Weathering the Obamacare storm?

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ecCA1

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Are you guys in private practice considering entering academics in the hopes of buffering of decreased unit values by the medical school/center?

While salaries across the board are expected to drop, I have heard from "those in the know" in my locale that PP may no longer be worthwhile. The concern involves a proportionally steeper drop in physician earnings since hospitals cannot make up the loss of private insurance. Coupled with the fact that one is more easily replaced by AMCs (at least in this line of reasoning), it gives me some reason to feel that an academic position paying $300-$350 might be much more highly coveted in the years to come.

What are your thoughts, ladies and gentlemen?
 
Are you guys in private practice considering entering academics in the hopes of buffering of decreased unit values by the medical school/center?

While salaries across the board are expected to drop, I have heard from "those in the know" in my locale that PP may no longer be worthwhile. The concern involves a proportionally steeper drop in physician earnings since hospitals cannot make up the loss of private insurance. Coupled with the fact that one is more easily replaced by AMCs (at least in this line of reasoning), it gives me some reason to feel that an academic position paying $300-$350 might be much more highly coveted in the years to come.

What are your thoughts, ladies and gentlemen?

All life is a trade off. For those that have options, academic practices usually offer better lifestyle and better mental stimulation and satisfaction for somewhat lower income. I don't expect this trade off to change. As salaries for nonacademic settings drop, be they private practice, or AMC, or straight hospital employee, you can expect the same to follow in academia.

There might be a lag of a few years and there will be exceptions, but you are nuts if you think that in the future academic incomes will equal or exceed nonacademic on average. Why would your chairman or dean agree to pay more than they need to?
 
You should look around. Just because pp groups are going to hurt in the coming years so will academia. They need to generate revenue as well. Most academic groups are large scale versions of private practice groups or amc's. if you want to know what your future holds look to Massachusetts, they have had the obamacare model going there since 2008 I think. Call up some I those academic groups and see how they are faring. I know at least one major center in that area is hurting for money. Blaz
 
"There might be a lag of a few years and there will be exceptions, but you are nuts if you think that in the future academic incomes will equal or exceed nonacademic on average. Why would your chairman or dean agree to pay more than they need to?"

I don't think that I implied that academic guys would make more than private practice. Rather, my concern is that while the large gap between the two will narrow, will we continue to see the "better lifestyle and better mental stimulation and satisfaction" aspect in academics?

If the salaries become less dissimilar, lifestyle advantages might cause academia to siphon people away from PP who might have otherwise stayed had Obamacare not passed.

Thanks for the replies.
 
Not sure academia has a better lifestyle. It's 2:30pm, I am on call today and yet I'm already home and will be off tomorrow post call. Yeah, pp is tough to beat.
 
Academics = better lifestyle???

:laugh::laugh::laugh::laugh::laugh:


- pod

Depends on your perspective. I am in a high volume, high acuity patients type of practice. Typically running 3-4 rooms in a practice that does high risk OB, sick neonates, level 1 trauma, major vascular. Typically up all night on call.

Compared to the local (lower tier) academic practice where the attendings run 2 rooms. Having surgical residents who are learning to operate. An entire day might be 3 inguinal hernias or 2 total joints in a room.

I consider that to be a better lifestyle job.

The tenure track attending in the high power name brand academic institution is working as hard as any private practice doc. But not alot of others IMO.
 
Are you guys in private practice considering entering academics in the hopes of buffering of decreased unit values by the medical school/center?

No.
 
After full on Obama care how low do you guys suspect average annual pay to be for physicians?

Even in Canada physicians make six figures. Is Obama care going to drop it to high fives?
 
After full on Obama care how low do you guys suspect average annual pay to be for physicians?

Even in Canada physicians make six figures. Is Obama care going to drop it to high fives?

No offense, but I think this is kinda silly. high fives? Nurses, PAs, NPs make that kind of money. It's hard to predict what will happen with incomes, there will likely be some sort of decrease, but this type of fear mongering seems a little excessive.
 
After full on Obama care how low do you guys suspect average annual pay to be for physicians?

Even in Canada physicians make six figures. Is Obama care going to drop it to high fives?

No. If Obamacare survives then anesthesiology continues to move into an employed model (hospital, AmC, etc) or the smarter groups merge into ACOs/multi specialty groups
 
No offense taken. I was just throwing a number out there.

No offense, but I think this is kinda silly. high fives? Nurses, PAs, NPs make that kind of money. It's hard to predict what will happen with incomes, there will likely be some sort of decrease, but this type of fear mongering seems a little excessive.
 
Academic departments are subject to the same economic forces as private practices. They require clinical revenue to pay the bills. Sometimes medical centers will subsidize the academic department, just like with private hospitals subsidizing private groups, but these subsidizes are just as tenuous. Medical centers and universities generally don't have a ton of money lying around and they're being squeezed by the economy and reduced state funding just like everyone else.

It is true that Medicare and private payors pay a slightly higher reimbursement rate for care at academic centers (the tacit agreement that everyone should pony up a bit for "training" institutions), but it's also true that academic centers, in general, have a much larger proportion of medicare/medicaid patients than the average private hospital, so this premium is offset.

Some (the minority, at least in anesthesia) departments benefit from the indirect revenues from NIH grants, and some of these grants replace partial salaries of some of their faculty, but the amount of money is quite small, and is limited to a handful of programs. The vast majority do not have enough grants to make any meaningful difference in the bottom line.

I would expect, as others have noted, that the lowering tide will drop all boats, that if reimbursement drops enough to lower PP salaries, it will drop enough to lower academic salaries as well.
 
In your view, Blade. Is Obomacare worse than Canadian health care? Is Canadian physician compensation the canary-in-the-mine for US physicians?




No. If Obamacare survives then anesthesiology continues to move into an employed model (hospital, AmC, etc) or the smarter groups merge into ACOs/multi specialty groups
 
In your view, Blade. Is Obomacare worse than Canadian health care? Is Canadian physician compensation the canary-in-the-mine for US physicians?


Medicare/Medicaid based compensation for Anesthesiologists is much worse than Canadian salaries.

In just a few short years 53% of all Americans will have Medicare or Medicaid. This means that many Anesthesiologists will experience a decrease in income; that decrease is related to the % increase in CMS patients vs non CMS patients. I fully expect Medicare reimbursement to be frozen at current levels or decreased even further.

By 2017 an American Anesthesiologist will be fortunate to earn as much money as his Canadian Colleague; but, that will be the exception and not the norm.

Long term ObamaCare means the demise of private practice for many Groups as you see them today. They will be absorbed into multispecialty groups, AMCs or hospital employed compensation.
 
The future is an employment model. I've spoken with many leaders in this specialty who agree with me. Think 'ER' and that is the model we face circa 2017-2020 under ObamaCare.

Those who take a 6 year partnership track are idealists at best or fools at worst. Only a repeal of ObamaCare warrants a track longer than 24-36 months (even then I am luke warm on that decision).

When Obama wins re-election this Fall the wisest course of action is to "cash out" of the practice by selling to an AMC (assuming one will buy you out).

I estimate the chance of repealing ObamaCare at around 5-10% at best. It requires a Romney win and a GOP Senate majority.
 
Depends on your perspective. I am in a high volume, high acuity patients type of practice. Typically running 3-4 rooms in a practice that does high risk OB, sick neonates, level 1 trauma, major vascular. Typically up all night on call.

Compared to the local (lower tier) academic practice where the attendings run 2 rooms. Having surgical residents who are learning to operate. An entire day might be 3 inguinal hernias or 2 total joints in a room.

I consider that to be a better lifestyle job.

The tenure track attending in the high power name brand academic institution is working as hard as any private practice doc. But not alot of others IMO.

And your definition of lifestyle. When I came out of training there was no academic practice that would give me half the vacation I get here. Take home income would have been similar and benefits better, but I have the option of working some of that vacation if I want, or not. As it is, I pay significantly more in federal taxes than I made in any single year as a resident or fellow.

My perspective; This week I did everything from two circ arrest aortic arch cases to a crani to ear tubes to a rescue "TURP" on a sick ass, obstructed dude with widely metastatic prostate CA, a preop sodium of 126 and significant coagulopathy, to a carotid endarterectomy on a guy with a c2-4 fusion and no neck, to a microlaryngoscopy on a guy with a vocal cord mass, to a bunch of chip shot ortho ****. On my non-call days I got home early enough to grab my bow and go elk hunting, in fact I spent more hours elk hunting this week than I did in the hospital. We do high risk OB, whatever trauma rolls through the door (car vs horse seeming to be some of the worst), major vascular etc, but we do it ourselves. We take call from home, and home is 15-30 min to the ski slopes (depending on where you want to live).

Sure I have to live in the paradise (and I do not mean that sarcastically) of BFE to do this, but that's what I call a good lifestyle!

The hardest part of living here is tying to figure out what you are going to do with your time off. Next weekend off I have invitations to go elk hunting, pheasant hunting, trap shooting or go do some world class fishing. I could take the kids out on the four wheeler, hiking, or to the pumpkin patch. I could go to Oktoberfest or one of the great brewpubs in town. Maybe one last trip to the lake. I could do a barbecue on my new big ass deck and have some friends over. I still need to button up the house for winter and start getting ready for ski season. The options are exhausting. Thankfully I am on call this weekend so I can rest up and get some of the house work done!

Now that's what I call a good lifestyle.

3 inguinal hernias or 2 total joints while watching someone else do the anesthesia with the realization that I only get 4-5 weeks per year away from this hell? That would be excruciatingly awful.

- pod
 
I estimate the chance of repealing ObamaCare at around 5-10% at best. It requires a Romney win and a GOP Senate majority.

... And some alternate solution that doesn't involve an aging demographic/poorer populace swelling the CMS roles and other cuts to CMS rates that have been looming for decades. Not an Obamacare fan, but it's hard to see anything but a drop regardless of what happens in November.
 
Why does everyone talk about Canadian physician income as if it is awful? Have you actually looked at physician income in Canada?

Just like in America, if you want to live in the major cities like Vancouver etc you are going to have lower take home pay. That is the price you pay for living in a "desirable" location. If you move to a province with money and a good physician/ provincial government relationship (Alberta), you will make good money and you actually get something for your taxes despite being a high wage earner. The docs that moved here from Calgary took a pay cut.

Their gun rights suck, but otherwise it ain't a half bad place to live.

- pod
 
I agree. From what I've heard it doesn't seem terrible. Low malpractice charges, lower educational debt, lower hour work weeks, and pretty comfortable pay.

The only thing I didn't like is when I read articles about physicians in Canada people talked about their income in a negative way - like them being "public employees". I remember someone saying "why pay them so much when they're on the public purse". People tend to have short memories - doctors don't need to be a public good to be in demand or command high wages - but I imagine many people forget that once the payment scheme goes to taxpayer -> government -> doctor. As if they wouldn't be paying out of pocket or for PPO if the government didn't become the single payer.




Why does everyone talk about Canadian physician income as if it is awful? Have you actually looked at physician income in Canada?

Just like in America, if you want to live in the major cities like Vancouver etc you are going to have lower take home pay. That is the price you pay for living in a "desirable" location. If you move to a province with money and a good physician/ provincial government relationship (Alberta), you will make good money and you actually get something for your taxes despite being a high wage earner. The docs that moved here from Calgary took a pay cut.

Their gun rights suck, but otherwise it ain't a half bad place to live.

- pod
 
Why does everyone talk about Canadian physician income as if it is awful? Have you actually looked at physician income in Canada?

Just like in America, if you want to live in the major cities like Vancouver etc you are going to have lower take home pay. That is the price you pay for living in a "desirable" location. If you move to a province with money and a good physician/ provincial government relationship (Alberta), you will make good money and you actually get something for your taxes despite being a high wage earner. The docs that moved here from Calgary took a pay cut.

Their gun rights suck, but otherwise it ain't a half bad place to live.

- pod

And you can say the same about most of the "socialist" European countries.
 
Just thought I would add a couple of cool things that happened at work this week that I forgot to mention earlier.

Bought a raffle ticket from one of my partners... His kid's Christian School is raffling off a NEMO Arms AR-15. 👍👍

Bought a 90's vintage Colt Sporter Match HBAR AR-15.

I love this country.

- pod
 
Most of the European countries have cheap, readily available suppressors without the 6 month wait and transfer tax.

Belgium and Switzerland have reasonably relaxed regulations on machine gun ownership.

Gun Culture Outside the US

And then there is the Czech Republic.

They all have their problems, but it certainly isn't the wasteland that one might think.

- pod
 
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