What specialty has the least goverment control over it?

[kk123]

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This thread is not meant to start a political controversy.
I am merely curious as to what profession allows the physician to be more independent. I am well aware that the healthcare system is becoming more and more subject to government control. Does anyone know if certain specialties will have to deal with this more than others? Would it depend more on the environment in which one works (i.e. hospital vs. clinic vs. private practice vs. nonprofit)?
I'm wondering because this may affect what direction I take if I get into medical school.

 

[darkjedi]

This question makes no sense. Physician's aren't really "controlled" by the government besides by a few laws, regardless of specialty.

If you are talking about how things like Medicare/Medicaid are run, that's a different story. It's far from physician "control" though.

 

[Silent Cool]

This thread is not meant to start a political controversy.
I am merely curious as to what profession allows the physician to be more independent. I am well aware that the healthcare system is becoming more and more subject to government control. Does anyone know if certain specialties will have to deal with this more than others? Would it depend more on the environment in which one works (i.e. hospital vs. clinic vs. private practice vs. nonprofit)?
I'm wondering because this may affect what direction I take if I get into medical school.

Derm.
Plastic Surgery.
Any field that reasonably allows for ownership of a facility.
Also delving into cash-only cosmetic work, which you can easily do in almost any field.

 

[Radon XP]

This question makes no sense. Physician's aren't really "controlled" by the government besides by a few laws, regardless of specialty.

If you are talking about how things like Medicare/Medicaid are run, that's a different story. It's far from physician "control" though.

Agreed. On the other hand, there's the very real problem of corporate control/interference in the practice of medicine.

 

[kk123]

This question makes no sense. Physician's aren't really "controlled" by the government besides by a few laws, regardless of specialty.

If you are talking about how things like Medicare/Medicaid is run, that's a different story. It's far from physician "control" though.

Yes, that's more what I was talking about. I wasn't really sure how to word it. It's just really worrying me. I hear about physicians retiring early because of how things are going politically, how there will be pay cuts for certain specialists, less jobs for certain specialties, etc. Also, it seems like patients are bound to only receive care for whatever medicare/medicade will pay for. I don't want to provide subpar care or no care because a patient couldn't afford it.

 

[Cyberdyne 101]

http://mobile.nytimes.com/blogs/well/2012/10/01/when-doctors-stop-taking-insurance/

 

[NickNaylor]

As darkjedi mentioned, "control" is really exerted at the level of third party payers rather than overt regulation. In other words: the gubment and private insurers exert control over physicians by dictating what will or won't be reimbursed and the hurdles necessary to receive that reimbursement, not by telling you "do this but not that." However, keep in mind there is still the concept of standard of care, which you might consider as some kind of "control," though the intent is really to ensure that a minimal level of care is provided by physicians in a given set of circumstances. By not following standard of care you open yourself up to malpractice concerns.

Thus, the best way to avoid this kind of "control" (I think the better word might be "influence") is to avoid taking third party insurers as reimbursement for your services. Some specialties are better able to do this than others, but for those with an entrepreneurial spirit and a willingness to be creative with how you set up your practice, it can be feasible in the more traditional fields like FM, peds, IM, etc..

 

[kk123]

Agreed. On the other hand, there's the very real problem of corporate control/interference in the practice of medicine.

So private practice would probably give a physician more independent control? I don't want to come across as a control freak, but I seriously do want to be able make decisions about patient care without a lot of control over I take care of patients. (One reason why I want to be a doctor and not a nurse.)

 

[DermViser]

Derm.
Plastic Surgery.
Any field that reasonably allows for ownership of a facility.
Also delving into cash-only cosmetic work, which you can easily do in almost any field.

I would also add Psych to that list - outpatient based, ability to go cash pay, ability to work in private practice.

 

[kk123]

As darkjedi mentioned, "control" is really exerted at the level of third party payers rather than overt regulation. In other words: the gubment and private insurers exert control over physicians by dictating what will or won't be reimbursed and the hurdles necessary to receive that reimbursement, not by telling you "

Thus, the best way to avoid this kind of "control" (I think the better word might be "influence") is to avoid taking third party insurers as reimbursement for your services. Some specialties are better able to do this than others, but for those with an entrepreneurial spirit and a willingness to be creative with how you set up your practice, it can be feasible in the more traditional fields like FM, peds, IM, etc..

Yes, this is what I am most worried about. My family has always had trouble with our insurance not paying for healthcare and consequently, we did not receive optimal treatment. I would like to provide optimal treatment for patients even if their insurance doesn't cover everything or they don't have insurance. I don't know if that is even possible. Do the doctors you were talking about have that capability?

 

[Crookster]

My current family physician just switched over to cash only. He's charging $2,000 a year and $1,500 for any additional family member and only taking 400 patients total. With the $2,000 you get pretty much everything covered. If things work out for him he should be grossing about $700,000 or so and then netting at least 40% of that I would guess. So as previously stated any specialty that allows you to set up your own practice would be your best bet.

 

[kk123]

My current family physician just switched over to cash only. He's charging $2,000 a year and $1,500 for any additional family member and only taking 400 patients total. With the $2,000 you get pretty much everything covered. If things work out for him he should be grossing about $700,000 or so and then netting at least 40% of that I would guess. So as previously stated any specialty that allows you to set up your own practice would be your best bet.

That's a pretty sweet deal for him if that works out! But would malpractice insurance be pretty high if you own your own practice?

 

[WhippleWhileWeWork]

Cash is king.

 

[Crookster]

That's a pretty sweet deal for him if that works out! But would malpractice insurance be pretty high if you own your own practice?

Yeah I mean I would think he would still keep paying his same malpractice insurance with the new transition (I doubt it would fluctuate for just switching to cash only). Overall, I think he is just sick of the insurance companies jerking him around as of recent *cough- obamacare* and not getting reimbursed as he should and having to fill out countless extra hours of paperwork for these insurance companies & gov't. By going cash only you hope to gain 1.) freedom from insurance companies and paperwork and less daily headaches and stresses that go along with that 2.) better profit margins but you risk your clientele and if all your patients leave becasue they don't want to pay out of pocket your SOL. So im guessing cash only business only works under cartain cirumstances/specialties and location probably has something to do with it as well. If things keep continuing they they are I think you are going to see a lot more family care and other privately run specialties for that matter switch to cash only.

 

[theseeker4]

That's a pretty sweet deal for him if that works out! But would malpractice insurance be pretty high if you own your own practice?

If anything, liability would be limited by having such a limited number of patients. My guess is it would cost the same, since malpractice insurance companies can get away with charging the same, but as far as additional risk, there is no increase in risk due to accepting cash only, not from a malpractice viewpoint anyway....

 

[kk123]

If anything, liability would be limited by having such a limited number of patients. My guess is it would cost the same, since malpractice insurance companies can get away with charging the same, but as far as additional risk, there is no increase in risk due to accepting cash only, not from a malpractice viewpoint anyway....

I meant would the cost of malpractice insurance be different if you own your own practice rather than work under someone else?

 

[theseeker4]

I meant would the cost of malpractice insurance be different if you own your own practice rather than work under someone else?

Depends on how you look at it....If you work for a hospital, you may be receiving "free" malpractice coverage, or partly paid for by your employer, but at the same time, you are not receiving all the money being billed for what you do. The hospital is either taking a significant cut of what you are billing for, or they are taking everything and simply paying you a salary. In that way, your malpractice coverage is not costing you less, there is simply a different process for your paying for the coverage. Now, there might be a discount on your individual malpractice coverage by working for a hospital, since they are absorbing some of the liability, but that is a different matter from comparing a cash-only practice to a practice that accepts insurance and/or medicare medicaid. Both of the latter are private practices, and in both cases the physician has to cover all the overhead, insurance, etc. The difference there is whether they accept insurance or only cash. Private practice doesn't mean the physician doesn't accept insurance, it simply means the physician isn't an employee of a hospital/etc.

 

[Crookster]

Depends on how you look at it....If you work for a hospital, you may be receiving "free" malpractice coverage, or partly paid for by your employer, but at the same time, you are not receiving all the money being billed for what you do. The hospital is either taking a significant cut of what you are billing for, or they are taking everything and simply paying you a salary. In that way, your malpractice coverage is not costing you less, there is simply a different process for your paying for the coverage. Now, there might be a discount on your individual malpractice coverage by working for a hospital, since they are absorbing some of the liability, but that is a different matter from comparing a cash-only practice to a practice that accepts insurance and/or medicare medicaid. Both of the latter are private practices, and in both cases the physician has to cover all the overhead, insurance, etc. The difference there is whether they accept insurance or only cash. Private practice doesn't mean the physician doesn't accept insurance, it simply means the physician isn't an employee of a hospital/etc.

Well Put!

 

[allantois]

Dentistry. The government will never mandate you to fix people's teeth.

 

[Gauss44]

Yes, that's more what I was talking about. I wasn't really sure how to word it. It's just really worrying me. I hear about physicians retiring early because of how things are going politically, how there will be pay cuts for certain specialists, less jobs for certain specialties, etc. Also, it seems like patients are bound to only receive care for whatever medicare/medicade will pay for. I don't want to provide subpar care or no care because a patient couldn't afford it.

Many doctors don't accept "poor people/government insurance"... Low reimbursement rates.

Patients: "No one takes my insurance."

Currently, doctors don't "HAVE TO" accept medicare or medicaid unless they are in emergency medicine, or work for a health center (like Fenway Health Center in Boston) that requires them to. (There might be a couple other exceptions, but I think this about covers it.

The problem with insurance designed for the poor has always been that most doctors don't accept it due to low reimbursement rates. As a result, poor people often cannot get the care they need despite having government insurance policies like medicaid or masshealth.