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A lot of people say they don't want to be general practitioners, because of the lower salary, and would rather specialize. Looking at the average salaries alone, it does appear that a general practitioner does make less, on average. However, realize that this data is based on a conglomerate of salary data from across the country. General practitioners tend to be found everywhere in the country, including the boonies; whereas a specialist is more likely to be found in a large city, where populations are higher, people make more money, and they have more flexibility in targetting specific populations for their practice. Perhaps looking at this broad data is insubstantial, and would be much more validated if a more specific geographic perspective were taken than an overall look at the entire country. Maybe then we would see that differences in salary are statistically insignificant, and perhaps even reversed w/regard to certain specialties. For instance, general practitioners in immediate suburbs of NYC in NJ (my area), are loaded. Just somehing to think about.
 
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efex101

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Yup, if you are willing to move to BFE you will be cashing in the mula as a GP. The *only* thing that makes me hesitate regarding GP is the growing encroachment that they are and will be facing from NP/PA this is for real. As more states pass laws that these healthcare professionals can run their own show sans physician supervision this will the preferred provider for many HMO's.
 

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Let's make some clarifications here. GP's are actually no longer in existence. GP is an old phrase from earlier medicine when docs graduated and went directly into practice, or did a one -year internship and then went into practice. You can't become board certified if you do that anymore, thus not being able to take insurance either. I am planning on going into family medicine, and doing rural practice. Am I worried about PA/NP encroachment? No way. I plan to obtain training in surgical obstetrics, and last I checked, a PA couldn't hold a knife.
 

chameleonknight

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thank you, adamj_ut for clearing that up.

I don't see the NP/PA threat as being very real, as long as physician groups keep fighting it. It may come down to ugliness (e.g. attack ads "take your kids to a doctor--not a nurse") but I don't think it will. People in this country are very demanding; everyone wants the best available. NPs/PAs will only dominate in impoverished areas where people couldn't afford a doc anyway.
 

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adamj_ut said:
Let's make some clarifications here. GP's are actually no longer in existence. GP is an old phrase from earlier medicine when docs graduated and went directly into practice, or did a one -year internship and then went into practice.
They still exist. My brother knows two who did it recently.
 

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Where is the best source of salary data? I have started researching this because I hear it all the time, usually from doctors practicing in primary care, that they don't make any money. I think the future is key, since NP and PA-Cs will take a chunk of this area.

Let me know!
 

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thackl said:
They still exist. My brother knows two who did it recently.

Sure, some still do this, but it is very difficult in many parts of the country to get hospital privledges and managed care contracts without completing a residencys and being board eligible/certified.
 

adamj_ut

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Like DrMom said... where I am looking to practice rural family medicine, I know that they won't even look at you if you're not BE/BC and have completed your residency.
 

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Dollar for dollar, a specialist in a given area will always have a higher income than a primary care doctor.
 

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ole doc brown2B said:
Where is the best source of salary data? I have started researching this because I hear it all the time, usually from doctors practicing in primary care, that they don't make any money. I think the future is key, since NP and PA-Cs will take a chunk of this area.
Let me know!
This looks pretty "official"

http://www.aamc.org/students/cim/specialties.htm
 

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Come on now, if you believe that NP's are gonna take a chunk out of FP's salaries then you also have to believe that other areas will take an even bigger hit. I mean a visit to an FP is cheap by compared to other services. Think how much money we could save if they trained people just to read x-rays, MRI's, etc. instead of paying radiologists craploads or cash. Or nurse anesthetists, for another example. Don't you think that those areas of more specialized knowledge are much more susceptible to "technician" encroachment than FP's who use a large amount of their basic training on a daily basis? I for one don't think NP's are gonna take over, who wants to go to one? I know I don't, the knowledge difference between the average FP and NP is pretty damn substantial, IMO.

-Frijolero
 
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efex101

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I think that the problem will come not from patients prefer or not but what HMO's will "allow". If HMO's can save $$$ by insisting that folks go to NP/PA as their primary care provider then this is when some family practice docs may see some decline in patients...this will not happen everywhere but it is happening in some states.
 

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To what frijolero stated that *is* happening in some hospitals where they are having X-rays read by docs overseas...CRNA's are now able to their jobs sans physician supervision in some states..again laws are changing and with physicians being more "laissez faire" than other healthcare counterparts this may become more of a trend. There will never be a time where primary care docs, radiologists, anesthesiologists will *not* be needed but it is good to keep your eye out for new changes in the way healthcare is delivered.
 

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Physician salaries don't vary that much from region to region. It's not like business or law where NYC is the big time, where you get the maximum income. In fact the typical physician in NYC has his income driven down by the fact that there are too many doctors per capita there, and also the high taxes + cost of living. My Dad is a doctor, and on Long Island, the typical wealth of physicians was nothing compared to what we are seeing here in Ohio, which is where we live now. We were literally amazed at the kind of mone physicians have here in Ohio. And the doctors that make the most money often times have practices or side-practices out in the sticks that they commute to from the suburbs of the cities.

You can make some comparisions for yourself on this site:

http://www.jacksonandharris.com/company/pcps.aspx

Some other things to keep in mind are the time value of money. People in IM and Pediatrics have to spend less time in residency. They start earning the six figure salary earlier so they can pay off debt, or make investments. That makes a big difference. From what I've seen doctors who are really wealthy are wealthy because they invested their money wisely in real estate, stocks or side businesses.
 

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efex101 said:
To what frijolero stated that *is* happening in some hospitals where they are having X-rays read by docs overseas.
This is happening. A company called Nighthawk reads xrays in Australia while people in the U.S. are sleeping.

But these are U.S. licensed docs located in Australia doing the reading of the Xrays. The attorneys would have a field day if they weren't. So bless the attorneys every one of them. He he :)
 

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adamj_ut said:
I plan to obtain training in surgical obstetrics, and last I checked, a PA couldn't hold a knife.
Zactly, become a surgeon, make a difference. :)
 

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In the future, insurance companies may make PA-Cs the preferred provider, but the difference in knowledge is substantial. I am in the healthcare industry and have seen firsthand this difference. I had tendonitis on the upper portion of my wrist and was misdiagnosed by a PA with carpal tunnel syndrome. The tendonitis was on the wrong side to be CPS!

This is one instance, but the knowledge and experience just isn't there with PA-Cs.
 

efex101

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Oh I agree 100% with you...
 

adamj_ut

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Okay, I've heard a number of physicians say that docs who just become licensed with one year of internship and try to go into practice are "grossly unprepared." Well, how about a PA, who has completed 27 months of medical training? Wouldn't they then qualify as super, horribly under prepared?
 

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adamj_ut said:
Okay, I've heard a number of physicians say that docs who just become licensed with one year of internship and try to go into practice are "grossly unprepared." Well, how about a PA, who has completed 27 months of medical training? Wouldn't they then qualify as super, horribly under prepared?
i think you would have to get some additional training if you were to be the first point of contact. they could develop more elaborate PA postgrad training positions.

but i still agree with the point that specialists have more to worry about than primary care docs. another example that no one has mentioned yet is optometrists that are gaining surgical rights in some states (maybe only one).. so ophtholmologists are definitely becoming worried/fighting back..
 

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Frijolero said:
Come on now, if you believe that NP's are gonna take a chunk out of FP's salaries then you also have to believe that other areas will take an even bigger hit. I mean a visit to an FP is cheap by compared to other services. Think how much money we could save if they trained people just to read x-rays, MRI's, etc. instead of paying radiologists craploads or cash. Or nurse anesthetists, for another example. Don't you think that those areas of more specialized knowledge are much more susceptible to "technician" encroachment than FP's who use a large amount of their basic training on a daily basis? I for one don't think NP's are gonna take over, who wants to go to one? I know I don't, the knowledge difference between the average FP and NP is pretty damn substantial, IMO.

-Frijolero
Do you think anyone off the street can just be trained to read radiographs? The knowledge base necessary to be efficient at reading films requires years.

A Radiology residency is 4-5 years if I am not mistaken.
Peds, IM, FP are only 3 years.

If I had some complex neurologic problem and had an MRI done, I would not count on my FP to read it correctly. I am not taking anything away from FP because if I was sick where would I go? FP.

Do not be condescending of other specialties, we are a team and you will count on Radiologists and other specialists at some point in your career.
 
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shocker said:
Do you think anyone off the street can just be trained to read radiographs? The knowledge base necessary to be efficient at reading films requires years.
radiologists have the threat of tele-radiology though. folks in india with much more experience than a kid who just finished residency would gladly read films that are sent over high speed lines for a small fraction of the price.. and in the cases where they are doing it in the US currently, they cover more films in less time without an increase in error rates..
 

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no exit said:
radiologists have the threat of tele-radiology though. folks in india with much more experience than a kid who just finished residency would gladly read films that are sent over high speed lines for a small fraction of the price.. and in the cases where they are doing it in the US currently, they cover more films in less time without an increase in error rates..

Are you a proponent of out-sourcing? Taking nothing away from Indian Rads they just aren't required to train as long. I prefer over-trained to under-trained when dealing with my health, thanks.

You are saying they do it just as well as their US counterpart and faster? Please provide references to such claims.
 

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shocker said:
Are you a proponent of out-sourcing? Taking nothing away from Indian Rads they just aren't required to train as long. I prefer over-trained to under-trained when dealing with my health, thanks.

You are saying they do it just as well as their US counterpart and faster? Please provide references to such claims.
no, i'm not promoting outsourcing, i'm just suggesting to you that the logistics and economics of telerads creates a threat to the field of radiology in the US. if you're actually interested in telerads you may find this article interesting.. i just found it after a quick search...
 

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My question is why is every physcian fearful of mid-levels?....wake up and realize that this is a trend that will never go away! And, a trend that will only become more of a reality as each year passes and each health dollar becomes more expensive. Medicine will be dead, unless the mid-levels save health care. MD reimbursemnt will dwindle even further if mid-levels, like NP's are restricted in practice. Do you all understand that a NP works literally for "half-price," thus saving HMO's, Medicare and Medicaid billions each year!And I should say that a PA is a far cry from a Nurse Practitioner. I hate when a NP is 'grouped' with a PA...they two different animals.

Does any physcian on this board realize the scope of a NP? Its infinity and beyond...there are NO limitations according to federal and state law! The one clarification I must make is that a PA is SUPERVISED in practice, a NP is not. NP's are independant practitioners, with the one variable that the NP must, by law, review one chart every 6 months with their collaborative MD.

Personally, I practially run a family health clinic, where my collaborating physcian works at my site about 8hrs/week at most. I have NEVER had a bad or negative outcome yet and beleive I practice with high standards and integrity.

So what is with the "I would never see a NP" on this board? Everyone here better warm up to the fact that it will be reality that at some point in your health mainentence or care, you will be treated by a Nurse Practitioner! And you might even be pleasantly surprised, when the NP properly removes that chip from your shoulder.
 

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Dire said:
My question is why is every physcian fearful of mid-levels?....wake up and realize that this is a trend that will never go away! And, a trend that will only become more of a reality as each year passes and each health dollar becomes more expensive. Medicine will be dead, unless the mid-levels save health care. MD reimbursemnt will dwindle even further if mid-levels, like NP's are restricted in practice. Do you all understand that a NP works literally for "half-price," thus saving HMO's, Medicare and Medicaid billions each year!And I should say that a PA is a far cry from a Nurse Practitioner. I hate when a NP is 'grouped' with a PA...they two different animals.

Does any physcian on this board realize the scope of a NP? Its infinity and beyond...there are NO limitations according to federal and state law! The one clarification I must make is that a PA is SUPERVISED in practice, a NP is not. NP's are independant practitioners, with the one variable that the NP must, by law, review one chart every 6 months with their collaborative MD.

Personally, I practially run a family health clinic, where my collaborating physcian works at my site about 8hrs/week at most. I have NEVER had a bad or negative outcome yet and beleive I practice with high standards and integrity.

So what is with the "I would never see a NP" on this board? Everyone here better warm up to the fact that it will be reality that at some point in your health mainentence or care, you will be treated by a Nurse Practitioner! And you might even be pleasantly surprised, when the NP properly removes that chip from your shoulder.

Correct me if I am wrong, but arn't NP's abilities different state by state? Including how much supervision and what they can and cannot do.
 

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Yes, NP's rights differ from state to state - my mom is a np in pennsylvania and she cannot work without MD supervision and cannot write scripts.
Medicine definitely needs np's and pa's. My dad is a GP in semi rural PA and he would not be able to run his practice without pa's - hiring another md or gaining a partner would be too expensive.
GPs definitely make less money than specialists AND every year medicare and medicaid reimbursemnet declines - its almost impossible to open a profitable solo private practice anymore b/c reimbursement is so low and you would have to see so many patients a day there would be no time for anything else.
My dad's practice is doing fine - but he works 12 hour days, rounds at the hospital then sees office patients, has 2 pa's to help with office patients, and he is on call ALL THE TIME. Basically, in my opinion he works way too much and gets paid way too little. But, he loves it - so if you like family medicine its worth it.
 

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SoCalRULES!!!!! said:
Specialists in the boonies make the most money of all.
You don't even have to specialize in BFE. My buddies' rural preceptor in Nebraska cleared $1.6 million last year and he's FP. Granted he was the only doctor in about a hundred mile radius, but damn that some serious green.
 

macdown

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Dire said:
Does any physcian on this board realize the scope of a NP? Its infinity and beyond...there are NO limitations according to federal and state law!
This is exactly why people don't like NP's. There are no restrictions and they can do what ever they want. Hey, that's fine if you want to be a nurse and I respect you for that. But if you want to be a physician, go to medical school, period. If that means a pay cut for me or anybody else, fine. I didn't work my @$$ off for that last umpteen years to have some nurse usurp my job.
 

chameleonknight

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Dire said:
My question is why is every physcian fearful of mid-levels?....wake up and realize that this is a trend that will never go away! And, a trend that will only become more of a reality as each year passes and each health dollar becomes more expensive. Medicine will be dead, unless the mid-levels save health care. MD reimbursemnt will dwindle even further if mid-levels, like NP's are restricted in practice. Do you all understand that a NP works literally for "half-price," thus saving HMO's, Medicare and Medicaid billions each year!And I should say that a PA is a far cry from a Nurse Practitioner. I hate when a NP is 'grouped' with a PA...they two different animals.

Does any physcian on this board realize the scope of a NP? Its infinity and beyond...there are NO limitations according to federal and state law! The one clarification I must make is that a PA is SUPERVISED in practice, a NP is not. NP's are independant practitioners, with the one variable that the NP must, by law, review one chart every 6 months with their collaborative MD.

Personally, I practially run a family health clinic, where my collaborating physcian works at my site about 8hrs/week at most. I have NEVER had a bad or negative outcome yet and beleive I practice with high standards and integrity.

So what is with the "I would never see a NP" on this board? Everyone here better warm up to the fact that it will be reality that at some point in your health mainentence or care, you will be treated by a Nurse Practitioner! And you might even be pleasantly surprised, when the NP properly removes that chip from your shoulder.
This is officially my new quote.
 

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adamj_ut said:
Okay, I've heard a number of physicians say that docs who just become licensed with one year of internship and try to go into practice are "grossly unprepared." Well, how about a PA, who has completed 27 months of medical training? Wouldn't they then qualify as super, horribly under prepared?
Yes! A number of PA's I have come across seem to feel that they know everything a doctor knows without the medical training.
 
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macdown said:
This is exactly why people don't like NP's. There are no restrictions and they can do what ever they want. Hey, that's fine if you want to be a nurse and I respect you for that. But if you want to be a physician, go to medical school, period. If that means a pay cut for me or anybody else, fine. I didn't work my @$$ off for that last umpteen years to have some nurse usurp my job.
Agree!
 

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Here is a copy of what I posted on another part of this forum regarding teleradiology:

It's a little different outsourcing a doctor's job than it is outsourcing programming job. The odds of this having a significant impact on radiology are very low. Each physician interpreting a study must be licensed in the state the study was performed and credentialed at the hospital it was performed. This limits the people reading to those who have passed the USMLE and have trained in the US. Not a huge number of those people wish to live in India (sure there are a few). There are also liability issues involved with a physician in another country reading studies. Who will the lawyers sue when there is a missed finding or misinterpretation? Additionally, Medicare currently does not reimburse for studies interpreted outside of the United States.

The total number of radiologists in india is about 3500. In comparison, the shortfall of radiologists in the United States is about 4500 and is projected by some to increase to as much as 15,000 in the next 15 years (of course projections are just speculation). The total number of US radiologists is 35,000 for comparison.

The companies that have non US trained, non US licenced radiologists do not provide a final interpretation, just a preliminary read. The final read is performed by the US radiologist. While I'm not too fond of this arrangement due to concerns about quality and liability, it in no way hurts American radiologists.

Teleradiology will actually increase the variety of opportunities for American radiologists. I would consider taking a position in Australia or Switzerland (the two places which Nighthawk Radiology has opened) for a few years for an interesting experience. One practice owns a condo in Barcelona, Spain, and sends one of their partners there for a month every year to do the nighttime reads. I could definitely live with that.

Foreign radiology will likely be used (and is already being used) primarily for nightime reads. Is is something to keep an eye on? Sure. Will I lose sleep over it? No.
 

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Just the replies I expected from this bunch. So narrow minded and grandoise. Yes, I am a nurse, and a nurse practitioner. And very proud of my accomplishemnts as well. And I certainly understand what a resident goes through, I've been married to one for 3 years now. But, hypothetically, come and ask my patients who they prefer to see, me or their 'previous' physcian. >95% will pick me. That is reality.
 

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Dire said:
But, hypothetically, come and ask my patients who they prefer to see, me or their 'previous' physcian. >95% will pick me. That is reality.
It's not reality 'cuz you just said it was hypothetical, but that's neither here-nor-there.

The reality is you are working as a physician without having gone through the training. If you wanted to work in that capacity, then you should have gone to medical school. I'm not saying doctors are god (by no means am I saying that), but the law of the land says you need to complete medical school and internship/residency to practice medicine. You took the back door, admit it.
 

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I'm sorry, but it's one thing to say that NPs/PAs contribute to the medical field, and it's quite another to say that you guys will be replacing doctors. How are we supposed to respond to that?

"OH, thank God, the mid-levels are here! I know I'm just wasting my time here in medical school. Now the HMOs can breathe easier." :p

NPs have a place, but it's not to replace a doctor. And most people I know would not prefer to see a nurse instead of a doctor.
 

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chameleonknight said:
NPs have a place, but it's not to replace a doctor. And most people I know would not prefer to see a nurse instead of a doctor.
This seems to be a fair statement.
 

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Whisker Barrel Cortex said:
Here is a copy of what I posted on another part of this forum regarding teleradiology:

It's a little different outsourcing a doctor's job than it is outsourcing programming job. The odds of this having a significant impact on radiology are very low. Each physician interpreting a study must be licensed in the state the study was performed and credentialed at the hospital it was performed. This limits the people reading to those who have passed the USMLE and have trained in the US. Not a huge number of those people wish to live in India (sure there are a few). There are also liability issues involved with a physician in another country reading studies. Who will the lawyers sue when there is a missed finding or misinterpretation? Additionally, Medicare currently does not reimburse for studies interpreted outside of the United States.

The total number of radiologists in india is about 3500. In comparison, the shortfall of radiologists in the United States is about 4500 and is projected by some to increase to as much as 15,000 in the next 15 years (of course projections are just speculation). The total number of US radiologists is 35,000 for comparison.

The companies that have non US trained, non US licenced radiologists do not provide a final interpretation, just a preliminary read. The final read is performed by the US radiologist. While I'm not too fond of this arrangement due to concerns about quality and liability, it in no way hurts American radiologists.

Teleradiology will actually increase the variety of opportunities for American radiologists. I would consider taking a position in Australia or Switzerland (the two places which Nighthawk Radiology has opened) for a few years for an interesting experience. One practice owns a condo in Barcelona, Spain, and sends one of their partners there for a month every year to do the nighttime reads. I could definitely live with that.

Foreign radiology will likely be used (and is already being used) primarily for nightime reads. Is is something to keep an eye on? Sure. Will I lose sleep over it? No.

You are looking at how things are today and making a prediction for the future based on that. The fact that there are some radiologists in India doing outsourced work from the U.S. opens up the possibility that this trend could grow in the future.

Also, from what you've said the barriers right are are purely legal/bureacratic. There is a lot of pressure on the government to take steps to make healthcare cheaper. One of the things that I would not be surprised to see is that many jobs that must be done by doctors today will be opened up to non-physicians in the healthcare world in the future, in an effort to contain costs. Psychologists are lobbying the government to let them prescribe drugs. Radiation oncologists are lobbying the government to give them autonomy from physicians. etc. The government will probably give into these demands eventually in an effort to make these aspects of healthcare cheaper for the consumer. Likewise, I would be willing to bet good money that eventually, they will relax the laws regarding who can and can't read X-Rays.
 

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Llenroc said:
Radiation oncologists are lobbying the government to give them autonomy from physicians. etc.
Hmmmmmmm........ :laugh:
 

DrMom

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Benzo4every1

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adamj_ut said:
Let's make some clarifications here. GP's are actually no longer in existence. GP is an old phrase from earlier medicine when docs graduated and went directly into practice, or did a one -year internship and then went into practice. You can't become board certified if you do that anymore, thus not being able to take insurance either. I am planning on going into family medicine, and doing rural practice. Am I worried about PA/NP encroachment? No way. I plan to obtain training in surgical obstetrics, and last I checked, a PA couldn't hold a knife.
Oooh you are willing to pay the same malpractice as Ob-Gyn or at least $60,000 to do Ob-Gyn with Family? Why don't you think about Ob-Gyn?
 

adamj_ut

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Benzo4every1 said:
Oooh you are willing to pay the same malpractice as Ob-Gyn or at least $60,000 to do Ob-Gyn with Family? Why don't you think about Ob-Gyn?
No, I won't have to worry about that -- I technically already have a job waiting for me and I'm an MS2. The hospital will pay my malpractice insurance if I do OB. I think FP with OB would suit me better than would an OB/Gyn practice because I want to care for the whole family, not just for women.
 

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I don't know if this is true or not, but a resident told me that an FP doc in a rural area can make an avg. of 250K+ versus one practicing in a major metropolitan city (~130K). Anyone want to confirm this?
 

Whisker Barrel Cortex

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Llenroc said:
You are looking at how things are today and making a prediction for the future based on that. The fact that there are some radiologists in India doing outsourced work from the U.S. opens up the possibility that this trend could grow in the future.

Also, from what you've said the barriers right are are purely legal/bureacratic. There is a lot of pressure on the government to take steps to make healthcare cheaper. One of the things that I would not be surprised to see is that many jobs that must be done by doctors today will be opened up to non-physicians in the healthcare world in the future, in an effort to contain costs. Psychologists are lobbying the government to let them prescribe drugs. Radiation oncologists are lobbying the government to give them autonomy from physicians. etc. The government will probably give into these demands eventually in an effort to make these aspects of healthcare cheaper for the consumer. Likewise, I would be willing to bet good money that eventually, they will relax the laws regarding who can and can't read X-Rays.

Sure, the future is always difficult to predict. Its not just a beurocratic/legal thing. Quality of interpretation is definitely poorer with third world radiologists. There are something like 350 CT scanners in all of India (population 1 billion). How do you think the training is given that relatively low volume?

An anecdotal case. Recently we did an outside film read from Mexico. The patient had started chemotherapy in Mexico for gastric cancer with liver mets and a lung met. We hang the films. The first thing that strikes us is that the "lung met" they had measured is actually a Bochdalek hernia. The largest "liver met" is actually more likely a benign cyst. So this guy had been grossly misdiagnosed. Good thing we did the outside read because the oncologist here was going to start treating the patient with the same chemo because the "lung met" aka hernia was smaller on the follow up exam!
 

adamj_ut

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LVDoc said:
I don't know if this is true or not, but a resident told me that an FP doc in a rural area can make an avg. of 250K+ versus one practicing in a major metropolitan city (~130K). Anyone want to confirm this?
All I can do in regard to this is speak from my knowledge of my rural hometown. There, the docs who have been in practice greater than 5 years and who do procedures make around $350K.
 

abcde

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What was the radonc lobbying comment about? anyone have a clue?
 
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