Reimbursement cuts - what other physicians are saying

[coroner]

I started a recent thread about a Medscape survey that showed which specialties in 2023 "reportedly" had pay increases, including Pathology. I mentioned the increase was because we are working harder; not because of CMS is bumping up reimbursement. To which someone also posted, 2024 will bring further proposed cuts to pathology.
From browsing various physician comments on other forums, it appears other specialties are feeling the crunch. Here are some of their quotes:

• "As a 60+ year old surgeon, I have watched my income fall 40+% in the last 10 years, despite have the same caseload and productivity. (In fact, with advanced technology now available, I am performing more complex surgeries than ever.) The cost of compliance, prior authorization, and general inflation continues to eat away at net revenue." (Orthopedic surgeon)
• "The Social Security administration sends me an annual summary of my anticipated future benefits...Reviewing this information, my highest earning year as a physician, **adjusted for inflation** was 2012 even though I am working harder no than I was then. I suspect most physicians have a similar experience." (Allergist & Immunologist)
• "Not sure I can stay open with next year's automatic fee decreases that will come with Medicare's fees decreases." (Allergist & Immunologist)
• "I ask. Which radiology practices saw a 10% increase? I sure don't know of any." (Radiologist)
• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."
• "Primary care reimbursement over the last 20 years has lagged > 22% behind inflation, with the largest deficits in rural areas. And the government wonders why they can’t get physicians to go into primary care or go to perpetually medically underserved rural areas." (Internist)
• "By the way, in 1985 the average Medicare reimbursement for cataract surgery was about $2700. Now with inflation since 1985, which is 38 years later, we have the privilege of earning $600." (Ophthalmologist)

I think this last quote sums it up pretty well:

• "It should be clear that reimbursement is being cut in ALL specialties and if any specialty is making more it's either because they are working more increasing their productivity relative to reimbursement cuts or those who are currently employed, in order for their employer to attract them, are getting paid more than the reimbursement cuts would otherwise allow." (Radiologist)

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[KeratinPearls]

Keep on cutting reimbursement. Eventually no one will go into medicine anymore and healthcare will collapse.

 

[SunBakedTrash]

Keep on cutting reimbursement. Eventually no one will go into medicine anymore and healthcare will collapse.

No one **good** will go into medicine anymore. It will be like pharmacy, all the premeds I knew with 2.0 GPAs are pharmacists now. Soon they can be interventional cardiologists.

There are no greener pastures. Everything is just a varying shade of brown. Do what you like because no one is getting ahead.

 

[KeratinPearls]

• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

 

[SunBakedTrash]

• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

I could buy all that stuff on credit too. Kaiser certainly doesn’t pay more than any other employed gig. Warren Buffett drives a 10 year old Cadillac XTS and eats at McDonalds every day. The point is medicine is not going to make you rich.

 

[caffeinegirl]

In my area (SF Bay area), due to COLA most professionals I know are dual income - doctor+doctor, doctor+lawyer, doctor+engineer, doctor+tech, etc. The only single income doctors are those who have other businesses - such as medical office real estate, or own their own mega practice - such as dermatology chain of offices (even then, he sold the majority share to PE but got a lot of $$). The other single income doctor I know had the second physician spouse "retire" after 15+ years of practice.
In my experience due to the high COLA, the single physician income family is a rare occurrence.

 

[coroner]

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Anyone can spend more money when they make a good income because it is much easier in America to earn a lot than to accumulate wealth because we are a consumption-oriented society. And it is easier to purchase products that denote financial superiority than to be actually superior in economic achievement.

 

[coroner]

In my area (SF Bay area), due to COLA most professionals I know are dual income...In my experience due to the high COLA, the single physician income family is a rare occurrence.

What about the single physicians without a family? Are they living high off the hog, driving Ferrari's, McLaren's and posting on Insta too?

 

[caffeinegirl]

What about the single physicians without a family? Are they living high off the hog, driving Ferrari's, McLaren's and posting on Insta too?

Don't know - not in my social circle...

 

[WEBB PINKERTON]

• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

See why it's good to be rural.

 

[Med Director New England]

Interesting…
as more and more fees are bundled and more and more MDs in different fields are employed by the same large medical group the fight for $ will get even worse. As things evolve - Not only do you have to fight nearby same speciality docs for patients / pro fees / $ — you have to also fight amongst your group against other specialities for your slice of the $ pie.

Most successful MDs will be the ones who are scarce / high demand.

May start a separate thread for salary / benefits for practicing paths just to get some real data on this. I don’t always trust these surveys

 

[KeratinPearls]

See why it's good to be rural.

Not rural Indiana. Think northwest Indiana.

 

[Guest8]

• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

I don't know, none of that sounds terribly impressive. I've been in practice for a little over 10 years and could go out tomorrow and buy literally all of these things in cash. I just wouldn't because it's financially *****ic and I don't have some weird psychological need to flaunt my wealth with horrible depreciating assets.

 

[Zarniwoop]

What about the single physicians without a family? Are they living high off the hog, driving Ferrari's, McLaren's and posting on Insta too?

A single physician is well positioned to escape the matrix.
Work at a VA - spend 25 years enjoying a relatively chill work day. VA's aren't as geographically competitive, so you don't need to go rural, but remember to live within your means.
Follow this up with early retirement on a government pension in a low COLA with nice weather and amenities.
You won't build an empire, but it should be a pleasant ride.

 

[KeratinPearls]

Anyone can spend more money when they make a good income because it is much easier in America to earn a lot than to accumulate wealth because we are a consumption-oriented society. And it is easier to purchase products that denote financial superiority than to be actually superior in economic achievement.

My response to your original post that physicians are feeling the crunch is not entirely true.

This ENT guy I know has plenty of income to buy nice cars. He is not dumb. Has plenty of money to buy a supercar AND still does well for himself. He certainly must not be “feeling the crunch” as you say.

 

[coroner]

A single physician is well positioned to escape the matrix.
Work at a VA - spend 25 years enjoying a relatively chill work day. VA's aren't as geographically competitive, so you don't need to go rural, but remember to live within your means.
Follow this up with early retirement on a government pension in a low COLA with nice weather and amenities.
You won't build an empire, but it should be a pleasant ride.

I think LADoc purported this career path or something similar i.e. the VA can be a cush job, low stress, good retirement package to pull the golden parachute if you're not the gunner-type.

And, staying single can go a long way to saving for retirement if that lifestyle suits you. Raising a family is expensive, and divorce is even more expensive. The divorce rate in America is over 50% and slightly higher for physicians. Divorce is the single largest destroyer of wealth in America.

 

[anonperson]

• "As an ENT, reimbursement for many surgeries/procedures by COMMERCIAL insurance have been cut so much that administrative costs are not even covered (e.g., $1500 for a 5 hr ear surgery with 3 months of aftercare)."

I know an ENT who lives in Indiana and flashes his Porsches and watches on instagram. He basically has a car rack (one Porsche on top of the other Porsche) for his cars inside his garage. This dude has 3 kids as well.

I follow a general surgeon on the gram in southern Cali. Dude has a Range Rover, Ferrari 458, Mclaren 720S ANDDDDD an AMG GT63S Mercedes. Works for Kaiser. Didn’t know they paid so well.

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

Why are you trashing someone for enjoying their wealth/income?

Physician pay is constantly under attack in this country. We're one of the few professions with so much liability. I don't blame any physicians for trying to max their income.

Other professions are constantly increasing their pay. Have you tried to hire a lawyer lately? The hourly rates for some of them are absurd and have definitely increased over the last few years. Hospital administrator salaries haven't decreased. The CEO of the small health system I operate out of is earning nearly $2 million a year and it is only increasing.

We didn't get cost of living raises so even with reimbursement being neutral, we still take a cut due to inflation.

As a profession, we should never give an inch. Doesn't matter if the income decreased from $500,000 to $490,000. It's hard earned money and we deserve every penny.

 

[octopusprime]

Why are you trashing someone for enjoying their wealth/income?

Physician pay is constantly under attack in this country. We're one of the few professions with so much liability. I don't blame any physicians for trying to max their income.

Other professions are constantly increasing their pay. Have you tried to hire a lawyer lately? The hourly rates for some of them are absurd and have definitely increased over the last few years. Hospital administrator salaries haven't decreased. The CEO of the small health system I operate out of is earning nearly $2 million a year and it is only increasing.

We didn't get cost of living raises so even with reimbursement being neutral, we still take a cut due to inflation.

As a profession, we should never give an inch. Doesn't matter if the income decreased from $500,000 to $490,000. It's hard earned money and we deserve every penny.

It's always irked me that talk of money is verboten in medicine, as if wanting more casts us in a bad light or makes us appear greedy, whereas with every single solitary other profession it is an expectation to want and receive more annually, keep pace with inflation, and not have to increase productivity every year just to maintain. What other career faces annual pay cuts literally hardwired in to government-set price control? We are expected to be selfless servants...be part of system where many if not most want to receive our services for free...physicians in Europe and around the world make less and we're overpaid compared to them... It's a complete apples to oranges discussion, IMO.

 

[KeratinPearls]

Why are you trashing someone for enjoying their wealth/income?

Physician pay is constantly under attack in this country. We're one of the few professions with so much liability. I don't blame any physicians for trying to max their income.

Other professions are constantly increasing their pay. Have you tried to hire a lawyer lately? The hourly rates for some of them are absurd and have definitely increased over the last few years. Hospital administrator salaries haven't decreased. The CEO of the small health system I operate out of is earning nearly $2 million a year and it is only increasing.

We didn't get cost of living raises so even with reimbursement being neutral, we still take a cut due to inflation.

As a profession, we should never give an inch. Doesn't matter if the income decreased from $500,000 to $490,000. It's hard earned money and we deserve every penny.

Chill tha f out bruhhh.

Where in my post did I trash these doctors for enjoying their wealth?!? Coroner was mentioning these docs complain their reimbursement is getting cut, etc but then again I see docs in the same field with 3 Porsches. Their life ain’t that bad cmon now.

 

[anonperson]

Give me a break they are doing very well for themselves. Its like Paris Hilton crying she’s worth 9.9 billion now instead of 10 billion.

That's your quote.

Comparing physician pay to someone who is independently wealthy is a red herring to get people worked up.

If you are happy to take a pay cut by $10k or $15k, just because you earn a few hundred thousand a year, be my guest. Most sane physicians would say no.