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"Reasons Not To Become A Doctor" on Forbes

Discussion in 'Med Business [ MD/MBA, DO/MBA, DDS/MBA ]' started by DrJosephKim, May 8, 2008.

  1. DrJosephKim

    DrJosephKim Advisor Physician SDN Advisor 7+ Year Member

    Mar 29, 2008
    "Reasons Not To Become A Doctor" on Forbes

    A very interesting article that hits some major points about being a physician in modern times.

    Here are some excerpts:

    Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America's Looming Doctor Shortage...

    But there are other significant reasons. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for...

    Insurance has become a loaded word. One-third of the country is insured by Medicare, and over the next nine years, the government program plans to cut payments to physicians by about 40%, while practice costs are projected to increase 20%, according to the American Medical Association. The first of those cuts will take place in July, when the reimbursement rate to doctors will drop by 10.6%. The next cut, of 5%, will occur in January...

    Meanwhile, getting sued by a patient is a major concern. Of course, doctors who make fatal mistakes and who are unqualified should be held responsible. But there's evidence that the bulk of lawsuits brought are frivolous. Of all malpractice lawsuits brought to jury trial in 2004, the defendant won 91% of the time. Only 6% of all lawsuits go to trial; those that aren't thrown out are settled. Only 27% of all claims made against doctors result in money awarded to the plaintiff, according to Smarr, president of the trade association for medical malpractice companies...

    To support that assertion, a 2007 survey by Merritt, Hawkins indicated that 57% of 1,175 doctors questioned would not recommend the field to their children...

    You can read some interesting comments by going to the article itself.
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  3. franklinave

    franklinave 2+ Year Member

    Dec 1, 2006
    I can't think of many other professions where $200k/yr is almost guaranteed. Add to that the great job security, high demand for physicians, flexibility in practice/large variety of positions available, and nothing really compares to medicine. Yes, CEOs and investment bankers can make a lot more, but how many people do you think are able to land such careers?
    RadDocGoneBadDoc likes this.
  4. LADoc00

    LADoc00 There is no substitute for victory. 10+ Year Member

    Sep 9, 2004
    well to put it another way, there are few if any jobs you can work say 30-40 hours a week, make 400-800K/year outside of owning your own business...
    that is key really, not the healthcare portion but the owning the business/practice part that really pays off.
  5. Faebinder

    Faebinder Slow Wave Smurf 10+ Year Member

    May 24, 2006
    1) Almost guaranteed? Maybe after you finish all the crazy boards/residency/shelf exams/training. You are looking at the finished product and not recognizing that IT WAS NEVER GUARANTEED. You just didn't witness the filtering.. such as 10,000 more applicants to residency than there are residency positions... or the surgery resident that got stuck with an HIV needle and got HIV and can't do surgery anymore or the psychiatry resident that got stabbed by a psychotic patient and can't walk anymore....etc etc It's like saying, the Honda car is guaranteed to be bought because it's already made and done.

    2) Flexibility of Practice? hahahahahha I suppose you dont know about needing a license for each state you want to practice in and how hard it is to get hospital privilages and how physicians and hospitals try to make sure you cant practice in their area. Ask LaDoc00 about flexibility of practice. :rolleyes:

    3) Great job security? You mean what you learned can't ever be obsolete? hahahahh and you mean to tell me they can't stop refering to you and kill your practice? hahahahahha. Malpractice and insurance cant sink you? hahahah.

    Oh hell.... you'll learn grass hopper.. don't worry... but it will be too late by then.
  6. arrhythmia7

    arrhythmia7 New Member 5+ Year Member

    Jul 29, 2005
    The shortage of doctors mentioned in the Forbes article is a great reason TO become a physician in my mind. Everyone ultimately determines their own reality, and physicians need to learn to realize how valuable they are. It is entirely possible in the area where I practice (Los Angeles) to open a cash only practice as an internist and be filled within 6 months. In fact, many of the physicians I know are charging cash up front now for the office visits, and giving patient's reimbursement forms that they are required to fill out and return to their insurance company. I would argue that it is still easier to make money as a physician than as any other type of professional; most doctors are just too lazy/disinterested in the financial aspect of their practice to handle it.
  7. MOHS_01

    MOHS_01 audemus jura nostra defendere Physician 10+ Year Member

    Oct 2, 2005


    Friend, I have been a fan of your posts over the years and have agreed with virtually every one of them more or less... but, with precious few exceptions, I do not believe that many physicians can realistically expect to work 30-40hrs / week and make 400-800k -- regardless of practice ownership or not. High throughput specialties such as path (especially dermpath) and radiology being the possible exceptions.

    Now if you own a practice and employee other physicians, securing a profit off of their services, then it would be easier -- but at that point you are operating an enterprise, not a medical practice.
  8. mshheaddoc

    mshheaddoc Howdy Moderator Emeritus 15+ Year Member

    Apr 24, 2002
    Wild west of Mistytown
    Oh be easy on the premed!!! I really feel bad for many of the premeds that have no idea what they are getting into financially. As someone who started the non-trad process and had to put the dream on hold (and pay off her debt while working an avg paying job), I'm having second thoughts. More just for financial reasons. Watching my husband go through this whole process and actually working with physicians out there that have no clue about how to "operate" a hospital from a management and financial aspect is quite scary.

    Being $200K in debt while trying to make a living in decline wages is never fun ....
  9. Futuredoctr

    Futuredoctr Member 7+ Year Member

    Jun 14, 2005

    I really don't appreciate your point of view. Did it ever occur to you....

    1.) that the majorty of those 10,000 applicaitons were FMG (IMG)?

    2.) By being a practice owner, you basically determine what your life looks like. Sure you might have to start by being hired into a practice that has hospital privleges, but those privleges REALLY should not be a concern if your a competent doctor.

    3.) Being a physician has the greatest job security over all most ANY profession, think about it, what other field projects a shortage as great as the medical field? (none). And there are these things called CME that are REQUIRED for a license EVERY YEAR, so sure you might learn things now that will definitly be obsolete by the time you leave school or residency (or in ten years), but if you are going to be anything close to a competent physician, you'll be a "life long learner".

    So before you go spouting off about "all" that you know and mocking someone with ridiculous unfounded statements why don't you stop and think about what you're really saying.
    ackattack likes this.
  10. michaelrack

    michaelrack All In at the wrong time Physician SDN Advisor 10+ Year Member

    Dec 22, 2007
    Memphis TN
    I agree with you that it is ownership that pays off. Ownership of equipment (echocardiogram machine, polysomnogram machine, etc) will usually increase earnings to a greater extent that owning an outpatient encounter practice alone.
  11. MOHS_01

    MOHS_01 audemus jura nostra defendere Physician 10+ Year Member

    Oct 2, 2005
    Traditionally, physicians have enjoyed great job security, respect, prestige, and high income -- these are all true. Practice ownership allows you to wear two hats (as Dr. Rack and LA have pointed out) -- that of entrepreneur and clinician. The entrepreneurial side allows for the addition of ancillary studies, tests, services, etc -- which creates the potential for passive revenue. There is no doubt that, if you truly want to be something more than a well paid plumber, these profit centers are absolutely necessary.

    That said, you err in your belief that docs are so vitally important that they will enjoy these "privileges" forever. For example -- anesthesiologists had the hospital world by the b**** for years -- enter the CRNA, an arguably overpaid, cheaper, lesser alternative to the MD that has afforded hospitals negotiating clout and effectively damaged traditional anesthesia practice.

    Next -- radiology. Radiology has enjoyed a very, very good run for the past 20 or 30 years. The same technology that has afforded them the luxury of being able to take night call from home, their home on the beach, slopes, etc is coming home to roost. They are truly at the mercies of market forces and "globalization". Currently many hospitals farm out their nighttime, weekend, and overflow radiology to Australia, India, etc. The local hospital chain recently sent the local radiologists packing because they signed a contract for services out of Chicago. There is a storm on the horizon for radiologists.

    Consider primary care. The advent of the mid-level provider has lessened the burden, but again, they can provide services cheaper b/c the inherent costs that they have are less (less time in education, less debt associated with education, overall lower opportunity costs, etc).

    Lastly -- while it is largely true that you can have more control over your life if you are driving your own bus, specialty choice and other factors still exert significant control over your life.
  12. MacGyver

    MacGyver Banned Banned

    Aug 8, 2001
    You need to check your figures. The average doctor (averaging across ALL specialties) makes 165k per year according to the US Labor Dept, so that 200k guaranteed number you cite is a myth.

    You also need to learn to ignore the "salary survey" crap. There's 2 reasons those numbers are not legit:

    1) Biased by high income reporters whereas lower income earners choose not to participate

    2) These income surveys are sponsored by physician recruitment companies, who have a vested interest in artificially inflating their numbers.

    The US Labor Department via the US Census is the database for salary that you should be using, because they have a much broader reporting range, a much higher number of data poins, and is not hindered by the 2 sources of bias above.
  13. DrJosephKim

    DrJosephKim Advisor Physician SDN Advisor 7+ Year Member

    Mar 29, 2008
    Salary surveys can be very misleading. Also, the range is very broad. Many in the academic environment may make $85-95k, while those in the private sector may make twice that amount in the same specialty.

    Also, salary changes depending on your geography. For example, those working in the northeast and living in the major cities may not make as much compared to those living in the south.
  14. raptor5

    raptor5 Fooled by Randomness 10+ Year Member

    May 28, 2003
    Without cell reception
    Currently the primary care shortage is that of allocation. A PCP to patient ratio of 1:1500 could be solved with HPSA reallocation.
  15. Jeff Mike Hoss Johonson

    Jeff Mike Hoss Johonson

    Oct 14, 2017
    I have to be frank and I hope that this does not get deleted but I am not a medical student but I happened across the article referred to in Forbes and wrote a rather long response but despite doing all the tomfoolery of registering and logging in I still could not post, so googling I found this site and will post what I wrote HERE as I think what makes a lot of common sense and those that do not agree with me, please post here.

    Initially after reading the article and seeing that since doctors in the U.S. are the second highest paid next to the Netherlands (and sometimes there´s a disparity of almost 100K even with other developed westernized countries) I thought yes, they were, but then I read another article in Forbes about the overtime pay in New York City, where some of the employees that were not highly technically trained (like adjusting the thermostat) were getting salaries over a hundred thousand, sometimes more than the head of their dept. (as a newbie I can NOT post a link to the article but google ¨
    Start Spreading The News! NYC Mayor de Blasio Paid City Employees $2B For 33 Million Overtime Hours¨
    and then thought not, doctors here are NOT overpaid.

    My proposal is let us have a two type healthcare system in this country, one like the ACA or what they have in other countries, first a one payer system funded by the government and the citizens have to pay for it other than payroll deductions or just paying a monthly fee and. This was staffed by doctors who had their medical training subsidized by the government at public colleges and in return they would have to spend at least a decade serving in government owned hospitals, clinics, and doctor offices staffed by physicians that are like civil service employees with comfortable salaries, (no need to earn very high salaries as no debt to pay off) working offices where they do not have to worry about paying office rent, office staff, malpractice insurance (government may have arbitration agreements) get all benefits that public employees get (public service supposedly pays less than private industry but supposedly gives you better retirement) no insurance hassles to deal with at ALL, no need to worry about admitting privileges. After they serve their obligatory terms they can go into private practice as they wish, maybe better compensation but more headaches, so some who primary desire to be a doctor is compassion and dealing with the interesting problems they face is more important than the money will most likely stay in the system but in another positive twist, is that doctors with a little experience under their belt, through this, may be more likely to set up a successful practice.

    For those who do NOT want to government physicians they have the option of shopping around and buying a private plan and choosing doctors who want to be entrepreneurial and more independent of government overseeing bu not entirely as for quality standards. These doctors can go to the most prestigious private colleges and set up fancy offices in affluent areas and deal with the insurance companies, as can some doctors who may go into practices that are in poorer areas because they may have come from that background or be socially conscious. The insurance companies should have two types of plans that doctors could join, both offering the same services but the doctors where the patients pay a higher premium are ones who have nicer offices, went to more prestigious schools, are board certified and more published and thus more highly compensated than the second tier of doctor who serve patients whose premiums are lower and are located in poorer neighborhoods and their patients may have to wait a little longer to be seen or wait longer in the offices that are more crowded as their doctors may have to do more volume to offset the lower compensation. Unlike the government where only legal residents, citizens or travelers who pay for their services upfront to us and get reimbursed by their government or travel insurance, the private doctors can take whoever they like including undocumented aliens who HAVE to be allowed to be able to buy any health insurance they can afford without prejudice.

    These private insurance plans can offer the high deductible, catastrophic insurance that some young people want (but the charges have to be in line with the insurance companies payments for those whose bills are covered by them.) Employees can buy their insurance from private insurance companies that need to offer the same things that are national insurance offers. Instead of the fines imposed for people who do not have health insurance, we would not impose them, BUT we would have the edict that everyone would have to register to get any type of health care including ER and if you did not, you did not get ANY help. We would need to have to have a program to reach everyone including the homeless and indigent and unless you were really, truly poor and not be able to afford anything, everyone would have to pay something.

    Of course there should be some oversight that the salaried doctors are not slacking off and seeing their fair share of patients. I once went to a student health center to see a psychiatrist and after a few minutes of talking he whipped out his prescription pad and started writing one out, when I protested and said I wanted to work out my problems, he ACTUALLY said to me ¨Your problems bore me¨ (sorry that I was not bi-polar, schizophrenic or had multiple personalities) and was too young and naiive at that time I should have reported him, another time saw a psychiatrist who kept checking his watch every five minutes making me feel, our my problems too boring for him also? I mention these incidents only in that I felt both these doctors wanted to just draw a salary and not work, but there will be a certain number of patients that doctors would be required to see and not be able to just turn patients away

    I am under Medi-Cal and the HMO plan I an under now is horrendous, where the only orthopedic surgeon I can use is two hours away, (Torrance attracts may elderly because it has FOUR hospitals nearby and many, MANY doctor offices, clinics and urgent care offices but none near me are available in specialties under the state health plan as most residents do not have to have Medi-Cal) and works only two days a MONTH. I would like to change to Covered CA the state plan. but at 62, my premiums would equal what I get from soc. sec. which is $600, since I have savings I can draw upon it for at least a thousand a month so I can afford to live, so I CAN afford to pay the subsidized price which is $39 a month with copays for visit, but since I am eligible for the Medi-Cal, if I don´t take it they will most likely not approve the subsidized cost private cost. Because most private doctors have office expenses and thus do not want to take Medi-Cal the only choice for the working poor (like I was) or truly indigent is under government health care whose offices are far away with doctors who were foreign trained or on the cusp of retirement with one star reviews on Yelp. If we had a government plans as initially suggested with doctors who are salaried employee with benefits, there will be more and better doctors available for the low income and in more areas.

    As for the doctor who in the Forbes article said that many people would not become a physician because what they feel is the low reimbursement rate for the cost of training, this might be a good thing. Many of the procedures that people come in for, do not demand a great deal of education or expertise, and can be handled by nurse practitioners who are now handling many of the general physician and internal medicine jobs that people who want to become doctors are not wanting to do because of the lower salaries. They could also be used more in the national doctors office and clinics vs. the private ones as doctors afraid of the threat to the profession have been fighting them tooth and nail but if it is for government funded medical practices they may be less likely to fight. Ahhh..if I could only run health care in this country, I DO hope that maybe someone in the government has read this and gives my suggestion SOME food for thought.

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