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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
You mean you worked like crazy to help patients out of your generous heart, right? Why else would someone work so hard?
 

wamcp

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You mean you worked like crazy to help patients out of your generous heart, right? Why else would someone work so hard?
Exactly. Look at the NHS and how their doctors suffer out of the goodness of their hearts, so much so that they even go on strike!
 

jdh71

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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?
The winner might be my free time.

If they are going to cut my pay, I’ll be ****ed if I’m going to work a day or hour or minute more than necessary.

People who need to see me can get on a list. See you in 6 months.
 

Trogghunter

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Hospitalists in Canada make the same or more than the US on average, even working in large cities, if that has not been mentioned.
 

wamcp

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Hospitalists in Canada make the same or more than the US on average, even working in large cities, if that has not been mentioned.
No they get paid slightly less in converted USD amounts, and pay more tax. They would hop the border to work here if canada paid a lot less which is why they are comparable. Otherwise it’s akin to assuming the VA won’t reduce their pay if non-VA compensation drops across the board around them.
 
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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.
The Democrats will not need 60 seats, they will simply do away with the filibuster and push it through with a simple majority. Sanders has come out today and proclaimed as much.

To be fair, I increasingly believe single payer is going to be the least of our worries going forward. The Left is radicalizing at an alarming rate. Four years ago, Bernie Sanders was on the leftmost fringe of the Democratic party, today his socialism makes him the moderate elder statesman while the likes of AOC lurk in the wings. Two years ago, single payer was the most radical proposal starting to make its way into the mainstream of the Democratic party, today reparations are espoused by most of the Democrat presidential frontrunners and packing the Supreme and lower Federal Courts is being seriously discussed by senior Democratic party officials.

Frankly, I believe we are less than a decade away from intensely punitive measures being implemented against racial and perhaps socioeconomic groups deemed to be "privileged."
 
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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
Nice work
I fear this wont be a possibility for me, still several years from exiting training. This recent political shift has the potential to wipe out medicine as it is forever. Winter is coming.
 
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QueenJames

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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
I want to be you in 4 years.

How do I do it?
 
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jdh71

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I want to be you in 4 years.

How do I do it?
First, don't get married or have children. This will make that reality much much much more likely.
 

wamcp

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First, don't get married or have children. This will make that reality much much much more likely.
This is true. Although not in my case.

For me I made 1 mil pretax over 2yr working 50-60 hr a week with tons of nocturnist moonlighting shifts

My wife herself works a fulltime day hospitalist position. But she will go to parttime whenever we have kids
 

wamcp

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Anyone see Bernie Sanders new details to pay for Medicare for All from this week?

4% new payroll income tax

Marginal income tax increased to 40% at 250k

All capital gains taxed like ordinary income if your household makes above 250k

All health expense tax breaks are eliminated

Add this to the 40% slash to physician payments....we get squeezed on both ends. Or three, if you have hundreds of thousands in student debt too.
 
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This is true. Although not in my case.

For me I made 1 mil pretax over 2yr working 50-60 hr a week with tons of nocturnist moonlighting shifts

My wife herself works a fulltime day hospitalist position. But she will go to parttime whenever we have kids
You make 500k/yr working 60 hrs/wk + some additional moonlighting shifts or the moonlighting shifts are included within the 60 hrs/wk...
 

jdh71

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Anyone see Bernie Sanders new details to pay for Medicare for All from this week?

4% new payroll income tax

Marginal income tax increased to 40% at 250k

All capital gains taxed like ordinary income if your household makes above 250k

All health expense tax breaks are eliminated

Add this to the 40% slash to physician payments....we get squeezed on both ends. Or three, if you have hundreds of thousands in student debt too.
Shooooooot . . . I'll do my best to work damn near 30hr per work for that noise.
 
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Anyone see Bernie Sanders new details to pay for Medicare for All from this week?

4% new payroll income tax

Marginal income tax increased to 40% at 250k

All capital gains taxed like ordinary income if your household makes above 250k

All health expense tax breaks are eliminated

Add this to the 40% slash to physician payments....we get squeezed on both ends. Or three, if you have hundreds of thousands in student debt too.
Not so fast, this is just to pay for "free healthcare." They'll have to jack this up even more to fund "free college." Imagine this:

-Your pay gets slashed nearly in half by socialist healthcare.
-Then the taxes on what's left go up by 50% in order to pay for the socialist healthcare that just destroyed your livelihood.
-But you STILL have to repay the hundreds of thousands of dollars in student debt that you invested into this now dead-end career.
-Except you can't, because whatever money you have left after this massacre that you could use to pay off your student loans is now being stolen by the IRS and given to complete strangers so that these strangers don't have to take on student loans themselves. Meanwhile, your own life is financially ruined forever with no escape.

Your "take home pay" at that point may well approach that of a debt-free fast food manager, with absolutely zero exaggeration. If the Left seizes power and manages to implement their schemes, we (current med students) will have thrown away the best part of our lives just to become paycheck to paycheck debt slaves till the end.
 
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wamcp

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Not so fast, this is just to pay for "free healthcare." They'll have to jack this up even more to fund "free college." Imagine this:

-Your pay gets slashed nearly in half by socialist healthcare.
-Then the taxes on what's left go up by 50% in order to pay for the socialist healthcare that just destroyed your livelihood.
-But you STILL have to repay the hundreds of thousands of dollars in student debt that you invested into this now dead-end career.
-Except you can't, because whatever money you have left after this massacre that you could use to pay off your student loans is now being stolen by the IRS and given to complete strangers so that these strangers don't have to take on student loans themselves. Meanwhile, your own life is financially ruined forever with no escape.

Your "take home pay" at that point may well approach that of a debt-free fast food manager, with absolutely zero exaggeration. If the Left seizes power and manages to implement their schemes, we (current med students) will have thrown away the best part of our lives just to become paycheck to paycheck debt slaves till the end.
Here is a real life example of what happens under a welfare state and it’s not even single payer system.

Germany. Multipayer system with compulsory insurance and private insurance. 74% of healthcare spending is government funded, 26% private.

Now look at how their hospitals will pay you:

You can be an attending for several years out and your pay only gets to 120K USD. Their overall taxes will remove over 40% of that too. Your take home pay is 72K. Absolutely horrendous direction to head towards.

Did you know they’re on strike right now for 5% pay increase? Lol
And they work insane hours for the low pay

“According to a recent survey by the doctors’ union, 40 percent of doctors in German municipal clinics work 49 to 59 hours a week. One in five doctors had even higher weekly averages of 60 to 80 working hours, including all services and overtime.”

 
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Anyone see Bernie Sanders new details to pay for Medicare for All from this week?

4% new payroll income tax

Marginal income tax increased to 40% at 250k

All capital gains taxed like ordinary income if your household makes above 250k

All health expense tax breaks are eliminated

Add this to the 40% slash to physician payments....we get squeezed on both ends. Or three, if you have hundreds of thousands in student debt too.
Okay so some additional facts to contextualize this Wall Street propaganda:

40% is the highest estimate on additional paycuts. But y'all continue to parrot that number to fear-monger about a common sense payment system that the entire rest of the developed world uses. The entire rest of the developed world which has better health outcomes than we have.

Source: https://www.washingtonpost.com/business/2018/08/27/what-would-sanderss-medicare-for-all-plan-mean-doctor-pay/

The 4% payroll income tax isn't a new additional tax, its instead of premiums you pay for health insurance anyway, and would save most people money. If you truly drop closer to the 75k tax bracket, which you definitely won't, you'll still likely be saving money on premiums by paying this tax instead.

Source: https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all?inline=file

The capital gains thing...if investments and real estate are a primary source of income for you, then you probably have enough wealth in your family to do just fine.
 
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VA Hopeful Dr

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Okay so some additional facts to contextualize this Wall Street propaganda:

40% is the highest estimate on additional paycuts. But y'all continue to parrot that number to fear-monger about a common sense payment system that the entire rest of the developed world uses. The entire rest of the developed world which has better health outcomes than we have.

Source: https://www.washingtonpost.com/business/2018/08/27/what-would-sanderss-medicare-for-all-plan-mean-doctor-pay/

The 4% payroll income tax isn't a new additional tax, its instead of premiums you pay for health insurance anyway, and would save most people money. If you truly drop closer to the 75k tax bracket, which you definitely won't, you'll still likely be saving money on premiums by paying this tax instead.

Source: https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all?inline=file

The capital gains thing...if investments and real estate are a primary source of income for you, then you probably have enough wealth in your family to do just fine.
That Washington Post article is hogwash.

First, it is a 40% cut because private insurance is where most offices/hospitals actually make money. If everything goes to Medicare rates (meaning private insurance goes down and Medicaid comes up), lots of offices and hospitals will go under.

Second, administrative costs won't go down all that much. Medicare is the one who keeps coming up with complicated rules that we have to follow. Private insurance just copies Medicare.

Third, even if we accept that an 11% cut is actually what the end result will be.... most places don't have margins high enough to manage that. The national average is around 4-5% in fact.
 

Espadaleader

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If physician’s pay was cut by 40% then there would be no PCPs or pediatricians. Period. At that point, why spend 7+ years after medical school working 80 hours per week when you could make a similar wage as a NP or PA without 300 K in debt. A STEM degree can make 70-100 K out of undergraduate. Financially it makes no sense. Only wealthy folk will be able to go into IM/Peds/FM. If you are a Doc supporting kids, parents, trying to save a bit etc. you will have to change fields. I DO think if the government waived medical debt for primary care, PCPs would work with a 40% pay cut.
 

Espadaleader

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My partner is an engineer/I have a professional masters and 100 K is a guarantee for a mid level manager with a pulse.
 

fldoctorgirl

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If they're going to cut physician pay, they better slash all of our debts too. There's no way I'm graduating with $300k in loans to make $100-150k after racking up even more interest for a few years in residency.
 
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Even if they eliminate debt, the years of training and stress of practicing in our system with the hours/expectations, paperwork, threat of potential lawsuits, loss of autonomy, etc. make most specialties not worth it. That’s what most people who aren’t physicians don’t understand. Docs here don’t work 40 hours per week and not worry about all the other stuff related to practice.
 

Anicetus

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If physician’s pay was cut by 40% then there would be no PCPs or pediatricians. Period. At that point, why spend 7+ years after medical school working 80 hours per week when you could make a similar wage as a NP or PA without 300 K in debt. A STEM degree can make 70-100 K out of undergraduate. Financially it makes no sense. Only wealthy folk will be able to go into IM/Peds/FM. If you are a Doc supporting kids, parents, trying to save a bit etc. you will have to change fields. I DO think if the government waived medical debt for primary care, PCPs would work with a 40% pay cut.
Yet I could see sanders pulling this because him and his supporters want to be like the European countries they tout about so much.

You talk to the lay person voting and 99% of them will agree to cut our salaries when they see that we make so much more than physicians in the countries they want america modeled after.

Meanwhile back in pre-med/med student forums, Sanders is a God amongst people.
 
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Yet I could see sanders pulling this because him and his supporters want to be like the European countries they tout about so much.

You talk to the lay person voting and 99% of them will agree to cut our salaries when they see that we make so much more than physicians in the countries they want america modeled after.

Meanwhile back in pre-med/med student forums, Sanders is a God amongst people.
Yeah did you see that town hall meeting he did on Fox. Yikes. This guy is an unapologetic democratic socialist and a millionaire to boot. He will not moderate the message. He’s not here to make friends with doctors or insurance companies. He will have no problem walking all over physicians and the people will back him up. Even if he loses he still wins. the rest of the Democratic candidates have already signed in to Medicare for all. If medicine wasn’t worth your time before this
Effect rest assured it won’t be once the govt is finished with it.

Imagine even if they come up with a decent plan. Once the republicans get a hold of it they’ll cut it to the bone. Leaving doctors whiplashed in the process.

Socialism is practically the default ideology for the young so no surprises there. The poor and middle class will latch on to anything free if t means they don’t need to fork over anything. No surprises there either.

The story ends badly
 
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biglurker

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Hospitalists in Canada make the same or more than the US on average, even working in large cities, if that has not been mentioned.
For those of you who refuse to believe single payer will cut our pay drastically, and point to Canada as an example of good pay in a socialist structure.

Guess what, the reason Canadian physician pay is relatively decent is precisely because American pay is good and canadian docs can definitely hop the border with ease (unlike true FMGs).

Physicians in canada who have LMCC (canadian accreditation of med school/training) credentials are accepted in 44 US states. They do not need to train in residency in the US to be a practicing attending here unlike true FMGs.

See also: Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis

“In Canada, a perceived surplus of physicians in the 1980s led to recommendations to limit the number of physicians by lowering medical school enrolment and reducing dependency on foreign trained physicians while also looking for other means of delivering health care [10]. As a result, there was a 10% reduction in medical school positions and immigrant physicians coming to Canada fell from a peak of 525 in 1993 to 243 in 1999 [11]... The movement of physicians from Canada to the US at this time was described as a ‘brain drain’ or ‘major exit ramp’ that contributed to physician shortages [16]...The Canadian dialogue then shifted from physician surplus to physician shortages, and many of the initiatives that were aimed at reducing physician numbers in the 1990s were reversed... Efforts at primary care reform were undertaken in most provinces and, though differing in detail, were aimed at improving primary care physician income and providing infrastructure funding. There were initiatives to improve hospital funding intended to reduce surgical wait times for select procedures [21].”

The bottom line: if America cuts its doctor pay you bet your sorry bottom that Canada will slash theirs as well. There would be no need for their government to keep pay high to prevent a resurgence in doctor brain drain to the USA.
 
Jul 30, 2018
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For those of you who refuse to believe single payer will cut our pay drastically, and point to Canada as an example of good pay in a socialist structure.

Guess what, the reason Canadian physician pay is relatively decent is precisely because American pay is good and canadian docs can definitely hop the border with ease (unlike true FMGs).

Physicians in canada who have LMCC (canadian accreditation of med school/training) credentials are accepted in 44 US states. They do not need to train in residency in the US to be a practicing attending here unlike true FMGs.

See also: Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis

“In Canada, a perceived surplus of physicians in the 1980s led to recommendations to limit the number of physicians by lowering medical school enrolment and reducing dependency on foreign trained physicians while also looking for other means of delivering health care [10]. As a result, there was a 10% reduction in medical school positions and immigrant physicians coming to Canada fell from a peak of 525 in 1993 to 243 in 1999 [11]... The movement of physicians from Canada to the US at this time was described as a ‘brain drain’ or ‘major exit ramp’ that contributed to physician shortages [16]...The Canadian dialogue then shifted from physician surplus to physician shortages, and many of the initiatives that were aimed at reducing physician numbers in the 1990s were reversed... Efforts at primary care reform were undertaken in most provinces and, though differing in detail, were aimed at improving primary care physician income and providing infrastructure funding. There were initiatives to improve hospital funding intended to reduce surgical wait times for select procedures [21].”

The bottom line: if America cuts its doctor pay you bet your sorry bottom that Canada will slash theirs as well. There would be no need for their government to keep pay high to prevent a resurgence in doctor brain drain to the USA.
Excellent point. I once fell victim to the idea that single payer wouldn’t be all the bad because well Canada! But of course this was a lie. In fact I have a few attendings that left Canada in the early 90s and also some that left after residency. It’s remarkable how similar their stories were despite a 20 year gap. The pay isn’t good and govt support is dwindling and if your not a PCP they really have no need for you.

They are also trying there hand at “Alternative Payment Methods” lest you think FFS is still there. In my field of oncology, they are even more restrictive. You really can only work at an academic center. No private practice, slim community hospitals.

Health economists in Canada are probably salivating right now ready to pounce and take another nice fat chunk out of a docs paycheck.

When are you guys gonna realize, doctors have no allies. Not even their patients.
 

Anicetus

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Excellent point. I once fell victim to the idea that single payer wouldn’t be all the bad because well Canada! But of course this was a lie. In fact I have a few attendings that left Canada in the early 90s and also some that left after residency. It’s remarkable how similar their stories were despite a 20 year gap. The pay isn’t good and govt support is dwindling and if your not a PCP they really have no need for you.

They are also trying there hand at “Alternative Payment Methods” lest you think FFS is still there. In my field of oncology, they are even more restrictive. You really can only work at an academic center. No private practice, slim community hospitals.

Health economists in Canada are probably salivating right now ready to pounce and take another nice fat chunk out of a docs paycheck.

When are you guys gonna realize, doctors have no allies. Not even their patients.
Oh I realize. Meanwhile on premed/med forums they have discussions about which luxury car they are going to buy with their first paycheck while they vote for Bernie Sanders.
 
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Oh I realize. Meanwhile on premed/med forums they have discussions about which luxury car they are going to buy with their first paycheck while they vote for Bernie Sanders.
The libs love the young. These early 20 somethings are just old enough to “think for themselves” but too stupid and arrogant to realize what they don’t know. Life isn’t the university. Socialism works for them because it’s literally just a natural extension of mommy and daddy’s dime.

When I was in college, all they had was a college democrat club. The conversation has been leftward for the last 50 years. It’s practically required for anyone else to lie about their convictions for fear of pissing off someone that could impact your career.

See how they like working for a resident salary for the rest of their lives while their friends in the rest of the world get promoted buy homes and take nice vacations.

Those warm fuzzy feelings about helping humanity fade fast when you have bills to pay. And everyone around you is literally hell bent on squeezing more work out of you for less.
 
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Oh I realize. Meanwhile on premed/med forums they have discussions about which luxury car they are going to buy with their first paycheck while they vote for Bernie Sanders.
And lest they think Bernie is just gonna forgive all those poor student loan debt burdens with no strings attached better get evaluated for delusional thinking. They’ll be so many strings attached to that it’ll be laughable.

Probably to tell them where to practice and what to practice and for how much and for how long. Oh and don’t forget that loan forgiveness might be taxed by the IRS as income. So you’ll still owe somebody.

Doctors never get off easy especially when it comes to the govt.
 
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wjs010

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The libs love the young. These early 20 somethings are just old enough to “think for themselves” but too stupid and arrogant to realize what they don’t know. Life isn’t the university. Socialism works for them because it’s literally just a natural extension of mommy and daddy’s dime.

When I was in college, all they had was a college democrat club. The conversation has been leftward for the last 50 years. It’s practically required for anyone else to lie about their convictions for fear of pissing off someone that could impact your career.

See how they like working for a resident salary for the rest of their lives while their friends in the rest of the world get promoted buy homes and take nice vacations.

Those warm fuzzy feelings about helping humanity fade fast when you have bills to pay. And everyone around you is literally hell bent on squeezing more work out of you for less.
Even Med students these days are nauseatingly politically correct and liberal to the point of self deprivation as a future doctor. It pisses me off. Does someone need to be 30 now to be old enough and mature enough to think for themselves and grow a pair? Yes, they are delusional voting for Bernie and expecting a nice hot rod
 
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