What do you predict will happen to IM under Medicare for All?

[wamcp]

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I heard under Bernie Sanders plan, payments to physicians would fall by 40%...

Wouldn’t also far more people schedule unnecessary or more frequent visits if they perceive healthcare as cheaper or “free” to them?

So a PCP could be seeing, say, 40% more patients each day for 40% pay cut (or paid even less since overhead costs remain the same).

Or a hospitalist will have 40% increase in volume and have to work 20+ shifts a month to keep the same pay

Etc etc.
Would all the subspecialists lose out? Any winners?

 

[whoknows2012]

I heard under Bernie Sanders plan, payments to physicians would fall by 40%...

Wouldn’t also far more people schedule unnecessary or more frequent visits if they perceive healthcare as cheaper or “free” to them?

So a PCP could be seeing, say, 40% more patients each day for 40% pay cut (or paid even less since overhead costs remain the same).

Or a hospitalist will have 40% increase in volume and have to work 20+ shifts a month to keep the same pay

Etc etc.
Would all the subspecialists lose out? Any winners?

There’s actually an intelligent conversation to be had here, but with what you wrote, I don’t even know where to start.

 

[Siggy]

I heard under Bernie Sanders plan, payments to physicians would fall by 40%...

Wouldn’t also far more people schedule unnecessary or more frequent visits if they perceive healthcare as cheaper or “free” to them?

So a PCP could be seeing, say, 40% more patients each day for 40% pay cut (or paid even less since overhead costs remain the same).

Or a hospitalist will have 40% increase in volume and have to work 20+ shifts a month to keep the same pay

Etc etc.
Would all the subspecialists lose out? Any winners?

I don't have access to the numbers, but it would be interesting to see the change in reimbursement between lower pay per patient who does pay, but no uninsured patients when it comes to inpatient care.

 

[QueenJames]

This is bull. Frickin' socialists dude.

I need to make atleast 300K.

Why the hell am I even doing this anymore.

 

[wamcp]

I don't have access to the numbers, but it would be interesting to see the change in reimbursement between lower pay per patient who does pay, but no uninsured patients when it comes to inpatient care.

Looking at physician pay in other countries:

A hospitalist or PCP will likely end up making 100k a year vs the 200k+ of today.

See: Physician Compensation Worldwide

 

[jas972]

That 40% figure comes from a Mercatus study which is a well-know Koch brothers funded think-tank. Urban Institute puts that number at 13%. Moreover, the average physician spends $83,000 annually in administrative costs and 9 hours a week just on billing. That's money and time (which = money).

 

[whoknows2012]

I stopped reading at “wouldn’t more people schedule appts if they knew it was cheap or free.”
@wamcp Have you actually ever taken care of patients in a low income primary care setting? Well I can tell you from experience around the time the aca went into effect it was rare thereafter to see uninsured patients and even more rare to see a “well” visit. (Unless it was for a pre employment physical or the like). People invariably come to the doctor when they’re ill, are in pain, or have a chronic medical problem that needs management and tinkering of meds (ie DM2, CAD, HTN,CKD etc).

 

[rhomboid]

@whoknows2012 do not stop reading because of that sentence. That can totally be true. In fact, that is true somewhere else in the world.

Let me share a story from an Asian country. That country started national health insurance in 1995. It is essentially a single-payer system with > 99.7% coverage. That country has a global budget on how much to spend on healthcare. However, that country has no limitations on how people can access healthcare. They don't need referrals. They can see spine surgery, rehab, neurology, family medicine all in one day for low back pain. The copay is the same and minimal no matter you're visiting your nearby clinic, or you're going to medical centers. And, over the past 20 years, the price tags for all the health services remain the same, if not lower. The entire healthcare community is dying.

If people can come to talk with physicians at will, and if the "Medicare for all" decides to cut down payments, that's what will happen. Physicians have no way to resist because there is only a single payer in the market.

 

[gutonc]

I stopped reading at “wouldn’t more people schedule appts if they knew it was cheap or free.”
@wamcp Have you actually ever taken care of patients in a low income primary care setting? Well I can tell you from experience around the time the aca went into effect it was rare thereafter to see uninsured patients and even more rare to see a “well” visit. (Unless it was for a pre employment physical or the like). People invariably come to the doctor when they’re ill, are in pain, or have a chronic medical problem that needs management and tinkering of meds (ie DM2, CAD, HTN,CKD etc).

...and the people who are going to abuse the system are still going to the ER, because your clinic doesn't have turkey sammiches.

 

[whoknows2012]

@whoknows2012 do not stop reading because of that sentence. That can totally be true. In fact, that is true somewhere else in the world.

Let me share a story from an Asian country. That country started national health insurance in 1995. It is essentially a single-payer system with > 99.7% coverage. That country has a global budget on how much to spend on healthcare. However, that country has no limitations on how people can access healthcare. They don't need referrals. They can see spine surgery, rehab, neurology, family medicine all in one day for low back pain. The copay is the same and minimal no matter you're visiting your nearby clinic, or you're going to medical centers. And, over the past 20 years, the price tags for all the health services remain the same, if not lower. The entire healthcare community is dying.

If people can come to talk with physicians at will, and if the "Medicare for all" decides to cut down payments, that's what will happen. Physicians have no way to resist because there is only a single payer in the market.

Pure speculation and yet you peddle it as near fact. Meh keep shaking in your boots worrying about a unicron.

Let me also say, that when people compare national health experiences from other countries I take it with a grain of salt. I also think people like your self decide that based on some negative anecdotal evidence (in your case from your own country without so much as practicing for one year in this country) that it must be how it’ll happen here. Also this presupposes that we’re moving towards Medicare for all and I wouldn’t by any means take that as a fact. I think (my opinion of course) that within the next 10 years given the politics of the country and the makeup of the house and senate, we’re way more likely to see the current system expanded with a public option than true Medicare for all. So I think this all ends up being a moot point especially in the near future (ie 10 yrs)

My advice? Pull up some threads from the late 2000’s after Obama was elected and pre meds and med students alike were freaking out about salaries under the aca. It’s now been nearly 10 years

 

[dragqueen]

Leaving this here: 'One of the Best Cases For Single Payer I've Ever Seen': Watch Dr. Adam Gaffney Take on Skeptics at Fox

Check out the PNHP site, many questions about people abusing the system, payment for physicians, etc are hashed out with the evidence. Also, we don't need to make 300k (though also med school should be free or close to free, like it is in most of the developed countries that have single payer or something like it).

 

[Anicetus]

I heard under Bernie Sanders plan, payments to physicians would fall by 40%...

Wouldn’t also far more people schedule unnecessary or more frequent visits if they perceive healthcare as cheaper or “free” to them?

So a PCP could be seeing, say, 40% more patients each day for 40% pay cut (or paid even less since overhead costs remain the same).

Or a hospitalist will have 40% increase in volume and have to work 20+ shifts a month to keep the same pay

Etc etc.
Would all the subspecialists lose out? Any winners?

Ironically enough if we actually had one single entity controlling the flow of money in all of healthcare in this country, the specialists would take the biggest cut of them all in order to incentivize people going into primary care since the lower income seems to be a driving force.

@whoknows2012 do not stop reading because of that sentence. That can totally be true. In fact, that is true somewhere else in the world.

Let me share a story from an Asian country. That country started national health insurance in 1995. It is essentially a single-payer system with > 99.7% coverage. That country has a global budget on how much to spend on healthcare. However, that country has no limitations on how people can access healthcare. They don't need referrals. They can see spine surgery, rehab, neurology, family medicine all in one day for low back pain. The copay is the same and minimal no matter you're visiting your nearby clinic, or you're going to medical centers. And, over the past 20 years, the price tags for all the health services remain the same, if not lower. The entire healthcare community is dying.

If people can come to talk with physicians at will, and if the "Medicare for all" decides to cut down payments, that's what will happen. Physicians have no way to resist because there is only a single payer in the market.

In response to this, do you know how long the average visit is in a doctor’s office in Asian counties like that? Like 5 minutes. We have this culture in America where if you spend 10 mins or less with a patient it’s considered rude. We have to get rid of that culture in order to fit in more patients. If nothing is wrong with the patient then there’s nothing wrong with the patient. Asian countries are more okay with that. I can already tell the Asian patients I see in the hospitals take way less time than my non-Asian patients who complain that I rush through my visits with them.

 

[anonperson]

Leaving this here: 'One of the Best Cases For Single Payer I've Ever Seen': Watch Dr. Adam Gaffney Take on Skeptics at Fox

Check out the PNHP site, many questions about people abusing the system, payment for physicians, etc are hashed out with the evidence. Also, we don't need to make 300k (though also med school should be free or close to free, like it is in most of the developed countries that have single payer or something like it).

Why don't you go to your employer and tell them to cut your paycheck to a more reasonable amount?

Lead by example.

 

[USCguy]

If, and that is a big if, they set it up correctly it could be better for most of us.

If you use it as a vehicle to provide funding source for everyone, and thus spread the risk across everyone, I think it would be better than what we have in many ways. Some people will say that you will go broke if you only get Medicare reimbursement and take away the BCBS or whatever private company. I would argue it would be the same or possibly better. For instance, if you give me Medicare reimbursement on the Medicaid patients I see now (18% of visits) I would be better off (30% pay increase). I also recently found out one of our private contracts pays LESS than Medicare on my highest volume CPT codes (that’s what happens to small practices with lower leverage)...so in the end, I think it would be a better system (depending on the structure of course)

 

[siliso]

Most systems I’m aware of with universal healthcare have less disparity between procedural and non procedural fields in terms of compensation (but they also have other differences like publicly funded medical education). Primary care has the most value to add in terms of population health, so if compensation were value based it could well be a good thing, I work in National socialized healthcare already in the VA and conditions for internists are good.

 

[QueenJames]

Giving up 10+ years to make 100K is absolutely stupid.

Even if medical school was free.

This route is definitely not worth it for only 100k.

I pray Bernie's socialist party doesn't screw it all up for us.

Buncha millenials want **** for free and don't wanna work for jack.

This country is going dowwwwwn.

 

[siliso]

I’d work in my field for free if I didn’t even need money, and do so in my spare time. I also don’t feel like I gave up any years, I’ve enjoyed all of it way more than I enjoyed cleaning hotel rooms or wiping butts or working the register at McD’s. I have need for a certain income to repay the debt from those years when I got to study and learn something I love rather than iron sheets, but in a different world maybe I wouldn’t. Especially in a world where my kids’ education and all of our healthcare, and maybe even our need to eat and have a roof over our heads, was not dependent on my income. Another world is possible. On a quiet night I can hear her breathing.

 

[Anicetus]

Giving up 10+ years to make 100K is absolutely stupid.

Even if medical school was free.

This route is definitely not worth it for only 100k.

I pray Bernie's socialist party doesn't screw it all up for us.

Buncha millenials want **** for free and don't wanna work for jack.

This country is going dowwwwwn.

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

 

[GastriqueGraffin]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

Why is wanting money and caring/wanting to help mutually exclusive of each other? If you cut pay of the best entertainers for example (actors, musicians, athletes, chefs, etc.) and tell them to do it just because they love their craft or for the love of their fans, do you think the quality of those things will improve overall? Why do you think the top of your med school class goes into things like Derm?

 

[bronx43]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

I rather my plumber have gone into plumbing for the passion of helping people unclog their pipes instead of money, but that's not exactly how the world works is it?

 

[bronx43]

If, and that is a big if, they set it up correctly it could be better for most of us.

If you use it as a vehicle to provide funding source for everyone, and thus spread the risk across everyone, I think it would be better than what we have in many ways. Some people will say that you will go broke if you only get Medicare reimbursement and take away the BCBS or whatever private company. I would argue it would be the same or possibly better. For instance, if you give me Medicare reimbursement on the Medicaid patients I see now (18% of visits) I would be better off (30% pay increase). I also recently found out one of our private contracts pays LESS than Medicare on my highest volume CPT codes (that’s what happens to small practices with lower leverage)...so in the end, I think it would be a better system (depending on the structure of course)

Just because ONE of your private payers has a low reimbursement rate for a single CPT code doesn't mean that private payers in general don't pay significantly more. I make substantially more per referral and return patient with private payers compared to Medicare/Medicaid. However, several of my CPT codes are reimbursed significantly higher by the government payers.

 

[QueenJames]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

Medical students are absolutely stupid when it comes to finances.

100K after taxes and 100k before taxes are two different things.

This path is not worth it for just that. Are you serious?

That’s the problem with a bunch of kiddos entering medicine who have no idea how the real world works. They never worked for anybody and have been in the books so long they might as well have had their head in their own rectums so to speak. Mommy and daddy paid their bills and they went to all of these private universities and lived sheltered lives and now wanna speak up for injustices.

Gtfoh.

Hate to break it to you but in many parts of this country, to live comfortably AND not work until you die or live paycheck to paycheck... 100K pre-tax is NOT life-changing money.

Add 300k+ debt from med schools...? Psshhh eff that.

This country is becoming a crap-hole because my millennial cohorts who were babied their entire lives want “fairness” and all that bull because it sounds good and they are all socialist justice warriors who wouldn’t last in the real world without handouts from mom and dad.

Idiots who don’t know how property taxes work, how electric bills and maintenance costs for homes add up, how childcare and products for children are expensive, or how the stupid ass government will take half of your paycheck because they can.

“Do it because it’s your passion” my ass.

 

[IMreshopeful]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

Sure most of us went into medicine because we like it. But if you think money isn’t a consideration you’re out of your mind. Obviously it’s not the ONLY thing but why should it not matter?

I 100% would have gone into a different field entirely if medicine did not have the lucrative nature that it has for the amount of training and time that I put into it. That’s the gods honest truth

 

[deleted941485]

Google Modicare in India. Pretty sure there’s an article in the Washington post a couple months ago. That’s pretty much the future. The govt will squeeze and squeeze and squeeze medical practitioners of all stripes. You will have no real say and the only option will be to either put up or shut up. Which is the choice they (the govt and their bean counters) always wanted you to have.

 

[Anicetus]

Why is wanting money and caring/wanting to help mutually exclusive of each other? If you cut pay of the best entertainers for example (actors, musicians, athletes, chefs, etc.) and tell them to do it just because they love their craft or for the love of their fans, do you think the quality of those things will improve overall? Why do you think the top of your med school class goes into things like Derm?

If the government controls us as a single entity, they won’t see it that way. They see it as us being selfless and passionate and would look down on those of us who even use money for as much as half the incentive. Just listen to what the left has to say whenever doctors are brought up. The only ones who actually advocate to keep high incomes high for doctors are the conservatives.

I rather my plumber have gone into plumbing for the passion of helping people unclog their pipes instead of money, but that's not exactly how the world works is it?

Non medical people (including the government) don’t see plumbing, baking, anything really on the same level at all as when they aren’t trusting us to care for their bodies and their loved ones bodies.

Sure most of us went into medicine because we like it. But if you think money isn’t a consideration you’re out of your mind. Obviously it’s not the ONLY thing but why should it not matter?

I 100% would have gone into a different field entirely if medicine did not have the lucrative nature that it has for the amount of training and time that I put into it. That’s the gods honest truth

Some of these on the rise dems don’t believe having a lucrative job is fair to the 98%. Just because doctors are all literally in the top 2% of income, we are automatically all lumped into that “evil 2%” that didn’t work hard and just were born privileged. Remember in 2019, it’s “bad to be rich and wealthy” when it comes to today’s politics.

 

[Splenda88]

It's not bad to be rich and wealthy but the system overall is skewed toward the rich and the wealthy. It's not our fault; it is what it is...

If income potential for docs were not 200k-1 million (neuro and spine surgeons 🙂), I would have done MRI or CT from a CC (zero student loan). Income potential of these people is 65k-100k. Not bad for an AS degree.

 

[DoctwoB]

Let’s take it easy here. Even if a dem president pushes for Medicare for all, unless you see the dems winning 60 seats in the senate (which is pretty much impossible with the current map) then it’s a moot point.

Best case scenario for dems is winning the presidency and a slim senate majority, and convincing enough republicans to sign on to a moderate plan to make some positive changes to strengthen Obamacare. Even that is a long shot.

 

[bronx43]

Let’s take it easy here. Even if a dem president pushes for Medicare for all, unless you see the dems winning 60 seats in the senate (which is pretty much impossible with the current map) then it’s a moot point.

Best case scenario for dems is winning the presidency and a slim senate majority, and convincing enough republicans to sign on to a moderate plan to make some positive changes to strengthen Obamacare. Even that is a long shot.

This is becoming a bipartisan issue. More and more surveys are showing that a large majority of the public favors a Medicare for all option. The old days of democrat versus republican in terms of single payer healthcare is eroding rapidly.

 

[Splenda88]

This is becoming a bipartisan issue. More and more surveys are showing that a large majority of the public favors a Medicare for all option. The old days of democrat versus republican in terms of single payer healthcare is eroding rapidly.

I guess by saying it over and over, dems are able to convince some people that Medicare for all is a good thing.

 

[bronx43]

I guess by saying it over and over, dems are able to convince some people that Medicare for all is a good thing.

It's that more and more people are realizing that the status quo doesn't work for them. When people get desperate, any alternative appears attractive.

 

[Splenda88]

It's that more and more people are realizing that the status quo doesn't work for them. When people get desperate, any alternative appears attractive.

Not that I like what the Dems are proposing but the issue is that Republicans have been intransigent or inflexible when it comes to most health insurance changes. I felt like ACA with the public options would have been a good way forward, but alas, both parties do not want the other one to have a "win." Since the health insurance market is a mess right now, I guess some moderate are willing to try Medicare for all

 

[DoctwoB]

This is becoming a bipartisan issue. More and more surveys are showing that a large majority of the public favors a Medicare for all option. The old days of democrat versus republican in terms of single payer healthcare is eroding rapidly.

Disagree that this matters. The majority of people approve of Obamacare. Hasn’t stopped republicans from attacking it. The majority disapproved of trump tax plan. Didn’t stop it from passing. Republicans in most states know that they are more in danger of losing their seat to a right wing primary challenger then to a democrat and act accordingly.

 

[bronx43]

Disagree that this matters. The majority of people approve of Obamacare. Hasn’t stopped republicans from attacking it. The majority disapproved of trump tax plan. Didn’t stop it from passing. Republicans in most states know that they are more in danger of losing their seat to a right wing primary challenger then to a democrat and act accordingly.

So you think public support on domestic issues has no bearing on actual policies?

 

[LebronManning]

You guys need to chill. Medicare for All is a long shot in this country given that half the electorate is against it and literally the biggest lobbies in America are firmly against it. If anything, we would have an extension of medicare/medicaid to cover all those people who don't qualify but "can't" (dont) purchase their own insurance. There is no way in hell the private insurance market or the beuracracy it sustains will fade away - that's literally millions of jobs and the biggest thing funding our economy and backed by the most powerful lobbies known to mankind. It will likely turn into a hybrid program like they have in Australia - the only country where physicians are paid more than in the US.

 

[DoctwoB]

So you think public support on domestic issues has no bearing on actual policies?

I certainly wouldn’t go that far, but the hyper partisan and gerrymandered state of our nation does insulate our leaders from public opinion. If you are in a house seat that only a dem/repub can win (i.e most of them) you are much more focused on the primary voter then the general election voter, and primary voters are much more on the extremes of their parties.

Likewise, the public is so partisan, you can take a popular idea and make it unpopular based on who it’s coming from. Remember when Obamacare was being debated and there was big time opposition, but if you asked people about the contents of the bill without naming it they were in favor? The same thing will happen to any Dem proposed health care plan, I can pretty much guarantee it.

 

[LebronManning]

So you think public support on domestic issues has no bearing on actual policies?

For policies like this, you need OVERWHELMING public support, which MFA will not get in the next 20-30 years at least. Also public support does not matter near as much as lobbying from trillion dollar sectors of our economy.

I guess by saying it over and over, dems are able to convince some people that Medicare for all is a good thing.

You realize that the Democratic party isn't even unified on Medicare for all right? It's likely to be the hottest debate point for them during the primaries.

 

[Lawpy]

Giving up 10+ years to make 100K is absolutely stupid.

Even if medical school was free.

This route is definitely not worth it for only 100k.

I pray Bernie's socialist party doesn't screw it all up for us.

Buncha millenials want **** for free and don't wanna work for jack.

This country is going dowwwwwn.

Medical students are absolutely stupid when it comes to finances.

100K after taxes and 100k before taxes are two different things.

This path is not worth it for just that. Are you serious?

That’s the problem with a bunch of kiddos entering medicine who have no idea how the real world works. They never worked for anybody and have been in the books so long they might as well have had their head in their own rectums so to speak. Mommy and daddy paid their bills and they went to all of these private universities and lived sheltered lives and now wanna speak up for injustices.

Gtfoh.

Hate to break it to you but in many parts of this country, to live comfortably AND not work until you die or live paycheck to paycheck... 100K pre-tax is NOT life-changing money.

Add 300k+ debt from med schools...? Psshhh eff that.

This country is becoming a crap-hole because my millennial cohorts who were babied their entire lives want “fairness” and all that bull because it sounds good and they are all socialist justice warriors who wouldn’t last in the real world without handouts from mom and dad.

Idiots who don’t know how property taxes work, how electric bills and maintenance costs for homes add up, how childcare and products for children are expensive, or how the stupid ass government will take half of your paycheck because they can.

“Do it because it’s your passion” my ass.

Thanks for keeping it real 👍

 

[IMreshopeful]

You guys need to chill. Medicare for All is a long shot in this country given that half the electorate is against it and literally the biggest lobbies in America are firmly against it. If anything, we would have an extension of medicare/medicaid to cover all those people who don't qualify but "can't" (dont) purchase their own insurance. There is no way in hell the private insurance market or the beuracracy it sustains will fade away - that's literally millions of jobs and the biggest thing funding our economy and backed by the most powerful lobbies known to mankind. It will likely turn into a hybrid program like they have in Australia - the only country where physicians are paid more than in the US.

I generally agree with this, most likely will end up this way.

 

[bronx43]

I certainly wouldn’t go that far, but the hyper partisan and gerrymandered state of our nation does insulate our leaders from public opinion. If you are in a house seat that only a dem/repub can win (i.e most of them) you are much more focused on the primary voter then the general election voter, and primary voters are much more on the extremes of their parties.

Likewise, the public is so partisan, you can take a popular idea and make it unpopular based on who it’s coming from. Remember when Obamacare was being debated and there was big time opposition, but if you asked people about the contents of the bill without naming it they were in favor? The same thing will happen to any Dem proposed health care plan, I can pretty much guarantee it.

The political structure certainly does make it more difficult for sweeping legislation to pass, but it still depends significantly, if not entirely, on public sentiment. The house and senate fluctuate in terms of party control, despite the fact that many districts or states are historically one sided.
The main issue for me is that compared to 5-10 years ago, the public sentiment towards single payer has changed drastically, as more costs are being pushed onto the consumer. Costs are no longer insulated from the public, and the middle class is taking on the brunt of this shift. Average premiums and deductibles have skyrocketed in comparison to wages. So, how much more can the middle class take before the status quo becomes politically untenable?

 

[dragqueen]

Why don't you go to your employer and tell them to cut your paycheck to a more reasonable amount?

Lead by example.

That's not how social change works in my experience and understanding. And I'll likely be making about half that as a primary care doc. And I'll still be doing far better than pretty much everyone I know.

Is self-interest the only way that you can personally relate to this question? I think there are other ways to think about it that are more fulfilling. I'd rather be a doctor making enough to live comfortably working in a system where I can maintain some integrity and actually get people what they need. Seems achievable and worth fighting for.

Interested in others' response to that question too.

 

[GastriqueGraffin]

That's not how social change works in my experience and understanding. And I'll likely be making about half that as a primary care doc. And I'll still be doing far better than pretty much everyone I know.

Is self-interest the only way that you can personally relate to this question? I think there are other ways to think about it that are more fulfilling. I'd rather be a doctor making enough to live comfortably working in a system where I can maintain some integrity and actually get people what they need. Seems achievable and worth fighting for.

Interested in others' response to that question too.

Who says you will get the people what they need in this system? What if they need advanced care that is too expensive? Preventative care is really all about lifestyle and good genetics, which is why we rank so much worse than other developed countries. Compare survival for patients who actually have advanced, critical, or rare diseases and you’ll see the true benefits of “self-interest”. Also we have midlevels in this country playing a larger role than other countries. Some of my family’s PCPs are actually NPs. That will be the future of primary care with dropping reimbursements.

 

[anonperson]

That's not how social change works in my experience and understanding. And I'll likely be making about half that as a primary care doc. And I'll still be doing far better than pretty much everyone I know.

Is self-interest the only way that you can personally relate to this question? I think there are other ways to think about it that are more fulfilling. I'd rather be a doctor making enough to live comfortably working in a system where I can maintain some integrity and actually get people what they need. Seems achievable and worth fighting for.

Interested in others' response to that question too.

Lol. Typical.

"Well, I don't want to take a paycut unless I'm forced to or it won't make a difference."

Very convenient. I guess you don't donate to charities either because your couple of hundred or even thousand dollars won't make a major difference in the grand scheme of things.

Some common clinical scenarios to ponder:
-Cardiologist taking STEMI call and coming in to cath someone at 3am
-Hospitalist admitting a COPD exacerbation who was stabilizedby the ED physician at 10pm on a major holiday
-OBGYN taking an ovarian torsion to the OR at 3am and the anesthesiologist who is right there securing the airway and safely putting them to sleep (personal example)
-IM/FM managing a myriad of patient issues at 4pm on a Friday afternoon

How much do you think these skills are worth? They are worth a heck of a lot more than $100k a year. Not to mention the fact that the second you lay hands on the patient you absorb an enormous amount of liability for any potential adverse outcomes even if you practice good medicine.

You may not value the work and skills you do but please don't speak for myself or my colleagues and devalue the immense amount of work and skill we do on a daily basis.

 

[puahate]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

100k is not worth it for the training

 

[puahate]

How easy is it for an MD to go into medical affairs

 

[Splenda88]

Their argument is that doctors do it because they care and WANT to be doctors since patients would rather have a doctor who did it for the passion instead of one who did it for the money.

That’s why everyone has said don’t do medicine for the money. I agree with them. Yes it’s stable, but 100k a year is also stable. I just would hate my job even more If I was a janitor, lawyer, engineer etc. but if any of those is actually more interesting than being a doctor then just go for that instead.

Who would do that job for 100k when one can make 100k/year with an AS degree in the healthcare industry?

Almost all nurses can make 80k+/yr if they are willing to work an extra day (4x12hrs)...

 

[Lawpy]

Lol. Typical.

"Well, I don't want to take a paycut unless I'm forced to or it won't make a difference."

Very convenient. I guess you don't donate to charities either because your couple of hundred or even thousand dollars won't make a major difference in the grand scheme of things.

Some common clinical scenarios to ponder:
-Cardiologist taking STEMI call and coming in to cath someone at 3am
-Hospitalist admitting a COPD exacerbation who was stabilizedby the ED physician at 10pm on a major holiday
-OBGYN taking an ovarian torsion to the OR at 3am and the anesthesiologist who is right there securing the airway and safely putting them to sleep (personal example)
-IM/FM managing a myriad of patient issues at 4pm on a Friday afternoon

How much do you think these skills are worth? They are worth a heck of a lot more than $100k a year. Not to mention the fact that the second you lay hands on the patient you absorb an enormous amount of liability for any potential adverse outcomes even if you practice good medicine.

You may not value the work and skills you do but please don't speak for myself or my colleagues and devalue the immense amount of work and skill we do on a daily basis.

Who would do that job for 100k when one can make 100k/year with an AS degree in the healthcare industry?

Almost all nurses can make 80k+/yr if they are willing to work an extra day (4x12hrs)...

Honestly, I was hoping those idealistic arguments that strangely advocate for pay cuts (and devaluing skills) only happened in preallo, so I'm a bit disappointed to see them here.

 

[dragqueen]

Lol. Typical.

"Well, I don't want to take a paycut unless I'm forced to or it won't make a difference."

Very convenient. I guess you don't donate to charities either because your couple of hundred or even thousand dollars won't make a major difference in the grand scheme of things.

Some common clinical scenarios to ponder:
-Cardiologist taking STEMI call and coming in to cath someone at 3am
-Hospitalist admitting a COPD exacerbation who was stabilizedby the ED physician at 10pm on a major holiday
-OBGYN taking an ovarian torsion to the OR at 3am and the anesthesiologist who is right there securing the airway and safely putting them to sleep (personal example)
-IM/FM managing a myriad of patient issues at 4pm on a Friday afternoon

How much do you think these skills are worth? They are worth a heck of a lot more than $100k a year. Not to mention the fact that the second you lay hands on the patient you absorb an enormous amount of liability for any potential adverse outcomes even if you practice good medicine.

You may not value the work and skills you do but please don't speak for myself or my colleagues and devalue the immense amount of work and skill we do on a daily basis.

So I don't have an answer to that particular question about how much it's worth to work at inconvenient hours. I also just won't answer questions about my donation habits because I think the merits of a single payer system are what I wanted to share. If you won't engage my arguments because you don't think they're being made in good faith, that's fine, but definitely not going to spend time trying to convince you that they are.

It also just isn't relevant because, as is stated in the video I shared, that's not a guaranteed outcome of having a better healthcare system. Here's another pretty short piece addressing this notion: Medicare for All and the Myth of the 40% Physician Pay Cut - PNHP

Private insurance companies make bank by denying people care, and they don't do anything valuable. They skim a whole bunch off the top every time you or a colleague does one of those things. Usually it's poor people who pay the price. And from what I know we can change that dynamic in a huge way, maybe without changing payments. But this question is more important than doctor pay for me, so again, not really engaging that question. But if you have evidence saying that medicare for all/single payer absolutely could never happen without DRASTIC cuts in doctor's pay, I'd be interested to read it. (Though as a PCP I might actually make more in single payer 😛) My understanding is that the savings come from abolishing evil ass insurance companies who waste a ton of our healthcare dollars on marketing and staff who deny needed care.That's why Medicare controls costs better, they don't waste money on any of that bull****. If you don't think getting rid of private/for-profit insurance companies is possible, you're right to be a little cynical, but that's also a different argument.

 

[VA Hopeful Dr]

So I don't have an answer to that particular question about how much it's worth to work at inconvenient hours. I also just won't answer questions about my donation habits because I think the merits of a single payer system are what I wanted to share. If you won't engage my arguments because you don't think they're being made in good faith, that's fine, but definitely not going to spend time trying to convince you that they are.

It also just isn't relevant because, as is stated in the video I shared, that's not a guaranteed outcome of having a better healthcare system. Here's another pretty short piece addressing this notion: Medicare for All and the Myth of the 40% Physician Pay Cut - PNHP

Private insurance companies make bank by denying people care, and they don't do anything valuable. They skim a whole bunch off the top every time you or a colleague does one of those things. Usually it's poor people who pay the price. And from what I know we can change that dynamic in a huge way, maybe without changing payments. But this question is more important than doctor pay for me, so again, not really engaging that question. But if you have evidence saying that medicare for all/single payer absolutely could never happen without DRASTIC cuts in doctor's pay, I'd be interested to read it. (Though as a PCP I might actually make more in single payer 😛) My understanding is that the savings come from abolishing evil ass insurance companies who waste a ton of our healthcare dollars on marketing and staff who deny needed care.That's why Medicare controls costs better, they don't waste money on any of that bull****. If you don't think getting rid of private/for-profit insurance companies is possible, you're right to be a little cynical, but that's also a different argument.

The Myth of Medicare's 'Low Administrative Costs'

 

[CheGuevaraMD]

The political structure certainly does make it more difficult for sweeping legislation to pass, but it still depends significantly, if not entirely, on public sentiment. The house and senate fluctuate in terms of party control, despite the fact that many districts or states are historically one sided.
The main issue for me is that compared to 5-10 years ago, the public sentiment towards single payer has changed drastically, as more costs are being pushed onto the consumer. Costs are no longer insulated from the public, and the middle class is taking on the brunt of this shift. Average premiums and deductibles have skyrocketed in comparison to wages. So, how much more can the middle class take before the status quo becomes politically untenable?

Interest groups (like physicians, hospitals, etc.) certainly have a lot of power in the US political system, but that power is heavily counterbalanced by public sentiment. So long as people don't care, interest groups can get their way.

Unfortunately, stakeholders in healthcare system are currently caught in the crosshairs over anger about declining middle class standards of living.
Healthcare is a middle class "essential," and therefore it is a political requirement that it be affordable to the median voter. It isn't, of course -- healthcare in the US is notoriously wasteful, but even moreso now, as cost increases outpace increases in wages.

I doubt key political stakeholders (senators, representatives, the President, etc.) are interested in sticking a knife in the back of their insurance executive (or pharma or physician) friends, but times are getting desperate. It seems like everyone is out of reasonable solutions at a time when cost increases show no sign of stopping, and this makes a brutal solution like across-the-board reimbursement cuts through public insurance all the more likely.

 

[wamcp]

Interest groups (like physicians, hospitals, etc.) certainly have a lot of power in the US political system, but that power is heavily counterbalanced by public sentiment. So long as people don't care, interest groups can get their way.

Unfortunately, stakeholders in healthcare system are currently caught in the crosshairs over anger about declining middle class standards of living.
Healthcare is a middle class "essential," and therefore it is a political requirement that it be affordable to the median voter. It isn't, of course -- healthcare in the US is notoriously wasteful, but even moreso now, as cost increases outpace increases in wages.

I doubt key political stakeholders (senators, representatives, the President, etc.) are interested in sticking a knife in the back of their insurance executive (or pharma or physician) friends, but times are getting desperate. It seems like everyone is out of reasonable solutions at a time when cost increases show no sign of stopping, and this makes a brutal solution like across-the-board reimbursement cuts through public insurance all the more likely.

100% agree
I have been moonlighting like crazy because of this very real risk of sudden drastic politically driven cuts to reimbursement. And even if they aren’t slashed in the next few years, I won’t regret having worked hard today as I can just retire early at that point anyway. Make hay while the sun still shines. I’m so glad I did not pursue a fellowship with this looming possibility of declining pay...instead I made 1 million pretax earnings in the past two years, have 200k investments, and have paid off my 250k loans entirely