When did reimbursement go down

[Strider_91]

So on sdn and physician griping in general I hear physicians complaining about salaries going down. I am sure we have all had that one person, or read an article that said how medical school is no longer a wise decision with the increasing cost of education and "decreasing salaries." With that said...

I have looked at the recent medscape physician compensation reports and almost every specialty has gone up since 2012, I think one or two went down. Most specialties were making more money than anyone I know personally (before interacting with doctors) and the top payed specialties were making really good money.

So why all this doom and gloom? What were these doctors making in the 80s and 90s where a 300k+/yr salary for more than half the specialties now is something to complain about? And a 200k salary is basically guarenteed for a full time worker in almost any specialty...

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[Dro133]

something something less $ for more work

 

[IlDestriero]

A good private practice workhorse anesthesia job could easily make you $600+ with a good payer mix and 8+ weeks of vaca. These jobs weren't particularly rare. Now Anesthesia Management Companies take your contract and offer the same work hours and call for 350- 400 without the fat benefits and advantages of owning the business, less vacation, and worse health/disability/retirement benefits. They restructure you and skim your profit while also negotiating a better rate with the insurance companies, and bill ~30% more than you could. That's a win:win for them and a lose:lose for you.
That $400 doesn't sound so great now, does it?


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Il Destriero

 

[Anti-PD1]

A good private practice workhorse anesthesia job could easily make you $600+ with a good payer mix and 8+ weeks of vaca. These jobs weren't particularly rare. Now Anesthesia Management Companies take your contract and offer the same work hours and call for 350- 400 without the fat benefits and advantages of owning the business, less vacation, and worse health/disability/retirement benefits. They restructure you and skim your profit while also negotiating a better rate with the insurance companies, and bill ~30% more than you could. That's a win:win for them and a lose:lose for you.
That $400 doesn't sound so great now, does it?


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Il Destriero

That's crazy. I think seasoned attendings should offer consulting services to new residency/fellowship graduates, to help them navigate contracts and advocate for themselves. This sounds like open season otherwise.

 

[Nikj]

That's crazy. I think seasoned attendings should offer consulting services to new residency/fellowship graduates, to help them navigate contracts and advocate for themselves. This sounds like open season otherwise.

Read this story in the EM forums, it's provides a good understanding of how physician compensation has and can go down. We've basically given up our bargaining power. The only thing that seems untouchable are plastics/derm cosmetics.

How Much Are YOU Actually Worth?

 

[Strider_91]

A good private practice workhorse anesthesia job could easily make you $600+ with a good payer mix and 8+ weeks of vaca. These jobs weren't particularly rare. Now Anesthesia Management Companies take your contract and offer the same work hours and call for 350- 400 without the fat benefits and advantages of owning the business, less vacation, and worse health/disability/retirement benefits. They restructure you and skim your profit while also negotiating a better rate with the insurance companies, and bill ~30% more than you could. That's a win:win for them and a lose:lose for you.
That $400 doesn't sound so great now, does it?


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Il Destriero

That sounds insanely awesome. I would like to have had that. That being said, there are MANY jobs that used to be way better than they are now; **** is hitting the fan across the board in America (thanks baby boomers).

Law used to be a golden ticket now the market is saturated and if you're not from a top 10 school or extremely lucky you're going to have a tough time paying off your loans.


Teachers never got paid great but they used to have great benefits in terms of health and pensions now they are increasing their premiums significantly every year, lowering their benefits, taking away protection of tenure, increasing bureaucratic bull**** worse than in medicine, and their pensions are going bankrupt (at least in my state).

The police officers in my state are actually killing it right now in terms of salary but pretty sure their pensions are going bankrupt too but everywhere else in the country people seem to hate them and want to make their job as miserable as possible.

Phd's in chem/ bio are in a saturated market according to my old teachers and If you don't come from a top program...good luck

Joining a manual labor union in NYC is probably a better financial decision than decision than becoming a primary care physician but they work hard and their body gets beat down (and you're not getting in unless you know somebody)...plus you're stuck in NYC where everything is expensive.

So yes, I wish I was going into the field during the good ol days but the baby boomers have basically destroyed every profession except for tech but that's only because it was in its infancy. If the tech boom happened earlier I'm sure they woulda found a way to ruin that too lol.

 

[IlDestriero]

That's crazy. I think seasoned attendings should offer consulting services to new residency/fellowship graduates, to help them navigate contracts and advocate for themselves. This sounds like open season otherwise.

The problem is that many people want to or "have to" work in specific desirable and saturated markets and they have limited options. If you want to work in a big city in the northeast for example, and can't use your networking and/or superstar status to get into the rare great jobs there, you settle for the 350-400 and think you're doing OK. After all, it's better than your buddy in academics starting at $275, right? (But that guy actually only takes 1 call/month vs your 4, works ~40 hours vs 60+/wk, gets better benefits, only covers 2-3 rooms at at time vs 3-4, and will be making 350+ in a few years). They do it to themselves.


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Il Destriero

 

[mimelim]

So on sdn and physician griping in general I hear physicians complaining about salaries going down. I am sure we have all had that one person, or read an article that said how medical school is no longer a wise decision with the increasing cost of education and "decreasing salaries." With that said...

I have looked at the recent medscape physician compensation reports and almost every specialty has gone up since 2012, I think one or two went down. Most specialties were making more money than anyone I know personally (before interacting with doctors) and the top payed specialties were making really good money.

So why all this doom and gloom? What were these doctors making in the 80s and 90s where a 300k+/yr salary for more than half the specialties now is something to complain about? And a 200k salary is basically guarenteed for a full time worker in almost any specialty...

The more time that I spend in and around private practice, the more I am convinced that physicians were over compensated in the past secondary to a lot of things. It was very easy in the past for physicians to setup practices that were absurdly profitable, even with extremely limited non-medical experience/know how. Turns out that there are a lot of non-physicians that are better at running businesses than physicians and have figured out how to drive healthcare.

 

[Nikj]

The more time that I spend in and around private practice, the more I am convinced that physicians were over compensated in the past secondary to a lot of things. It was very easy in the past for physicians to setup practices that were absurdly profitable, even with extremely limited non-medical experience/know how. Turns out that there are a lot of non-physicians that are better at running businesses than physicians and have figured out how to drive healthcare.

Do you mean under the guise of driving healthcare? They've certainly figured out how to make enormous profits off the work of healthcare providers while cutting costs at every corner, often decreasing quality of care. I don't think the direction of medicine should be business oriented, even if that is an unrealistic point of view.

 

[mimelim]

Do you mean under the guise of driving healthcare? They've certainly figured out how to make enormous profits off the work of healthcare providers while cutting costs at every corner, often decreasing quality of care. I don't think the direction of medicine should be business oriented, even if that is an unrealistic point of view.

You sound like someone who has spent their entire education/training in/around academic hospitals. How much time have you spent in/around private practice (how the majority of physicians practice)? Physicians cut corners. Physicians decrease quality of care based on compensation and their schedules. They are people, just like everyone else. They are no better and no worse. By the same token as administrators making enormous profits, physicians in the 80s/90s were doing the same thing. Now the money is simply going to a different group of people.

I'm not arguing any particular side, but the concept that healthcare is somehow the only field that is not financially driven or ever has been is incredibly naive.

 

[Nikj]

You sound like someone who has spent their entire education/training in/around academic hospitals. How much time have you spent in/around private practice (how the majority of physicians practice)? Physicians cut corners. Physicians decrease quality of care based on compensation and their schedules. They are people, just like everyone else. They are no better and no worse. By the same token as administrators making enormous profits, physicians in the 80s/90s were doing the same thing. Now the money is simply going to a different group of people.

I'm not arguing any particular side, but the concept that healthcare is somehow the only field that is not financially driven or ever has been is incredibly naive.

In all honesty I'm just a student, but as someone who will be a Physician one day I take a strong interest in these matters. I completely agree that even Physicians were/are concerned with cutting costs, but there's a difference between running things efficiently with costs in mind and an outright corporatization of medicine.

I meant that Physicians, as one poster mentioned, are now working longer hours, for less pay, with less power to change the system and the way care is delivered.

But that's exactly part of the issue here, how many intelligent minds will continue to be attracted to medicine if the compensation is not there? Thats in large part due to these "non-physicians."

 

[mimelim]

In all honesty I'm just a student, but as someone who will be a Physician one day I take a strong interest in these matters. I completely agree that even Physicians were/are concerned with cutting costs, but there's a difference between running things efficiently with costs in mind and an outright corporatization of medicine.

I meant that Physicians, as one poster mentioned, are now working longer hours, for less pay, with less power to change the system and the way care is delivered.

But that's exactly part of the issue here, how many intelligent minds will continue to be attracted to medicine if the compensation is not there? Thats in large part due to these "non-physicians."

What you are describing can be found in virtually every profession over time. Longer hours, less pay, less autonomy etc.

How many intelligent minds will continue going into medicine if compensation is not there? The compensation IS there. There is no other profession where being ****ty at the job will still drive you into the top 3-4% of all earners in the US. Something that is lost on many physicians because of their family backgrounds and lack of other employment experience is that making money is hard. Financial security is hard to get. Compensation is way higher across the board than virtually any other avenue in the US.

I am far from immune to the financial pressures of medical training, mostly for having entered a 7 year residency. And, like everyone, I would love to make more money. But, the financial struggles of the majority of the population are not lost on me. Outside of how much I love what I do, I wouldn't trade my financial situation for almost anyone that I know and I'm hard pressed to think of any physician that would disagree.

 

[Strider_91]

What you are describing can be found in virtually every profession over time. Longer hours, less pay, less autonomy etc.

How many intelligent minds will continue going into medicine if compensation is not there? The compensation IS there. There is no other profession where being ****ty at the job will still drive you into the top 3-4% of all earners in the US. Something that is lost on many physicians because of their family backgrounds and lack of other employment experience is that making money is hard. Financial security is hard to get. Compensation is way higher across the board than virtually any other avenue in the US.

I am far from immune to the financial pressures of medical training, mostly for having entered a 7 year residency. And, like everyone, I would love to make more money. But, the financial struggles of the majority of the population are not lost on me. Outside of how much I love what I do, I wouldn't trade my financial situation for almost anyone that I know and I'm hard pressed to think of any physician that would disagree.

This guy/gal gets it ^^

"No other job allows you to be ****ty at it and earn in the top 3-4% of Americans"

Also, people on here always say "go into finance if you want to make money" I literally LOL at that every time. So many of my friends tried going into finance and it is almost the equivalent of trying to hit the lottery unless you are a computer/ math genius from a top 3 school or you know a ton of rich people who will let you manage their money to begin with.

 

[AcademicNeurosurgery]

How many intelligent minds will continue going into medicine if compensation is not there? The compensation IS there. There is no other profession where being ****ty at the job will still drive you into the top 3-4% of all earners in the US. Something that is lost on many physicians because of their family backgrounds and lack of other employment experience is that making money is hard. Financial security is hard to get. Compensation is way higher across the board than virtually any other avenue in the US.

This is so important to remember. Many of the people in my class who complain or are concerned about compensation come from a family of physicians who have grown up with a white picket fence house, nice cars, plenty of vacations/gifts, eating out weekly, etc. Those, who like myself, are first generation to even go to college, care far less about compensation because we've seen how difficult it is to attain financial security. Hard work does not translate unequivocally into financial stability in practically every profession, except medicine. If you jump through all the hoops in medicine, you are guaranteed the opportunity to make a six-figure salary and attain financial security. That is simply not the case for >95% of the country.

 

[DrWhozits]

Physicians with 15+ years experience can complain about how medicine is worse than it used to be, but the fact is, most people on this site will never know the difference. It doesn't matter what people made in the 80s and 90s...you didn't practice then.

Similar to the use of EMR being the standard for people who graduate over the next few years rather than paper charts...this is the new normal. The fact still remains that being a physician in the US is still one of the most financially secure and stable jobs in the WORLD. And unless there is a cataclysmic event that cuts pay by 50% (which would still pay the average physician $100-150k+) it will continue to be.

If you want to be disgustingly rich, go to Wall Street. But I promise, more people fail there than in medicine (assuming you graduate and stuff).

**steps off soap-box**

 

[cellsaver]

Physicians with 15+ years experience can complain about how medicine is worse than it used to be, but the fact is, most people on this site will never know the difference.

**steps off soap-box**

stay on the soap box. this is a good topic to discuss for future docs and present young ones (under 40).

There are many things one can do with an MD Degree. Many. Working for a hospital or a medical group are very limiting ways. It sets up a trap for the employed physician, stifles their possibilities, leads them to hopelessness. They become a monkey on a chain - dancing to the tune of another player. Additionally, it puts another in the payer seat; the physician put herself/himself in a position of little to no control of their income. This is completely antithetical to being a physician, at least historically globally.

If you are happy with the medical business landscape as it is played today, then stay in it. However, if you think the sky is falling (and it is) in the current medical business environment, get out of that paradigm.
With the health care sector accounting close to 20% of the USA GDP, third party payers and CMS are going to rule you - if they haven't already. You are essentially studying/training for them. You are beholden to "the man" above. That need not be the case.

Talk to your business attorney or CPA. Dream big and draw up a plan. You don't need an MBA Degree but you need to start dreaming again....and take action

 

[DrWhozits]

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[ChordaEpiphany]

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[dottorone]

One quick thing to point out is that while you can be "****ty" at the job, even the worst physicians worked their asses off to get here, and in almost any other profession they'd be fantastic at their jobs with that level of effort. I actually spoke with some classmates last night about this and nearly all of us had offers and career tracks elsewhere that, while not as profitable as the top of medicine in the long run, would have been quite close and a far better value, and certainly better than primary care or the lower paying specialties. Off the top of my head there was a guy making six figures at 24 in insurance and a girl making six figures in pharma, and personally I was told I was on track for $200K+ by 30 if I stayed in pharma. The one thing we all agreed on was that expectations were far, far lower in those industries. Really only top tier consulting and I-banking compare in terms of the time sacrifice up front, and those at least allow you to make significant salary on the way there instead of incurring massive debt. I'd be far happier putting in 16 hour days or 24 hour shifts if I got to come home to a luxury apartment in the nicest part of the city and enjoy a bougie lifestyle in whatever time I had off.

The point of this is basically that medical training today is setup such that it is one of the most mentally demanding professions with the highest level of sacrifice. You cannot compare yourself to a police officer or a run-of-the-mill office worker. While it's not true for everyone, most of us had options. The talent pool for physicians is the same as that for lawyers (from top programs), computer scientists, Wall Street traders/I-bankers, etc... With the level of sacrifice required, we're already driving away plenty of top talent despite the salaries.

At the end of the day, society can have 1 of 2 things: physicians who come from the top of the talent pool or physicians who make less money. As long as people want the person in charge of their mother/father/children/spouse's life to be the high school valedictorians who slaved away training for 10+ years and not the average guy who slid by racking up B's and smoking weed behind the dumpster, we should keep paying physicians in line with other top level professionals (and more to make up for the horrendous lifestyle and debt incurred during the training years).

Enter the 'providers' whose white coats deign physician parity in the patients eyes in turn putting $s into health systems pockets as they charge the same for a visit and pay less to the 'practitioner'.

 

[cellsaver]

.......the most mentally demanding professions with the highest level of sacrifice....

is being a loving mother, a loving wife, the calm eye of the storms of life for the family and look fabulous while pulling it all off. That my dear is the most mentally demanding career with the highest level of sacrifice.

 

[ChordaEpiphany]

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[Stagg737]

What you are describing can be found in virtually every profession over time. Longer hours, less pay, less autonomy etc.

How many intelligent minds will continue going into medicine if compensation is not there? The compensation IS there. There is no other profession where being ****ty at the job will still drive you into the top 3-4% of all earners in the US. Something that is lost on many physicians because of their family backgrounds and lack of other employment experience is that making money is hard. Financial security is hard to get. Compensation is way higher across the board than virtually any other avenue in the US.

I am far from immune to the financial pressures of medical training, mostly for having entered a 7 year residency. And, like everyone, I would love to make more money. But, the financial struggles of the majority of the population are not lost on me. Outside of how much I love what I do, I wouldn't trade my financial situation for almost anyone that I know and I'm hard pressed to think of any physician that would disagree.

I mostly agree with what you're saying but if we're going to talk about the financial aspect of medicine, we can't ignore the risk vs. reward issue and the cost of becoming a physician, which simply doesn't exist in almost any other profession. @ChordaEpiphany touched on it a bit, but there are many other careers where one can safely make 6 figures without investing an extra 4 years (minimum) and $200k+ just to have a shot at getting into a field you want, which is something that physicians 30 years ago in the 80's and 90's didn't have to deal with. I've talked to multiple ortho guys who did their residency in the 80's that said they pretty much just walked into residency without worrying about not matching or having to enter a different field. It seems like even the mildly competitive fields today are more competitive than the top fields in the 80's.

Add on that back then docs were graduating with 50k or less in debt and significantly lower interest rates and the risk side of medicine is a completely different game than it was back then. Given the setup of med school, a doc could easily get into their desired field and pay off their student loans in a single year while still living comfortably, that's just not realistic today and many med students wonder if they'll have to choose between living like a resident for the next 15-20 years or just have massive debt hanging over them. So while I agree the reward side is still as good if not better than it's always been, the risk side of the equation has gotten significantly worse and I think this is why many of the older docs say medicine just isn't worth it anymore.

Another thing to point out is the difference between income and spending power. Again, I agree that there are few jobs out there that have the level of income, job security, and general opportunity as medicine. However, that "risk" side of the equation with massive debt and high interest rates significantly impacts the spending power of physicians. A while ago someone (I believe it was WhiteCoatInvestor) did an analysis of the average physicians spending power and it was far worse than most people here lead on. The most striking thing I saw was that the average physician actually had less spending power than a plumber or electrician (who average around 50k/year) until they were in their late 50's. Considering the amount of sacrifice, time, and financial investment that is required to start making physician salary in a person's early to mid thirties, few people want to spend the next 20-25 years with restrictive spending power and worrying about "catching up" financially. The process of becoming a physician and the current financial situation of docs is a completely different landscape than it has ever been, and it's something that the guys in the 80's and 90's just didn't have to worry about.

I'm not saying that being a physician isn't a good deal financially or that we should be preparing for the apocalypse, but I absolutely believe that we should be cognizant of the changing landscape of healthcare and take steps to ensure that the profession is protected. Given the amount of financial and personal sacrifice required to become a physician, I think it's worth

is being a loving mother, a loving wife, the calm eye of the storms of life for the family and look fabulous while pulling it all off. That my dear is the most mentally demanding career with the highest level of sacrifice.

Several of my classmates who are medical students and mothers would disagree with you. I'm not saying being a parent isn't difficult or that it doesn't require sacrifice, but you're really comparing apples to organs there.

 

[cellsaver]

"These mothers are bending over at the waist, putting DVDs into DVD players. I don't know how they do it!"

and giving us millennials who are entitled about everything

Histology? Buy/study Textbooks? Attend ledtures?

Gimme FA and Im gud wif dat

My husband and I went for a walk this morning with our dog before church (Palm Sunday is today). We saw a flyer stapled to a telephone pole urging readers to "resist", "fight", "rebel" against "authority", blah blah blah. My husband said wryly: "they probably live with their parents and are on public assistance", and we laughed.

you can ban me now.

Happy Easter

 

[PathoTurnUp1865]

Future makes trap houses sound like a lucrative investment. May be able to offset that hundo we are all missing out on now. :/

 

[ChordaEpiphany]

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[Strider_91]

I mostly agree with what you're saying but if we're going to talk about the financial aspect of medicine, we can't ignore the risk vs. reward issue and the cost of becoming a physician, which simply doesn't exist in almost any other profession. @ChordaEpiphany touched on it a bit, but there are many other careers where one can safely make 6 figures without investing an extra 4 years (minimum) and $200k+ just to have a shot at getting into a field you want, which is something that physicians 30 years ago in the 80's and 90's didn't have to deal with. I've talked to multiple ortho guys who did their residency in the 80's that said they pretty much just walked into residency without worrying about not matching or having to enter a different field. It seems like even the mildly competitive fields today are more competitive than the top fields in the 80's.

Add on that back then docs were graduating with 50k or less in debt and significantly lower interest rates and the risk side of medicine is a completely different game than it was back then. Given the setup of med school, a doc could easily get into their desired field and pay off their student loans in a single year while still living comfortably, that's just not realistic today and many med students wonder if they'll have to choose between living like a resident for the next 15-20 years or just have massive debt hanging over them. So while I agree the reward side is still as good if not better than it's always been, the risk side of the equation has gotten significantly worse and I think this is why many of the older docs say medicine just isn't worth it anymore.

Another thing to point out is the difference between income and spending power. Again, I agree that there are few jobs out there that have the level of income, job security, and general opportunity as medicine. However, that "risk" side of the equation with massive debt and high interest rates significantly impacts the spending power of physicians. A while ago someone (I believe it was WhiteCoatInvestor) did an analysis of the average physicians spending power and it was far worse than most people here lead on. The most striking thing I saw was that the average physician actually had less spending power than a plumber or electrician (who average around 50k/year) until they were in their late 50's. Considering the amount of sacrifice, time, and financial investment that is required to start making physician salary in a person's early to mid thirties, few people want to spend the next 20-25 years with restrictive spending power and worrying about "catching up" financially. The process of becoming a physician and the current financial situation of docs is a completely different landscape than it has ever been, and it's something that the guys in the 80's and 90's just didn't have to worry about.

I'm not saying that being a physician isn't a good deal financially or that we should be preparing for the apocalypse, but I absolutely believe that we should be cognizant of the changing landscape of healthcare and take steps to ensure that the profession is protected. Given the amount of financial and personal sacrifice required to become a physician, I think it's worth



Several of my classmates who are medical students and mothers would disagree with you. I'm not saying being a parent isn't difficult or that it doesn't require sacrifice, but you're really comparing apples to organs there.

There's no way a plumber making 50k has a greater spending power than a physician making 300k. Maybe if you factor in the total spending power up until that point when the physician is making the 300 but most people making 50k are not saving that well either. It is far easier to live on 80k and save 120k/yr to catch up your savings than to live on 30 or less and save 10k, yr. at least for me I'd take the higher paycheck later in life every time. Its so much easier to be poor when you're young.

 

[ChordaEpiphany]

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[ChrisMack390]

If I end up in FM or Psych and make 200k/year, that is still more than my family ever made in a year in my entire life. Keep complaining folks, I'll take the jobs 🙂

 

[Stagg737]

There's no way a plumber making 50k has a greater spending power than a physician making 300k. Maybe if you factor in the total spending power up until that point when the physician is making the 300 but most people making 50k are not saving that well either. It is far easier to live on 80k and save 120k/yr to catch up your savings than to live on 30 or less and save 10k, yr. at least for me I'd take the higher paycheck later in life every time. Its so much easier to be poor when you're young.

If I can find the post again I will. I believe it was done by WhiteCoatInvestor, so I trust his financial analysis and savvy. I also mixed up spending power and earning power I don't remember all the details, but it was basically taking into account income, debt owed, interest, investment power, retirement benefits. Keep in mind, the average plumber has an extra 10-12 years of income. So the plumber will have a $500k head start in terms of income, which may not seem like much given a physician's salary until you look at debt and interest (which will add another ~$300k to that head start), taxes (which hit the physician much harder than the plumber), and potential investments (which can give the plumber a huge head start assuming they're actually investing). I believe they also assumed that the plumber and physician were both retiring at the same age in their mid-60's, so it's ~45 years of working as a plumber vs. 30ish years of being a physician. I'll try and find the article/post where the analysis was done, but if I can't I can do a quick one myself and run some basic numbers. Either way, the financial aspect of being a physician is not nearly as lucrative as people think once expenses, taxes, and everything else is taken into account.

 

[citykid92]

If I can find the post again I will. I believe it was done by WhiteCoatInvestor, so I trust his financial analysis and savvy. I also mixed up spending power and earning power I don't remember all the details, but it was basically taking into account income, debt owed, interest, investment power, retirement benefits. Keep in mind, the average plumber has an extra 10-12 years of income. So the plumber will have a $500k head start in terms of income, which may not seem like much given a physician's salary until you look at debt and interest (which will add another ~$300k to that head start), taxes (which hit the physician much harder than the plumber), and potential investments (which can give the plumber a huge head start assuming they're actually investing). I believe they also assumed that the plumber and physician were both retiring at the same age in their mid-60's, so it's ~45 years of working as a plumber vs. 30ish years of being a physician. I'll try and find the article/post where the analysis was done, but if I can't I can do a quick one myself and run some basic numbers. Either way, the financial aspect of being a physician is not nearly as lucrative as people think once expenses, taxes, and everything else is taken into account.

This is an absurd argument. Are you really suggesting that your average plummer is going to be better off financially than a doc? A doctor may be 10 years behind but making SIX times the yearly salary makes up for that in no time. Although if you want to do an experiment, you become a plummer and I'll be a doctor and we'll see who makes more money.

 

[IlDestriero]

These financial comparisons are faulty on many levels. So the financial analysis is not sound.


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Il Destriero

 

[Stagg737]

This is an absurd argument. Are you really suggesting that your average plummer is going to be better off financially than a doc? A doctor may be 10 years behind but making SIX times the yearly salary makes up for that in no time. Although if you want to do an experiment, you become a plummer and I'll be a doctor and we'll see who makes more money.

No, I argued that the plumber would be at a financial advantage for a good part of their career until the physician can catch up (this was assuming the physician makes around 200k, the median for PCP, not specialist pay). Once the physician makes up the difference in earnings and investments, their financial outlook compared to those making 50k will obviously increase exponentially. The question isn't will the physician catch up, it's when will the physician catch up. Also, the post I saw was comparing 2 single individuals earning and spending the average amounts for their fields, supporting only themselves. Those numbers will of course change if you want to look at supporting families, adding in spousal incomes, or rapid debt repayment and investment into the equation.

The comparison, imo, was mostly meant to show the cost of pursuing careers that require higher education and highlight the cost side of the financial equation. The only reason I brought it up was to point out the other side of the "reimbursement" equation that the investment required to become a physician has become far greater than it ever was with fewer guarantees on career outcome. So even if the analysis isn't exact or is flawed, the underlying concept is still relevant.

 

[Strider_91]

No, I argued that the plumber would be at a financial advantage for a good part of their career until the physician can catch up (this was assuming the physician makes around 200k, the median for PCP, not specialist pay). Once the physician makes up the difference in earnings and investments, their financial outlook compared to those making 50k will obviously increase exponentially. The question isn't will the physician catch up, it's when will the physician catch up. Also, the post I saw was comparing 2 single individuals earning and spending the average amounts for their fields, supporting only themselves. Those numbers will of course change if you want to look at supporting families, adding in spousal incomes, or rapid debt repayment and investment into the equation.

The comparison, imo, was mostly meant to show the cost of pursuing careers that require higher education and highlight the cost side of the financial equation. The only reason I brought it up was to point out the other side of the "reimbursement" equation that the investment required to become a physician has become far greater than it ever was with fewer guarantees on career outcome. So even if the analysis isn't exact or is flawed, the underlying concept is still relevant.

I understand what you are saying and am an avid reader of the WCI website. There is a real and significant cost to becoming a physician and it is far from the golden ticket that it used to be which propelled you into the blanket category of "rich." But he would usually argue that the plumber would have the physician beat for many years, but a financially savvy physician would far surpass him. The issue is that physicians are notorious for bein terrible with money and over spending because of the pressure to keep up with the "rich physician" image that rarely exists anymore.


But even having financial security and being able to save for retirement is a luxury that many many professions do not have these days, and I believe that is what many complaining physicians do not understand. Literally 1 in 4 Americans have 0 dollars saved for retirement...

 

[IlDestriero]

The physician has access to opportunities that the plumber will never have. There's a 38 unit apartment that's for sale now for example in a place that I used to live. It's very expensive, but fairly priced. I could buy that property if I wanted myself, or split the potential pain with another physician partner and start a new business. A couple plumbers would never have access to the credit or cash needed to start that new company, perhaps at the end of their careers if they wanted to sink their whole wad into it. It's a great opportunity if you want to get into the apartment rental business.


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Il Destriero

 

[Stagg737]

If I recall correctly, you go to a DO school where all your third year grades are determined by solely based on shelf score...Yeah i would love that too, and it would make showing to rotations i don't care for much easier. In the majority of USMD schools evaluations make up a significant portion, half of the time at my school its equal to or worth more than shelf grade. Which is mainly why third year sucks

You are correct, but based on the comments my attendings have made in their evaluations, I'd probably have almost all honors third year if our grades weren't completely dependent on our shelf exams and grades have nothing to do with how much I'm enjoying this year. Imo just being able to see patients and help them instead of sitting at some desk/table for most of the day studying minutiae I don't care about and may never use after boards is far more miserable than actually doing something in person. Some people will disagree, but that's just my opinion.

I understand what you are saying and am an avid reader of the WCI website. There is a real and significant cost to becoming a physician and it is far from the golden ticket that it used to be which propelled you into the blanket category of "rich." But he would usually argue that the plumber would have the physician beat for many years, but a financially savvy physician would far surpass him. The issue is that physicians are notorious for bein terrible with money and over spending because of the pressure to keep up with the "rich physician" image that rarely exists anymore.


But even having financial security and being able to save for retirement is a luxury that many many professions do not have these days, and I believe that is what many complaining physicians do not understand. Literally 1 in 4 Americans have 0 dollars saved for retirement...

I agree with most of that, the basis of the comparison was the "average" physician vs. the "average" plumber. While a physician who is financially savvy or even just somewhat conservative with expenditures and aggressive with payment, there are plenty of physicians who are financially *****ic or just choose to enjoy the lifestyle immediately once they hit attending salary and put the long term investments on the back-burner. Even if a doc is financially irresponsible, they'll still have a pretty solid life and I realize that docs as a whole enjoy a far better financial outlook than most people. I only brought up the analogy to point out the extent of the financial cost of becoming a physician, not to mention the risk and possible disaster that could occur should a student take on so much debt and find themselves unable to work for some reason.

 

[IlDestriero]

If you're truly unable to work, or die, your student loans are dischargeable.


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Il Destriero

 

[anbuitachi]

It's because doctors have so little control over their salary.. Imagine you own Target, except you dont get to decide on the prices, the government/insurance companies do. See how messed up that is? Basically in medicine, your salary can go down vastly in one year because insurance companies decide to lower their reimbursements, and you can't do anything about it. If you want the same pay you better increase your work hours to make up for it. Like what one of the above posters said about anesthesiology, businesses are buying out anes groups, and using doctors to make money. The docs are the ones doing the work while they just collect. They do no service to society and are basically just a leech, while increasing healthcare cost in the process (since they get higher reimbursements from doctors due to being large)

The goal of non government insurances or any business in general, is to make money. Don't forget that!

 

[GrapePropel]

Physicians are already reimbursed too much. US doctors make way more than doctors in other advanced countries such as Germany. If you went into medicine hoping to get rich or earn a lot of money you went into it with the wrong idea and expectation. CRNAs are replacing the demand for Anesthesiologists in many states. NPs and PAs (and ever RPHs) will continue to get more and more prescribing power whittling away the main differentiating factor doctors have to make money.

Medicine is a great profession. Just not one you should be in if you are seeking lots of cash. That's investment banking or programming. Realistically doctors should be making like 4x federal minimum wage. With the internet advancing further and further information is available for everyone. Healthcare providers no longer have a monopoly on information.

 

[akwho]

Physicians are already reimbursed too much. US doctors make way more than doctors in other advanced countries such as Germany. If you went into medicine hoping to get rich or earn a lot of money you went into it with the wrong idea and expectation. CRNAs are replacing the demand for Anesthesiologists in many states. NPs and PAs (and ever RPHs) will continue to get more and more prescribing power whittling away the main differentiating factor doctors have to make money.

Medicine is a great profession. Just not one you should be in if you are seeking lots of cash. That's investment banking or programming. Realistically doctors should be making like 4x federal minimum wage. With the internet advancing further and further information is available for everyone. Healthcare providers no longer have a monopoly on information.

You have literally no idea what you are talking about. Every single one of your sentences was stupid in a different and unique way.

Germany has a different training process and subsidizes their medical education heavily, it is not directly comparable to the U.S. medical education system.

CRNA's will run out of the room if you ask them to do high risk cases. Anesthesiologists can make more money by supervising them and running multiple rooms at once.

You can read the internet as much as you want, you'll still never be able to preform a cholecystectomy or total hip replacement on yourself or your family member. You can read the internet as much as you want, you still won't have the diagnostic tools, chemotherapy drugs or knowledge of how and when to cycle the drugs and deal with their side effects if you have pancreatic cancer (unless you do the Steve Jobs juice cleanse, then good luck). If you have sepsis or sustain severe trauma the internet won't save you, you will need a team of healthcare professionals lead by a physician to resuscitate you and address the source of your pathology. In summary...

 

[AnalisCanalis]

Physicians are already reimbursed too much. US doctors make way more than doctors in other advanced countries such as Germany. If you went into medicine hoping to get rich or earn a lot of money you went into it with the wrong idea and expectation. CRNAs are replacing the demand for Anesthesiologists in many states. NPs and PAs (and ever RPHs) will continue to get more and more prescribing power whittling away the main differentiating factor doctors have to make money.

Medicine is a great profession. Just not one you should be in if you are seeking lots of cash. That's investment banking or programming. Realistically doctors should be making like 4x federal minimum wage. With the internet advancing further and further information is available for everyone. Healthcare providers no longer have a monopoly on information.

I disagree with almost everything you wrote. But if all you need is an NP with a stable internet connection for your next appointment, be my guest.

 

[vernhart]

Physicians are already reimbursed too much. US doctors make way more than doctors in other advanced countries such as Germany. If you went into medicine hoping to get rich or earn a lot of money you went into it with the wrong idea and expectation. CRNAs are replacing the demand for Anesthesiologists in many states. NPs and PAs (and ever RPHs) will continue to get more and more prescribing power whittling away the main differentiating factor doctors have to make money.

Medicine is a great profession. Just not one you should be in if you are seeking lots of cash. That's investment banking or programming. Realistically doctors should be making like 4x federal minimum wage. With the internet advancing further and further information is available for everyone. Healthcare providers no longer have a monopoly on information.

....yeah ok

 

[Man o War]

Physicians are already reimbursed too much. US doctors make way more than doctors in other advanced countries such as Germany. If you went into medicine hoping to get rich or earn a lot of money you went into it with the wrong idea and expectation. CRNAs are replacing the demand for Anesthesiologists in many states. NPs and PAs (and ever RPHs) will continue to get more and more prescribing power whittling away the main differentiating factor doctors have to make money.

Medicine is a great profession. Just not one you should be in if you are seeking lots of cash. That's investment banking or programming. Realistically doctors should be making like 4x federal minimum wage. With the internet advancing further and further information is available for everyone. Healthcare providers no longer have a monopoly on information.

CRNAs are not taking over. Even in states where they can legally practice independently the vast majority of facilities don't let them.
There's too much work and not enough anesthesiologists which is why it's still one of the highest paid specialties.
If you've ever seen a decent number of CRNAs in action you'd know why there's still high demand for anesthesiologists.

 

[GrapePropel]

Germany has a different training process and subsidizes their medical education heavily, it is not directly comparable to the U.S. medical education system.

The US also has a training process that subsidizes students medical education heavily. It's called federal scholarships, University full ride scholarships and University partial ride scholarships. The only way I can see medicine being a proftitable occupation is if you are going to school on the feds or on the university's money. If I wasn't, I would have to ask myself, do I really belong here at school if society hasn't chosen to support me financially at this institution. But that's just me. Thousands of people that truly belong at medical school get free rides every year.

 

[GrapePropel]

You have literally no idea what you are talking about. Every single one of your sentences was stupid in a different and unique way.

You can read the internet as much as you want, you'll still never be able to preform a cholecystectomy or total hip replacement on yourself or your family member. You can read the internet as much as you want, you still won't have the diagnostic tools, chemotherapy drugs or knowledge of how and when to cycle the drugs and deal with their side effects if you have pancreatic cancer (unless you do the Steve Jobs juice cleanse, then good luck). If you have sepsis or sustain severe trauma the internet won't save you, you will need a team of healthcare professionals lead by a physician to resuscitate you and address the source of your pathology.

I agree that surgical intervention will continue to be a valuable service to society. However the bulk of physicians are in primary care/internal med/family med, aka one of the easiest residencies for the average to poor performing medical students. Actually anyone can look up what chemotherapy drugs to use and how to cycle them. It's all on federal websites, the drug packaging and on websites such as Lexicomp. You are cherry picking heavily interventional aspects of being a surgeon or emergency med doc while misrepresenting my argument as supporting herbal supplements vs taking real pharmaceutical active medications. Most patients don't need a doctor to read a quantiferon - TB gold Tube test. Any one can easily interpret the results of this test and practically any other medical test.

Also sorry that you are so immature and insecure that you are projecting insults such as "idiot" on me. Maybe once you finish your residency you will be more mature and able to talk in a more professional and adult tone.

 

[GrapePropel]

CRNAs are not taking over. Even in states where they can legally practice independently the vast majority of facilities don't let them.
There's too much work and not enough anesthesiologists which is why it's still one of the highest paid specialties.
If you've ever seen a decent number of CRNAs in action you'd know why there's still high demand for anesthesiologists.

Yes there is still a high demand and yes they are still compensated well. My point is that demand is decreasing and their compensation is going down (especially against inflation). My point is that this is a trend that is growing. With more DO's entering the field increasing supply and CRNAs, NPs, PAs and now even pharmacists taking responsibilities from physicians, doctor reimbursement will continue to fall greatly.

 

[akwho]

I agree that surgical intervention will continue to be a valuable service to society. However the bulk of physicians are in primary care/internal med/family med, aka one of the easiest residencies for the average to poor performing medical students. Actually anyone can look up what chemotherapy drugs to use and how to cycle them. It's all on federal websites, the drug packaging and on websites such as Lexicomp. You are cherry picking heavily interventional aspects of being a surgeon or emergency med doc while misrepresenting my argument as supporting herbal supplements vs taking real pharmaceutical active medications. Most patients don't need a doctor to read a quantiferon - TB gold Tube test. Any one can easily interpret the results of this test and practically any other medical test.

Also sorry that you are so immature and insecure that you are projecting insults such as "idiot" on me. Maybe once you finish your residency you will be more mature and able to talk in a more professional and adult tone.

Sorry if I was rude initially, I thought you were a troll since you had one post and were making ridiculous statements. Now it's obvious you just have never dealt with a patient before.

The idea of patients choosing their own chemotherapy drugs, cycling them, self-administering them and dealing with the complications is laughable. 40% of patients can't even take their once a day diabetic medication correctly. I as a surgeon wouldn't run my own chemotherapy course, and would defer to my oncologist.

Secondly, family medicine, internal medicine, and primary care are not for the "average to poor performing medical students." Some of my most brilliant classmates went into those specialities and are providing a major service to humanity because they believe in longitudinal health care and taking care of a population over time. The people that go into primary care are saints in my book. You really just don't know what you are talking about and should stop writing strongly worded ill-informed opinions.

 

[Mona nucleosis]

I havent heard any complaints about salaries from the older physicians. Their biggest gripes are EMRs, amount time spent documenting, and patients reading unreliable internet sources and being adamant and argumentative.