Salary, private practice and obamacare

[kurite]

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Hello,
Ive been reading a bit online that due to obamacare as well as the general trend of doctors getting paid less, doctors will be earning less money and essentially wont be able to open a private practice past 2018 due to financial reasons. Any truth, any insights on this?
Thank you

 

[NotASerialKiller]

TrumpCare will fix everything don't worry!

 

[Dr.Sticks]

Don't worry, you can always work for Taylor Swift.

 

[kurite]

Does anyone actually have insight on this matter?

 

[Lawpy]

Does anyone actually have insight on this matter?

I can probably carry out an economic analysis on this topic but it will take a while

 

[Glazedonutlove]

Does anyone actually have insight on this matter?

Let me go find my crystal ball

 

[kurite]

Any help

 

[gyrfalcon]

Any help

You might have more luck asking this of people who are farther along in their training, or who are physicians already.

 

[NotASerialKiller]

Any help

You deleted your post thanking @Lawper for actually offering to model an answer to your question, so that you could instead demand for the 2nd time in your 15 minute old thread that someone give you an answer? You're a class act, I hope you make a killing in your private practice.

 

[LizzyM]

More and more hospitals and health care systems are buying up private practices and turning physicians into employees rather than small businessmen. Just as there is no longer a corner store in every neighborhood and a milkman who delivers to your door, physicians are becoming part of larger health systems, just as corner stores and milkmen were replaced by supermarkets through the 20th century. Sure there still may be some bodegas in some neighborhoods and some towns still have a milkman, but for the most part, this commercialization of ambulatory care and hospital care (with hospitalists taking the place of the personal physician/internist or pediatrician at the bedside) is happening across America.

 

[StudyLater]

Any help

I don't see Obamacare completely shuddering all PP's. Hospitals will share in the same issues and will have more overhead to which they must distribute their revenue. I could see smart PP owners winning out, particularly ones that make ample use of midlevels.

 

[Petrichor1]

practitioners are combatting this by merging into groups to counter hospital control. Once you're an employee of a hospital, your autonomy shrinks based off of the policies the hospital mandates. These are sad times for those going into medicine thinking they will open their own clinic. I personally find it irritating why doctors just didn't follow the route of dentistry in terms of policy. Makes sense to work closely with a profession that has so much experience with business and clinical matter.

 

[Dr.Sticks]

You know A LOT can changing by the time you actually finish residency.
Heck, if we get a Republican president in 2016 Obama Care will probably be tossed out.

 

[Petrichor1]

You know A LOT can changing by the time you actually finish residency.
Heck, if we get a Republican president in 2016 Obama Care will probably be tossed out.

I don't know. I feel like politicians won't really affect healthcare changes as it sucked out so much time. It's one of those things that was just messed up to begin with and it takes a lot of time from a presidency perspective to fix it up because any changes made can have drastic effects. I will commend that our president dove into highlighting the problems in the system in the first place.

 

[allantois]

You know A LOT can changing by the time you actually finish residency.
Heck, if we get a Republican president in 2016 Obama Care will probably be tossed out.

No chance Republicans are keeping the Senate.

 

[Glazedonutlove]

You know A LOT can changing by the time you actually finish residency.
Heck, if we get a Republican president in 2016 Obama Care will probably be tossed out.

no

 

[StudyLater]

No chance Republicans are keeping the Senate.

This is because most Americans are whiny lazy goodfornothings that only think about their problems they got themselves into instead of taking responsibility for their own weaknesses.

We need to return to family values, where a woman respects her man but not the other way around. @Seth Joo will back me up.

 

[Dr.Sticks]

This is because most Americans are whiny lazy goodfornothings that only think about their problems they got themselves into instead of taking responsibility for their own weaknesses.

We need to return to family values, where a man respects his woman but not the other way around. @Seth Joo will back me up.

Yeah, it should be like little house on the prairie. Just with a modern doctor so nobody dies of typhus.

 

[WingedOx]

More and more hospitals and health care systems are buying up private practices and turning physicians into employees rather than small businessmen. Just as there is no longer a corner store in every neighborhood and a milkman who delivers to your door, physicians are becoming part of larger health systems, just as corner stores and milkmen were replaced by supermarkets through the 20th century. Sure there still may be some bodegas in some neighborhoods and some towns still have a milkman, but for the most part, this commercialization of ambulatory care and hospital care (with hospitalists taking the place of the personal physician/internist or pediatrician at the bedside) is happening across America.

...a trend that predates the ACA.

 

[LizzyM]

...a trend that predates the ACA.

Absolutely true.

 

[Seth Joo]

This is because most Americans are whiny lazy goodfornothings that only think about their problems they got themselves into instead of taking responsibility for their own weaknesses.

We need to return to family values, where a woman respects her man but not the other way around. @Seth Joo will back me up.

Ever watch the show Modern Family? The old family model is probably never coming back among a good percent of the population, its mostly people of immigrant background that prefer to latch onto traditional family structures. My parents are foreign born. I grew up in that kind of environment so that is what makes me happy.

A friend of mine was dating a woman for a year who and he found out only after a year that she was divorced with two children. Apparently she did a clever job of hiding the fact she was divorced with kids. I have no idea how he could not figure it out in the first place given her age and other clues but he was really upset when he found out he broke up with her and never spoke to her again.

 

[StudyLater]

Ever watch the show Modern Family? The old family model is probably never coming back among a good percent of the population, its mostly people of immigrant background that prefer to latch onto traditional family structures. My parents are foreign born. I grew up in that kind of environment so that is what makes me happy.

Fair enough. It just doesn't work for everyone, however. I'm sure it's great for the right person with all of the right components in the right place, but that is very difficult to accomplish for many.

A friend of mine was dating a woman for a year who and he found out only after a year that she was divorced with two children. Apparently she did a clever job of hiding the fact she was divorced with kids. I have no idea how he could not figure it out in the first place given her age and other clues but he was really upset when he found out he broke up with her and never spoke to her again.

So the moral of this story is....?

Are you saying your friend is an example of the lack of family values in this country, i.e. he doesn't want to have anything to do with children?

 

[Seth Joo]

Fair enough. It just doesn't work for everyone, however. I'm sure it's great for the right person with all of the right components in the right place, but that is very difficult to accomplish for many.



So the moral of this story is....?

Are you saying your friend is an example of the lack of family values in this country, i.e. he doesn't want to have anything to do with children?

Had nothing to do with family values, had everything to do with a certain ahem well you know what and her ability to pull wool over his eyes, but smarter guys would have figured it out already. He wisened up though, no sane guy wants a divorced woman with a kid.

 

[writing]

Had nothing to do with family values, had everything to do with a certain ahem well you know what and her ability to pull wool over his eyes, but smarter guys would have figured it out already. He wisened up though, no sane guy wants a divorced woman with a kid.

depending on the state, if he married and divorced a woman with kids, he could be made to pay child support.
sometimes the only winning move is not to play!

 

[Seth Joo]

depending on the state, if he married and divorced a woman with kids, he could be made to pay child support.
sometimes the only winning move is not to play!

My girlfriend is about 10 years younger than me, lucky for me she has no prior husbands nor kids. As for me I would never go near a divorced woman with kids, even if she was kind of attractive. And I have been approached by quite a few, but there so many issues, its just not worth the kind of trouble that can happen. I would say most men would probably agree with me, some would probably have a short term affair with one, but for me, I would just stay away.

 

[writing]

My girlfriend is about 10 years younger than me, lucky for me she has no prior husbands nor kids. As for me I would never go near a divorced woman with kids, even if she was kind of attractive. And I have been approached by quite a few, but there so many issues, its just not worth the kind of trouble that can happen. I would say most men would probably agree with me, some would probably have a short term affair with one, but for me, I would just stay away.

Well for me it's not even about the issues. It's about one basic fact: these are not my kids and they will never be. Another man put bread in the toaster, walked out, and now here I am? No thanks.

 

[Nietzschelover]

More and more hospitals and health care systems are buying up private practices and turning physicians into employees rather than small businessmen. Just as there is no longer a corner store in every neighborhood and a milkman who delivers to your door, physicians are becoming part of larger health systems, just as corner stores and milkmen were replaced by supermarkets through the 20th century. Sure there still may be some bodegas in some neighborhoods and some towns still have a milkman, but for the most part, this commercialization of ambulatory care and hospital care (with hospitalists taking the place of the personal physician/internist or pediatrician at the bedside) is happening across America.

EXACTLY. And has ZERO to do with Obama. Indeed, some might argue exactly the opposite. Big banks, big for-profit health care systems, big capitalism.

 

[LizzyM]

EXACTLY. And has ZERO to do with Obama. Indeed, some might argue exactly the opposite. Big banks, big for-profit health care systems, big capitalism.

The not-for-profit health care systems are in this game, too.

Long gone are the days when a physician could run a solo practice, doing his own lab tests with his own microscope and chemistry kit, depending on little more than his hands and his stethoscope to make a diagnosis. The costs of setting up a practice are astronomical and combined with the debt a newly trained physician arrives with, it is not realistic to expect medicine to continue as a small business.

 

[writing]

The not-for-profit health care systems are in this game, too.

Long gone are the days when a physician could run a solo practice, doing his own lab tests with his own microscope and chemistry kit, depending on little more than his hands and his stethoscope to make a diagnosis. The costs of setting up a practice are astronomical and combined with the debt a newly trained physician arrives with, it is not realistic to expect medicine to continue as a small business.

Honestly the baby boomers had it best:

• medical school was less competitive
• lower under grad tuition
• lower med school tuition
• prestige
• insane compensation

Only thing that really sucked was their residencies, but even then.

 

[Nietzschelover]

The not-for-profit health care systems are in this game, too.

Long gone are the days when a physician could run a solo practice, doing his own lab tests with his own microscope and chemistry kit, depending on little more than his hands and his stethoscope to make a diagnosis. The costs of setting up a practice are astronomical and combined with the debt a newly trained physician arrives with, it is not realistic to expect medicine to continue as a small business.

Do the "management" folks in not-for-profit health care systems make significantly less than their brethren in for-profits?

 

[writing]

Do the "management" folks in not-for-profit health care systems make significantly less than their brethren in for-profits?

Well if they're anything like the management of charity organizations.. salaries range from 6 to 7 figures

 

[Seth Joo]

Honestly the baby boomers had it best:

• medical school was less competitive
• lower under grad tuition
• lower med school tuition
• prestige
• insane compensation

Only thing that really sucked was their residencies, but even then.

They still had all the above, today's doctors do not have that. No one really cares about doctors anymore. I heard you actually had to read textbooks rather than memorize Powerpoints in those days though.

 

[22031 Alum]

The costs of setting up a practice are astronomical and combined with the debt a newly trained physician arrives with, it is not realistic to expect medicine to continue as a small business.

This is the take-home point of this thread. I have one acquaintance who set up a new practice as an internist. I think it was two or three years to actually make a profit after all the initial investment- which meant even more loans.

 

[LizzyM]

Honestly the baby boomers had it best:

• medical school was less competitive
• lower under grad tuition
• lower med school tuition
• prestige
• insane compensation

Only thing that really sucked was their residencies, but even then.

Are you kidding me? The Golden Age was from the establishment of Medicare (1965, 50 years ago) to the institution of DRGs in the early 80s. The physicians who reaped the rewards were those who were a generation ahead of the boomers, those who graduated medical school in the 1950s and 60s and managed to avoid being drafted and sent to war.

Births peaked in about 1957 meaning that the competition for medical school admission in the 1970s into the 1980s was fierce as the population of eligible applicants was increasing and the greater openness to female applicants further enlarged the pool, too.

 

[Petrichor1]

Had nothing to do with family values, had everything to do with a certain ahem well you know what and her ability to pull wool over his eyes, but smarter guys would have figured it out already. He wisened up though, no sane guy wants a divorced woman with a kid.

what? are you kidding me? This should be, no sane guy would ever marry a woman who lied to him for an entire year...
Being divorced with a kid doesn't make a difference if that woman is good in the heart.

 

[Mad Jack]

I don't know. I feel like politicians won't really affect healthcare changes as it sucked out so much time. It's one of those things that was just messed up to begin with and it takes a lot of time from a presidency perspective to fix it up because any changes made can have drastic effects. I will commend that our president dove into highlighting the problems in the system in the first place.

Yeah, they spent so much time writing Obamacare...

If we end up with republicans controlling everything, it'll be replaced in two weeks with something that screws doctors in new and exciting ways.

 

[Mad Jack]

Are you kidding me? The Golden Age was from the establishment of Medicare (1965, 50 years ago) to the institution of DRGs in the early 80s. The physicians who reaped the rewards were those who were a generation ahead of the boomers, those who graduated medical school in the 1950s and 60s and managed to avoid being drafted and sent to war.

Births peaked in about 1957 meaning that the competition for medical school admission in the 1970s into the 1980s was fierce as the population of eligible applicants was increasing and the greater openness to female applicants further enlarged the pool, too.

Yeah, most people forget that physicians used to be middle class and only began to make six figures with the passage of Medicare. The government turned being a doctor into a lucrative career and has been trying to reign things in ever since. They had it best in '65, when Medicare was essentially an endless put of free money no one expected to be there. Millionaire overnight surgeons and anesthesiologists were the norm.

 

[StudyLater]

Had nothing to do with family values, had everything to do with a certain ahem well you know what and her ability to pull wool over his eyes, but smarter guys would have figured it out already. He wisened up though, no sane guy wants a divorced woman with a kid.

depending on the state, if he married and divorced a woman with kids, he could be made to pay child support.
sometimes the only winning move is not to play!

 

[writing]

Are you kidding me? The Golden Age was from the establishment of Medicare (1965, 50 years ago) to the institution of DRGs in the early 80s. The physicians who reaped the rewards were those who were a generation ahead of the boomers, those who graduated medical school in the 1950s and 60s and managed to avoid being drafted and sent to war.

https://en.wikipedia.org/wiki/Baby_boomers
"Baby boomers" ranges from 1946 to 1964
Let's pick 4 points:

• 1946: ms 1968, residency 1972, practice in 1976
• 1952: ms 1974, residency 1978, practice in 1982
• 1958: ms 1980, residency 1984, practice 1988
• 1964: ms 1986, residency 1990, practice 1994

These are our assumptions:
1. Finish college at 22
2. Matriculate to medical school straight away.
3. Residencies are 4 years long
4. Pay private tuition/fees from 1986-1987: (page 13-14)$14,962*4 = $59,848
5. Average salary is $90k

They are still much better off than today's grads. Note I'm being very liberal.
Average indebtedness from 1986-87 was $35,000.
https://www.aamc.org/download/374956/data/ar_1986-1987.pdf

Births peaked in about 1957 meaning that the competition for medical school admission in the 1970s into the 1980s was fierce as the population of eligible applicants was increasing and the greater openness to female applicants further enlarged the pool, too.

Was competition in the 70s/80s as bad as it is now? Did undergrads do research, have hundreds of hours of volunteer, shadow physicians, and still not get in?
At worst, things were only competitive for half of the baby boomers. The 1958-1964 folk; people who applied in the early 1980s.

From to 1982-2011 total graduates has stayed the same: (page 4) 16,000
You cannot say, the boomers had as much competition as millenials do.

 

[writing]

Yeah, most people forget that physicians used to be middle class and only began to make six figures with the passage of Medicare. The government turned being a doctor into a lucrative career and has been trying to reign things in ever since. They had it best in '65, when Medicare was essentially an endless put of free money no one expected to be there. Millionaire overnight surgeons and anesthesiologists were the norm.

I respectfully disagree. Look at my post. Even if doctors only made 90k/year, doctors before the 1990s had it very very good.
Lower tuition, easier to get into medical school. Only thing that sucked for them was residency hours (and possible abuse) and medical school harshness.

 

[LizzyM]

https://en.wikipedia.org/wiki/Baby_boomers
"Baby boomers" ranges from 1946 to 1964
Let's pick 4 points:

• 1946: ms 1968, residency 1972, practice in 1976
• 1952: ms 1974, residency 1978, practice in 1982
• 1958: ms 1980, residency 1984, practice 1988
• 1964: ms 1986, residency 1990, practice 1994

These are our assumptions:
1. Finish college at 22
2. Matriculate to medical school straight away.
3. Residencies are 4 years long
4. Pay private tuition/fees from 1986-1987: (page 13-14)$14,962*4 = $59,848
5. Average salary is $90k

They are still much better off than today's grads. Note I'm being very liberal.
Average indebtedness from 1986-87 was $35,000.
https://www.aamc.org/download/374956/data/ar_1986-1987.pdf



Was competition in the 70s/80s as bad as it is now? Did undergrads do research, have hundreds of hours of volunteer, shadow physicians, and still not get in?
At worst, things were only competitive for half of the baby boomers. The 1958-1964 folk; people who applied in the early 1980s.

From to 1982-2011 total graduates has stayed the same: (page 4) 16,000
You cannot say, the boomers had as much competition as millenials do.

The point is, the guys who were born in 1926 and 1936 were in position to make the most of the Golden Goose of Medicare.
See this report to become more aware that the challenges in 2015 are similar to those who applied in the early 70s.
http://www.rand.org/content/dam/rand/pubs/reports/2007/R2030.pdf

 

[Mad Jack]

I respectfully disagree. Look at my post. Even if doctors only made 90k/year, doctors before the 1990s had it very very good.
Lower tuition, easier to get into medical school. Only thing that sucked for them was residency hours (and possible abuse) and medical school harshness.

potential medical students had it good. Doctors peaked in the 70s and have been going downhill ever since, however. Yeah, the baby boomers had it easier than you, but the generation ahead of them had it best of all.

 

[rocklobstr]

EXACTLY. And has ZERO to do with Obama. Indeed, some might argue exactly the opposite. Big banks, big for-profit health care systems, big capitalism.

Excuse me, but obviously the president has total control of the country, and the senate, house, lobbyist, and etc. don't do anything.
#ThanksObama

 

[Mad Jack]

https://en.wikipedia.org/wiki/Baby_boomers
"Baby boomers" ranges from 1946 to 1964
Let's pick 4 points:

• 1946: ms 1968, residency 1972, practice in 1976
• 1952: ms 1974, residency 1978, practice in 1982
• 1958: ms 1980, residency 1984, practice 1988
• 1964: ms 1986, residency 1990, practice 1994

These are our assumptions:
1. Finish college at 22
2. Matriculate to medical school straight away.
3. Residencies are 4 years long
4. Pay private tuition/fees from 1986-1987: (page 13-14)$14,962*4 = $59,848
5. Average salary is $90k

They are still much better off than today's grads. Note I'm being very liberal.
Average indebtedness from 1986-87 was $35,000.
https://www.aamc.org/download/374956/data/ar_1986-1987.pdf



Was competition in the 70s/80s as bad as it is now? Did undergrads do research, have hundreds of hours of volunteer, shadow physicians, and still not get in?
At worst, things were only competitive for half of the baby boomers. The 1958-1964 folk; people who applied in the early 1980s.

From to 1982-2011 total graduates has stayed the same: (page 4) 16,000
You cannot say, the boomers had as much competition as millenials do.

That's good and all, but no one cares about medical school applicants or how hard they have it. More competition us better for patients, as you'll get more qualified doctors rather than whatever schmuck happened to fill out the app.

 

[writing]

The point is, the guys who were born in 1926 and 1936 were in position to make the most of the Golden Goose of Medicare.

In the position to take advantage =/= only ones who benefited
Even discounting the higher salaries there is:

• easier admissions into medical school
• abysmally low tuition

There is the simple fact that back then, that 2nd or 3rd year medical students could leave medical school without $100k+ in debt.

See this report to become more aware that the challenges in 2015 are similar to those who applied in the early 70s.
http://www.rand.org/content/dam/rand/pubs/reports/2007/R2030.pdf

That's almost insulting to applicants in 2015.
From 1982-2011 (close to 30 years), total graduation has not changed. It has ranged from 16,000 (1982) to 17,000 (2011).
Unless you think population and applications sent have stayed the same, you cannot deny that medical school has gotten much more competitive.

That's good and all, but no one cares about medical school applicants or how hard they have it. More competition us better for patients, as you'll get more qualified doctors rather than whatever schmuck happened to fill out the app.

I agree, but you are changing the subject.. The discussion has been about baby boomer advantages vs. current applicants.

potential medical students had it good. Doctors peaked in the 70s and have been going downhill ever since, however. Yeah, the baby boomers had it easier than you, but the generation ahead of them had it best of all.

Legitimately every one before 1990 has had it good simply from: lower tuition + less competitiveness. If they hated medical school, they could actually leave.
Med students going into Duke in 2015 are a world apart from med students going into Duke in 1990.

 

[Mad Jack]

The not-for-profit health care systems are in this game, too.

Long gone are the days when a physician could run a solo practice, doing his own lab tests with his own microscope and chemistry kit, depending on little more than his hands and his stethoscope to make a diagnosis. The costs of setting up a practice are astronomical and combined with the debt a newly trained physician arrives with, it is not realistic to expect medicine to continue as a small business.

The trouble is, many of those costs only exist due to bureaucratic hurdles that have been put in place by the government. You don't need to do your own in-house testing-that's what Quest our any of the other diagnostic services is for. All a physician really needs is some basic diagnostic equipment and a couple rooms for patient exams, as well as a medical assistant for a small practice. But if you want Medicare reimbursement, costs skyrocket and profits tank due to EMR requirements, billing and coding, and the inherent low overhead in taking Medicare. It isn't expensive to open a practice- it's expensive to open a Medicare compliant practice. Cash only practices have a fraction of the startup costs.

What this is really all about is control of the billing stream. The government is tired of dealing with a party that has their own best interest in mind in regard to reimbursement. So they need a middleman that can force that party to comply, to take less money while seeing more patients- and that middleman is health care systems and hospitals. They will put the screws to physicians in exchange for control of referrals and the revenue stream, skimming a little off the top, but gradually more and more. And when cuts get negotiated, they'll come out of physicians' pockets, not the hospital's bottom line.

 

[writing]

See this report to become more aware that the challenges in 2015 are similar to those who applied in the early 70s.
http://www.rand.org/content/dam/rand/pubs/reports/2007/R2030.pdf

I know grade inflation has occured, but holy smokes.
In 1970, 80% of med students had a GPA below 3.5.

 

[Mad Jack]

In the position to take advantage =/= only ones who benefited
Even discounting the higher salaries there is:

• easier admissions into medical school
• abysmally low tuition

There is the simple fact that back then, that 2nd or 3rd year medical students could leave medical school without $100k+ in debt.



That's almost insulting to applicants in 2015.
From 1982-2011 (close to 30 years), total graduation has not changed. It has ranged from 16,000 (1982) to 17,000 (2011).
Unless you think population and applications sent have stayed the same, you cannot deny that medical school has gotten much more competitive.



I agree, but you are changing the subject.. The discussion has been about baby boomer advantages vs. current applicants.




Legitimately every one before 1990 has had it good simply from: lower tuition + less competitiveness. If they hated medical school, they could actually leave.
Med students going into Duke in 2015 are a world apart from med students going into Duke in 1990.

It's irrelevant to the topic at hand, in any case. We're talking about the future, about salaries and private practice under Obamacare, not the past. You want to start a thread about how easy the boomers had it, feel free, but don't derail this thread.

 

[Stagg737]

Do the "management" folks in not-for-profit health care systems make significantly less than their brethren in for-profits?

Depends on what you consider "average" for the for-profit people. It's not specific to medicine, but here's a NFP analysis:

http://www.charitynavigator.org/docs/2014_CEO_Compensation_Study.pdf

You can see the mean for NFP CEOs was just above 120k. In the for-profit sector, idk what the average actually is (I got numbers ranging from 150k to 800k with the Bureau of Labor Statistics reporting 180k as the mean and 173k as the median), but if you take out he fortune 500 companies where the average is something like 13 mil then I don't think it's as big of a gap as most people would think.

I know grade inflation has occured, but holy smokes.
In 1970, 80% of med students had a GPA below 3.5.

Things have changed a lot. My previous mentor (who I'm guessing is about 50 now, graduate med school in the early 90's) said when he matched that 'competitiveness' in terms of fields wasn't really a thing and you pretty much went into what you wanted. Go back another 20-25 years and some of the guys hadn't even heard of the MCAT when they entered med school. Go back another 25 years and the LCME hadn't even been formed yet. Medicine, and everything involving it, changes rapidly. So it's not surprising to see a change like that from 40 years ago.

 

[writing]

It's irrelevant to the topic at hand, in any case. We're talking about the future, about salaries and private practice under Obamacare, not the past. You want to start a thread about how easy the boomers had it, feel free, but don't derail this thread.

I was responding to @LizzyM 's response ("Are you kidding me") to my comments, not trying to start a new thread or just complain.
I just find it silly that people think medical school matriculants of 2015 are comparable to matriculants of 1970.

Seriously, some of today's matriculants start preparing in high school!