The demise of medicine

[rory1215]

Anyone else worried about the soaring budget deficit, the myriad of baby boomers who will soon be retiring and feeding off of social security, and the amazingly high cost of end of life treatment in ICU's?

Face it, in 20 years physicians will have taken a huge pay cut. Our economy won't be able to support the myriad of docs all earning the top 5% of income. Out of economic necessity, medicine will become focused on prevention rather than intervention, and no one will be making much more than 100,000/ year. No more huge reimbursements for radiologists, gas, cards, etc.

We picked the right time to enter medicine, didn't we.

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[Seaglass]

Physician salaries are about 10% of all healthcare spending in the US. There are bigger pieces of the pie to attack than us.

C

 

[rory1215]

Even though physician salaries only account for about 10% of expenditures, you have to remember that the U.S. is now spending approx. $5000 per capita in healthcare. Shaving a few percentage points off will NOT be insignificant, and society will feel little shame in reducing our already well above average salaries.

 

[dochuffman]

I think that if reimbursement is cut to much that it will eventually cause an even greater physician shortage because young college grads won't see as big of an incentive to become physicians. In theory this may drive up the salary of the physicians "left over." Lets face it, we spend 4 years in college getting excellent grades in hard courses to get into med school. Then we spend another 4 years in an even harder curriculum and take on an enormous debt. Next we can spend up to 8 years in a residency with super long hours getting paid peanuts. Finally, somewhere in our mid forties we can finally make some money. Our student loan debt dictates that we make enough to pay it back and live at the same time. We will face lawsuits and hours more than the average American. Then you look back and realize you forfeited your twenties on this quest to become a physician. Not to mention you are not flipping burgers but saving lives. I think you are right that they will continue to cut reimbursement as long as they can get away with it, which is a shame. Maybe when some senator can't find a physician to take care of his family, a compensation increase will occur or at least they will stop cutting. We make some of the top salaries and with the debt we end up with, the amount of sacrifices our family and ourselves take, and the great responsibility of our job, we deserve it.

 

[avendesora]

Yeah, physician compensation has remained pretty much constant when you take into account inflation while the cost of health care in general has balooned out of control in the last 10 years or so. The huge cost increases have come from that cube farm that your hospital and mine now has filled with non-provider personel. I'd be curious if anyone has data on how much of every dollar billed is eaten up by the administration of trying to collect it.

When you come down to it, the problem we face is so multifactorial that trying to find "the solution" becomes laughable.

Pharmaceutical prices contiue to soar -- had a lecture today on all the new directed colon cancer therapies -- $5-15K per month, and all of these with VERY shaky data to back them up.

The American consumer demands the best, and that usually translates into the most espensive (see cancer therapy above).

Litigation leads not only to increased malpractice rates and operating costs, but also forces us to practice in a way that wastes TONS of money. A simple headache turns into a $2000 when your patient threatens to sue.

Our culture demands heroic measures for everyone - even for those beyond hope. Patients become permanent residents in our ICUs while we do countless tests even thouh we know they had an SAH and stand no chance of meaningful recovery. Thankfully, I see this one getting better with more and more people willing to talk honestly about end-of-life instructions.

Lastly we have ourselves -- we're pounded with the culture of "we're not in it for the money". While I'm definitely not in it for the money, I'm also not with the camp of those who say "I'd do this even if they didn't pay me" -- be careful what you wish for. If we don't stand up for ourselves, sure as heck no one else is going to. Like it or not, even if we are not calling many of the shots anymore, physicians will be viewed as the face of medicine. The image of the wealthy doctor is not going away for at least another generation.

We NEED to get paid, though, to keep attracting the best minds to medicine. When a person of above average smarts can get a bachelor's and MBA, enter the workforce and be making physician-level income by the age of 28-30, it really makes it hard to convince someone to work for peanuts till they're 33. I have friends from college who already make $100K. I think that may be the only think I regret about medical school -- that I spent my mid-20s getting by on student loans in student housing rather than disposing of income.

So, yes, sometimes I worry. BUT, then I think about how much I like what I'm doing and how for smart people, things tend to work out. Just remember to look out for yourself first and foremost.

 

[rory1215]

avendesora-

Good point about the enormous administrative costs. According to an article in NEJM (Vol. 349, pgs. 768-775, 2003), administration makes up more that 30% of our healthcare costs. That compares to about 17% in Canada. Not to say we should necessarily strive to make our system like Canada's, but it's interesting to compare...

 

[kinetic]

First of all, assuming nothing changes, this is a great time to enter medicine - and I'm not being sarcastic. Why? Because all the losers who are in it just for the money are running for the hills. That means that at some point in time (due to early retirements and decreased applications to medical school), we'll all be in high demand.

Second of all, the system WILL change. Voluntarily or not. If we continue on this path, where we pour a million dollars into keeping one old geezer alive for an extra two months in an ICU without blinking an eye, the system will be bankrupt pretty quickly. It's about time that patients learned that this country doesn't exist in order to keep their mom alive on a ventilator for an extra few months so that they can assuage their guilty feelings. They want mommy alive for no reason, make them pay for it and we'll see just how much they care about her ("This costs HOW much? Pull the plug! Pull the damn plug!!").

P.S. It's about time we stopped caring about how we look compared to other countries. They always talk about how drugs are cheaper in other countries. You know why? Because WE do all the R&D and those poser countries just rip them off. If the U.S. acted like all the other countries, the only medicine we'd be using would be aspirin. The reason administrative costs are lower is because their system is like a deli: "take a number and get in line". Our system is more like "take what you want and we'll cover it somehow".

 

[jdg222]

Thanks for the optimistic outlook, Kinetic. I hope you're right.

I hate the fact that because I'll be $200,000 in debt, I need to take pay so seriously, but with these loans, what choice do I really have? I guess I could look into NHSC, too.

 

[banner]

Boo hoo! Poor doctors! We want to help everyone, and nobody wants to help us! Boo hoo! The demise of medicine! The demise of society! The horror! The horror!

Pathetic.

The only reason why a group of such highly motivated and capable individuals would not be able to maintain their salary is because of their own lack of common sense. If we work 10% as hard lobbying for our interests as we did in pursuing stupid AOA and sporadic pseudo-compliments from surgery attendings, there will be no problem.

Do you really think that West Coast longshoremen average $120,000/year with just a high school education because they want to help people or because they make society a better place? Please.

 

[kinetic]

Boo hoo! Poor doctors! We want to help everyone, and nobody wants to help us! Boo hoo! The demise of medicine! The demise of society! The horror! The horror!

Pathetic.

The only reason why a group of such highly motivated and capable individuals would not be able to maintain their salary is because of their own lack of common sense. If we work 10% as hard lobbying for our interests as we did in pursuing stupid AOA and sporadic pseudo-compliments from surgery attendings, there will be no problem.

Do you really think that West Coast longshoremen average $120,000/year with just a high school education because they want to help people or because they make society a better place? Please.

True. When I heard those lazy ass union guys were making that much with a high school education and no liability I wanted to kick their asses for striking. Unions are for *****s and idiots with no regard for anything except scratching their rear ends.

 

[banner]

jdg222,

Don't do it! No NHSC! I beg you!

Find yourself a nice lucrative specialty with the shortest residency possible. Get out and find yourself a nice private practice.

Really, if you're that on the ropes with your debt, don't make it worse by doing the NHSC and delaying making precious income that you could be investing. That's a far better financial strategy. Do the math. You'll see.

 

[hookaman]

Should doctors unionize? What are the pros and cons?

 

[kinetic]

Cons: you become a lazy SOB who strikes every time you have a bowel movement; your patients die when you strike.

Pros: you make more money; your patients die when you strike.

 

[juddson]

Physicians in Canada and the UK don't make half what those in the US do, but there are still three applicants for every spot in medical school. I'm not sure that the United States will have to bend and take it up the rear even if reimbursemenst were cut in half (or by 3/4).

Moreover, I'm guessing that IF applications to medical school fell because income was not keeping with expectations (NOT true, by the way - income is at its lowest level (in real dollars) in quite some time and applications are up again this year and last) there are a million "mid-level" providers who are more than willing to take your place for half the money. Look at PA's and NP's. You think they make less money because they don't want the "responsibility" of being a full blown doctor? No way. They'd happily inhabit the entire scope of MD practice for little more than they make now.

And finally, I predict that the response to this is that without the best minds in medicine (like we have now) the state of the art simply cannot advance - and the US is not willing to tolerate this. I think the premise is wrong. I agree that the US would not tolerate a back-slide in terms of the quality of care its citizenry gets, but does the US as a whole really appreciate the advances before they get here. Somehow I doubt it. I don't think most of us are that forward thinking. How many of you are? Who's willing to pay three times more than they need to TODAY for healthcare just because of a general future anticipation that the survival rate for osteogenic sarcoma will be 80% in 10 years rather than 60% today. People don't think like this.

The truth of this is played out daily in the pharma debates. People with $250 monthly drug bills don't care about R&D with payouts slated for the future, for others. They care about cheap drugs now.

So, here's the big finale - In my opinion, if the level and quality of healthcare and pharma were to arrest today, to never advance another iota, the American public would not give two ****ts about it as long as it did not regress. They are happy with the technology they have now. What they want is access, and thrift.

Anyway, just my opinion.

Judd

 

[kinetic]

Physicians in Canada and the UK don't make half what those in the US do, but there are still three applicants for every spot in medical school. I'm not sure that the United States will have to bend and take it up the rear even if reimbursemenst were cut in half (or by 3/4).

Another argument for matching the suckiness of other countries. We don't suck that badly yet, so we'll just have to work harder at it! Our taxes aren't as high as France's, so we must be doing something wrong! We get paid more than Canadians; what's wrong with us? Etc.

Moreover, I'm guessing that IF applications to medical school fell because income was not keeping with expectations ...there are a million "mid-level" providers who are more than willing to take your place for half the money.

True. And at less than half the training, so it's a steal all around. Hey, if mid-level providers take over the place of physicians, then let the games begin! First lawyers use malpractice to force physicians to retire and leave states; then they'll sue whoever takes their place. Hooray for lawyers! Keeping you health care-provider free since 1901!

The truth of this is played out daily in the pharma debates. People with $250 monthly drug bills don't care about R&D with payouts slated for the future, for others. They care about cheap drugs now.

Yes, let's all be short-sighted like the average American. I don't care about R&D as long as I get the drugs I need now. Uh, where do you think your drugs came from? Past R&D. Where do you think future drugs will come from? Current R&D. Hey, if Americans are OK with freezing the status quo, then let's do it. No more progress in medicine! Too bad we didn't do this back before penicillin. Ah, well, we'll soon have widespread VRSA anyway because these idiots keep whining that they want antibiotics for their viral infections.

 

[juddson]

Another argument for matching the suckiness of other countries. We don't suck that badly yet, so we'll just have to work harder at it! Our taxes aren't as high as France's, so we must be doing something wrong! We get paid more than Canadians; what's wrong with us? Etc.

Not an argument at all. A counterexample, merely. Your state (imply, whatever) that if doctors made less, there would be less of them. I say "no - not true". In Canada and the UK doctors are paid less, and there are plenty of applicants to medical school. This is NOT a normative statement - NOT a comparison of the US system to the Canadian one - NOT an endorsement of one system over another. It's simply pointing out that even with lower reimbursements and income, there will be NO diminishment of applicants to medical school.

True. And at less than half the training, so it's a steal all around. Hey, if mid-level providers take over the place of physicians, then let the games begin! First lawyers use malpractice to force physicians to retire and leave states; then they'll sue whoever takes their place. Hooray for lawyers! Keeping you health care-provider free since 1901!

Again, I'm not making a normative statement. I'm not suggesting this is how it should be. I'm saying this is how it will be. This is a prediction, which, no matter how you feel about, will come to pass. Moreover, I think you are taking the prediction too literally. What I'm saying is that those people who would have today become mid-level providers would gladly attend medical school and fills the spots that you no longer want. I'm not suggesting that mid-levels will provide all the medical care. I AM suggesting that there are tens of thousands of people standing in line behind you to fill the medical schools spots that you claim you will not want when reimbursements are low.

Anyway, you seem to be sooooo upset by this issue that you are blinded with fury and rage. What's this HUGE blowout on lawyers? Try to pull it together - I didn't know I have this effect on you.

Yes, let's all be short-sighted like the average American. I don't care about R&D as long as I get the drugs I need now. Uh, where do you think your drugs came from? Past R&D. Where do you think future drugs will come from? Current R&D. Hey, if Americans are OK with freezing the status quo, then let's do it. No more progress in medicine! Too bad we didn't do this back before penicillin. Ah, well, we'll soon have widespread VRSA anyway because these idiots keep whining that they want antibiotics for their viral infections.

whoa, again - you think I'm suggesting this is how it should be. I'm suggesting nothing of a sort. I'm saying this is how it will be. I'm make a prediction based on how I read the average joe. I'm in favor of progress. But I'm going to be a doctor. I'm not the average guy on the street. Moreover, you are more right than you know regarding the penicillin issue. My prediction holds true then as well. Before the advent of anti-biotics, I'm not sure people were unhappy with the state of medical technology. It only looks awfull to us via hindsight.

Judd

 

[kinetic]

Just out of curiousity - why am I always "blinded with rage" and "out of control" when I disagree with you? I mean, you disagree with me and I don't tell you "hey, snap out of it! Your head is about to explode!" or "jeez, get ahold of yourself - you're out of control!!"

 

[juddson]

Just out of curiousity - why am I always "blinded with rage" and "out of control" when I disagree with you? I mean, you disagree with me and I don't tell you "hey, snap out of it! Your head is about to explode!" or "jeez, get ahold of yourself - you're out of control!!"

Two reasons. First, because I've just been through a thread where you lost all ability to reason regarding the Mclitigation issue. Has nothing to do with you disagreeing with me - I don't support Mclitigation. So we agree - you still ran around like a chicken with his head cut off.

Secondly, this lawyer issue is only seconday (tertiary, quatranary) to the issues raised in this thread - but because you were responding to me, you just couldn't help yourself. "Ahh. . . the damned midlevels, I'm just so. . .ahhh . . .so upset with the midlevels. . .and the lawyers. . the lawyers are ruining our lives. . .Ahhh"

You get the idea. You get a bit worked up.

Judd

 

[kinetic]

Two reasons. First, because I've just been through a thread where you lost all ability to reason regarding the Mclitigation issue. Has nothing to do with you disagreeing with me - I don't support Mclitigation. So we agree - you still ran around like a chicken with his head cut off.

I "lost my head" and I "ran around like a chicken with his head cut off." Hmm. You'd better calm down. You're out of control. Woah, Nellie! Last I checked, the only thing that was happening in that thread was a bunch of people ripping the hell out of lawyers (which you happen to be). Sorry if that means that I'm craaaaaazy!

...because you were responding to me, you just couldn't help yourself. "Ahh. . . the damned midlevels, I'm just so. . .ahhh . . .so upset with the midlevels. . .and the lawyers. . the lawyers are ruining our lives. . .Ahhh"

First of all, I wasn't moaning, like you make me out to be. What's with all the 'ahhhhhhhhh'? Oh, wait ...by questioning you I have become a crazed psychotic loon. Sorry. Question retracted. Second of all, the reason I brought up lawyers was because excessive and fradulent litigation is what leads to the problems we are discussing. Therefore, discussing the role lawyers play is not QUITE like running around like a crazed man.

 

[kinetic]

Here's the thread I believe he was referencing, by the way:

http://forums.studentdoctor.net/showthread.php?t=121067&page=1&pp=20

Watch out! I'm craaaazy!

 

[juddson]

Here's the thread I believe he was referencing, by the way:

http://forums.studentdoctor.net/showthread.php?t=121067&page=1&pp=20

Watch out! I'm craaaazy!

We have a long history on these forums. I agree with everything you say in the Mclitigation thread. You still are a loon.

Judd

 

[Tom345]

If I am not mistaken, Physician salaries are coming down steadily. There is an expectation that over the next 5 years, salaries in the top specialities will be cut drastically..i.e. compensation for Cardiology (cath), GI (sigs, colonoscopy), radiology, dermatology and ortho. This will be the first step.

Over subsequent years it is going to be a steady compensation cut for all specialities. In the end you are looking at PCPs making about 125 K, cardiologists and other specialities making about 200K(Inflation adjusted). The time frame is over the next 10 years.

Medicine as we know it in the US will become a mix of european style socialized medicine and for those who can afford - CEOs and executives of HMOs and hospitals - continuation of the present style of over-investigative defensive medicine.

This is the future, unless aliens join med schools as professors and teach us miracle cures.

 

[tastytreat]

At this point, something like half of all health care expenditures go to administration (read: bureaucracy). If a change needs to happen, it's not on physicians to take a pay break but the paperwork to be more efficient.

 

[kinetic]

Just out of curiosity:

I've just been through a thread where you lost all ability to reason regarding the Mclitigation issue.

I agree with everything you say in the Mclitigation thread. You still are a loon.

 

[kinetic]

I started a thread about the future of medicine a while ago ...

http://forums.studentdoctor.net/showpost.php?p=1290225&postcount=1

It's long, but if you want you can read it. It'll cure your insomn-

 

[Apollyon]

I've just been through a thread where you lost all ability to reason regarding the Mclitigation issue.

We have a long history on these forums. I agree with everything you say in the Mclitigation thread. You still are a loon.

Don't mind Judd for now (just for this little time period)...he's literally FOS for now.

 

[juddson]

"I agree with everything you say in the Mclitigation thread."

This was saying a bit too much, I guess. I should have said that i agree with your basic conclusion. We get there for different reasons....mine is reasoned and principled. . your's is. . .well, you are just being you.

That said, I don't want to get into it with you. I'm getting tired of the medico-legal threads. We'll agree to disagree.

Judd is no longer literally FOS (floating plenty of air bombs, though) Now he's just figuratively FOS.

Judd

 

[Hudson]

If I am not mistaken, Physician salaries are coming down steadily. There is an expectation that over the next 5 years, salaries in the top specialities will be cut drastically..i.e. compensation for Cardiology (cath), GI (sigs, colonoscopy), radiology, dermatology and ortho. This will be the first step.

Over subsequent years it is going to be a steady compensation cut for all specialities. In the end you are looking at PCPs making about 125 K, cardiologists and other specialities making about 200K(Inflation adjusted). The time frame is over the next 10 years.

Medicine as we know it in the US will become a mix of european style socialized medicine and for those who can afford - CEOs and executives of HMOs and hospitals - continuation of the present style of over-investigative defensive medicine.

This is the future, unless aliens join med schools as professors and teach us miracle cures.

To reiterate what has been said previously: Doctors salaries only make up ~10% of health care costs. It does not make sense to cut doctor's salaries in half to save 5% on health care costs. I've asked a lot of PP physicians about this and most of them say if reimbursement continues to get cut they will just refuse to see medicare patients. If medicine becomes pseudosocialized they said they would retire early and make money some other way. There would be a mass exodus from the medical field. The government will be forced to realize that decreasing compensation will destroy medicine. Doctor's will refuse to see patient's if it is not worth it for them financially (medicare). Salaries will not fall to the levels you speak of and if they do, no one in their right mind would go through medical school to become a doctor, and a lot of those in medicine would get the hell out. It is not that hard to find a job that pays 150-200K a year if you are smart enough to make it into one of the more competitive specialties( and have some savy beyond you medical expertise). The scenario you paint is the beginning of the end of medicine if it happens. You simply cannot place such drastic price controls on a high quality serivce in a purely capitalistic society and expect the best and the brightest to work in that field. The most important entity to the field of medicine is the physician. Medicine/healthcare can not function without out us. If we simply stopped being a bunch of pansies, stood up for ourselves and lobbied as hard as we b**ch we would be just fine. Our salaries and high quality available patient care would be preserved.

 

[PsychMD]

Excuse me from intruding here. I am a psychiatrist and, due to recent developments re. giving psychologists prescription rights, I just have learned that there seemingly is an ongoing similar "debate" re. the MEDICAL Model of health-care delivery VS. OTHER (?) Models going on, not only in Psychiatry (where maybe it's expected, and has been historically going on for centuries), but ALSO in the other medical specialties, including the most fundamental specialty of Internal Medicine.

Again, please excuse my ignorance, but what the hell is this "Medical model" and what are the "Other models"? And who is even driving this debate? Is it a local or academic debate? Is it a public health debate? Is this going on at a national level?

I must really seem out of touch, but maybe I really am, and I need to wake up and learn more about this.

 

[windsurfr]

Everyone loves to throw around the 'canadian model' of healthcare and the 'UK' model. Do you really think our capatilist society would put up with the innefficiency and limitations of government run healthcare????

How many times have you explained to patients that 'X' test or 'X' drug has not been shown to be any better than the next (esomeprazole vs. omep).
They will always want the biggest and the best, and will not accept anything less.

Patients want it:
1)Best
2)Now
3)Perfect

These are not possible with 'universal healthcare'... thus it wont happen.
Just my thoughts