Salary-Something to ponder

[daveshnave]

I too wonder what llenroc was referring to regarding radonc docs... what are they lobbying for?

HOWEVER,

Before everyone jumps down llenroc's throat, he/she makes a good point. Namely, that there is FINANCIAL pressure/incentive to promote the spread of NPs, PAs, etc. My intention here isn't to offend any of these people (sorry dire), but I do question whether this is ETHICALLY right or not. Yes, I understand the reality of the need for these caregivers, but that reality is based on finance. When it comes to patient care, we should look at the ethics of the situation, and in this regard I have an issue with a less-trained caregiver having complete or near-complete autonomy with patients. Do I think most if not all of these caregivers are capable, competent, intelligent people? Absolutely. Nevertheless, with less education under their belts, they are more apt to make mistakes early in their careers, with little to no supervision of this. Even medical residents are supervised when it comes to major issues regarding patient care. The learning curve is steep for anyone beginning to care for patients by themselves, whether you are an MD, NP, PA, etc, and mistakes will be made. This being said though, I would like to believe that less mistakes are being made by those with a broader foundation of medical knowledge.

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[Llenroc]

I used the wrong term. The correct term is "radiation oncology physicist". My friend is doing a radiation oncology physicist program (MSBS), which is for people with BS or PhD degrees. He says that they have a strong lobbying group in Washington, which is trying to get them more autonomy from physicians, with regard to directing patient's treatments.

 

[IceKid]

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.

wait wait, this is my favorite part!! apparently NPs are not only as capable as physicians, but they are also GOD. they don't make mistakes- ever.

Dire- I'm not really sure what you expect a bunch of medical students to say when you tell them that you're a more effective physician than a physician is. we're in MEDICAL SCHOOL for a reason. we obviously believe that physicians provide the best quality of care... otherwise we would have taken the easy route too!

 

[chief3630]

wait wait, this is my favorite part!! apparently NPs are not only as capable as physicians, but they are also GOD. they don't make mistakes- ever.

Dire- I'm not really sure what you expect a bunch of medical students to say when you tell them that you're a more effective physician than a physician is. we're in MEDICAL SCHOOL for a reason. we obviously believe that physicians provide the best quality of care... otherwise we would have taken the easy route too!

snap

 

[Random_Walk]

If physician earnings concern you, the safest specialty in my view is a surgical subspecialty. Complicated procedures require the human touch, and that's where highly specialized medical devices will further ensure that specialized surgeons will have rents in the long term. While biotech / pharmaceutical companies don't typically benefit physicians with their innovations from a financial standpoint, medical devices definitely benefit orthopods and other surgeons. Their technologies have to be operated in specialized surgeon hands.

Right now radiologists are making lots of money. But just as X-ray interpretation is a commodity, a lot of imaging study interpretations will be commoditized in the future. I'd say you'll be fine if you go into diagnostic radiology, but you have to keep this in mind. However, as long as radiologists are on the cutting edge in areas like MRI / PET and interventional, they won't have to worry about this. On the other hand, there's probably overcapacity of MRIs and maybe even PETs, so these are no longer the kind of money-making machines they used to be.

Anesthesiologists are basically being replaced by cheaper labor and machines. Sure, there are opportunities for anesthesiologists, but they are in complicated procedures and no doubt the "market" is shrinking for anesthesiologists.

As long as it's the drug companies who are innovating, I cannot see salaries in many non-surgical specialties rise, unless it's due to demographics expanding the market for medical care.

Also, consumers are becoming more knowledgeable about health care. With increasing costs, they may be price sensitive and you might actually see real competition with nurse practitioners and people who work in complementary medicine (particularly for pain management and musculoskeletal ailments)

A principle in services businesses is as follows: in order to earn high profit margins, your customer must be high-net worth. So people in dermatology, plastics, or even family medicine, cater to the high-net worth individuals by setting up premium-level health care centers. Offer your patients green tea and aromatherapy, along with 24-hour communication via blackberry or e-mail. I'm not kidding. People want health care cheap when it comes to life and death situations, but when it comes to things like skin rejuvenation, they treat such service as a luxury and are willing to pay lots of $$$ for it. There may be barriers to entry, but you might find a way to develop a reputation. There might be competition, but you can always differentiate yourself as a city is always crowded with all types of high-end restaurants with different themes.

Also, it is true that working in rural areas is lucrative. But it is still more lucrative to subspecialize, and subspecialists don't live in rural areas, they live in metropolitan areas. Everybody pays a premium for living in places that offer a wide range of things (so-called "culture"), a wide range of good schools, low pollution, good weather, beautiful scenery, etc. That's just the laws of economics.