Psych Salaries Under Obama?

Discussion in 'Psychiatry' started by YOOOUK09, Dec 22, 2008.

  1. YOOOUK09

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    Anyone want to guess at how Obama's health care plan will affect Psychiatrist salaries?

    On the one hand, more people would be covered, and there's supposedly "parity" now.

    On the other hand, a single payer could force down psychiatrist salaries.

    Since you can only see "X" number of patients in a day, I'm thinking there will be an overall decrease in amount paid per patient and so salaries will decrease.

    Anyone care to speculate?
     
  2. Faebinder

    Faebinder Slow Wave Smurf
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    Psychiatrist salaries wont be changing under Obama. Single payer is actually a good thing for all physicians. Universal healthcare is a negative thing for all physician but it affects the higher paid specialties way more than the lower paid specialties.. so psychiatry is not afraid of that one. Socialized medicine will greatly reduce subspecialties and improve primary care.. psychiatry would be more under primary care.

    Really can't lose at this point. What are you going to do? Higher an NP to come do capacity on a psychotic or parkinson patient without a psychiatrist signing off on it? Don't make me laugh. The lawyers would enjoy tearing this one out in court.
     
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  3. masterofmonkeys

    masterofmonkeys Angy Old Man
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    Private pay prospects will be better thanks to parity law (not Obama per se).

    Medicaid will be worse. Not only was medicaid exempt from the parity bill, but if we do seek to grow the rolls of medicaid (which seems to be the most likely option for expanding insured populations), they will be struggling to get the bills paid as it is. They will be more likely to deny whatchamacallits for psychotherapy and we'll see primary care share an even larger burden of psych issues.

    Medicaid psych coverage is pretty terrible as it is and it will NOT get better.

    Single payer IS universal health care. And I fail to see how health care rationing will IMPROVE the lot of physicians, especially psychiatrists.

    I am thankful that the parity bill has passed, but I am very wary of what will happen under universal healthcare or expanded medicaid coverage. especially as many people who are currently paying for their own health insurance may try to go the medicaid route,meaning poorer mental health coverage.

    There is a tendency to pill push to an unhealthy degree especially in pediatric populations and I am eager to hear anyone argue that this will get better under a government health care plan that favors pediatrician/FP psychiatric medication treatment over psychiatric consultation and/or psychotherapy from a doctorate level practitioner (phd, psyd, or md).

    As I have said before, this is particularly concerning for me as I do not want a rich kid practice, and I refuse to participate in the care of someone who is not seeing ANYONE for psychotherapy or counseling on a regular basis.
     
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  4. Faebinder

    Faebinder Slow Wave Smurf
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    Clearly you need to read this thread to understand what you are saying. Single payer is not necessarily universal coverage.
     
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  5. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Obama's plan does not call for single payer at this time.

    Our salaries and reimbursement for services are far more likely to be subjected to the downward pressures of reduced state funding of health care programs and stricter utilization management by private insurance plans due to the horrific condition of the economy at present.

    We're already seeing a definite increase in people being admitted for decompensation that could likely have been prevented if they'd been able to continue their outpatient medications and office visits. It's a horrible catch 22--that those who need services the most are least likely to be able to afford them, and are most likely to have their access cut.
     
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  6. biogirl215

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    Additionally, the MIPPA legislation passed this summer will gradually increase mental health coverage under Medicare.
     
  7. notdeadyet

    notdeadyet Still in California
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    Ditto. I'm not sure why folks confuse the two, as they're very, very different things.

    Even those who think the current system is working just swell would be able to get behind a universal coverage system that meant more of the same. And Obama's plan is a far cry from single payer.
     
  8. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    It concerns me a great deal that medical students and residents are not conversant in these concepts, pros & cons, regarding how health care is paid for in this country. If we're willing to reduce our positions on these issues to "sound bites", and largely misinformed ones at that, how can we hope that the general public is going to be able to make an informed decision about health care reform? :(
     
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  9. Faebinder

    Faebinder Slow Wave Smurf
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    Why are you so surprised? I spoke with one internal medicine who came from china and she reported she only had 2 weeks of psychiatry as a med student. She is a nice gal but you kinda have to wonder for a moment... wow, these guys will be calling for psych consults in the future... Go figure. You expect residents from different countries to actually know the difference in the systems? I'll settle for them knowing that refusing a txt plan does not equal "call psychiatry".
     
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  10. notdeadyet

    notdeadyet Still in California
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    Couldn't agree more.

    One thing that's been a disappointment is seeing folks identify a party or philosophy or candidate that they choose to identify with, and then feel the need to trumpet all facets of that particular party/philosophy/candidate without really giving the tires a good kick.

    I heard lots of folks pooh-pooh Clinton's approach but support Obama's and vice versa, but couldn't find many people able to intelligently describe the difference.

    You can be left wing and support privatized-only for-profit healthcare (editorial: shame on you) and you can be right wing and support a single payer government-run system. Let's each dig a little deeper and support a healthcare strategy that we think would elicit quality and equality of service.
     
  11. whopper

    whopper Former jolly good fellow
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    I'm cynical that there will be no real improvement.

    There's too many people entrenched in the current system making too much money.

    The only good thing about this economic downturn is it sobers people. When the economy is good & there aren't things to worry about, people want to vote for the guy they'd like to have a beer with. When things are bad, people finally come to their senses & start demanding for an improvement.

    However, will things stay bad long enough & bad enough for people to change the corruption that has already entrenched the current system?

    And if so, will that change actually be beneficial? I see several changes people want that are rooted in bogus concepts that do not work in reality.

    As for our salaries, there currently is a shortage of psychiatrists, and there will be for years. Legislation wise-Parity has passed, and the trend is to put even more money into mental health.

    I do think mental health funding would be slash & burned if things got worse--but they'd have to be much worse than they are now....I'm talking Great Depression type of worse--in which case several doctors would be screwed.
     
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    #11 whopper, Dec 23, 2008
    Last edited: Dec 23, 2008
  12. masterofmonkeys

    masterofmonkeys Angy Old Man
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    I am plenty conversant with the different systems of healthcare and the difference between 'single-payer' versus other schemes. It's one of those areas where I'm prone to lump them all together which from my position (anti except for TRUE safety net) they all do seem to blend together.
     
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  13. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    I fear that you will have the opportunity to test your hypothesis. :(
     
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  14. Faebinder

    Faebinder Slow Wave Smurf
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    I give it a 50-50 shot.
     
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  15. YOOOUK09

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    I'm prone to the same laziness of speech.

    While single-payer is typically used in discussing the bargaining relationship between insurance companies and drug/device companies, the same concept can be transferred to insurance companies and physicians.

    An expanded medicaid/Medicare acts as a single-payer towards physicians. Even a Massachusetts-type plan would expand medicaid/medicare, and that would act as a de facto single payer in terms of setting salaries (please correct me if I'm wrong).

    However, I apologize for not using more precise language in my original post.

    To take this thread in another direction: it already takes months to see a psychiatrist, and if we expand the number of insured that wait will only grow longer. Do folks see the possibilities of expanded use of PA's and NP's? If so, could that increase psychiatrist salaries?
     
  16. masterofmonkeys

    masterofmonkeys Angy Old Man
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    I think that we're more likely to see even more expanded role of primary care handling psych issues, and PAs and NPs working for primary care docs handling those psych issues.

    The barriers to access for psychiatry with medicaid are pretty big and the parity bill will not make it better (as i feel like i've been obsessing over recently).

    "Oh what's that Mrs. Smith? Your marriage still sucks, you have body image issues as menopause approaches ever more rapidly, you feel like you sacrificed your most productive years to take care of a husband that'd rather drink at the bar than be home with you and a kid that doesn't bother to talk to you unless he needs money and you're wondering what your legacy will really be?"

    "....no problem, you're not near the dosage limit on your lexapro. Let me just write you a scrip and we'll fix everything. And I know things seem pretty bleak right now, but remember! There's always pristiq!"

    That said, I think there might be a role for PAs and NPs in the management of stable individuals in need of lifelong medication (i.e. bipolar and schizophrenia) doing things like drug level checks, metabolic and TD screening, and for individuals with mood and anxiety DO with continued residual symptoms.
     
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  17. masterofmonkeys

    masterofmonkeys Angy Old Man
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    Dang I just lost a looong reply.

    cliffnotes:

    Yes, I think that we can use PAs and NPs to handle long-term stable patients. Bipolar/schizophrenia for drug levels, metabolic and TD monitoring. Depression/Anxiety with mild residual symptoms, etc.

    Personally I am planning on hiring a derm PA, undercutting cosmetic dermatologists, and putting them all out of business. I will donate most of the proceeds to charity. After buying a 1969 mustang coupe and giving it the full Pro Street treatment. And paying for the lawyer when my wife divorces me over said monstrosity. But everything after that, charity!
     
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  18. HCE

    HCE
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    honestly, do you really expect to have anything left after that divorce?
     
  19. masterofmonkeys

    masterofmonkeys Angy Old Man
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    two words. prenup.
     
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  20. whopper

    whopper Former jolly good fellow
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    All things being equal, IMHO the economy will start to recover in the 2nd quarter in 2009. That's ATBE--> things that would not make it equal--war with Iran, another major terrorist attack on America, collapse of one of the big 3 carmakers.

    The last one is the one that is most probable IMHO. GM's banking a lot of money on their upcoming Chevy Volt-costing $40,000 for a new type of car that the public may interpret as an unproven technology. BYD is planning on bringing their own plug in car only 1 year after Chevy with a range of about 50% more before needing a recharge & at about $22,000. That could be the very thing that drives GM out of business.
     
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  21. masterofmonkeys

    masterofmonkeys Angy Old Man
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    *blech* was on his website just now, and he wants to expand employer-based healthcare. The free market maven in me is vomiting.

    It's like the opposite of Pangloss: worst of all possible worlds.

    More here on why I think it sucks: http://www.indiancowboy.net/blog/?p=316
     
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    #21 masterofmonkeys, Dec 25, 2008
    Last edited: Dec 25, 2008
  22. fMRI

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    WOW, could somebody maybe voice what's best? Having stumbled around the wards of an inner city hospital for some time, I guess socialized health care would be, by far, the best for our patient population and their particular needs. :D
    Anybody disagree?? :)
     
  23. notdeadyet

    notdeadyet Still in California
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    Socialized healthcare is the best for those who don't have money. Private insurance is best for the wealthy. For the middle class, things get fuzzy.
     
  24. fMRI

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    At the risk of stating the blatantly obvious:
    I observe a negative relationship between the severity of pathology (=need for care) and the patient's health insurance coverage.

    In other words: nobody ever flung me their platinum health insurance card in the face in a psychotic rage. :D
    Hearsay, folks who go suddenly manic, but they are rare around here. ;)
     
  25. notdeadyet

    notdeadyet Still in California
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    Sure. Folks who are chronically ill have a tougher time keeping jobs.
    Makes sense. I doubt folks who fly into psychotic rages hold down professional jobs with great perks for very long.

    Though I've worked for a few executives who make a pretty good case to the contrary.
     
  26. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Did you mean Surgery Attendings?:D
     
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