Psychiatrists are not fulfilling their social contract?

[Brigade4Radiant]

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Psychiatrists aren't fulfilling the social contract that subsidized their training

Psychiatrists who won't see patients covered by Medicare or Medicaid, which supported their training, are violating a social contract.

www.statnews.com

It’s funny he says nothing about insurance and he posts like residents are getting this money directly

 

[Ironspy]

No word about improving the reimbursement rates or ease of reimbursement from these payors either and how these are not sustainable for many private practices.

Lots of complaining and light on solutions

 

[calvnandhobbs68]

Yeah I don't take opinions on my work from people who have never done my job. Another reason why I hated the hospital.

You could say this about literally any specialty. Are we gonna ban cosmetic or cash only derm, ophtho and plastics practices too? Or hey maybe my solution is we end up like NPs and just don't do a residency, then I won't have any medicare subsidy to "pay back" socially and I could start working 3-4 years sooner!

This is like saying some HVAC tech should give 50% off to 50% of their customers because my property taxes paid for the public school system that let them take their trade courses for free in 11th and 12th grade.

 

[comp1]

Wow, if cash psychiatry upsets this economist, wait until he hears about plastic surgeons! This guy reads like a troll. I'm not sure what an "implicit contract" is. If you wanted additional public service in exchange for residency training, that should be in the actual contract, not some sort of only exists in the mind of Dr. Frank contract. Taking Medicaid at all is very much a public service. It's horrifically underfunded in the vast majority of the country and you couldn't run business overhead with just it without a block grant. Also, the reason Medicare funds residencies is that residents...treat Medicare patients during residency. He seems to be valuing the care provided by residents at...$0? He conflates Medicaid and Medicare as a single thing. They are not in many ways, including funding of residencies. Also, Medicare is not the only funder of GME. The VA is a major sponsor as well. Should all psychiatrists work for the VA too?

 

[Sushirolls]

I have paid my unspoken societal contract debt in full and with interest.

I donated my pound of flesh in residency, hark, even before residency with efforts to even get into medical school. And in call with other jobs. In missing funerals of family members. In truncated personal recoveries from surgeries and other ills to return to work as fast as possible. Staying late and providing more time to patients at personal expense. Dealing with insurance companies. Prior authorizations. Death threats, and even ensuing restraining orders. Enduring hospital admins to start new services and their never endless meetings. And in today's speak, being victimized by the ills of a left leaning liberal education system trying to force their political indoctrination into you at every turn, as though conservative thought (or even libertarian) is a moral failing. Mailings from scientologists and their front organizations meant to push fear. Keeping my mouth shut in public or other arenas to maintain decorum of professionalism - i.e. constricting freedom of speech. My education was paid for by me, and in excess of actual cost due to interest on loans. CMS funds for residency aren't needed, and I've been posting on here for years to get rid of it. No one is entitled to my labor, no more than a plumber, or electrician. He can keep his socialist pandering that is an affront to the capitalism that is America - to himself or go emigrate to whatever the latest country is perceived as the utopia. Before I give an ounce of my labor by force from the government, I quit.
*Exception is draft for military, I'll serve with pride be it gun or stethoscope.

 

[splik]

I'm not sure we do have an obligation to accept medicare or medicaid. However, from an economic perspective, it is absolutely correct that the public does not benefit enough from their tax dollars paying for residency training. Personally, I don't believe that medicare should be funding residency spots. Just make it so residents can bill insurance and the problem is mostly solved. Judging by the recent expansion in residency programs, many hospitals also see the advantage of paying minimum wage for residents without sucking on the government's teat (most of these new positions have not come from medicare funding).

I do believe we should be giving back in some way, however there are many ways to do this. That could include teaching students and residents, doing some low bono or pro bono work, working sometime in the public sector or with marginalized groups, doing some case consultation, doing community engagement or doing talks for the public on mental health, immigration evaluations etc.

There are also many public positions that do not require one to accept medicare (e.g. working at the VA, jails, prisons, state hospitals) in which a significant minority of psychiatrists work.

 

[PsyDr]

Cost of living goes up, Medicare rates go down.

The social contract is broken, but it’s not in the side they say.

 

[VA Hopeful Dr]

I'm not sure we do have an obligation to accept medicare or medicaid. However, from an economic perspective, it is absolutely correct that the public does not benefit enough from their tax dollars paying for residency training. Personally, I don't believe that medicare should be funding residency spots. Just make it so residents can bill insurance and the problem is mostly solved. Judging by the recent expansion in residency programs, many hospitals also see the advantage of paying minimum wage for residents without sucking on the government's teat (most of these new positions have not come from medicare funding).

I do believe we should be giving back in some way, however there are many ways to do this. That could include teaching students and residents, doing some low bono or pro bono work, working sometime in the public sector or with marginalized groups, doing some case consultation, doing community engagement or doing talks for the public on mental health, immigration evaluations etc.

There are also many public positions that do not require one to accept medicare (e.g. working at the VA, jails, prisons, state hospitals) in which a significant minority of psychiatrists work.

I thought I read that new spots get like 50% of the funding the older spots do. I will see if I can find where I read that.

 

[Merovinge]

I'm not sure we do have an obligation to accept medicare or medicaid. However, from an economic perspective, it is absolutely correct that the public does not benefit enough from their tax dollars paying for residency training. Personally, I don't believe that medicare should be funding residency spots. Just make it so residents can bill insurance and the problem is mostly solved. Judging by the recent expansion in residency programs, many hospitals also see the advantage of paying minimum wage for residents without sucking on the government's teat (most of these new positions have not come from medicare funding).

I do believe we should be giving back in some way, however there are many ways to do this. That could include teaching students and residents, doing some low bono or pro bono work, working sometime in the public sector or with marginalized groups, doing some case consultation, doing community engagement or doing talks for the public on mental health, immigration evaluations etc.

There are also many public positions that do not require one to accept medicare (e.g. working at the VA, jails, prisons, state hospitals) in which a significant minority of psychiatrists work.

I believe to whom much is given, much should be expected on a personal level. Beyond that, I do not see why MD/DOs should be more expected to give back than anyone else. I don't see any IB folks clearing 2mill/year by the time I finished fellowship being harped on for this... Unlike many high income individuals who have some to a large part of their work being rent seeking, I help kids all day every day at my job.

That said, I personally choose to teach and give community talks all for free, but I wouldn't be frustrated with any doc who rather spend time with their family.