i don't think it will deter many students from pursuing optometry. i am aware of the problems that this profession faces, but after thoroughly evaluating them, i have decided that it is still the right path for me. i did notice on my interview day, however, that a lot of the other applicants had an idealized view of the profession. from chatting with them, it didn't seem they were aware of many of the issues ODs are currently facing. i doubt many students will put a lot of thought into how the changing healthcare system will affect their future.
How did you thoroughly evaluate the problems facing the profession? I can assure you that, while you might believe you are up on all that's going on, you can't possibly have a complete understanding of how it will affect you in the future. It's not a shortcoming on your part; there's simply no way to see the big picture until you've become a part of it. Unfortunately, it's those small (or large) gaps in understanding that will get you in the end. Most of the students I interviewed had confidence that they knew what they were getting into, but in reality they had no clue. When I was deciding on optometry, I thought I had it all figured out. It made perfect sense, and it looked right. I talked to ODs, I shadowed, I read articles. I thought I had it all down. I wouldn't be a millionaire, and I was ok with that, but I'd have a solid profession with a stable income and I wouldn't have to stress over finances, since I worked hard and put my time in. I could work anywhere in the country, maybe except for a couple of places. None of that was true and it's even less true now.
Optometry faces its own declining future, completely independent of the changing climate in health care. What you guys probably can't see, and this goes for all the pre-health professions, is that the entire face of health care is changing in ways you probably can't understand yet, since you haven't even started school.
The forces are in place to drive private practice health care out of existence. If you really look at Obamacare, not on the basis of its shiny selling points, but on the whole, you'll see a package that is designed to make it very difficult to stay alive as a private, independent doc. That goes for ODs as much as any other doctor. It won't happen overnight, but we'll slowly start to see a shift from private medicine, to institutional medicine, and from institutional medicine, to government institutional medicine. How or why is this going to happen? Primarily, it's a money issue. As usual, everything usually boils down to cash. You guys probably don't want to believe that right now, but that's the way the world works.
The Obamacare machine is going to be one of the most expensive endeavors ever undertaken by our government. The problem is, it's largely thought of as "free health care" by those who would benefit. It's no such thing. It's basically a giant tax machine, with health care providers putting the bulk of the money into the system. (Nancy and Harry like to tell you it's the insurance companies, but I can assure you, they're not going to experience much of a net loss of anything, they're far too smart to let that happen.) The primary target, if you read the law, will be providers. They don't spell that out in words, but when you see things like "increased efficiency of care," "reimbursement adjustments," and "reduction of provider overpayment," you're seeing the tip of the iceberg. As of now, medical specialists will see a 5.6% reimbursement cut, each year, for three years once the law is enacted. That's just shy of a 20% pay cut over three years. If you think it will stop there, you're crazy. The federal government, under a liberal mind's leadership, has no problem saying "Well, we'll just take a little more.....and then a little more....and then a little more." That's how it works. It's never about the direction we're moving, it's about the fact that "taking a little more right now won't hurt anyone, so we'll just take that aaaaaand put it over here for us." That's ok, though, because medical specialists are overpaid, right? Well, when you get out of medical school with 300 to 400K in student debt, you've worked your ass off for 15 or more years, and you see the government, time after time, reaching into your wallet to "spread the wealth around," it's going to get old. Where are you going to get the money to start or buy a practice when you've got massive debt, a lower income potential, and interest rates are through the roof because the economy has steadily declined? (...and it will, believe me, the great Obama has a couple of high-priority agenda items, but not one of them is the economy. If you don't see that in his decisions over the last 4 years, you're kidding yourself). Banks won't be letting some fresh-faced MD, or anyone else for that matter, borrow large sums of money to propagate private practice, because their risk will be too high. They'll know that as a doctor, you don't have the earning potential you once had.
Right now, government doctor salaries are lower than private incomes, but they know they have to compete, to some extend, with other practice modes, and government positions offer benefits that might outweigh the lower pay. Once we go to a health care system in which most/all doctors are employees of the federal government, we're going to see a disappearance of that need to compete. It'll be a "take it or leave it" pay scale. This is where we're going - it won't happen tomorrow or within Obama's next term, but it will happen.
I think many American's don't fully realize that what Obama is doing is not limited to his terms in office. It's not a "Hey, let's just see what this guy can do, and if he sucks, we'll just wait for the next guy to fix it." We saw what happens with that approach when we re-elected the last idiot in the White House. So, what I'm saying is, Obama is trying to make changes to our society's fabric that will be in place for the next 100 years, not the next 4. With that in mind, ask yourself what you think Obama's dream would be, with regard to health care. Do you think he would prefer what we have now, lot's of private docs, hospitals, and clinics, with a few government facilities? Or would he rather see a nation with government-controlled facilities, all under the hand of Uncle Sam? Obama's answer to every problem is "Let's create some government control and fix the problem."
You guys who are entering health care will be the future providers for our nation. My fear is that about 90% of you think you're entering for the right reasons, but you'll realize too late that, despite your desire to help people, it gets old when you work, work, work, spend, spend, spend, and a huge chunk of your effort is taken from you, to give to those who want to watch the View at home during the day, or go to the Swap Meet to pick up some new bedazzling for their tax-payer funded, $600 iPhone. You're kidding yourselves if you think that you don't want or deserve to be compensated for the immensely difficult road you're about to set out upon. If you really had no interest in being financially secure, being paid fairly, or having a stable future, you'd all be joining the Peace Corps or Americorps. Both of those organizations allow you to help others in ways most Americans can't, with all of your living expenses paid, but you don't see millions of Americans running to volunteer for them.
I may seem cynical now, but you'll get it in a few years.......I promise.
