What would you do if physicians' income dropped to 70K

[Yipster32]

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Continue to med school, and still b a physician....if ur heart is into medicine like mine.

 

[OB1]

Ah yes, Germany: the land of the kielbasa, bratwurst, and pint-sized lagers... I don't know what the average life expectancy is over there but a diet of this sort would no doubt lead to a gradual quickening of an average person's life. I would hazard a guess than in countries like Libya, where death commonly comes quicker via injuries from rocket-propelled grenades and other forms of firearms as opposed to an infarct, the life expectancy in those countries is even shorter. That said, doctors there are only as useful as someone giving the stricken their last rites as opposed to actually saving them. Make sense? Hope so...

One of our graduated cyto fellows started at 240K with her new job this year, and she'll be making well over 300K after three years. Our other cyto fellow makes a bit less... but he only works Monday-Thursday. If you look at any of the available physician salary surveys you'll find that median pathology salaries are in the vicinity of 240K (and skewed downward somewhat by the folks in academics).

Anyways, if you have a better number, feel free to post it and demonstrate where you obtained it. During last year's physician strike in Germany, Spiegel published this comparison of average hospital physician salaries (which, if you'll note, gives a higher average salary than I previously assumed):

No, my point is that people are throwing around this 5% figure but I haven't seen any substantiation of its validity. If you can point to some supporting data, again, feel free.

 

[YupGypsy]

law, is your real name nicholas?

 

[TheMightyAngus]

You want to talk about your superior experience, well hey I did four years of missionary work to the poor after highschool and I only came out of that loving them more for it.

Where's the emoticon for 'throws up in mouth a little?'

 

[Gut Shot]

Btw Gutsgot, I think I am going to add the U.K to the list of countries I plan on bailing to if the American ship starts to sink(and I cant find a way to enslave my own crew of idealist doctors), but I heard they protect their turf like crazy. Is this true?

Yes, it is true nowadays. Back before the UK's private system started to take root, German docs (particularly surgeons) could go there with relative ease and make a nice living. Britain has, in the meantime, started to significantly shift the structure of its healthcare system (which has included moves toward privatization along with increased funding of the NHS). Essentially they're tired of being one of the world's poster children for lousy healthcare delivery, and part of their newfound self-respect has included circling the wagons against foreign physicians. I believe their implicit goal is to "re-Britify" their healthcare workforce.

My advice is to stash money as fast as possible and then, if you really have to jump ship, head to New Zealand. The pay isn't great, but the country is beautiful, the atmosphere is laid back, and the chicks dig Americans.

 

[medicward]

Huh? Without equipment it's all just BLS (basic life support). I don't know why you think that EM and CCM physicians don't know how to do BLS. If I were in an MVA in the middle of nowhere I'd much rather have an Emergency Physician happen by without any equipment than a paramedic without any.

You poor, poor soul....

Truthfully, here's what both would do in the situation you listed.

1) Call 9-1-1
2) Maintain an open airway, if necessary, and control any significant breathing or bleeding issues.
3) Encourage you not to move.
4) Pray the paramedics with the equipment hurry the heck up and get there

If you think the ED doc is going to break out a pen to secure your airway, or pull some other David Copperfield, super secret squirrel EM technique that a paramedic would never dream of, then you obviously watch way too much TV.

Besides, good paramedics rarely get caught in the middle of nowhere without at least some equipment.

You don't need that much equipment to do ACLS or ATLS anyways. You certainly don't need a ventilator or a fancy pumps.

Exactly which part of ACLS, or ATLS, do you not need "much equipment" for? I've been an ACLS instructor for over a decade. Can't remember any of the skills areas that don't require "much equipment." Maybe your thinking of BCLS, where a good set of lungs and a strong back are all that are necessary.

Just because the critical care doctor or the EM attending is standing around giving orders while the tech is giving chest compressions doesn't mean that they don't know what they're doing or that the tech is in charge.

You're only partially right. Many EM and CCM docs certainly know how to do BLS. I've even witnessed it. Most, however, refrain from doing CPR because they are busy deciding on the treatment pathways for the cardiac arrest. Many, however do not remember. Doesn't make them any less of a doctor. That's why the ED's and CCU's are team-based environements.

The paramedics, you seem quick to disrepect, often work cardiac arrests where there are the only person who is doing compressions, monitoring an airway, deciding on treatment modalities and enacting those treatment plans through the administration of cardiac or other drugs or other necessary interventions.

I'm betting from your statements you've never worked in the ED, nor have you ever been EMS certified in anything. It's okay, though. When you become a doctor someday, there will be a nurse, paramedic or "tech" there to bail you out when you forget your BLS, too. (BTW its 30-to-2 now.)

Just my $0.02 and sorry for the late chime-in. Just struck a nerve.

 

[gujuDoc]

this is a really good debate.

I still stand that the government steps in and caps actors' incomes before they consider regulating physicians'.

AGREED!!

 

[gujuDoc]

You poor, poor soul....

Truthfully, here's what both would do in the situation you listed.

1) Call 9-1-1
2) Maintain an open airway, if necessary, and control any significant breathing or bleeding issues.
3) Encourage you not to move.
4) Pray the paramedics with the equipment hurry the heck up and get there

If you think the ED doc is going to break out a pen to secure your airway, or pull some other David Copperfield, super secret squirrel EM technique that a paramedic would never dream of, then you obviously watch way too much TV.

Besides, good paramedics rarely get caught in the middle of nowhere without at least some equipment.



Exactly which part of ACLS, or ATLS, do you not need "much equipment" for? I've been an ACLS instructor for over a decade. Can't remember any of the skills areas that don't require "much equipment." Maybe your thinking of BCLS, where a good set of lungs and a strong back are all that are necessary.



You're only partially right. Many EM and CCM docs certainly know how to do BLS. I've even witnessed it. Most, however, refrain from doing CPR because they are busy deciding on the treatment pathways for the cardiac arrest. Many, however do not remember. Doesn't make them any less of a doctor. That's why the ED's and CCU's are team-based environements.

The paramedics, you seem quick to disrepect, often work cardiac arrests where there are the only person who is doing compressions, monitoring an airway, deciding on treatment modalities and enacting those treatment plans through the administration of cardiac or other drugs or other necessary interventions.

I'm betting from your statements you've never worked in the ED, nor have you ever been EMS certified in anything. It's okay, though. When you become a doctor someday, there will be a nurse, paramedic or "tech" there to bail you out when you forget your BLS, too. (BTW its 30-to-2 now.)

Just my $0.02 and sorry for the late chime-in. Just struck a nerve.

All I'm going to say is

Do your research before you make your assumptions. You might be surprised.

 

[gujuDoc]

Ah-Haaah!!!! I knew you would slip up sooner or later!...The Office is on and I gotta go.

He's never disguised that he was a cynic so I don't see how he's slipped up. But if you say so.

 

[DropkickMurphy]

You poor, poor soul....

Truthfully, here's what both would do in the situation you listed.

1) Call 9-1-1
2) Maintain an open airway, if necessary, and control any significant breathing or bleeding issues.
3) Encourage you not to move.
4) Pray the paramedics with the equipment hurry the heck up and get there

If you think the ED doc is going to break out a pen to secure your airway, or pull some other David Copperfield, super secret squirrel EM technique that a paramedic would never dream of, then you obviously watch way too much TV.

Besides, good paramedics rarely get caught in the middle of nowhere without at least some equipment.



Exactly which part of ACLS, or ATLS, do you not need "much equipment" for? I've been an ACLS instructor for over a decade. Can't remember any of the skills areas that don't require "much equipment." Maybe your thinking of BCLS, where a good set of lungs and a strong back are all that are necessary.



You're only partially right. Many EM and CCM docs certainly know how to do BLS. I've even witnessed it. Most, however, refrain from doing CPR because they are busy deciding on the treatment pathways for the cardiac arrest. Many, however do not remember. Doesn't make them any less of a doctor. That's why the ED's and CCU's are team-based environements.

The paramedics, you seem quick to disrepect, often work cardiac arrests where there are the only person who is doing compressions, monitoring an airway, deciding on treatment modalities and enacting those treatment plans through the administration of cardiac or other drugs or other necessary interventions.

I'm betting from your statements you've never worked in the ED, nor have you ever been EMS certified in anything. It's okay, though. When you become a doctor someday, there will be a nurse, paramedic or "tech" there to bail you out when you forget your BLS, too. (BTW its 30-to-2 now.)

Just my $0.02 and sorry for the late chime-in. Just struck a nerve.

"Medicward, SDN Center.....turn right 2-6-0 and descend one four thousand."

 

[NickRiviera]

Alright! A new "EMS Guru" to sink my teeth into. Who is this medicward guy anyway? He says he's a medic shooting for med school but he reminds me of how older medics get...

 

[DropkickMurphy]

Alright! A new "EMS Guru" to sink my teeth into. Who is this medicward guy anyway? He says he's a medic shooting for med school but...

You've got my backup on this one (after Panda gets done trimming his ego down to size) if you want it Nick.

 

[NickRiviera]

You've got my backup on this one (after Panda gets done trimming his ego down to size) if you want it Nick.

Sounds good to me

 

[gujuDoc]

You've got my backup on this one (after Panda gets done trimming his ego down to size) if you want it Nick.

Ooh I'm with you guys on this one!!!

I can't wait to see Panda's response.

 

[8744]

You poor, poor soul....

Truthfully, here's what both would do in the situation you listed.

1) Call 9-1-1
2) Maintain an open airway, if necessary, and control any significant breathing or bleeding issues.
3) Encourage you not to move.
4) Pray the paramedics with the equipment hurry the heck up and get there

If you think the ED doc is going to break out a pen to secure your airway, or pull some other David Copperfield, super secret squirrel EM technique that a paramedic would never dream of, then you obviously watch way too much TV.

Besides, good paramedics rarely get caught in the middle of nowhere without at least some equipment.



Exactly which part of ACLS, or ATLS, do you not need "much equipment" for? I've been an ACLS instructor for over a decade. Can't remember any of the skills areas that don't require "much equipment." Maybe your thinking of BCLS, where a good set of lungs and a strong back are all that are necessary.



You're only partially right. Many EM and CCM docs certainly know how to do BLS. I've even witnessed it. Most, however, refrain from doing CPR because they are busy deciding on the treatment pathways for the cardiac arrest. Many, however do not remember. Doesn't make them any less of a doctor. That's why the ED's and CCU's are team-based environements.

The paramedics, you seem quick to disrepect, often work cardiac arrests where there are the only person who is doing compressions, monitoring an airway, deciding on treatment modalities and enacting those treatment plans through the administration of cardiac or other drugs or other necessary interventions.

I'm betting from your statements you've never worked in the ED, nor have you ever been EMS certified in anything. It's okay, though. When you become a doctor someday, there will be a nurse, paramedic or "tech" there to bail you out when you forget your BLS, too. (BTW its 30-to-2 now.)

Just my $0.02 and sorry for the late chime-in. Just struck a nerve.

Dear Medicward,

I'll keep your advice in mind the next time I am standing at the head of the bed directing the resuscitation of a patient.

Sincerely,

P. Bear, MD
PGY-2, Emergency Medicine
PALS, NALS, ACLS, ATLS Certified and usin' every day, baby!

(Uh, and EMT-B)

 

[8744]

Seriously though, the contention of the post I referenced was that without equipment, CCM physicians and EM physicians would be helpless which is not true. Go back and re-read what I said. I know BLS and ACLS as well as any paramedic (if not better) and I don't think (although I could be wrong) that paramedics do ATLS training because it involves invasive procedures (DPL, Chest Tubes, Thoracotomies) that they are not allowed to do.

Look, I have six years of training. I respect paramedics, cops, firefighter, and EMTs and they are all part of the team but I am being trained to be in charge of the team. Okay? (And I say this with humility and as a guy who doesn't always have to be in charge of everything. It's a lot easier to be the tech giving compressions because you, at least, have a simple, useful job that is easy to figure out.)

As for equipment, for ACLS all you need is laryngoscope, a few airways,a defibrilltor, a BVM, some drugs, and a couple of IVs. It's hardly a critical care set-up which is what you imply us dumb-as-dirt physicians need.

This is the classic "I know more than the doctor because my education didn't include all of that superfluous anatomy n' pathology stuff" gambit.

 

[8744]

Let me also add that the difference between a paramedic, an EMT, a tech or what-have-you and me is that you guys follow protocols from which you are not allowed to deviate.

I, on the other hand, have "guidelines" (ACLS is a guideline) and am free to use my clinical judgment at any point to deviate, modify, ammend, bend, spindle, or mutilate said guideline. I'd need a good reason and I might have to justify it later but there it is.

 

[8744]

You poor, poor soul....

Truthfully, here's what both would do in the situation you listed.

1) Call 9-1-1
2) Maintain an open airway, if necessary, and control any significant breathing or bleeding issues.
3) Encourage you not to move.
4) Pray the paramedics with the equipment hurry the heck up and get there

If you think the ED doc is going to break out a pen to secure your airway, or pull some other David Copperfield, super secret squirrel EM technique that a paramedic would never dream of, then you obviously watch way too much TV.

Besides, good paramedics rarely get caught in the middle of nowhere without at least some equipment.



Exactly which part of ACLS, or ATLS, do you not need "much equipment" for? I've been an ACLS instructor for over a decade. Can't remember any of the skills areas that don't require "much equipment." Maybe your thinking of BCLS, where a good set of lungs and a strong back are all that are necessary.



You're only partially right. Many EM and CCM docs certainly know how to do BLS. I've even witnessed it. Most, however, refrain from doing CPR because they are busy deciding on the treatment pathways for the cardiac arrest. Many, however do not remember. Doesn't make them any less of a doctor. That's why the ED's and CCU's are team-based environements.

The paramedics, you seem quick to disrepect, often work cardiac arrests where there are the only person who is doing compressions, monitoring an airway, deciding on treatment modalities and enacting those treatment plans through the administration of cardiac or other drugs or other necessary interventions.

I'm betting from your statements you've never worked in the ED, nor have you ever been EMS certified in anything. It's okay, though. When you become a doctor someday, there will be a nurse, paramedic or "tech" there to bail you out when you forget your BLS, too. (BTW its 30-to-2 now.)

Just my $0.02 and sorry for the late chime-in. Just struck a nerve.

You know what? Strike my previous posts. You're an idiot.

 

[gujuDoc]

You know what? Strike my previous posts. You're an idiot.

Except don't strike out Panda's signature on the first post because it might do you some good to keep in mind that perhaps some day you'll be working with him in the Emergency Dept. seeing how he's already where most of us want to be.

 

[8744]

I think I understand what people mean by "paragod" as it applies to Medicward. Give a guy eight months of training in a limited job that he can master in that amount of time, cut him loose to do it, and it's no wonder he believes himself to be the master of his universe as he is operating independently with nobody looking over his shoulder but an EMT-B or two. This kind of thing leads to an understandable but dangerous arrogance of a kind that also afflicts mid-level providors who know enough to do their job but not enough to know their limitations.

Physicians get a bad rap for being arrogant. Take my training. Not counting first and second year of medical school, I have been getting clinical training for the last four years and have two more to go. Although I have been making steady progress, there is not a day that goes by when I am not humbled by the limits of my knowledge and abilities and I am continuously supervised by attendings and senior residents whose job is to make sure I am trained to a level that I can be trusted to practice without supervision.

Not to mention that I am scrutinized by everybody in the department from the techs to the PAs and everybody in between who are ready to offer their advice in their own limited areas of expertise, advice that I take humbly and without rancor. I asked the phlebotimist, for example, to give me pointers on starting IVs and I learned to intubate by coaching from our respiratory therapists.

So the idea that I'm going to have to be "bailed out" by the support staff while I stand around sheepishly with my thumb in my ass is laughable. It's a team, we work together, but, like I said, I am being trained to be in charge of the team. Lord knows that your Uncle Panda is not the biggest fan of the medical profession or medical training but there is a huge difference between the level of training of an Emergency Medicine attending and a paramedic. If it makes me arrogant to point this out then so be it.

 

[jillibean]

I think if anyone deserves a pay cut its the RNs. Their average salary hovers around 60K+ for an associates degree and in many hospitals they are only resposible for 3-4 patients. Plus one study estimated that there are 8.7 RN working per 1000 people in the population, so by Gut Shots logic they are eating up a larger piece of the heath care pie than the MDs.... but still they whine incessantly about being underpaid and undervalued. Please, what do you expect for two years of education beyond high school.....

 

[Gospe1]

I think the essence of the question is would you still be a doctor without its financial benefits. To be realistic i know that:
1. I love medicine
2. I don't like the fact that you start practicing at 27-29
3. I don't like the debt, the stress, the paperwork
4. I like the salary, job security, and over satisfaction.

Unfortunately, one of the primary reasons for me to become a doctor, that is financial security, is now unavaliable with 70k salary. For me, its unacceptable to have to train that hard and be in so much debt with 70k salary. I'm not sure there is a calling where i would make that sacrifice. I feel like realistically, the SDN would be nearly empty that this happened.

 

[sunnyjohn]

I think if anyone deserves a pay cut its the RNs. Their average salary hovers around 60K+ for an associates degree and in many hospitals they are only resposible for 3-4 patients. Plus one study estimated that there are 8.7 RN working per 1000 people in the population, so by Gut Shots logic they are eating up a larger piece of the heath care pie than the MDs.... but still they whine incessantly about being underpaid and undervalued. Please, what do you expect for two years of education beyond high school.....

WHAT THE HELL????

*Sunny practices deep breathing so she won't loose her cool and get her butt banned!!!*

 

[ryandote]

It's unreasonable, however, for the current cost of education to be the same while cutting the average income of physicians. I doubt this could be successfully maintained....

It doesn't have to be successfully maintained. It only has to happen to about 5 years of graduating classes until market forces equalize costs/benefits.......it would really blow goats to be one of the suckers that gets screwed, though

 

[atomi]

I was just wondering if you guys will still try to go to medschool, quit medicine if you are already doctors, or work while whinning?

Assuming tuition and interest rates stayed the same, anybody who knows anything about finance would tell you that is an extremely poor return on investment. If you don't believe me, talk to any recently graduated Ph.D. in the life sciences and see they you think that the 12 years they spent in school was worth it.

 

[atomi]

I think the essence of the question is would you still be a doctor without its financial benefits. To be realistic i know that:
1. I love medicine
2. I don't like the fact that you start practicing at 27-29
3. I don't like the debt, the stress, the paperwork
4. I like the salary, job security, and over satisfaction.

Unfortunately, one of the primary reasons for me to become a doctor, that is financial security, is now unavaliable with 70k salary. For me, its unacceptable to have to train that hard and be in so much debt with 70k salary. I'm not sure there is a calling where i would make that sacrifice. I feel like realistically, the SDN would be nearly empty that this happened.

Yes, there are other fields of medicine that allow you to satisfy (1) and would be more attractive options. But 70k certainly can provide financial security if managed intelligently - it is still a lot of money disregarding the time-valued cost of medical education. In regards to your second point, try to find an active message board like SDN for Ph.D. students in the sciences and humanities. Can't find one? Huh, isn't that interesting?