What specialty best insulates me from socialized medicine.

[WakeDoc]

Clearly we have some big issues in this country with healthcare. Any changes will lead to a new group being dissatisfied as healthcare is a limited resource. Obama, as a democrat, places high value on the satisfaction of one his major support groups, low income families and minorities which are statistically some of the highest rate of uninsured. Bush did the opposite, his support base was the upper end wage earners, including physicians. So, I'm guessing that any reforms will include distributing more of the pie to the uninsured / underinsured; and likely take a little pie from...us. I won't say I like it....but clearly the masses of uninsured need a better solution then the current system. Part of the solution should probably be figuring a way to mandate them paying for some of their own coverage, as I take care of people everyday who have no health insurance but have nice clothes, expensive cell phones, 6 kids, on disability for fibromyalgia, etc. I hope that the current administration will require some accountability, but given that is their voter base...

Also, I haven't been too encouraged by the administration's support of physician's thus far. One example is the impending repeal of the good conscience law allowing physicians autonomy in decisions related to their own morals. Its a sticky situation involving a lot of ethical challenges, but in the end it really is a loss in terms of further government intrusion into physician practice.

On tax raises...well clearly this will not go well if the taxes increase as drastically as up to 90%. I would be shocked if they did. Remeber, in the 50s anybody making over 200K was doing extraordinarily well, so a similar tax bracket today would likely be way above any physician salaries. That being said, if taxes increase to a level where you start getting significant diminishing returns, anticipate a lot of high earners (ortho, rads, most surgical speacilities) suffering drastic work shortages as they just take a bunch of vacation instead of busting out those 70 hour weeks. Heck, even for me (an emergency doc) I would probably work a couple less shifts a month rather then work extra so Uncle Sam can get paid.

Hopefully, some of what I just wrote made sense...I just got off a string of nights.

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[docB]

Finally, even if you think that Obama is going to completely demolish the free market in medicine, think about what happens after eight (or maybe four) years when he is out of office. You might get a conservative republican who will reverse all of his changes in the healthcare system.

I disagree. We have a horrible track record of getting rid of the socialist programs that don't work. We still have social security even though it's a much more thinly veiled Ponzi scheme than anything Madoff had going. We are still living with various elements of the New Deal and the horrendously expensive yet totally ineffective War On Poverty. We still have income taxe with holding even though it were created as a temporary wartime program.

That's the insidious nature of socialism. It incrementally addicts people who quickly become completely dependent. Both proponents and opponents have to agree that once we socialize healthcare we will never be able to go back.

 

[frank51]

On tax raises...well clearly this will not go well if the taxes increase as drastically as up to 90%. I would be shocked if they did. Remeber, in the 50s anybody making over 200K was doing extraordinarily well, so a similar tax bracket today would likely be way above any physician salaries. That being said, if taxes increase to a level where you start getting significant diminishing returns, anticipate a lot of high earners (ortho, rads, most surgical speacilities) suffering drastic work shortages as they just take a bunch of vacation instead of busting out those 70 hour weeks. Heck, even for me (an emergency doc) I would probably work a couple less shifts a month rather then work extra so Uncle Sam can get paid.

Hopefully, some of what I just wrote made sense...I just got off a string of nights.

You're absolutely right, the up side is that most of the people in the fields you mentioned will probably end up enjoying their life more.

 

[dacrocytic]

I don't want to get political here, just practical. I am an MS2 who still has time to decide what specialty to pursue. I also go to a private medical school that will leave me around $250k in debt by the time I START residency.

I don't care what anyone says about socialized medicine being better for patients (it isn't), for government (it isn't) or for doctors (it most certainly isn't).

I have freaking loans to pay off, and I'd like to do it before my kids have to go to college. I have had a long-term girlfriend for a while now, and we want to get married, but we can't because I don't want to live off of her salary as a (private) school teacher, which is barely enough for her.

I'll be blunt. I want to make some money to have a positive net worth. Now it seems I timed it exactly wrong, the second I have to stop borrowing is the second decides that doctors "make too much" or need to "spread the wealth around" even though what we do can only be done competently by a select few and takes a decade to learn.

What specialty can I go into that will most insulate me from a partial or complete government takeover???? I don't care how selective it is. My grades are fine, I'm prepping for Step 1. I'll get a 280 if I have to. My life as I want to live it literally depends on it.

Oh, and if you think I'm just being greedy, just don't bother to respond. My dad works in a furniture store.

any canadian will tell you- socialized medicine is defintely not for the better for the patient

 

[thedrjojo]

This is one of the most rediculas and uninformed thread I have seen on this subject.

I don't even know where to begin.

So some people on this thread would rather make less money than give more of it to the government? Everyone saying they would work less to get into a lower tax bracket would really give up 10's of thousands of dollars just because the government takes a bigger bite out of it, especially considering the reason this post even started is because an ill informed and fox news biased medical student is concerned that he will be making $300K instead of $350K shaving off moles?

The proposal on the table is not Socialized Medicine as Fox News keeps referring to it, it is a public option for health insurance. It isn't even a single payer system which has plenty of ACTUAL evidence and not heresay and fear based in beliefs and nothing else like is being spewed on this thread. Is a single payer system without problems? Of course not. Like in everything, there is limitations to what any system can have: Quality, Access, and Cost. Control for two and you lose the 3rd one (right now we don't control for any of them... costs is highest per GDP of any nation, access is worse than some 3rd world countries, and Quality is also worse than in some 3rd world contries). Cost is definately an issue so that must be controlled for, which can be started by removing the 30% overhead seen in insurance companies and by removing profit from hospitals, and can be addressed by removing the Cat scan from the ABC's of ED admission, or the plethera of unnecessary or repeated tests. Access is the next issue that is a hot bed, because we have rationing in this nation already. The rationing is based not on utility of medical services, which universal systems attempt to ration based on, but rationed solely on financial considerations: if you can pay for it, you can get it, but if you can't, you have a hard time being able to do get it. What is more fair? Depends on what your value or belief about a health system is. If you see medicine as a humanistic profession where we treat patients without prejudice and try to do what is best for our patient and that our nation as a whole will be stronger if it is healthier on a whole, then medical access should not be rationed on how much money you have, but on necessity of medical need. Does canada get this right all the time? No, but they sure do a better job than we do here in the US. If you see medicine as a business where we practice in order to become rich and see our patients as clients only and have no emotional investment and feel no obligation to them (and if you do, I feel sorry for you) than you open your boutique peds practice and you perform that 12th breast augmentation because they can pay you for it, and hard working americans who just make enough to feed their family and are losing their jobs by the 1000's right now will continue to be left waiting months for appointments at clinics because they can't afford insurance and their employeers don't offer it to them. If you contain the costs too much, or if you have unfeathered access, you by necessity, will decrease quality. However, quality right now is not matching the level of investment and the lack of access people have. Steps are trying to be implemented to improve quality, including standardized order sheets, computerized records with the ability to be shared across hospitals and offices, decreases to the time doctors spend on paperwork and insurance forms (the "unbilled" time investment of all those primary care physicians), and allow more time to be spent with patients. Physican extenders (PA's, NP's, etc) also provide ways to allow MD's to spend time doing stuff only MD's can do instead of wasteful time elsewhere.

As for the specialty that best insulates you, there is no one way to answer this. Under no system is a Neurosurgeon or Orthopaedic surgeon going to make less than a pediatrician. Under no system is Dermatology going to make less than an internist. Those top specialties are likely to take the biggest hit if a hit is going to be had, but still, the specialites that have the top average salaries (which, as of 2008 were Neurosurgeons (spine in particular), Orthopaedic (spine also in particular), and Cardiothorasic Surgeon) will continue to have the top salaries. As for your I'll get a 280 on the test if I have to, you clearly don't understand the test and the challenges of it. Most US med schools give 6-8 weeks to study for it, and most students study 12 hours a day during that time, and the average is 220. The carribean schools give significantly longer to study, but they also NEED to do better than the average US med student to even be considered in the same breath, and in areas listed above, they almost never have a chance at them. You aren't suddenly going to be able to become the best student in the nation because you are that concerned with becoming a rich doctor. And even getting a score like that does not assure you a spot. You obviously will be doing something solely because of the financial reward, not the interest and joy of doing it, so you seem like the student that is going to be cutting corners and doing stuff to try to make yourself look good at the expense of your classmates, and it will be seen through. You should do what inspires you, what you shine in, and within that practice, do what you can to bring in the most money.

Medicine is a horrible field to go into if you are interested in making it rich. Most doctors live comfortably now, but mostly gone are the days of the swank doctors. I feel sorry for you, and most importantly, sorry for your potential "clients".

 

[jacksonhole]

Some of the posters wanted to know what happens if they do not repay their loans.

Most of us have loans with the Federal Government. Those Staffords have the lowest interest rate of all student loans and they are available to you even if you have the worst credit. The Government has no intention of letting you get away with not paying those type of loans back. If you stop paying the government goes to court and WILL place a wage garnishment upon your paycheck. It is like child support payments. If you work, they will find your company and inform them that they are required to deduct payments directly from your check to send to the Government. Your employer cannot fire you if you are garnished wages, but eventually it always comes to the knowledge of your supervisor...they may love you or hate you for it...

If you get into financial trouble and your left with filing for bankruptcy. Student loans are protected from discharge unless you can prove "Undue Hardship". The Feds never defined what "Undue Hardship" means in their law, therefore the Judge can and does use his own definition for that day. Most are very strict and will not discharge those loans unless your are paralyzed from the neck down and cannot ever work in any field ever, ever again.

If you have HEAL loans....they rarely if ever discharge those.

Private loans are treated differently and requires more time to write about....in essence it depends an numerous factors such as non-profit involvement and if it is a "qualified education loan".

 

[mikkey]

As a Canadian, who yes, has experienced the dreaded "socialized medicine" phenomenon, I must admit that the ignorance on this thread is rather interesting.
While all you keep looking at making less money, you haven't quite caught on to the fact that no one anywhere in the world pays this much money to learn medicine. This is where the problem stems. If you hadn't paid 250K to go to BU instead of your state school which is substantially cheaper (although still rather expensive) you wouldn't really need to make 350K a year to pay your debt off.
Also, I agree with the poster that said that American healthcare was wasteful. My boyfriend got an ultrasound done a few months ago, and the hospital charged 1200$ for the ultrasound and 200$ to read it. I hate to say it, but I could probably buy an ultrasound machine for that price.
I am not saying that Canadian medicine is better. We wait forever to see doctors and we don't have every latest bit of technology. However, I don't think bashing on a different system is going to get us very far. We NEED a new system, and we need it fast. So start looking around and mix and match different healthcare models from around the world.
Everything must be reajusted, from medical school all the way to the way we practice "defense medicine" because of lawsuits. This will mean huge societal changes, where society takes care of its members a little more than we do now. For having lived in many places, I firmly believe the American government needs to have a greater place in medicine. And we as doctors need to stop thinking about Staline every time this is mentionned.

 

[gallons]

About as accurate as guns being taken away. Oh well.

 

[exsanguination]

This is one of the few times thread necromancy results in an interesting read

I wonder what people would answer now to the OPs original question and the general consensus going forward

 

[Mad Jack]

About as accurate as guns being taken away. Oh well.

A fine necrobump.

Which, fun fact, Swype autocorrects to meconium.

 

[ThoracicGuy]

About as accurate as guns being taken away. Oh well.

 

[VA Hopeful Dr]

This is one of the few times thread necromancy results in an interesting read

I wonder what people would answer now to the OPs original question and the general consensus going forward

DocB nailed it - if a socialized system forbids people from going outside it then the field doesn't matter.

If it doesn't (more like the UK setup) then every field has the potential to go outside if you're good enough that people will pay cash/private insurance for your services.

 

[Mad Jack]

DocB nailed it - if a socialized system forbids people from going outside it then the field doesn't matter.

If it doesn't (more like the UK setup) then every field has the potential to go outside if you're good enough that people will pay cash/private insurance for your services.

Or if there is a big enough gap in supply and demand

 

[VA Hopeful Dr]

Or if there is a big enough gap in supply and demand

Nope, that doesn't work as well as you'd think. Otherwise PCPs would be doing much better.

 

[Perrotfish]

Nope, that doesn't work as well as you'd think. Otherwise PCPs would be doing much better.

That's not demand. Demand is based on what people want, not what they need. There is a huge demand for lottery tickets and very little demand for financial planners. All the demand in medicine is for immediate relief of current symptoms. No one is willing to pay for preventative healthcare, they're barely willing to take the time to do it when its free.

 

[Mad Jack]

Nope, that doesn't work as well as you'd think. Otherwise PCPs would be doing much better.

Salaries are coming up as the demand gap widens. I've seen PCP offers of 300k plus production a couple of hours from where I'm living, which would have been unthinkable in employed positions a few years back. Hell, 200k was considered good a while ago.

 

[VA Hopeful Dr]

That's not demand. Demand is based on what people want, not what they need. There is a huge demand for lottery tickets and very little demand for financial planners. All the demand in medicine is for immediate relief of current symptoms. No one is willing to pay for preventative healthcare, they're barely willing to take the time to do it when its free.

Fine, then replace PCP with Urgent Care. Still applies.

 

[VA Hopeful Dr]

Salaries are coming up as the demand gap widens. I've seen PCP offers of 300k plus production a couple of hours from where I'm living, which would have been unthinkable in employed positions a few years back. Hell, 200k was considered good a while ago.

Look at the fine print on those contracts and get back to me.