Which Specialties Are Most at Risk??

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FootballFoot

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I have heard there's a lot of healthcare reform going on with the CMS, and people think that salaries are going to go down across the board.

Which specialties are most at risk or have the most to lose with new reforms? Which ones are more safe with their current standing, even if they lose a little reimbursement?

Especially between Rads, Derm, Ophthal, EM, Anesth, ENT, Uro, PM&R, Endocrine, Rheum, GI, Allergy?

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Affordable care act was in reality destined to set the path of this country into an eventual single payer model. Congress views the average reimbursement should be up to an avg of about 200 bucks an hour of physician time - and from this you have to pay all the overhead / supplies / salaries / etc and non revenue generating activities demanded of clinicians. This can be offset for now by a number of procedural cpt codes.

Any specialty that utilizes particular codes more than other codes...it 17311 for mohs... will trigger various algorithms to bring them into the scope of discussion by the various penny pinchers at CMS.

When CMS makes rules or changes....private insurers follow as it is generally a reduced total reimbursement and the govt / cms can be used as a standard.

No specialty is truly safe if dependent on insurance reimbursements.
Wanna make big money? Don't do medicine. Otherwise...learn the cosmetics / elective procedures / vanity medicine game
 
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This is a common sentiment that doesn't make that much sense to me.

The top 1% of *individual* income earners in the US make ~250k. Source: http://politicalcalculations.blogspot.com/2014/09/what-is-your-income-percentile-ranking.html
Specialists definitely make >250k now, and primary care can theoretically make >250k as well in our current healthcare system.

What other *job* allows top 1% income generation potential to the same degree as medicine?

Wall Street? Yes - but good luck going to one of the target undergraduate schools and breaking in to the field at all.
Silicon Valley software engineering? Yes - but good luck being a tech genius since only the most elite firms reach these compensation levels for the most part.
Other fields (Sales/Consulting/Accounting/Engineering)? Very rare to make 250k and therefore very hard to predict if you will ever make it

Medicine is a hard field to excel in, but it is the most guaranteed way to get into the top 1% at the present time IMO.

Also, just because you have the brain to do well in medicine doesn't mean your talents will translate elsewhere. If you work hard in med school, chances are you will graduate and move on and become a doctor. Just because you work hard in business or any other field doesn't mean you are the one who gets the raise or promotion to get to that high-paying job.
 
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Radiology in my opinon and by talking to a Doctor. Salaries have dropped and so its golden days are over. Not to say it is isn't a good speciality any more though.
 
Much of physician reimbursement suffers from the supporting the bloat of hospital administrators or from the downward squeeze from CMS and other insurance companies. It seems that the safest fields then would be the fields independent from those pressures- derm, psych, and direct primary care.

As for the poster yakking about Silicon Valley salaries, that just shows ignorance about the compensation model in the Valley. Their compensation doesn't come from labor, it comes from ownership. A $90,000 per year salary is irrelevant when your net worth rises or falls by $90,000 a week.
 
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Much of physician reimbursement suffers from the supporting the bloat of hospital administrators or from the downward squeeze from CMS and other insurance companies. It seems that the safest fields then would be the fields independent from those pressures- derm, psych, and direct primary care.

This.

Driving home today, I was listening to NPR and heard a story about this lady whose monthly premium went from 210 to 390 starting next year, due to the recent changes in ACA. She was left in a dilemma where she needs to choose between going with Kaiser and save money or bite the bullet and pay double what she was originally paying just to keep seeing her PCP of 20 years. Ultimately she chose to go with Kaiser because she couldn't justify the high premiums under the ACA. I couldn't help by think about how direct primary care is the way to go. For $70/month plus another $100/month for a catastrophic insurance is much cheaper than ACA or even Kaiser.
 
Spending the past couple of weeks in a primary care office is making me question my decision to go into medicine.
 
This is a common sentiment that doesn't make that much sense to me.

The top 1% of *individual* income earners in the US make ~250k. Source: http://politicalcalculations.blogspot.com/2014/09/what-is-your-income-percentile-ranking.html
Specialists definitely make >250k now, and primary care can theoretically make >250k as well in our current healthcare system.

What other *job* allows top 1% income generation potential to the same degree as medicine?

Wall Street? Yes - but good luck going to one of the target undergraduate schools and breaking into the field at all.
Silicon Valley software engineering? Yes - but good luck being a tech genius since only the most elite firms reach these compensation levels for the most part.
Other fields (Sales/Consulting/Accounting/Engineering)? Very rare to make 250k and therefore very hard to predict if you will ever make it

Medicine is a hard field to excel in, but it is the most guaranteed way to get into the top 1% at the present time IMO.


This.

I've got friends who went to law school, top biz schools, etc. None of them make 200k at the moment. Some arent even over 150.

As a non trad student, I can say this...if you think getting in is difficult and arbitrary, try landing one of those wall Street jobs or VC silicon Valley jobs.

The fact of the matter is, even with an advanced degree and intelligence, the odds of you ever making over 200k is small....let alone 3 or 400k which is possible for pretty much any doctor, though some may have to work themselves to death for it.
 
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This is a common sentiment that doesn't make that much sense to me.

The top 1% of *individual* income earners in the US make ~250k. Source: http://politicalcalculations.blogspot.com/2014/09/what-is-your-income-percentile-ranking.html
Specialists definitely make >250k now, and primary care can theoretically make >250k as well in our current healthcare system.

What other *job* allows top 1% income generation potential to the same degree as medicine?

Wall Street? Yes - but good luck going to one of the target undergraduate schools and breaking into the field at all.
Silicon Valley software engineering? Yes - but good luck being a tech genius since only the most elite firms reach these compensation levels for the most part.
Other fields (Sales/Consulting/Accounting/Engineering)? Very rare to make 250k and therefore very hard to predict if you will ever make it

Medicine is a hard field to excel in, but it is the most guaranteed way to get into the top 1% at the present time IMO.

To answer your question about people saying don't do medicine for big money.

First, I'm pretty sure the top 1% is right above or around 400k per year which most doctors don't hit, but a good portion do hit that benchmark or even more. Also I think per profession doctors have the largest percent of member in the 1%

More importantly though, making 400k a year isn't absurd money. That doesn't buy you a yacht, multiple beach houses, a private jet, etc. You can only make so much money seeing patients yourself even with midlevels. After taxes it gives you a lot of money to live extremely comfortably and enough to live a great retirement.

The only fields where you will make it rich (multiple millions of dollars a year) are things like top jobs in law, tech, business, hollywood, etc which are all incredibly rare and risky. Basically it comes down to risk.

I guess to summarize I would say:
Do medicine (low risk, good reward) if you want a guarantee of wealth, but don't do it if you think it'll make you filthy rich (high risk, incredibly high reward).
 
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To answer your question about people saying don't do medicine for big money.

I guess to summarize I would say:
Do medicine (low risk, good reward) if you want a guarantee of wealth, but don't do it if you think it'll make you filthy rich (high risk, incredibly high reward).

This x1000, my father is a fairly successful business man, in the good years, he could rack up millions, but in the bad years, he'll actually loose money out of pocket. So he turned to me and told me to go into medicine, where you are pretty much guaranteed a job as long as human populates the earth, not to mention that the job's baseline salary is among the highest paying careers...
 
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The salary floor in medicine (around 200k) is what you aim for your entire career in corporate america.
 
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Sure salaries will probably be going down but the average still looks good depending on specialty (base for derm/GI docs is $350-400k).

You can still make an absurd amount of money but you got to be innovative and take risks just like in any other business. My buddies mom is a renal doctor and owns dialysis clinics. She rakes in close to 1 mil /year. Our chief of thoracic surgery has a $2.5 million salary. I know a plastic surgeon med school alumni who parks his big red butterfly door Mercedes right in front of his own spa center/titty factory.
 
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Sure salaries will probably be going down but the average still looks good depending on specialty (base for derm/GI docs is $350-400k).

You can still make an absurd amount of money but you got to be innovative and take risks just like in any other business. My buddies mom is a renal doctor and owns dialysis clinics. She rakes in close to 1 mil /year. Our chief of thoracic surgery has a $2.5 million salary. I know a plastic surgeon med school alumni who parks his big red butterfly door Mercedes right in front of his own spa center/titty factory.

Titty factory. The best.
 
To answer your question about people saying don't do medicine for big money.

First, I'm pretty sure the top 1% is right above or around 400k per year which most doctors don't hit, but a good portion do hit that benchmark or even more. Also I think per profession doctors have the largest percent of member in the 1%

More importantly though, making 400k a year isn't absurd money. That doesn't buy you a yacht, multiple beach houses, a private jet, etc. You can only make so much money seeing patients yourself even with midlevels. After taxes it gives you a lot of money to live extremely comfortably and enough to live a great retirement.

The only fields where you will make it rich (multiple millions of dollars a year) are things like top jobs in law, tech, business, hollywood, etc which are all incredibly rare and risky. Basically it comes down to risk.

I guess to summarize I would say:
Do medicine (low risk, good reward) if you want a guarantee of wealth, but don't do it if you think it'll make you filthy rich (high risk, incredibly high reward).

Combine a bit of business sense with a medical degree and there's absolutely no reason you can't make multi millions.

That said, 400k a year will buy you a 1.5 million dollar house in a great location, Maserati in the driveway, Michelin restaurants weekly, vacations wherever you want, a boat, and a trophy wife to boot if that's your thing. No, it won't buy you a private plane or multiple beach houses...that's just absorb someone feels they need that to be considered rich.

Maybe it's because I'm 6 or 7 years older than most of my classmates, but I can tell you im absolutely starting to see that life is about so much more than compiling material goods. To me, life is about compiling awesome experiences...and those are almost always cheaper than designer crap and fancy cars (in full disclosure, I do have a soft spot for maseratis). A doctor's salary and, this is perhaps most important thing, the ability to work your own schedule as you see fit, is what makes medicine so awesome. Try telling the partner of that vc or law firm you don't want to work for a couple of months....and as far as I know there's no locum tenens for ibankers...
 
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Something else I think bears mentioning is the ability to work/live reasonably close to where you want. Maybe it doesn't matter to you now, but one day it will. The ability to say, I want to live in southern california where I went to undergrad and still have all of my old friends...or I want to live by my mom in middle of nowhere Oklahoma....the choice is yours. You really can't put a price on that.

I have one friend in particular who works on wall street. He has an MBA from a prestigious east coast school, has a great, high paying job with a well-known company....yet he's dying to get back to the Bay Area. He's looking in the same field and even determined he's okay with a pay reduction. He's been on a few interviews, but keeps striking out. This has been going on for almost two years now. Medicine (for the most part) means you don't have to become another corporate drone running the rat race, hoping someone higher up notices you, and generally allowing a corporation to dictate your life.
 
Boy, do I have news for you...

I was under the impression (field dependent of course) setting up your own practice wasn't insanely difficult with a bit of business sense, or the option to work locums, or perhaps both. Or to seek out a medical group to work for. I won't assume I know more than someone much further along than myself...but I do a fair bit of reading on this and that's what my take away was.

Ultimately though, I guess my point was the above aren't really options for 98% of corporate workers.
 
I was under the impression (field dependent of course) setting up your own practice wasn't insanely difficult with a bit of business sense, or the option to work locums, or perhaps both. Or to seek out a medical group to work for. I won't assume I know more than someone much further along than myself...but I do a fair bit of reading on this and that's what my take away was.

Ultimately though, I guess my point was the above aren't really options for 98% of corporate workers.

From what I've been told by attending's about owning your own practice, it is extremely difficult to set up and maintain your own office. Alone that is. Most docs join established groups that then can form into larger groups that can then tell insurance companies to go f*%# themselves. Then eventually they get so big they form their own insurance plans that tell other physicians they won't pay them. I call it the circle of effin' hypocrisy! Haha


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Radiology in my opinon and by talking to a Doctor. Salaries have dropped and so its golden days are over. Not to say it is isn't a good speciality any more though.
How do you figure? Sure MACRA is going to affect compensation, but I see radiology still being at the 300-350k mark in the 5-10 years experience. Some articles I've read suggest it will even go up due to the ultrasound boom.
 
I'm not looking for private jets and vacation houses. I want a field that can help me achieve financial independence, working when I want to, or not having to work at all if I choose to do so. More money = more freedom.

Anyone know the best specialty for that?
 
I'm not looking for private jets and vacation houses. I want a field that can help me achieve financial independence, working when I want to, or not having to work at all if I choose to do so. More money = more freedom.

Anyone know the best specialty for that?
Any specialty would work in that regard, because true financial independence is a state of mind and not a function of how much money you have in the bank (beyond a surprisingly small sum that any physician can achieve).

You might have luck exploring which doctors choose to work the least. But you should disregard the low average hours in peds because that average is brought down by the large number of part-timers who are married to another physician.
 
I'm not looking for private jets and vacation houses. I want a field that can help me achieve financial independence, working when I want to, or not having to work at all if I choose to do so. More money = more freedom.

Anyone know the best specialty for that?

Psych. Tele-psych from home, easiest field to open a private practice, loads of locums work, super in demand and will be for the foreseeable future. Rate per hour is actually quite high making it a great field to earn a significant income if you want to be a work horse too.
 
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