WHy is anyone fearful of entering medicine - MARKET DRIVES REIMBURSMENT

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TOMFighter

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Even if medicine goes socialized, the avg doctor in Canada is making 200K, and they have way more primary care base than anyone else. I read an article with some primary care docs in Canada making 500K by seeing more patients since there is a physician shortage....specialists make more. ER docs there are making 170/hr.

It takes a certain capacity to be a doc. There is a huge barrier to entry that requires a large amount of sacrifice and experience that demands proper compensation.

Let's face it. There are other ways to help people and to be compassionate and caring for humankind that don't require the sacrifice of becoming a Doc. WIthout proper compensation, physicians will not enter the field

No one needs to be worried, IMO. Doom and gloom articles were written, I'mm sure in the 70s about medicine in the 90s, and in the 90s about medicine today.

If you look at relative pay scale of professions in any country, Docs are always the highest paid. With education and sacrifice comes compensation. The market drives the price.
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The market drives the price? Yeah, except when the government has control of the "market", your little theory no longer applies.

Doc's are the highest paid people in every country? Are you insane? I'm not even going to dignify that with an example.

Finally, I think many of us that have been exposed to government entities have an uncontrollable gag reflex at the though of being employed by one.
 
I'm not advocate of socialized medicine, first off. I believe in a market mechanism.

THe government's ATTEMPT AT CONTROLLING THE MARKET is always a failure. The invisible hand of the market is usually the best way.

Here's how the government would attempt to control the market: Let's slash Doc's pay and see what happens. Less people enter medicine (especially competent ones), physician shortage, compensate the new physician shortage by paying existing physicians more to treat the abundance of patients. It's already happened in Canada.

And yes, doctors are paid the most in every country on average. DO research on that on google. avg doc in Japan is making 200K also, australia - something like 150K, etc. etc.

In India, Docotrs are given the utmost respect, and have 10 or so people working for them taking care of their homes, cleaning for them, doing whatever they ask. They live like kings there. THe only reason they come to the U.S. is because it's trendy, and although their earning potential is high in India, the available amenities and quality of life in general is low.
 
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TOMFighter said:
Here's how the government would attempt to control the market: Let's slash Doc's pay and see what happens. Less people enter medicine (especially competent ones), physician shortage, compensate the new physician shortage by paying existing physicians more to treat the abundance of patients. It's already happened in Canada.
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Physician reimbursement has been slashed repeatedly over the years, it's going down, not up. There isn't a drop in the people entering medicine (you might see a drop in the people staying in medicine), but that hasn't been enough to affect a change in policy and I doubt that if the trend has been going on this long it will change anytime soon.

We have our own uniquely F'ed up healthcare system here. You can't successfully compare it to any other country's with a blanket statement.
 
Depakote said:
Physician reimbursement has been slashed repeatedly over the years, it's going down, not up. There isn't a drop in the people entering medicine (you might see a drop in the people staying in medicine), but that hasn't been enough to affect a change in policy and I doubt that if the trend has been going on this long it will change anytime soon.

We have our own uniquely F'ed up healthcare system here. You can't successfully compare it to any other country's with a blanket statement.
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No it hasn't. Check the avg salary of all the different specialties in the U.S. for 2007. It's as high as ever. WHy would anyone choose to not enter medicine? Docs in Canada and the U.S. are paid very comparable wages.
 
Depakote said:
also, you seem to be comparing the US to a lot of countries with socialized medicine when citing examples.
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The comparison is made there because that is the worst case scenario whereby the government tries to interfere with a market mechanism.

Even in the worst case scenario, the market prevails.

Physician salaries are still as high as ever according to 2007 statistics. As I understand it, although the government attempts to slash pricing, the AMA consistently lobbies the government not to do so....

Besides, if salaries were cut SIGNIFICANTLY, people wouldn't make the sacrifice. THey might be cut A LITTLE BIT in the future, but Docs will always be in the top 1-5% of earning potential as they are in every country. That's my point.
 
TOMFighter said:
I'm not advocate of socialized medicine, first off. I believe in a market mechanism.

THe government's ATTEMPT AT CONTROLLING THE MARKET is always a failure. The invisible hand of the market is usually the best way.

Here's how the government would attempt to control the market: Let's slash Doc's pay and see what happens. Less people enter medicine (especially competent ones), physician shortage, compensate the new physician shortage by paying existing physicians more to treat the abundance of patients. It's already happened in Canada.

And yes, doctors are paid the most in every country on average. DO research on that on google. avg doc in Japan is making 200K also, australia - something like 150K, etc. etc.

In India, Docotrs are given the utmost respect, and have 10 or so people working for them taking care of their homes, cleaning for them, doing whatever they ask. They live like kings there. THe only reason they come to the U.S. is because it's trendy, and although their earning potential is high in India, the available amenities and quality of life in general is low.
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Your THEORY is right... in theory. I actually believe that eventually the market will prevail over government intervention like you're saying. The PROBLEM is that you haven't mentioned how long it takes to get government out and the free market in. It looks to me like, depending on how the elections go in the next several years, that we could be in a period of highly increased govt. involvement in tons of things, especially healthcare.

If a free market prevails, how long will it take? If we get government more involved following the elections, it will take a long time(many many many years) to reverse the process. In the meantime, what damage will have been caused? How drained will the economy be from being burdened by an expanding government machine that already decreases incentive for individuals(via progressive income tax) and companies(via one of the most expensive corporate profit and capital gains tax systems in the world) to be more productive? How damaged will the American competitive advantage be with such a huge government?

Finally, how long would it take for the free market to kick in, clear out government, and readjust doctor's wages? Too long. Your theory is fine w/o time consideration; in the end, I think, demand will trump all else. The problem is that the process is a lengthy one, one that could result in a prolonged period of wage decreases screwing over incoming doctors while simultaneously decreasing the number of physicians. The free market of which you speak could take decades to come back.

Also, I think Indian doctors probably have a lot of servants because of the lower cost of hiring them, not necessarily b/c they make a ton of money. Try to come up with an analogy for what the daily wage of a lower-class Indian servant in India would cost compared to something we spend daily money on in the US(trip to Starbucks, anyone?).
 
AZhopeful said:
Your THEORY is right... in theory. I actually believe that eventually the market will prevail over government intervention like you're saying. The PROBLEM is that you haven't mentioned how long it takes to get government out and the free market in. It looks to me like, depending on how the elections go in the next several years, that we could be in a period of highly increased govt. involvement in tons of things, especially healthcare.

If a free market prevails, how long will it take? If we get government more involved following the elections, it will take a long time(many many many years) to reverse the process. In the meantime, what damage will have been caused? How drained will the economy be from being burdened by an expanding government machine that already decreases incentive for individuals(via progressive income tax) and companies(via one of the most expensive corporate profit and capital gains tax systems in the world) to be more productive? How damaged will the American competitive advantage be with such a huge government?

Finally, how long would it take for the free market to kick in, clear out government, and readjust doctor's wages? Too long. Your theory is fine w/o time consideration; in the end, I think, demand will trump all else. The problem is that the process is a lengthy one, one that could result in a prolonged period of wage decreases screwing over incoming doctors while simultaneously decreasing the number of physicians. The free market of which you speak could take decades to come back.

Also, I think Indian doctors probably have a lot of servants because of the lower cost of hiring them, not necessarily b/c they make a ton of money. Try to come up with an analogy for what the daily wage of a lower-class Indian servant in India would cost compared to something we spend daily money on in the US(trip to Starbucks, anyone?).
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I agree with you. YOu don't want to be stuck in the tansitioning period. THe market always balances itself out eventually. However, we would hope that if the government did attempt to cut prices, that they wouldn't low ball it so horribly that it would cause the worse of outcomes. It would be something similar to Canada. But even if it were a Canadian system, they're still getting paid VERY WELL is my point.

One last beautiful point I'd like to make that keeps me sleeping at night: THe MD degree is a a certificate of intelligence and experience in Science and clinical application. An MD can easily transition INTO ANY FIELD. They're not CONTRACTED to work in medicine. They can make their own hours and are free to even enter into other fields - even less stressful ones.
 
Umm, is the University of Chicago Department of Economics trolling on SDN these days?
 
TOMFighter said:
Even if medicine goes socialized, the avg doctor in Canada is making 200K, and they have way more primary care base than anyone else. I read an article with some primary care docs in Canada making 500K by seeing more patients since there is a physician shortage....specialists make more. ER docs there are making 170/hr.
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The $500k for family physician is really only true for doctors in underserved populations and other rural areas, where the government allows them to bill more per visit. Also, bear in mind that some provinces have a cap and limit the total amount that a physician (primary care or specialist) may bill annually to the government. This means that once doctors have reached their cap, they simply stop seeing patients; this along with the general shortage of physicians is what causes the tremendous waits just to see a doctor. If the American healthcare system continues to spiral down the toilet (from a doctor's perspective of course), Canada may become a marginally better place for a practicing physician, but it is certainly no utopia for healthcare.
 
TOMFighter said:
In India, Docotrs are given the utmost respect, and have 10 or so people working for them taking care of their homes, cleaning for them, doing whatever they ask. They live like kings there.
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Doctors are not well respected in India unless they specialize. As well, majority of the average middle-class families in India have all of the luxuries you mentioned and more, simply because there is so much poverty in the country. You can hire someone off the street to come in and do anything you want for pennies.
 
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Medicine is a guild with a series of barriers to entry that keeps wages up and job security well above market levels. If anyone who had the ability to do the work and pass a series of board exams could hang up their shingle and start seeing patients (as is the case in some fields like engineering where if you can build a cool widget and sell it for a big profit, no one cares if you even completed college and many practicing engineers aren't even licensed, particularly in high-tech), physicians would not be earning what they are today. Medical care would be superior and cheaper in my opinion as well because we would have a true market and non-competitive physicians would be forced out. I'm not sure the system is currently so error-free that medical errors would change that much.

Keep in mind that there are 2X more people who want to go to medical school as there are seats. The government also has a strong lever on price with the medicare reimbursement which anchors many private reimbursement rates. I would not underestimate the ability of the government to cut compensation of physicians. At the same time, physicians are politically fairly strong, and so is is politically difficult for the government to cut physician compensation, although it can be done. I'm not worried about declining compensation (not expecting huge drops) but at the same time, I'm not going into the field for the money. I expect that physicians will still earn a living wage well into the future, even considering repayment of student loans. I agree that if you go into it for the right reasons (and maybe even for reasons like making the most cash for given abilities in medical field) it looks pretty nice.
 
OncoCaP said:
Medicine is a guild with a series of barriers to entry that keeps wages up and job security well above market levels. If anyone who had the ability to do the work and pass a series of board exams could hang up their shingle and start seeing patients (as is the case in some fields like engineering where if you can build a cool widget and sell it for a big profit, no one cares if you even completed college and many practicing engineers aren't even licensed, particularly in high-tech), physicians would not be earning what they are today. Medical care would be superior and cheaper in my opinion as well because we would have a true market and non-competitive physicians would be forced out. I'm not sure the system is currently so error-free that medical errors would change that much.

Keep in mind that there are 2X more people who want to go to medical school as there are seats. The government also has a strong lever on price with the medicare reimbursement which anchors many private reimbursement rates. I would not underestimate the ability of the government to cut compensation of physicians. At the same time, physicians are politically fairly strong, and so is is politically difficult for the government to cut physician compensation, although it can be done. I'm not worried about declining compensation (not expecting huge drops) but at the same time, I'm not going into the field for the money. I expect that physicians will still earn a living wage well into the future, even considering repayment of student loans. I agree that if you go into it for the right reasons (and maybe even for reasons like making the most cash for given abilities in medical field) it looks pretty nice.
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You overestimate the general population. Even from those who are accepted into the medical program, 10-15% of potential MD's do not complete it. As many as 30% will either failout completely or have to take summer courses. Medicine is brutal. The seat number is controlled BECAUSE you want only the most competent hard-working people available. Residency COSTS THE GOVERNMENT A LOT OF MONEY to train physicians. Few people realize that it costs about 100K/yr to train a single resident.
 
noskill said:
Doctors are not well respected in India unless they specialize. As well, majority of the average middle-class families in India have all of the luxuries you mentioned and more, simply because there is so much poverty in the country. You can hire someone off the street to come in and do anything you want for pennies.
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Correct me if I'm wrong - but is there even a so-called middle class in India?

Nevertheless, my Indian coworkers tell me that Indian doctors are treated like Kings there.
 
People like doom and gloom. This isn't the first time med students have freaked out about salaries, and it won't be the last. Talk to the people who are actually hiring doctors, they have a different story. Bottom line, you might not end up with a Porshe, but you're going to be able to have a comfortable lifestyle. Anyone who tells you otherwise is fear-mongering for fun, or has a political agenda.
 
TOMFighter said:
Correct me if I'm wrong - but is there even a so-called middle class in India?

Nevertheless, my Indian coworkers tell me that Indian doctors are treated like Kings there.
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Yes, the middle class in India numbers 300 million and growing. They are the reason for India's recent huge economic growth. The country's economy is the second fastest growing economy in the world after China.

And yes, it is true, doctors in India are very well respected. There are so few doctors in the country outside of the huge urban areas because there is less money to be made in the rural areas of the country. My cousin is a radiologist in Bombay and he lives better than radiologists I see in this country (his house is like DAMN!).
 
Taurus said:
Agreed. People speaking without sources are like if they are speaking through their buttholes.
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Doctors in Canada make an average of $202,000 a year (2006, before expenses).[31] Alberta has the highest average salary of around $230,000, while Quebec has the lowest average annual salary at $165,000, creating interprovincial competition for doctors and contributing to local shortages.[31]

http://en.wikipedia.org/wiki/Health_care_in_Canada







UNITED STATES 2007:

http://bp0.blogger.com/_jyVH1tFBOXI...egUk2FI/s1600-h/2007-Merrit-Salary-Survey.gif




And if they get paid **** in other countries, they're still paid THE MOST relative to others.
 
TOMFighter said:
Doctors in Canada make an average of $202,000 a year (2006, before expenses).[31] Alberta has the highest average salary of around $230,000, while Quebec has the lowest average annual salary at $165,000, creating interprovincial competition for doctors and contributing to local shortages.[31]

http://en.wikipedia.org/wiki/Health_care_in_Canada


And if they get paid **** in other countries, they're still paid THE MOST relative to others.
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1>BEFORE expenses. What are expenses??? I posted a link of gross salary, which is what we talk about here in the US. That is salary after malpractice,etc. I guess I Can put 25k-50k more on top of US doctor's incomes if we are going to talk about BEFORE expenses.

2>keep the sources coming buddy.
 
phatmonky said:
1>BEFORE expenses. What are expenses??? I posted a link of gross salary, which is what we talk about here in the US. That is salary after malpractice,etc. I guess I Can put 25k-50k more on top of US doctor's incomes if we are going to talk about BEFORE expenses.

2>keep the sources coming buddy.
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expenses are taxes and overhead, I'm guessing. If you join a practice, overhead doesn't really exist.....and everyone's avg. salary that is posted is before taxes.
 
TOMFighter said:
If you join a practice, overhead doesn't really exist.....
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Where is the money to pay for staff and office rent going to come from? You still have to pay your share of the overhead if you are a partner in a group, though that share would likely be lower than if you were going solo.
 
TOMFighter said:
Even if medicine goes socialized, the avg doctor in Canada is making 200K, and they have way more primary care base than anyone else. I read an article with some primary care docs in Canada making 500K by seeing more patients since there is a physician shortage....specialists make more. ER docs there are making 170/hr.

It takes a certain capacity to be a doc. There is a huge barrier to entry that requires a large amount of sacrifice and experience that demands proper compensation.

Let's face it. There are other ways to help people and to be compassionate and caring for humankind that don't require the sacrifice of becoming a Doc. WIthout proper compensation, physicians will not enter the field

No one needs to be worried, IMO. Doom and gloom articles were written, I'mm sure in the 70s about medicine in the 90s, and in the 90s about medicine today.

If you look at relative pay scale of professions in any country, Docs are always the highest paid. With education and sacrifice comes compensation. The market drives the price.
Click to expand...

:confused::confused::confused:
Which market are you talking about? Is it the same market that has handed physicians declining wages in the past 12 years? My good friend, the forecast is dark and cloudy with a huge chance of thunderstorms.
 
JacobSilge said:
Where is the money to pay for staff and office rent going to come from? You still have to pay your share of the overhead if you are a partner in a group, though that share would likely be lower than if you were going solo.
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It's like car pooling.

If you rented the bus and paid for gas yourself, that's a lot of expense. If you share gas and rental cost of bus with all the passengers, the cost is minimal.
 
sirus_virus said:
:confused::confused::confused:
Which market are you talking about? Is it the same market that has handed physicians declining wages in the past 12 years? My good friend, the forecast is dark and cloudy with a huge chance of thunderstorms.
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where's your data for that? All the sources I've seen have shown increasing wages. Canada has recently uncapped physician salaries in some locations as well to encourage seeing more patients.

Obviously, you don't understand the market and that people are largely driven by incentives on a grand scale. If you take a class on human behavior, you'll find that in the grand scheme, humans behave as animals. Animals operate on a cost-benefit analysis.
 
sirus_virus said:
:confused::confused::confused:
Which market are you talking about? Is it the same market that has handed physicians declining wages in the past 12 years? My good friend, the forecast is dark and cloudy with a huge chance of thunderstorms.
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wtf are you talking about declining wages? The data I just posted showed an increase in wages from the year before in the u.s.
 
TOMFighter said:
where's your data for that? (1) All the sources I've seen have shown increasing wages. (2) Canada has recently uncapped physician salaries in some locations as well to encourage seeing more patients.

Obviously, you don't understand the market and that people are largely driven by incentives on a grand scale. If you take a class on human behavior, you'll find that in the grand scheme, humans behave as animals. (3) Animals operate on a cost-benefit analysis.
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(1) Medicare reimbursements are a major source of most physicians' income. They have been declining sharply vs. inflation across the board for most procedures/office visits/etc. Private insurance companies index what they reimburse to Medicare reimbursements, although they pay more than Medicare. The net result is a decrease in pay in real dollars vs. hours worked--for most specialties.

You can argue this point all you like, but the majority of physicians are in agreement that we're making less and it's going to get worse--it is unlikely that this is some kind of mass delusion. That being said, we'll all be able to live comfortably and if reimbursements decrease enough to deter smart, motivated people from going into medicine, then the market will self-correct.

(2) I don't live in Canada, and I don't care about family practice docs in the far reaches of Manitoba.

(3) This is an overly simplistic view of a complex issue. If you want to compare humans to animals in that sense then read Orwell's Animal Farm again.
 
TOMFighter said:
It's like car pooling.

If you rented the bus and paid for gas yourself, that's a lot of expense. If you share gas and rental cost of bus with all the passengers, the cost is minimal.
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Though that idea is true to a degree, it isn't really the case. A solo practice doesn't have so much extra space and personnel capacity that it can just absorb more docs without upping the total cost. So yes, being in a group will limit overhead, but it certainly doesn't make it "minimal." If overhead for a solo primary care office is around 50% of collections, the group might get it down to 25%. That's still substantial!

Though I do agree that overhead is probably less in Canada since you only have one entity to bill and much lower malpractice, but not that much less.
 
TOMFighter said:
wtf are you talking about declining wages? The data I just posted showed an increase in wages from the year before in the u.s.
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Decrease relative to the rampant inflation we currently enjoy in the US. The actual number goes up around 1% per year, which is still a loss relative to inflation (indexed by the federal government at around 5% now).
 
dr in hong kong makes what engineers here make....they are highly respected though
 
DrDre311 said:
(1) Medicare reimbursements are a major source of most physicians' income. They have been declining sharply vs. inflation across the board for most procedures/office visits/etc. Private insurance companies index what they reimburse to Medicare reimbursements, although they pay more than Medicare. The net result is a decrease in pay in real dollars vs. hours worked--for most specialties.

You can argue this point all you like, but the majority of physicians are in agreement that we're making less and it's going to get worse--it is unlikely that this is some kind of mass delusion. That being said, we'll all be able to live comfortably and if reimbursements decrease enough to deter smart, motivated people from going into medicine, then the market will self-correct.

(2) I don't live in Canada, and I don't care about family practice docs in the far reaches of Manitoba.

(3) This is an overly simplistic view of a complex issue. If you want to compare humans to animals in that sense then read Orwell's Animal Farm again.
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I'm just saying that with sacrifice in such a speciliazed field as medicine comes due compensation, and that Canada as a model of socialized medicine is providing excellent compensation.
 
DrDre311 said:
(1) Medicare reimbursements are a major source of most physicians' income. They have been declining sharply vs. inflation across the board for most procedures/office visits/etc. Private insurance companies index what they reimburse to Medicare reimbursements, although they pay more than Medicare. The net result is a decrease in pay in real dollars vs. hours worked--for most specialties.

You can argue this point all you like, but the majority of physicians are in agreement that we're making less and it's going to get worse--it is unlikely that this is some kind of mass delusion. That being said, we'll all be able to live comfortably and if reimbursements decrease enough to deter smart, motivated people from going into medicine, then the market will self-correct.

(2) I don't live in Canada, and I don't care about family practice docs in the far reaches of Manitoba.

(3) This is an overly simplistic view of a complex issue. If you want to compare humans to animals in that sense then read Orwell's Animal Farm again.
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(1) - Then why did I just show data reporting income increase
(2) - you're ignoring that even under socialized medicine (worst possible outcome) - physicians are paid extremely well
(3) - Humans behave on a grand scale like animals;: http://en.wikipedia.org/wiki/Paternity_fraud. The issue is simple: supply and demand.
 
jyw003 said:
dr in hong kong makes what engineers here make....they are highly respected though
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I guarantee you, however, it is higher relative to others in Hong Kong.
 
TOMFighter said:
(1) - Then why did I just show data reporting income increase
(2) - you're ignoring that even under socialized medicine (worst possible outcome) - physicians are paid extremely well
(3) - Humans behave on a grand scale like animals;: http://en.wikipedia.org/wiki/Paternity_fraud. The issue is simple: supply and demand.
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You are misinterpreting the data, which is just a survey from Merritt-Hawkins, a physician recruitment firm. This is not science. Again, the issue is not an absolute number, it is that number vs. inflation, which translates into "real dollars." By that I mean what can the dollars you are making buy vs. what those same dollars could buy 5 or 10 years ago?


Example: Pediatrics, according to this dubious source, experienced an increase of 3%--less than the 5% that the dollar devalued due to inflation. Therefore pediatricians who responded to this survey experienced a net loss in income in 2007 vs. 2006.

Counter-example: Family practice physicians who responded to this survey experienced an 11% increase in income, which is greater than the increase due to inflation.

Problems: From the graphic you posted, I have no idea how many of the doctors surveyed were pediatricians, and I have no idea how many of the doctors surveyed were family practice docs, or obstetricians, or cardiologists, or whatever. I don't know where these doctors live, which absolutely affects salary. I don't know how many docs responded in 2006 for each specialty, or how many docs responded in 2007 for each specialty.

The survey does not mention: How many survey respondents in each specialty? Did PCP's make up the majority? Standard deviation of each average salary? Median salary by specialty? Range? It isn't solid statistics. Furthermore, the survey only accounts for a change over one year. That is a very short-sighted view of finance in any business. Your survey has no statistical power and no predictive value at all.

From what I know about Merritt-Hawkins surveys, they mail out surveys about this kind of thing periodically--usually 10000--and get anywhere from a 10% response rate to a 35% response rate.

Your entire argument is based on a one-year trend from a survey of at most 3500 docs whose baseline characteristics we know nothing about.

In fact, your "source" contradicts your argument: As of this moment, there is a poll on www.merrithawkins.com regarding what physicians will do if the proposed 10.6% Medicare reimbursement cut is enacted.

Also, the following survey http://www.merritthawkins.com/pdf/2007_survey_primarycare.pdf of primary care docs is more useful than your chart: read the part about how only one third of respondents (despite the majority being in groups of more than three physicians) believe that they will be able to sustain their overhead--let alone clear increasing profits! Sixty percent of respondents are dissatisfied enough with their jobs that they would not select primary care if they had it to do over again, and more than a third of these would not select medicine as a career at all.

I restrict the discussion to primary care physicians because there are more primary care docs than specialists, and there will be a shortage of PCP's in the future if reimbursements for these specialties do not improve (or alternatively a paradigm shift in the U.S. healthcare/medical education system).

I say again: you are taking an overly simplistic view of a complex issue. There are many factors at play, and many people who want a piece of the pie. Healthcare is not like other industries--physicians can't unionize and we can't strike because it would be unethical--and "supply and demand" doesn't quite cover it when the service we provide is in some cases a life or death issue; we are obliged to provide necessary services BEFORE we are paid (many times with the foreknowledge that we will not be paid for our work).
 
TOMFighter said:
(1) - Then why did I just show data reporting income increase
(2) - you're ignoring that even under socialized medicine (worst possible outcome) - physicians are paid extremely well
(3) - Humans behave on a grand scale like animals;: http://en.wikipedia.org/wiki/Paternity_fraud. The issue is simple: supply and demand.
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We may have one in the future, but we certainly don't have one now. You can't assume that simply because Canadian physicians are well-compensated that our government will be as good and generous to us, just because they like us.

Also, as an aside, physicians are not the best-compensated professionals: Entertainers are. Professional athletes, musicians, TV actors, movie stars, etc. are the people making ridiculous money (and save the argument about your "starving artists"--people that can't make a living in entertainment go into other fields--like foodservice, prostitution, or politics).
 
DrDre311 said:
I say again: you are taking an overly simplistic view of a complex issue. There are many factors at play, and many people who want a piece of the pie. Healthcare is not like other industries--physicians can't unionize and we can't strike because it would be unethical--and "supply and demand" doesn't quite cover it when the service we provide is in some cases a life or death issue; we are obliged to provide necessary services BEFORE we are paid (many times with the foreknowledge that we will not be paid for our work).
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Obligated. Bwhahahahaha!!! YOu act as if the public has us by the balls to take care of them. MDs can easily transition into other fields.

I'll give you a perfect and clear example of how people are motivated by money/lifestyle. LOOK AT THE MOST COMPETITIVE RESIDENCIES!! Dermatology for christ's sake!?!?!?! Plastic surgery, ear nose throat!!

Give me a break. You might get your occasional compassionate person who doesn't care about money whatsoever and is willing to endure the hell, but that person is EXTREMELY RARE or may not even exist. People on a grand scale are driven by incentives. The argument IS REALLY as simple as supply and demand.
 
DrDre311 said:
We may have one in the future, but we certainly don't have one now. You can't assume that simply because Canadian physicians are well-compensated that our government will be as good and generous to us, just because they like us.

Also, as an aside, physicians are not the best-compensated professionals: Entertainers are. Professional athletes, musicians, TV actors, movie stars, etc. are the people making ridiculous money (and save the argument about your "starving artists"--people that can't make a living in entertainment go into other fields--like foodservice, prostitution, or politics).
Click to expand...

"government will be good to us." Garbage. The Canadian government would have no trouble reducing physician incomes to the lowest possible value. Are you kidding me?

Take an econ class. The market determines physician incomes in Canada. You talk as if the government is doing physicians a favor by paying them so well. Garbage.
 
DrDre311 said:
You are misinterpreting the data, which is just a survey from Merritt-Hawkins, a physician recruitment firm. This is not science. Again, the issue is not an absolute number, it is that number vs. inflation, which translates into "real dollars." By that I mean what can the dollars you are making buy vs. what those same dollars could buy 5 or 10 years ago?


Example: Pediatrics, according to this dubious source, experienced an increase of 3%--less than the 5% that the dollar devalued due to inflation. Therefore pediatricians who responded to this survey experienced a net loss in income in 2007 vs. 2006.

Counter-example: Family practice physicians who responded to this survey experienced an 11% increase in income, which is greater than the increase due to inflation.

Problems: From the graphic you posted, I have no idea how many of the doctors surveyed were pediatricians, and I have no idea how many of the doctors surveyed were family practice docs, or obstetricians, or cardiologists, or whatever. I don't know where these doctors live, which absolutely affects salary. I don't know how many docs responded in 2006 for each specialty, or how many docs responded in 2007 for each specialty.

The survey does not mention: How many survey respondents in each specialty? Did PCP's make up the majority? Standard deviation of each average salary? Median salary by specialty? Range? It isn't solid statistics. Furthermore, the survey only accounts for a change over one year. That is a very short-sighted view of finance in any business. Your survey has no statistical power and no predictive value at all.

From what I know about Merritt-Hawkins surveys, they mail out surveys about this kind of thing periodically--usually 10000--and get anywhere from a 10% response rate to a 35% response rate.

Your entire argument is based on a one-year trend from a survey of at most 3500 docs whose baseline characteristics we know nothing about.

In fact, your "source" contradicts your argument: As of this moment, there is a poll on www.merrithawkins.com regarding what physicians will do if the proposed 10.6% Medicare reimbursement cut is enacted.

Also, the following survey http://www.merritthawkins.com/pdf/2007_survey_primarycare.pdf of primary care docs is more useful than your chart: read the part about how only one third of respondents (despite the majority being in groups of more than three physicians) believe that they will be able to sustain their overhead--let alone clear increasing profits! Sixty percent of respondents are dissatisfied enough with their jobs that they would not select primary care if they had it to do over again, and more than a third of these would not select medicine as a career at all.

I restrict the discussion to primary care physicians because there are more primary care docs than specialists, and there will be a shortage of PCP's in the future if reimbursements for these specialties do not improve (or alternatively a paradigm shift in the U.S. healthcare/medical education system).

I say again: you are taking an overly simplistic view of a complex issue. There are many factors at play, and many people who want a piece of the pie. Healthcare is not like other industries--physicians can't unionize and we can't strike because it would be unethical--and "supply and demand" doesn't quite cover it when the service we provide is in some cases a life or death issue; we are obliged to provide necessary services BEFORE we are paid (many times with the foreknowledge that we will not be paid for our work).
Click to expand...


This entire post is irrelevant. I'm not trying to point out any TRENDS. I'm just giving this data is a rough comparison to Canadian reimbursement - citing that in both coutnries, physicians are compensated very well.
 
TOMFighter said:
This entire post is irrelevant. I'm not trying to point out any TRENDS. I'm just giving this data is a rough comparison to Canadian reimbursement - citing that in both coutnries, physicians are compensated very well.
Click to expand...

More subjective terms to describe the issues - "very well".

Why don't you find us an apples to apples comparison of DATA first and then restart this thread.
Right now, I've still got a question about a wikipedia description of "before expenses" with you describing what expenses are with no source of that information, but instead "you guessing".

Why waste our time arguing a point without a base to begin with?
 
phatmonky did you read my post above?
 
TOMFighter said:
The comparison is made there because that is the worst case scenario whereby the government tries to interfere with a market mechanism.

Even in the worst case scenario, the market prevails.

Physician salaries are still as high as ever according to 2007 statistics. As I understand it, although the government attempts to slash pricing, the AMA consistently lobbies the government not to do so....

Besides, if salaries were cut SIGNIFICANTLY, people wouldn't make the sacrifice. THey might be cut A LITTLE BIT in the future, but Docs will always be in the top 1-5% of earning potential as they are in every country. That's my point.
Click to expand...

You are trying to draw conclusions from flawed premises. Physician salaries have been on the decline against inflation for over a decade, not, as you suggest, "still as high as ever". Simply not accurate. Second, the AMA is perhaps the most impotent lobby in existence. The insurance company lobbies are among the most powerful. So in a system where insurance companies get to set reimbursements (aka physician salaries), you can see how the AMA's voice is not going to have a meaningful impact. Finally, you have to bear in mind that market forces only work where an industry is capable of setting its own prices. The theory of supply and demand depends on this being the case. In medicine it isn't. Physicians depend on reimbursements, set by the insurance industry and government agencies. They cannot set their own prices.

As for your last point, that may be true in the very long run, but not in the short run (ie our lifetimes). Over 50% of med school hopefulls don't get into US medical schools. Probably 90% of all folks who were premed at some point during college get self selected out of the process due to the competitiveness and numbers required. So you can cut and cut and cut and will still have ample people ready to fill those slots. Many foreign countries have physicians who earn a third or less of what US doctors do. Yet there is a steady supply of folks ready to fill those jobs.
 
TOMFighter said:
Obligated. Bwhahahahaha!!! YOu act as if the public has us by the balls to take care of them. MDs can easily transition into other fields.

I'll give you a perfect and clear example of how people are motivated by money/lifestyle. LOOK AT THE MOST COMPETITIVE RESIDENCIES!! Dermatology for christ's sake!?!?!?! Plastic surgery, ear nose throat!!

Give me a break. You might get your occasional compassionate person who doesn't care about money whatsoever and is willing to endure the hell, but that person is EXTREMELY RARE or may not even exist. People on a grand scale are driven by incentives. The argument IS REALLY as simple as supply and demand.
Click to expand...

Not everyone can be a plastic surgeon or a dermatologist. You obviously did not read my posts. The majority of medical school graduates cannot be subspecialists because there are not enough spots.

If you doubt this then go to www.nrmp.org and look at the data from Match cycles in recent years--check the number of medicine/family medicine/peds spots vs. the number of spots for plastics/derm. The number of primary care spots per year is in the TENS OF THOUSANDS--vs. 90 for PRS and 330 for derm. I am not implying that people do primary care because they have some altruistic motivation--it's a simple fact of numbers that generalists outnumber subspecialists.

And yes, the government does in fact have docs, as a profession, by the balls. Why do you think everyone's so doom & gloom about Medicare (which determines reimbursement for everything; even third-party payers index their reimbursements to Medicare)? Check your "source."

And most MD's are in fact 'trapped' in their current practices, due to financial/family obligations (or whatever) without an easy way to transition in to "other fields." Read the survey that I got from your "source."

You DID try to imply a trend with your "source." You tried to imply that physician reimbursement is increasing--a TREND. I pointed out that your source is not a legitimate source at all. Your conclusions are misguided. You fail to note that there is only one driving force for physician reimbursement (Medicare), which negates your imaginary laissez-faire view of the medical industry.

After reading your arguments in this thread as well as your erroneous view that it's easy to get into derm (other readers: look up his "Match Rates are Really High" thread) I have drawn several conclusions:

Either you are:

(A) Not a medical student at all

(B) Suffering from a personality disorder which makes you inflexible and ignorant of your own ignorance

(C) Unable, in spite of all evidence, to comprehend the crisis that faces the U.S. healthcare system

(D) Unable to understand basic statistical arguments or read more than a paragraph at a time

(E) A troll

(F) Some combination of the above.


Also, I could give a crap about Canada. I don't live there and don't anticipate living there, and you can't assume that the healthcare situation would translate to the U.S.
 
DrDre311 said:
Not everyone can be a plastic surgeon or a dermatologist. You obviously did not read my posts. The majority of medical school graduates cannot be subspecialists because there are not enough spots.

If you doubt this then go to www.nrmp.org and look at the data from Match cycles in recent years--check the number of medicine/family medicine/peds spots vs. the number of spots for plastics/derm. The number of primary care spots per year is in the TENS OF THOUSANDS--vs. 90 for PRS and 330 for derm. I am not implying that people do primary care because they have some altruistic motivation--it's a simple fact of numbers that generalists outnumber subspecialists.

And yes, the government does in fact have docs, as a profession, by the balls. Why do you think everyone's so doom & gloom about Medicare (which determines reimbursement for everything; even third-party payers index their reimbursements to Medicare)? Check your "source."

And most MD's are in fact 'trapped' in their current practices, due to financial/family obligations (or whatever) without an easy way to transition in to "other fields." Read the survey that I got from your "source."

You DID try to imply a trend with your "source." You tried to imply that physician reimbursement is increasing--a TREND. I pointed out that your source is not a legitimate source at all. Your conclusions are misguided. You fail to note that there is only one driving force for physician reimbursement (Medicare), which negates your imaginary laissez-faire view of the medical industry.

After reading your arguments in this thread as well as your erroneous view that it's easy to get into derm (other readers: look up his "Match Rates are Really High" thread) I have drawn several conclusions:

Either you are:

(A) Not a medical student at all

(B) Suffering from a personality disorder which makes you inflexible and ignorant of your own ignorance

(C) Unable, in spite of all evidence, to comprehend the crisis that faces the U.S. healthcare system

(D) Unable to understand basic statistical arguments or read more than a paragraph at a time

(E) A troll

(F) Some combination of the above.


Also, I could give a crap about Canada. I don't live there and don't anticipate living there, and you can't assume that the healthcare situation would translate to the U.S.
Click to expand...


You're missing the point. I'm citing people's preference for residencies originating from a calculation of money/lifestyle rather than any genuine interest in the field FOR WHAT IT IS AND FOR WHAT IT DOES FOR PEOPLE. I'm telling that as an example for the fact that people are largely driven to work the least amount of hours for the most amount of PAY regardless of their interest. In fact, that is their interest, for the most part.

These same people are not going to enter into medicine in the first place if the incentives aren't right.

If expenses for doctors (malpractice, overhead, etc.) become too great for the payoff, talented people don't enter the industry. It's as simple as that. The market determines compensation.

I think you should consider taking econ for your medical school electives if you're still having trouble with this very simple point.
 
Law2Doc said:
You are trying to draw conclusions from flawed premises. Physician salaries have been on the decline against inflation for over a decade, not, as you suggest, "still as high as ever". Simply not accurate. Second, the AMA is perhaps the most impotent lobby in existence. The insurance company lobbies are among the most powerful. So in a system where insurance companies get to set reimbursements (aka physician salaries), you can see how the AMA's voice is not going to have a meaningful impact. Finally, you have to bear in mind that market forces only work where an industry is capable of setting its own prices. The theory of supply and demand depends on this being the case. In medicine it isn't. Physicians depend on reimbursements, set by the insurance industry and government agencies. They cannot set their own prices.

As for your last point, that may be true in the very long run, but not in the short run (ie our lifetimes). Over 50% of med school hopefulls don't get into US medical schools. Probably 90% of all folks who were premed at some point during college get self selected out of the process due to the competitiveness and numbers required. So you can cut and cut and cut and will still have ample people ready to fill those slots. Many foreign countries have physicians who earn a third or less of what US doctors do. Yet there is a steady supply of folks ready to fill those jobs.
Click to expand...


I call B.S. Give me your sources where doctors are not the highest paid profession in a certain country RELATIVE TO OTHERS.

Here's Australia:

http://mdsalaries.blogspot.com/2007/05/2006-physician-salaries-in-australia.html

Saudi Arabia: 215K/yr USD
Qatar: 130K- 216K/yr USD

http://mdsalaries.blogspot.com/2007/10/public-sector-doctor-salaries-in-kuwait.html

Turkey (153K/Yr USD)
http://mdsalaries.blogspot.com/2008/01/doctor-salaries-in-turkey.html

You guys need to do your research. In india they don't make much in USD, but they still live like kings relative to others.


And then of course, you have to question other country's quality of training, care, etc.

Keep in mind when you see what others make in other countries, they're still making the MOST RELATIVE TO OTHERS. The amount of earning potential in USD may be lower, but the relative amount relative to others in the country is MUCH MUCH MUCH higher.
 
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