What specialties have the least reliance on medicare or medicaid?

[Proudfather94]

With reimbursements being cut every year I'm skeptical that it will improve unless something drastic and unrealistic happens such as physicians uniting to lobby to congress or the majority of physicians not accepting Medicare or Medicaid.

Which specialties deal with these insurances the least? I'm figuring ones that can delve into more cosmetic stuff like plastics and derm and specialties with a high patient variance and practice flexibility like FM.

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[ontiquicuo]

Cash-only private practice psych

 

[Proudfather94]

Cash-only private practice psych

Thanks I didn't think of that one.

 

[Angus Avagadro]

Boutique primary care practice. What's wrong with Medicare? It will soon be your best payer.

 

[Proudfather94]

Boutique primary care practice. What's wrong with Medicare? It will soon be your best payer.

Thanks how so? I keep hearing that they're cutting their reimbursements every year.

 

[Angus Avagadro]

Thanks how so? I keep hearing that they're cutting their reimbursements every year.

They are. So are the private insurers, some who pay below Medicare. Currently this year,, specialists,especially those who do procedures will be cut and those cuts will be given to primary care. This from a recent hospital email sent to my wife.The privates take their lead from CMS, aka Medicare. We live in a low reimbursement state in the Midwest which doesn't help, just our cuts are lower.

 

[Proudfather94]

They are. So are the private insurers, some who pay below Medicare. Currently this year,, specialists,especially those who do procedures will be cut and those cuts will be given to primary care. This from a recent hospital email sent to my wife.The privates take their lead from CMS, aka Medicare. We live in a low reimbursement state in the Midwest which doesn't help, just our cuts are lower.

Do you think doctors in primary care may start switching to cash only if the cuts continue to happen?

 

[Angus Avagadro]

Do you think doctors in primary care may start switching to cash only if the cuts continue to happen?

Several already have. More are heading back to large group practices. Some specialists only, like urologists, others are multidisciplinary groups with primary care and specialists.

 

[ortnakas]

You’re not going to escape medicare cuts unless you only take cash.

 

[Proudfather94]

Several already have. More are heading back to large group practices. Some specialists only, like urologists, others are multidisciplinary groups with primary care and specialists.

Ultimately doesn't that just make it harder for people with Medicare to see a doctor? I don't see why the government would do that.

 

[Proudfather94]

You’re not going to escape medicare cuts unless you only take cash.

That's true I have quite a few years to wait to see if this trend continues.

 

[Angus Avagadro]

Ultimately doesn't that just make it harder for people with Medicare to see a doctor? I don't see why the government would do that.

I don't disagree. People with insurance from the exchanges have it worse. Why would the govt do that? The same reason any govt does that. To control rising costs. The only way to do this is to reduce reimbursement and access. If you can't get in, you can't spend their money. Why do you think some countries like Australia or the EU impose draconian lockdowns? It's cheaper to make people stay home than take care of sick people in the hospital. If you think the govt or insurers are interested in quality or increased access, you are mistaken.

 

[Proudfather94]

I don't disagree. People with insurance from the exchanges have it worse. Why would the govt do that? The same reason any govt does that. To control rising costs. The only way to do this is to reduce reimbursement and access. If you can't get in, you can't spend their money. Why do you think some countries like Australia or the EU impose draconian lockdowns? It's cheaper to make people stay home than take care of sick people in the hospital. If you think the govt or insurers are interested in quality or increased access, you are mistaken.

It shocks me how little the government cares about its own citizens. This leaves physicians with options that will decrease patient care in the longrun

1 physicians eat the pay cut and keep taking care of Medicare pts. This will most likely lead to burnout seeing ones pay decrease each year and will cause physicians to leave the field. Alot of people in my generation are tired of not being able to live the lifestyle that our parents and grandparents got to live. I'm sure these cuts won't help that sentiment.

2 physicians take Medicare but cut patient time even shorter causing an increased risk of missing something and the pt doctor relationship doesn't form as well.

3 Physicians just don't accept Medicare or limit the percentage of Medicare patients. This would allow doctors to pick and choose which Medicare pts to accept and would make the pts that require longer visits struggle to get a doctor.

4 physicians join large groups. If you don't have the insurance the group takes and there's no doctors around that are not in the group you are screwed.

 

[NotAProgDirector]

You can completely avoid Medicare in Peds!

 

[Proudfather94]

You can completely avoid Medicare in Peds!

That's true. I love taking care of my kid but I don't think I'd love to take care of others. I think my anxiety would get the better of me with chronic and severe issues and I would think about if my child had it.

 

[hfiso]

I wouldnt choose a specialty based on future reimbursement rates. In general, want better reimbursement? younger/healthier/richer.
No matter what- volume determines your pay in many practices.

Crappy ortho doc? you'll make less than a family doc who stays slammed and does procedures.

volume is to doctor pay, as location is to real estate. (but to have volume, you gotta be good)

 

[8YearsLate]

Here's a better question: Why is it that everyone seems to go from "I want to help the underserved" to "how can I avoid medicaid patients" in about 60 seconds flat after the white coat ceremony? As a medicaid patient myself and even watching the majority of my peers hold this sentiment + the majority of my practicing professors not accepting medicaid/medicare it really makes me wonder how this "underserved" charade continues.

 

[Proudfather94]

Here's a better question: Why is it that everyone seems to go from "I want to help the underserved" to "how can I avoid medicaid patients" in about 60 seconds flat after the white coat ceremony? As a medicaid patient myself and even watching the majority of my peers hold this sentiment + the majority of my practicing professors not accepting medicaid/medicare it really makes me wonder how this "underserved" charade continues.

I think it's because people want to help the undeserved but find out they will be getting paid less every year to do so. The problem isn't the pt on Medicaid but with the government refusing to provide fair compensation

 

[Proudfather94]

I wouldnt choose a specialty based on future reimbursement rates. In general, want better reimbursement? younger/healthier/richer.
No matter what- volume determines your pay in many practices.

Crappy ortho doc? you'll make less than a family doc who stays slammed and does procedures.

volume is to doctor pay, as location is to real estate. (but to have volume, you gotta be good)

Thanks that's good advice!

 

[Lawpy]

Here's a better question: Why is it that everyone seems to go from "I want to help the underserved" to "how can I avoid medicaid patients" in about 60 seconds flat after the white coat ceremony? As a medicaid patient myself and even watching the majority of my peers hold this sentiment + the majority of my practicing professors not accepting medicaid/medicare it really makes me wonder how this "underserved" charade continues.

Because premeds are insincere and only say things to get admitted

 

[theendisnigh]

Here's a better question: Why is it that everyone seems to go from "I want to help the underserved" to "how can I avoid medicaid patients" in about 60 seconds flat after the white coat ceremony? As a medicaid patient myself and even watching the majority of my peers hold this sentiment + the majority of my practicing professors not accepting medicaid/medicare it really makes me wonder how this "underserved" charade continues.

Incredibly surprising to me too. Anyone not coming from money is exponentially rising in their familial wealth through medicine. People haven't even graduated medical school yet and are worrying about a 210K versus 230K salary in medicine. For many of us coming from low-income backgrounds, the fact that we're making above 40K a year makes us the highest earners in our families.

Anyone who's doing this job to get rich or make it big, it has already been beaten to death that there are far better professions to do that in, ones where the goal IS your own gain and not to care for the poor, the destitute, etc.

 

[Ho0v-man]

Incredibly surprising to me too. Anyone not coming from money is exponentially rising in their familial wealth through medicine. People haven't even graduated medical school yet and are worrying about a 210K versus 230K salary in medicine. For many of us coming from low-income backgrounds, the fact that we're making above 40K a year makes us the highest earners in our families.

Anyone who's doing this job to get rich or make it big, it has already been beaten to death that there are far better professions to do that in, ones where the goal IS your own gain and not to care for the poor, the destitute, etc.

That’s what happens when medical schools disproportionately select applicants from wealthy backgrounds. Be the change you want to see in the world. No one’s stopping you.

 

[Proudfather94]

Incredibly surprising to me too. Anyone not coming from money is exponentially rising in their familial wealth through medicine. People haven't even graduated medical school yet and are worrying about a 210K versus 230K salary in medicine. For many of us coming from low-income backgrounds, the fact that we're making above 40K a year makes us the highest earners in our families.

Anyone who's doing this job to get rich or make it big, it has already been beaten to death that there are far better professions to do that in, ones where the goal IS your own gain and not to lcare for the poor, the destitute, etc.

Instead of putting the blame on those who are trying to succeed in a capitalistic society put the blame on where it belongs the government. They keep decreasing how much they are paying physicians for their care. When you spend over ten years and hundreds of thousands of dollars to train to do something you want the pay to go up not down. Physicians also see the bloated administration salaries going up along with nursing and other Healthcare fields so its unreasonable to expect them to sit by and take pay cuts without resistance.

At the end of the day doctors want to help people that's why they went into medicine but expecting them to not think about income is absurd. Your entire quality of life is tied to how much you make and when one spends as long training in a competitive field always having to be one of the best you should expect that they want to live a great life.

 

[2021Doctor]

In fact, Medicare physician pay has increased only 11 percent from 2001-2020. Meanwhile, the cost of running a medical practice increased 39 percent from 2001-2020. Adjusting for inflation and the cost of running a practice, Medicare physician pay dropped 22 percent over the time period.

Where did the money go?

Medicare payment to hospitals increased nearly 60 percent over the same time period.

What’s happening now is that due to these pressures, more and more physicians are turning towards hospital-based employment. And they are turning over in droves. Eighty-five percent of all physicians under the age of 40 are now employees. Medicare cuts make stand-alone private practices, owned by physicians, simply much harder to maintain.

Physician pay cuts are another threat to independent practices

These types of cuts place external pressure on physicians and drive them into more hospital-employed practices.

thehill.com

 

[Goro]

OMM/NMM.

Set up a practice in a well to do area (think Great Neck, NY), and you can clear $400-500/hr in cash.

And your overhead will be less than a Dermatologist's.

 

[VA Hopeful Dr]

That’s what happens when medical schools disproportionately select applicants from wealthy backgrounds. Be the change you want to see in the world. No one’s stopping you.

I don't think it's that so much. It's that the training is very difficult and takes a long time. I wouldn't have put off earning until almost age 30 for 80k/year.

Plus debt.

 

[VA Hopeful Dr]

Incredibly surprising to me too. Anyone not coming from money is exponentially rising in their familial wealth through medicine. People haven't even graduated medical school yet and are worrying about a 210K versus 230K salary in medicine. For many of us coming from low-income backgrounds, the fact that we're making above 40K a year makes us the highest earners in our families.

Anyone who's doing this job to get rich or make it big, it has already been beaten to death that there are far better professions to do that in, ones where the goal IS your own gain and not to care for the poor, the destitute, etc.

Not quite. While there are other jobs that outpay medicine significantly, there are almost no other fields that will guarantee you the income we receive.

 

[Ho0v-man]

I don't think it's that so much. It's that the training is very difficult and takes a long time. I wouldn't have put off earning until almost age 30 for 80k/year.

Plus debt.

No one’s suggesting 80k/year. This thread is about picking the field that maximizes one’s income above all else. And it was started by a pre-DO student who’s probably 30 seconds out from an interview where he lied about wanting to help underserved communities.

So here’s an accepted premed, who hasn’t even started med school yet, who is already looking to avoid taking care of our sickest/most vulnerable populations because he’s much more focused on his bottom line.

Sounds like a recruiting problem to me.

 

[Proudfather94]

No one’s suggesting 80k/year. This thread is about picking the field that maximizes one’s income above all else. And it was started by a pre-DO student who’s probably 30 seconds out from an interview where he lied about wanting to help underserved communities.

So here’s an accepted premed, who hasn’t even started med school yet, who is already looking to avoid taking care of our sickest/most vulnerable populations because he’s much more focused on his bottom line.

Sounds like a recruiting problem to me.

The whole point of this thread was me looking for options that I can do if the reimbursement for Medicare or Medicaid keeps going down. If I can pay my loans and have a decent lifestyle I won't have to worry it, I'm literally looking at the shtf worst case scenario. You're reaching quite a bit to assume I want to make money above all else or that I lied during my interview. I would love to help the most vulnerable but at the end of the day I have my family to take care of.

If I can have a decent house in a nice area so that I can send my kid to a good school and have money to pay for his college I'll take any insurance. This thread was about if reimbursement rates get ran into the ground and the government expects people to live on UK salaries or worse. Money isn't everything to me but giving my kid the best life I can give him and set him up for success is, and if it gets to the point to where I need to be more picky with what insurance I accept than so be it.

Since I seemed to have proverbialy kicked the murder hornets nest with this thread let me elaborate further. In today's market, making 250k a year would make me perfectly happy. I am concerned about the trend that is going on with these insurances and am looking for a plan B for if they go too low. I will have invested over 10 years of my life by the time this is said and done to be highly educated and I expect to be compensated for this. Helping people come first but providing for my family is a very close second. If all I wanted was money I would not have embarked on this journey and would have given up at many of the roadblocks I ran into on the way.

 

[AlbinoHawk DO]

Cash-only private practice psych

Cash-only private practice OMT

 

[Ho0v-man]

The whole point of this thread was me looking for options that I can do if the reimbursement for Medicare or Medicaid keeps going down. If I can pay my loans and have a decent lifestyle I won't have to worry it, I'm literally looking at the shtf worst case scenario. You're reaching quite a bit to assume I want to make money above all else or that I lied during my interview. I would love to help the most vulnerable but at the end of the day I have my family to take care of.

If I can have a decent house in a nice area so that I can send my kid to a good school and have money to pay for his college I'll take any insurance. This thread was about if reimbursement rates get ran into the ground and the government expects people to live on UK salaries or worse. Money isn't everything to me but giving my kid the best life I can give him and set him up for success is, and if it gets to the point to where I need to be more picky with what insurance I accept than so be it.

You can do this in every field. And if you’re picking a field based on the flexibility to avoid these types of coverage, you likely will end up doing exactly that. After all, you can have a “decent lifestyle” accepting these patients. But definition of a decent lifestyle is subject to change.

Being a parent doesn’t make this pursuit more noble. It just further perpetuates the stereotype of the “greedy doctor.”

 

[Proudfather94]

You can do this in every field. And if you’re picking a field based on the flexibility to avoid these types of coverage, you likely will end up doing exactly that. After all, you can have a “decent lifestyle” accepting these patients. But definition of a decent lifestyle is subject to change.

Being a parent doesn’t make this pursuit more noble. It just further perpetuates the stereotype of the “greedy doctor.”

I don't see how wanting to live in a nice area and being able to send my kid to a good school and pay for his college is seen as being a "greedy doctor". If I said I wanted a mansion and to buy myself and my kid matching lambos or bust then I would understand. After all of this education and time I've devoted to this field to help people I don't believe it is unreasonable to expect that.

 

[DrZoidbergDO]

OMM/NMM.

Set up a practice in a well to do area (think Great Neck, NY), and you can clear $400-500/hr in cash.

And your overhead will be less than a Dermatologist's.

Yeah but you'll have to sell your soul to AT Still

 

[calivianya]

I don't see how wanting to live in a nice area and being able to send my kid to a good school and pay for his college is seen as being a "greedy doctor". If I said I wanted a mansion and to buy myself and my kid matching lambos or bust then I would understand. After all of this education and time I've devoted to this field to help people I don't believe it is unreasonable to expect that.

A lot of these things are subjective and open to interpretation, which is why some people could see it as greedy.

Like I have classmates with dual physician parents who grew up in (multi)million dollar mansions and went to private schools that probably cost as much as my med school from K-12... their definitions of what a "nice area" and a "good school" look like is probably pretty different from what my ideas of those things are.

 

[Proudfather94]

A lot of these things are subjective and open to interpretation, which is why some people could see it as greedy.

Like I have classmates with dual physician parents who grew up in (multi)million dollar mansions and went to private schools that probably cost as much as my med school from K-12... their definitions of what a "nice area" and a "good school" look like is probably pretty different from what my ideas of those things are.

That's a good point. I'm looking at it from the perspective of someone who grew up in a family that's almost entirely blue collar and struggled greatly financially growing up. A 2 story house in a great school district is literally what would make me happy. I see how badly this initially came off. I'm just nervous with getting ready to take out these loans for a career whose salary is getting slashed every year. Whenever I make life decisions I tend to focus on every possibility that can happen and plan a response for it. This was meant to be asking for advice in case it isn't sustainable to accept these insurances.

 

[Candidate2017]

Here's a better question: Why is it that everyone seems to go from "I want to help the underserved" to "how can I avoid medicaid patients" in about 60 seconds flat after the white coat ceremony? As a medicaid patient myself and even watching the majority of my peers hold this sentiment + the majority of my practicing professors not accepting medicaid/medicare it really makes me wonder how this "underserved" charade continues.

Answers:
1. Medicaid reimbursement doesn't cover costs of keeping the lights on.
2. Medicaid has onerous administrative requirements because... bureaucrats. I know a doctor who is dedicated to working with the underserved, did nothing wrong, but Medicaid requested an audit and threatened them with forced repayment of Medicaid payment for the past X number of years.
3. Medicaid has a much higher percentage of patients who will threaten you and your staff, destroy your office when you don't prescribe their controlled substance of choice, refuse all medical advice despite their serious comorbidities but whose families will sue you if anything bad happens.

Basically, Medicaid usually leads to a lot more work and stress with increased physical, legal, and economic risk for lower pay.

Medicare generally pays decently and attracts a nicer crowd, but again it's a lot of work to med rec someone's 20 page med list, 20 comorbidities, and review labs before being able to come close to addressing their primary complaint with the remaining 3 minutes left in the visit. And god forbid your medication causes a severe interaction with grandma's 20 other medications.