would want to keep paying higher amounts for private insurance if the government offers the same thing at a lower price by decreasing reimbursements?

Well that's because anesthesia is a luxury DUH! Only a real girly man (or girly girl) undergoes open heart surgery with the luxury of anesthesia.

 

[pharaoh88]

This thread has done an excellent job of explaining to me what is meant by: "going into medicine for the wrong reasons."

 

[spyderracing32]

This thread has done an excellent job of explaining to me what is meant by: "going into medicine for the wrong reasons."

I don't know why you think that. I live with a bunch of kids who are in the business program at one of the best business schools in the country, so I'm under no illusions that medicine is the fast track to easy money. One of my good friends tonight told me that he hopes to make his first million by 30 and I responded "I hope to only be slightly in debt by 30". Not wanting the government to take over health care isn't greedy. Think about how a $750B budget would cover the 50M people that are currently uninsured. That's $15k annually. Let's not forget the fact that the 50M uninsured individuals are likely the less-educated members of our society, and will likely be a greater drain on the health care system than their college educated counterparts (that's not to say they don't deserve health care for that reason though, let's not go there). The $15k annually probably isn't going to cover it. Thus, things will likely be rationed for the federal program, even with the competing private insurance companies operating at the capacity they do today. Let's not forget to mention the wonderful task it's going to be to apply for and be approved on the gov't program. Plenty of slam dunk cases are dismissed by medicare leading to accrual legal fees in simply trying to get covered.

I'm not saying our system is good right now, but people need to stop swooning over Obama's oratory prowess and start listening to the actual words coming out of his mouth. It is simply not fiscally sensible to throw money at the problem, because WE DON'T HAVE IT! He and the Dems have already spent our country into the ground, and this isn't about to get any cheaper. To give you an idea of what $750B represents; that was the national defense budget at the peak of Bush's war-time spending (a Republican spending the country into the ground, going for some balance here). Let's not forget that we still need to maintain a defense budget, with or without gov't health care.

 

[TopSecret]

What would you do if post-health-care-reform, you can't stand working as a doctor anymore? This worst case scenario only applies to you as it is specific to you, caused by any number of factors:
- No physician autonomy
- Reimbursements rates are at insulting levels
- Med mal gets the best of you
- The amount of uninsured patients out there make you sick
- Whatever else comes to mind.

Suppose you just finished your first year of residency. What do you do now? You can't stand medicine. State what would no longer make medicine your dream job, and what you would do afterwards.


Personally, I am afraid of having the government dictate what I can and can't do as a physician, to the point where I am just a technician at their disposal. I would be working unfair hours for the salary (unfair for me would be 70 - 80 hours a week for 150k). Hah, sounds like primary care right now...

So instead, I would love to do research with a PhD at a medical center. I feel like I would be making a difference with patients and I would have a decent salary for decent hours (40 hours a week for 120k?). I would also have a lot of that autonomy brought back.


What would you all do?

I would finish residency and then join the doctors union and strike like they do in France. It seems to work for them.

 

[spyderracing32]

Unless I'm misinterpreting you would finish the first year of residency 6 -7 years from now depending on how quickly you get into medical school. That would be around when the full range of the proposed current reforms would start to be realized (since many proposed changes don't even start working until 2013). Our healthcare system will still be relatively solvent at that time if we do nothing. It will take much longer for a serious crisis to develop to develop.

Yea that's about right as far as the time line goes, but the bottom line is I don't want to see a crisis develop ever. I think that massive government spending will lead to A) Increased taxes (duh) B) Reduced reimbursements ===> C) Hospitals facing financial problems D) (also following from B) Reduced quality of care for everyone (privately insured included). I don't even want to think about the effects all of the spending is going to have on the economy in the long term...

 

[spyderracing32]

I just realized I haven't even answered the question here yet, but if for some reason I were to find the clinical practice of medicine unbearable I would probably move toward academia. I might also go into health care consulting or something along those lines as well.

 

[vokey588]

The difference is at the point of care and in the human element. They're not going to be bringing suit against the gov't for the methods by which medicine is practiced. They're going to be bringing suit against the physician who administered the care (and it is then the court's job to decide whether it was done so inappropriately). You may not be able to bring suit against a corporation producing an FDA approved pace-maker, but you sure can bring suit against the physician who put that pace-maker in your chest. There's no mention of tort reform in any of this, and a public health system is not going to achieve the same affect. I'm just waiting for Obama to exhibit some real saavy and hedge gov't health insurance against gov't malpractice insurance. Then we can all just hold hands in the bread line and share vodka while wearing our snazzy new red scrubs.

Of course things will be more fuzzy with procedures, namely surgeries. However, the execution of the procedure can be a source of liability but the choice of procedure--if the choice follows the hypothetical federal guidelines--will be more difficult to sue over. It wouldn't be eliminating liability risk for physicians, which liability reform should NOT do, but at least it would reduce it. Trial lawyers really don't stand to gain anything from this legislation.

Edit: An addition; I think there's a good chance that some amount of liability reform will be included as one concession Democrats make to the 'Pubs and Blue Dogs (God I hate that term).

 

[mipp0]

Look here OP.

They can take away my pay. Work me to near death.

They can strip me of my dignity.

Spit at me. Curse me. Sue me. Ruin me.

And I'd still go Med baby!!!

Does that answer your question you little baby?

Oh wait, I lose physician autonomy?

DENTISTRY, HERE I COME!!!

 

[LiveUninhibited]

Yea that's about right as far as the time line goes, but the bottom line is I don't want to see a crisis develop ever. I think that massive government spending will lead to A) Increased taxes (duh)

Yeah that one is obvious, but you should note a few things:

1. Private insurance is already a huge expense, and single payer would be replacing that expense, not adding to it.

2. Private insurance must make a profit, and their profit is the rest of society's expense. This would not be the case for government insurance.

3. Given the plethora of private insurance companies, administrative overhead would be reduced under single payer, both on the provider and payer sides.

4. The government already subsidizes private insurance, in a way as health benefits are not taxed.

B) Reduced reimbursements ===> C) Hospitals facing financial problems

Hospitals already get a large chunk of their money from medicare and the DRG system. Increases in that could be offset by making the emergency department less of a financial black hole. Uninsured people use the resource-intensive ER as the sole source of healthcare, and then must declare bankruptcy. If the government were to insure them but require copays for ER visits (but lower or no copays for recommended primary care visits), the hospitals could actually come out ahead.

But I admit, that would be only if this is done right.

 

[Hyperstudyosis]

What I fear the most is losing the ability to give my patients quality care and losing my ability to treat them as I best see fit. I do not want the government to dictate to me what treatments to use and how many patients to see per day, etc. If ever they take away from me the freedom to do what I think is best for my patients, I will go and practice in another country.

 

[the freest man]

From what I've seen so far, this American healthcare reform will be the best thing that happened to medical practice in the rest of the world.

 

[BrainBuff]

Greedy physicians who over-use tests are the ones who are a big part of the health crisis in America today.

Only someone completely ignorant about the current climate of the practice of medicine could make an absurd comment like that. But I guess that also includes our President and most of Congress.

One of the reasons why health care expenses are out of control in our country is because doctors practice defensive medicine. The days of strictly clinical diagnosis are over, because physicians must back up their decisions with the most expensive diagnostic tests to cover themselves in case they are threatened with a law suit.

My parents are both physicians and I will give you a classic scenario. A patient presents with a headache and his neurologic examination is normal. The clinical history does not suggest anything but a migraine and there is a strong family history as well. The patient responds 100% to anti migraine medications and never has another headache. Six months later, the patient begins to have headaches again and does not go back to her doctor. Eventually, she goes to the ER for pain relief and because of her exam at that time, she has a brain MRI that now shows a malignant tumor.

Well.... the first doctor gets sued and even though his records show a NORMAL neurologic exam and that the patient RESPONDED well to the anti migraine medications, his malpractice insurance settles for 100 k because there was NO MRI or CT done. The insurance company decides that it is better to settle because they are afraid of a prolonged expensive defense or a rogue jury verdict. The doctor's malpractice insurance premium increases to 50k per year and he now has a "history" of a settlement on his record.

LESSON : You come into my office with whatever complaint and even if your exam is normal, I am not going to do like the rest of doctors do all over the world and just rely on my clinical skills. I am going to get whatever test covers my diagnosis, whether it is an MRI for $1000 or an Echo for $ 800 or WHATEVER. If your insurance does not want to pay, that will be their problem. May be you may choose to turn around and sue them for a change.

If you want to see what a national health insurance does, just go and shadow a doctor at a Veterans Administration Hospital for a week. The overbooked appointments, the major red tape to get any test done and the long waiting lists to have some procedures.
But then again, you CAN NOT SUE the federal government.

Americans need to snap out of it.

 

[Kaustikos]

Consulting
Hollywood
Backalley abortion clinic
The mob/mafia
Pharmaceuticals
If you really want autonomy, there you go. I mean, honestly, people act as if an MD only lets you work in the hospital

 

[TopSecret]

Consulting
Hollywood
Backalley abortion clinic
The mob/mafia
Pharmaceuticals
If you really want autonomy, there you go. I mean, honestly, people act as if an MD only lets you work in the hospital

I know MD's who have migrated to non-invasive cosmetic procedures especially in SoCal. But times are tough these days and discretionary income is down for plastic surgery and other beautifying procedures.

Still, you can branch out and be a consultant for Hollywood, do locum tenens work overseas like in New Zealand and Australia, work in the pharmaceutical industry, conduct research, write a book, work as a hospital administrator, etc.