ROAD specialties not as appealing anymore?

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DermViser said:
Of course, as then you are able to charge high facility fees to Medicare for the same service. Once those disappear, the real competition between academics and private practice begins.
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I don't see this happening. Government hates private practice for some reason. If they get rid of facility fees to hospitals, it bolsters the private practice environment. Of course by that point, any private practice physician may just be considered 'out of network'.
 
evilbooyaa said:
I don't see this happening. Government hates private practice for some reason. If they get rid of facility fees to hospitals, it bolsters the private practice environment. Of course by that point, any private practice physician may just be considered 'out of network'.
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Yes, but the goal of "healthcare reform" is to keep people OUT of hospitals. Facility fees are one of the driving reasons why costs have exceeded projections. Hospitals have abused this, which is why the govt. is now cracking down: http://www.modernhealthcare.com/article/20130907/MAGAZINE/309079978

http://www.advisory.com/daily-brief...-proposes-flat-facility-fee-for-all-ed-visits
 
DermViser said:
Yes, but the goal of "healthcare reform" is to keep people OUT of hospitals. Facility fees are one of the driving reasons why costs have exceeded projections. Hospitals have abused this, which is why the govt. is now cracking down: http://www.modernhealthcare.com/article/20130907/MAGAZINE/309079978

http://www.advisory.com/daily-brief...-proposes-flat-facility-fee-for-all-ed-visits
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Can't read the first article (don't have access). Post whatever is relevant from it.

Regarding the second - I feel like the facility fee should depend on how long the patient is in the ED/hospital rather than the complexity of the patient. Of course, that'll probably be abused as well.
 
At some point someone in CMS is going to realize how much money they are throwing away with facility fees and clamp down on them across the board. Once that happens the current trend of hospital employment will completely disappear, as the only reason it is occurring is because the facility fees are a cash cow for hospitals from outpatient practices. Another point that needs to be made is in most cases hiring midlevels do not make hospitals more profit. Midlevels almost always bill at 85% of the physician fee schedule, and the few cases they bill 100% require substantial physician involvement and can expose even large health systems to costly fraud investigations if they don't follow the rules exactly. You might say "well midlevels get paid 50% of attendings and are making 85% so its a total win" but that isn't accounting for the high fixed costs inherent in medicine. 70% of that gross collection goes to overhead which does not shrink between midlevel/physician. Most of the remaining 15/30% goes to provider salary/benefits so the profit gained off of a midlevel is negligible. The real agent benefiting here is government and insurance payers that get a flat 15%+ discount on care provided by midlevels, but if midlevels overuse tests and misdiagnose that 15% can quickly evaporate. I agree with a lot of the concern here but midlevels aren't going to completely replace physicians in every case.
 
mcloaf said:
When you have no idea what you're talking about, it may be better not to post.
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Yeah I'm not a big surgery guy but I found the urology anatomy and pathology to be the most fascinating out of all the surgical subspecialties. Also can be very complex.
 
mcloaf said:
When you have no idea what you're talking about, it may be better not to post.
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I don't think Urology is for her anyways.

Pretty sure she'd quiz her patients on neurotransmitters and ask to see their oral cavities before they drop trou, just like at the clubs.
 
auburnO5 said:
Yeah I'm not a big surgery guy but I found the urology anatomy and pathology to be the most fascinating out of all the surgical subspecialties. Also can be very complex.
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I only saw a 2 hour video following a urologist around. She seemed to be mainly doing vasectomies and reversals. It probably varies. All in all, her work didn't include anything to raise an eyebrow in anticipation.
 
Anastomoses said:
I only saw a 2 hour video following a urologist around. She seemed to be mainly doing vasectomies and reversals. It probably varies. All in all, her work didn't include anything to raise an eyebrow in anticipation.
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Of course that's going to be boring. Urologists can also do stuff like open retro-peritoneal lymph node dissections, urethral reconstruction with buccal grafting, etc.
 
Urology is pretty awesome. As is Ophthalmology.

Afraid of a little competition? 😉
 
Anastomoses said:
I saw a program on urology and it seems painfully boring. Even the procedures are just so mundane that it could almost be done with eyes closed...okay, not really but still.
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Prostate removal is tricky business because there is the potential to damage some very small nerves, which can leave a man impotent.
 
Anastomoses said:
I only saw a 2 hour video following a urologist around. She seemed to be mainly doing vasectomies and reversals. It probably varies. All in all, her work didn't include anything to raise an eyebrow in anticipation.
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urologists play with the best toys around

they mostly deal with non-life-threatening stuff and lifestyle is as good as it gets for an attending surgeon

they get to be super creative

they get to do lots of cool outpatient procedures

seriously it's the best surgical field out there and its competitiveness reflects that
 
Anastomoses said:
I only saw a 2 hour video following a urologist around. She seemed to be mainly doing vasectomies and reversals. It probably varies. All in all, her work didn't include anything to raise an eyebrow in anticipation.
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Well, that about covers the breadth of that field.

Jesus, do you listen to yourself sometimes?
 
I think this discussion this highlights that in the end pick a specialty that you'll enjoy for the rest of your career....something that you'll look forward going to most days (probably not every morning lol they'll be those days). You can't predict the future of a specialty or its reimbursements. The landscape of medicine is going to change by the time we are all out practicing.
 
VisionaryTics said:
Well, that about covers the breadth of that field.

Jesus, do you listen to yourself sometimes?
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Do you know how to read? I summed up what I perceived from a video. And clearly said that.
 
Well, I certainly hope that Ophthalmology becomes less competitive. I'm just a college Sophomore right now, but I've been interested in Ophtho since I was 14. I got really sad when I read that it was a competitive residency because I was thinking that it would be a little out of my league in terms of realistic careers. Oh, and maybe the money will drop a little bit, but I really just want to do Cataract surgery one day........
 
Gregor Wiesmann said:
Well, I certainly hope that Ophthalmology becomes less competitive. I'm just a college Sophomore right now, but I've been interested in Ophtho since I was 14. I got really sad when I read that it was a competitive residency because I was thinking that it would be a little out of my league in terms of realistic careers. Oh, and maybe the money will drop a little bit, but I really just want to do Cataract surgery one day........
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The money has already dropped [def more than just a little bit] and it has only gotten more competitive [stats-wise]...This past cohort had a 242 Step 1 average.

With more med students slowly being pumped into the system, no specialty is going to get less competitive, IMO...perhaps the best anyone can hope for is stagnation until they match into what they want.
 
Frazier said:
The money has already dropped [def more than just a little bit] and it has only gotten more competitive [stats-wise]...This past cohort had a 242 Step 1 average.

With more med students slowly being pumped into the system, no specialty is going to get less competitive, IMO...perhaps the best anyone can hope for is stagnation until they match.
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It seems like physician compensation has decreased across ALL specialties though. Even if Ophtho had the salary of Family Medicine, I would still pursue it. Maybe other fields like Plastics and and Derm have greater incomes, but they really don't interest me in the slightest. Eyes are way cooler in my opinion.
 
Gregor Wiesmann said:
Well, I certainly hope that Ophthalmology becomes less competitive. I'm just a college Sophomore right now, but I've been interested in Ophtho since I was 14. I got really sad when I read that it was a competitive residency because I was thinking that it would be a little out of my league in terms of realistic careers. Oh, and maybe the money will drop a little bit, but I really just want to do Cataract surgery one day........
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First get into med school, then think about residency.

Logical thinking.
 
Frazier said:
The money has already dropped [def more than just a little bit] and it has only gotten more competitive [stats-wise]...This past cohort had a 242 Step 1 average.

With more med students slowly being pumped into the system, no specialty is going to get less competitive, IMO...perhaps the best anyone can hope for is stagnation until they match into what they want.
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All the more reason I think lifestyle (perceived or not) is going to mean even more to medical students (not that we really haven't reached that point already).
 
Lysinee said:
First get into med school, then think about residency.

Logical thinking.
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I don't believe there is anything illogical about being realistic. Medicine isn't a financially sound thing to do if you end up 300k in debt with a match to Family Practice. I think I'm actually being quite reasonable with the assumption that I might not match into my dream field. If I rock the rest of my pre-med requirements, and do awesome on the MCAT, then maybe I'll have faith that I will be able to do well in Medical school and gain that residency spot. Only time will tell.
 
This is getting crazy.
-Downward pressure being put on physician reimbursement to afford liabilities; yet, government wants to expand coverage directly, or indirectly via subsidy, to voters. Do you see the moral hazard?
-CMS is able to bargain as a government entity, allowing politics to enter into their decision making, while also controlling lic abilities of physicians.

There are even powerful people like Sanders that want to have a single payer system where the government is, potentially, in charge of 1/6 of the US economy. Do you realize at that point the US government will be appropriating ~70% of the US' GNP! Are we sefs? Where is the outrage? Where is the revolution? Where is the East-West United States territories with a giant wall separating them? I don't want to be apart of this ****.
 
evilbooyaa said:
Coming from someone who never shuts up, this is priceless.


Anyways, just let it go and move on. You said some dumb crap, got called out on it, and now are getting defensive.
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I didn't get defensive about the ****ty manner in which people felt the need to tell me I'm wrong about my take on urology. I addressed the specific insult from DermViser.
 
Frazier said:
The money has already dropped [def more than just a little bit] and it has only gotten more competitive [stats-wise]...This past cohort had a 242 Step 1 average.

With more med students slowly being pumped into the system, no specialty is going to get less competitive, IMO...perhaps the best anyone can hope for is stagnation until they match into what they want.
Click to expand...
I fail to understand why Ophtho is so competitive given the relatively low salary (200Ks) and awful job market in major cities. Good luck finding a job after residency in New York or LA.
 
ValentinNarcisse said:
I fail to understand why Ophtho is so competitive given the relatively low salary (200Ks) and awful job market in major cities. Good luck finding a job after residency in New York or LA.
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200k? No, that's not right. Maybe your first couple of years, but not if you're working in a practice that does a lot of cataract surgeries. In fact, when I intervied an Ophthalmologist and asked him how much you can make(No, I didn't start out with this question. It was the very LAST question I asked him), the number he gave me was so high, that I'm not even going to tell you guys because you won't believe me. Honestly, I think this guy was probably in the top 10% of Ophtho salaries, but I left that interview shocked. You can read about their salaries online, or you can ask one firsthand(which is what I did).
 
ValentinNarcisse said:
I fail to understand why Ophtho is so competitive given the relatively low salary (200Ks) and awful job market in major cities. Good luck finding a job after residency in New York or LA.
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IMO, it is so competitive because out of the ~17,000 graduating med students, about 4% find eyes/vision fascinating enough to compensate for the financial/job disparities between ophtho and their other options...which for the average successful ophtho applicant is basically any specialty perhaps sans PRS.
 
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Anastomoses said:
I didn't get defensive about the ****** manner in which people felt the need to tell me I'm wrong about my take on urology. I addressed the specific insult from DermViser.
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Story of SDN the past few months:

Someone starts a thread with an interesting question/topic. Anastomoses eventually replies with an arrogant or weird response. Everyone else calls her out (I applaud you all). She comes back with an even weirder, more arrogant, and overly defensive response ending with "shut up, you're ugly" or "shut up, you're obnoxious". Fancyherlotus likes anastamoses' comment and says something about dentistry and how hot anastomoses is. Then the rest of the thread is spent arguing with anastomoses. A few days go by, then the cycle begins again.

I'm a long time SDN reader, and I don't contribute much. But I can't help to wonder when will this trend ever end?
 
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DermViser said:
Sadly for her I think her own voice and thinking is music to her ears.
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Anastomoses said:
Coming from someone who never shuts up, this is priceless.
Click to expand...
evilbooyaa said:
Coming from someone who never shuts up, this is priceless.


Anyways, just let it go and move on. You said some dumb crap, got called out on it, and now are getting defensive.
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We're all colleagues. Let's respect each other and move on.

Only one life to live, better to be nice to each other.
 
ValentinNarcisse said:
I fail to understand why Ophtho is so competitive given the relatively low salary (200Ks) and awful job market in major cities. Good luck finding a job after residency in New York or LA.
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The average salary for general ophtho is closer to $350k in an established practice. Retina is serious bank, $400-500k/year, and cornea isn't too far behind.

The job market might be crap in NYC or LA, but that's true for all medical specialties in those cities. The good thing is that there are more cities in the US than just NYC, LA, Chicago, Miami, Seattle, etc.
 
Immunophile said:
Story of SDN the past few months:

Someone starts a thread with an interesting question/topic. Anastomoses eventually replies with an arrogant or weird response. Everyone else calls her out (I applaud you all). She comes back with an even weirder, more arrogant, and overly defensive response ending with "shut up, you're ugly" or "shut up, you're obnoxious". Fancyherlotus likes anastamoses' comment and says something about dentistry and how hot anastomoses is. Then the rest of the thread is spent arguing with anastomoses. A few days go by, then the cycle begins again.

I'm a long time SDN reader, and I don't contribute much. But I can't help to wonder when will this trend ever end?
Click to expand...

Pretty interesting that the mods are letting one poster ruin the allo board
 
Gregor Wiesmann said:
200k? No, that's not right. Maybe your first couple of years, but not if you're working in a practice that does a lot of cataract surgeries. In fact, when I intervied an Ophthalmologist and asked him how much you can make(No, I didn't start out with this question. It was the very LAST question I asked him), the number he gave me was so high, that I'm not even going to tell you guys because you won't believe me. Honestly, I think this guy was probably in the top 10% of Ophtho salaries, but I left that interview shocked. You can read about their salaries online, or you can ask one firsthand(which is what I did).
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Yeah, you can't look at starting salaries. Huge ceiling in optho. Even in Canada opthos are pulling in 1 mil+/yr
 
ValentinNarcisse said:
I fail to understand why Ophtho is so competitive given the relatively low salary (200Ks) and awful job market in major cities. Good luck finding a job after residency in New York or LA.
Click to expand...

I know this will come as a great shock to you, but there are people who have absolutely no desire to live in places like NYC or LA, esp. with it's ridiculous cost of living. Shocking to imagine, I know.
 
I thought the "o" was ortho..? Ortho, so i've heard, is literally one of the ONLY specialties that won't get too cut by the ACA...how this is, I don't really know..maybe because it's a high volume money-maker. I really don't know, but I know they make a lot. I'm sure the lifestyle is horrible though.
 
wjs010 said:
I thought the "o" was ortho..? Ortho, so i've heard, is literally one of the ONLY specialties that won't get too cut by the ACA...how this is, I don't really know..maybe because it's a high volume money-maker. I really don't know, but I know they make a lot. I'm sure the lifestyle is horrible though.
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It'll get cut to some extent for sure, no doubt about it. But they will always be reimbursed well because their outcomes are so good. There is literally no other procedure in medicine that provides a better QALY gained per dollar spent than total joint arthroplasty.
 
wjs010 said:
I thought the "o" was ortho..? Ortho, so i've heard, is literally one of the ONLY specialties that won't get too cut by the ACA...how this is, I don't really know..maybe because it's a high volume money-maker. I really don't know, but I know they make a lot. I'm sure the lifestyle is horrible though.
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'O' is for optho. I don't know in what universe ortho would be considered a 'lifestyle' specialty. And you heard wrong about the cuts, no specialty is safe.
 
wjs010 said:
I thought the "o" was ortho..? Ortho, so i've heard, is literally one of the ONLY specialties that won't get too cut by the ACA...how this is, I don't really know..maybe because it's a high volume money-maker. I really don't know, but I know they make a lot. I'm sure the lifestyle is horrible though.
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No it is definitely ophtho. Radiology, ophtho, aneshesia, derm. Ortho may or may not make more money or be more competitive, but the ROAD is strictly about specialties where you work few, predictable hours for maximal financial return.
 
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