Salary, private practice and obamacare

[Seth Joo]

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.

Of course medical school admission has gotten more competitive, Osteopathic Medical schools, which used once to be an after thought in medical education are now as competitive as lower tier MD schools were 20 years ago. Many of the people that are teaching me are people who said they would never get accepted today. That being said its also more expensive.

Obamacare is not good news for new doctors.

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[writing]

Of course medical school admission has gotten more competitive, Osteopathic Medical schools, which used once to be an after thought in medical education are now as competitive as lower tier MD schools were 20 years ago. Many of the people that are teaching me are people who said they would never get accepted today. That being said its also more expensive.

Obamacare is not good news for new doctors.

The hustle's gotten harder, but I can't imagine anything better than medicine (intellectual challenge and compensation). Without considerably higher risk.

 

[Seth Joo]

The hustle's gotten harder, but I can't imagine anything better than medicine (intellectual challenge and compensation). Without considerably higher risk.

You are right, Medicine is stable, but I would say the field will not have the same kind of lifestyle that it used to have but then again this has been said for long time and people keep applying to medical school.

 

[IlDestriero]

In the short term Obama care is good for doctors. More patients with insurance, less on Medicaid or self pay (no pay charity care). My income continues to go up.
However, it's not sustainable and costs more than planned (imagine that!) as a result more will need government subsidies and it will cost more than planned for the government as well (no way! I never saw that coming!)
That's when we will have to switch to some form of government program for all/most. We're already $17T in debt, we can't afford to subsidize everyone's medical care.
I hope there is a private system as well, as in some other countries with a government system.
Some hospitals and systems and specialties will weather the storm and still do OK. Anesthesia will get destroyed unless they fix the unfair reimbursement system. Fortunately I'll be retired by then, or will use it as an excuse to retire early. Bundled payments are a much closer threat for all hospital service specialties. And that may become widespread before I can retire.

 

[Seth Joo]

In the short term Obama care is good for doctors. More patients with insurance, less on Medicaid or self pay (no pay charity care). My income continues to go up.
However, it's not sustainable and costs more than planned (imagine that!) as a result more will need government subsidies and it will cost more than planned for the government as well (no way! I never saw that coming!)
That's when we will have to switch to some form of government program for all/most. We're already $17T in debt, we can't afford to subsidize everyone's medical care.
I hope there is a private system as well, as in some other countries with a government system.
Some hospitals and systems and specialties will weather the storm and still do OK. Anesthesia will get destroyed unless they fix the unfair reimbursement system. Fortunately I'll be retired by then, or will use it as an excuse to retire early. Bundled payments are a much closer threat for all hospital service specialties. And that may become widespread before I can retire.

The people that are in medical school right now and those just graduating are going to get the shaft from Obamacare. I only think primary care incomes will go up because more people will have insurance but specialist incomes are in for a big fall. And the increase in primary care income will not be that big anyway.

Managed care organizations already shafted doctors a long time ago, the good old days was when there was indemnity insurance the old school Blue Cross Blue Shield.

 

[Nietzschelover]

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

Excuse me, did Obama have anything to do with the advent and rise of managed care? Was there something called "RomneyCare" that preceded ObamaCare? Was the healthcare system a thing of beauty before Obama? Was reform in healthcare one of the top 3 agenda items before Obama was elected? Intellectual laziness (or outright prejudice) is the cause of 90% of the targeting of Obamacare as "the problem." It was a given 30-40 years ago that ultimately a single payer system is the inevitable answer.

 

[Nietzschelover]

Managed care organizations already shafted doctors a long time ago, the good old days was when there was indemnity insurance the old school Blue Cross Blue Shield.

And there ya go. From Trump himself.

 

[rocklobstr]

Excuse me, did Obama have anything to do with the advent and rise of managed care? Was there something called "RomneyCare" that preceded ObamaCare? Was the healthcare system a thing of beauty before Obama? Was reform in healthcare one of the top 3 agenda items before Obama was elected? Intellectual laziness (or outright prejudice) is the cause of 90% of the targeting of Obamacare as "the problem." It was a given 30-40 years ago that ultimately a single payer system is the inevitable answer.

My statement was sarcasm, and I was agreeing with you.

 

[Seth Joo]

Excuse me, did Obama have anything to do with the advent and rise of managed care? Was there something called "RomneyCare" that preceded ObamaCare? Was the healthcare system a thing of beauty before Obama? Was reform in healthcare one of the top 3 agenda items before Obama was elected? Intellectual laziness (or outright prejudice) is the cause of 90% of the targeting of Obamacare as "the problem." It was a given 30-40 years ago that ultimately a single payer system is the inevitable answer.

Obamacare is not single payer insurance.

 

[Nietzschelover]

My statement was sarcasm, and I was agreeing with you.

Well thank goodness, especially with you being a Vermonter and all.

 

[Nietzschelover]

Obamacare is not single payer insurance.

Right. He proposed something on the way towards single payer that he thought had a shot of getting through Congress.

 

[Glazedonutlove]

Obamacare is not single payer insurance.

who said it was

 

[StudyLater]

You are right, Medicine is stable, but I would say the field will not have the same kind of lifestyle that it used to have but then again this has been said for long time and people keep applying to medical school.

Well, people are desperate for a better life or strongly driven by external pressures, which a high paying job will obviously totally resolve.

 

[IlDestriero]

Obamacare is not single payer insurance.

You don't say?
Tell me more about this Obama-care thing.
It's the first stop on the express train to universal medicare. Medicare pays poorly now, it will get worse across the board.

 

[Cotterpin]

Well, people are desperate for a better life or strongly driven by external pressures, which a high paying job will obviously totally resolve.

Don't forget the all people who want to go into medicine just because they genuinely enjoy it.

 

[StudyLater]

You don't say?
Tell me more about this Obama-care thing.
It's the first stop on the express train to universal medicare. Medicare pays poorly now, it will get worse across the board.

I'm sure you and your colleagues are super excited about this. I mean, since you are so selfless and love your patients so much, I'm sure you'd be fine working for like 50k if they really benefited from your pay cut, right? RIGHT????

@Cotterpin like your profile subtitle

 

[Glazedonutlove]

Why would single payer mean 50k salaries

 

[StudyLater]

Why would single payer mean 50k salaries

I didn't mean single payer would cause 50k salaries. I'm just saying that we are all prepared to receive that in the future if we must.

 

[md-2020]

I didn't mean single payer would cause 50k salaries. I'm just saying that we are all prepared to receive that in the future if we must.

Yeah but all of us know that's literally not going to happen, as much as we like to complain about physician compensation.

 

[writing]

I didn't mean single payer would cause 50k salaries. I'm just saying that we are all prepared to receive that in the future if we must.

I'm not. If market conditions in the U.S. get that bad, I'll go where ever is best. Canada if possible. Germany or Netherlands if i can.

 

[StudyLater]

Yeah but all of us know that's literally not going to happen, as much as we like to complain about physician compensation.

Maybe. I don't purport to know the future. I am but a lowly mortal swayed by forces much greater than my meager existence.

I'm not. If market conditions in the U.S. get that bad, I'll go where ever is best. Canada if possible. Germany or Netherlands if i can.

UAE sounds like fun. Though I'm not sure if you'd have to learn the language or not.

 

[Glazedonutlove]

Maybe. I don't purport to know the future. I am but a lowly mortal swayed by forces much greater than my meager existence.



UAE sounds like fun. Though I'm not sure if you'd have to learn the language or not.

Majority can speak English in Germany

 

[writing]

Maybe. I don't purport to know the future. I am but a lowly mortal swayed by forces much greater than my meager existence.
UAE sounds like fun. Though I'm not sure if you'd have to learn the language or not.

I actually know a media lawyer (think Viacom, Sony) who lives in UAE. He is an Arab who grew up in America, but he loves it there. This is all hypothetical, but personally I'd prefer western europe (Germany, Nederlands, Scandinavia) or Britain before the middle east.

 

[StudyLater]

I actually know a media lawyer (think Viacom, Sony) who lives in UAE. He is an Arab who grew up in America, but he loves it there. This is all hypothetical, but personally I'd prefer western europe (Germany, Nederlands, Scandinavia) or Britain before the middle east.

I know. That's the one drawback -- it's in the middle east. But seriously no taxes and similar wages + 1st world quality of life? Yes please.

 

[StudyLater]

Majority can speak English in Germany

I'll consider it. But I mean....what's the hook with Germany? i.e. a good reason for wanting to go there.

 

[LizzyM]

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.

About 10 years ago, there was a doc in my (middle class, urban) neighborhood who opened a cash-only practice for people who wanted primary care services (although truth be told, mostly it was confidential treatment of STIs, check ups of chronic diseases like diabetes and hypertension, etc without generating a medical record that could be seen by insurance companies or one's spouse). The services were limited though as someone discovered when there was no way for this doc to get a Holter monitor for a patient who needed a work-up including EKG monitoring. The practice folded in a year or two.

 

[writing]

I know. That's the one drawback -- it's in the middle east. But seriously no taxes and similar wages + 1st world quality of life? Yes please.

Uggh tempting, but I, in general, would be hesitant to leave America for one reason and one reason alone:

Some Doctors want a Porsche, others want an arsenal.

 

[allantois]

Yea, good luck making bank in Germany.
Also, medicine is not something you can easily take from one country to the next.
The truth is, when US moneymaking in medicine ship sinks, there will be nowhere to run in the world as there is no other place where you have the potential to make bank in medicine.

For anyone interested:
http://www.insidermonkey.com/blog/16-highest-paying-countries-for-doctors-314590/?singlepage=1

 

[StudyLater]

Uggh tempting, but I, in general, would be hesitant to leave America for one reason and one reason alone:

Some Doctors want a Porsche, others want an arsenal.

But I don't want either. I just want to practice. And have a mansion. And three wives. And 2 private jets. And tropical island vacations.

 

[StudyLater]

Yea, good luck making bank in Germany.

Yeah...

The truth is, when US moneymaking in medicine ship sinks, there will be nowhere to run in the world as there is no other place where you have the potential to make bank in medicine.

Well who knows. Maybe others will retain their reimbursements even as ours decline (if they decline that much).

 

[writing]

But I don't want either. I just want to practice. And have a mansion. And three wives. And 2 private jets. And tropical island vacations.

Africa and/or the Middle East.

 

[Seth Joo]

Yea, good luck making bank in Germany.
Also, medicine is not something you can easily take from one country to the next.
The truth is, when US moneymaking in medicine ship sinks, there will be nowhere to run in the world as there is no other place where you have the potential to make bank in medicine.

For anyone interested:
http://www.insidermonkey.com/blog/16-highest-paying-countries-for-doctors-314590/?singlepage=1

Its not easy for doctors to immigrate to other countries, US trained doctors might have more options that physicians from other parts of the world because America still has a lot of status, but that being said there are countries where health care is as advanced or better than the US. Most rich industrialized countries in Europe, Japan, etc would be on par with the US in terms of their physicians.

I was in grade school when a friend's uncle told me Medicine would not be a good career to be in, but you can still make a good living as a physician, you just won't live in luxury.

 

[Mad Jack]

Uggh tempting, but I, in general, would be hesitant to leave America for one reason and one reason alone:

Some Doctors want a Porsche, others want an arsenal.

You do realize that you can have a much less freedom-impinged arsenal in many nations in the Middle East, right? Full automatics, RPGs, whatever you want.

 

[StudyLater]

Africa and/or the Middle East.

Exactly.

You do realize that you can have a much less freedom-impinged arsenal in many nations in the Middle East, right? Full automatics, RPGs, whatever you want.

Oh well fantastic. Just what I always wanted. Cuz you know, like....there's like a million things I'd need an RPG for.

 

[Seth Joo]

You do realize that you can have a much less freedom-impinged arsenal in many nations in the Middle East, right? Full automatics, RPGs, whatever you want.

Saudi Arabia has a much lower incarceration rate than the United States. I found that real interesting.

 

[Mad Jack]

Exactly.



Oh well fantastic. Just what I always wanted. Cuz you know, like....there's like a million things I'd need an RPG for.

I'm just pointing out to the arsenal guy that America is hardly the freest country in the world in regard to guns, if that's what he's into.

 

[Seth Joo]

I'm just pointing out to the arsenal guy that America is hardly the freest country in the world in regard to guns, if that's what he's into.

America is hardly the freest country in the world in many respects.

 

[allantois]

Saudi Arabia has a much lower incarceration rate than the United States. I found that real interesting.

Does anyone have a higher incarceration rates than us?

 

[Seth Joo]

Does anyone have a higher incarceration rates than us?

Not a single country, not even North Korea, Iran, Russia, nor China.

We have an American who took up refugee status in Russia to flee our country that is how insane its gotten, anyway if our government got their hands on Snowden he would not be going to jail, might be going somewhere else.

 

[StudyLater]

I'm just pointing out to the arsenal guy that America is hardly the freest country in the world in regard to guns, if that's what he's into.

I'm not into stockpiling weapons, no. World domination would be nice, but where would all my free time go?

 

[StudyLater]

Yeah we should probably stop putting people in cages at some point....or at least give them nicer accommodations. I hear they get XBOX in the UK.

 

[Seth Joo]

I'm not into stockpiling weapons, no. World domination would be nice, but where would all my free time go?

Madjack was just pointing out that America is not the most free country when it comes to owning firearms, there are many states where its actually quite hard to get one.

 

[StudyLater]

Madjack was just pointing out that America is not the most free country when it comes to owning firearms, there are many states where its actually quite hard to get one.

Well, public places keep getting shot up, so it's not super surprising that they'd try to tone it down a bit.

 

[StudyLater]

@Seth Joo quick question: Are you also in love with the way Trump says China? He's extremely hard on the "ch," like "CHina." Ah man that cracks me up every time.

 

[IlDestriero]

I'm sure you and your colleagues are super excited about this. I mean, since you are so selfless and love your patients so much, I'm sure you'd be fine working for like 50k if they really benefited from your pay cut, right? RIGHT????

@Cotterpin like your profile subtitle

I wouldn't do what I do now for $250k, but I'm happy to take the extra ~50k that I'm making.

 

[Seth Joo]

@Seth Joo quick question: Are you also in love with the way Trump says China? He's extremely hard on the "ch," like "CHina." Ah man that cracks me up every time.

Whatever he's doing it seems to be working, he is already beating Hilary in the polls, a lot people wrote him off, but this guy was swimming with sharks his whole life, he is no joke. Sure he has a certain thing about him, but he is really tough businessman. I recall an actor became one of the most popular and charismatic leaders America ever had, why not a guy like him?

 

[allantois]

@Seth Joo quick question: Are you also in love with the way Trump says China? He's extremely hard on the "ch," like "CHina." Ah man that cracks me up every time.

I see you doing great with auscultation in the future

 

[Gandyy]

Can we stop calling it "ObamaCare" please?

 

[StudyLater]

Can we stop calling it "ObamaCare" please?

Agreed. Creepy name.

 

[StudyLater]

Whatever he's doing it seems to be working, he is already beating Hilary in the polls, a lot people wrote him off, but this guy was swimming with sharks his whole life, he is no joke. Sure he has a certain thing about him, but he is really tough businessman. I recall an actor became one of the most popular and charismatic leaders America ever had, why not a guy like him?

I really like him a lot as a person. Some of the **** he says is kind of ridiculous, but I mean, he's a politician and a business leader combined. Compared to the rest of the pack he actually seems so much more like he knows what he's doing.

And I don't even feel like he definitely knows what he's doing.

Oh, and would you mind linking me to that poll?