- Joined
- Dec 12, 2006
- Messages
- 3,884
- Reaction score
- 3,661
Really? How many months of inpatient do you do? How many months of L&D call?
Not being snippy, I'm really curious.
Why Make 150k When 450k Is Out There?
- Thread starter jetproppilot
- Start date
Really? How many months of inpatient do you do? How many months of L&D call?
Not being snippy, I'm really curious.
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
Ortho and "life style" don't normally go together...you bust your but in residency and usually in private practice as well (if you want the money anyway).
- Joined
- Oct 5, 2007
- Messages
- 354
- Reaction score
- 1
At my program we cover our inpatient and OB service every month no matter what service we are on. For my intern class we're looking at 5-6 calls a month.
2nd and 3rd year our lighter with 2-3 calls per month, and those are in- house backup call to the interns.
I don't know what Anesthesia residents call schedule looks like (aside from the fact they take 24hr instead of 30 hr call) but my program is on par call wise with most IM programs I've heard of.
I assume you are not a FM resident, so I understand your "curiousity"...
I am at an Unopposed program. This means we are the ONLY residents in our main clinical site, a 500 bed hospital. This means when we are on our surgery rotation, we are the surgical residents. When we do peds, we are the peds residents...and so on. We also rotate at University Hopsital, and 2 other community hospitals.
Adult = 4 Medicine Service + 1 FM service = 5 months/year
Pediatric = 3 months/year (including NICU and Nursery)
Surgery = 1-2 months/year (we take surgery call when on surgery)
Total Inpatient per year = 8-9 months/per year (adult + Peds + surgery)
L&D call = ALL THE TIME, ANY TIME. We deliver our patients. If my patient, who I am following, goes to the L&D...I will be paged to deliver her. If she needs a C-section, I will call an Ob/Gyn attending to be my 1st assistant. I will be the primary surgeon, and the ob/gyn attending will be the Ist assistant.
Hope that helps.
- Joined
- Dec 21, 2007
- Messages
- 805
- Reaction score
- 38
Luekocyte, you lucked out. I can't BELIEVE Tired didn't maul you for saying ortho has a great lifestyle. Beware in the future -- he's perpetually grumpy.
- Joined
- Dec 12, 2006
- Messages
- 3,884
- Reaction score
- 3,661
I was going to get all indignant . . . until I realized you were right. 😀
Thanks for the info Leuk. For whatever reason, I was under the impression that the majority of y'alls residencies were clinic months. I had no idea you did so much inpatient.
- Joined
- Jun 3, 2007
- Messages
- 4,844
- Reaction score
- 3,269
holy crap that took me a long time to read those 8 pages.
Anyway, I think I understand what many of you have said in previous posts about why you choose FP over other. Almost all of the anesthesiologist at my training program (when I was a resident) that were FP's before doing anesthesia (and the few at my current gig that were IM or FP before doing anesthesia) all say that the one thing they miss about doing primary care is the doctor-patient relationship that develops over a long period of time. I can certainly relate. As a GMO on an aircraft carrier, I remember a patient coming by to talk with me to specifically thank me. He said, "doc, I just wanted to sincerely thank you for taking my asthma serious and getting it under control. All other docs have just given me more albuterol. You took steps to really make it controlled. You changed my life. Thanks from the bottom of my heart." That was one of the coolest and gratifying moments of my life.
In medical school, I thought I would be an FP because it seemed noble, and plus I knew it was one of the shortest residencies available (stupid I know, but that is how I felt.) I'm glad I figured out that length of residency was a really stupid reason to choose, and I actually found FP rather boring and stressful (as many of you find anesthesia boring). I am very happy to have found something that for me is thrilling to do.
Finally, I just had to mention that it is very strange that JPP asked a question about primary care (about 3 fields...IM, FP, Peds) vs all the other (about 30 or so fields), yet many of the posters turned it into a FP vs Anesthesia thing. That is very, very strange.
Oh, I guess one more thing. Someone on the last page suggested that FP uses more brain power and works much harder than anesthesiologists. That has seriously got to be one of the dumbest, ******ed things I have ever seen written. How much someone works or how much they use their brain on a daily basis has absolutely nothing to do with one's chosen specialty.
Anyway, I think I understand what many of you have said in previous posts about why you choose FP over other. Almost all of the anesthesiologist at my training program (when I was a resident) that were FP's before doing anesthesia (and the few at my current gig that were IM or FP before doing anesthesia) all say that the one thing they miss about doing primary care is the doctor-patient relationship that develops over a long period of time. I can certainly relate. As a GMO on an aircraft carrier, I remember a patient coming by to talk with me to specifically thank me. He said, "doc, I just wanted to sincerely thank you for taking my asthma serious and getting it under control. All other docs have just given me more albuterol. You took steps to really make it controlled. You changed my life. Thanks from the bottom of my heart." That was one of the coolest and gratifying moments of my life.
In medical school, I thought I would be an FP because it seemed noble, and plus I knew it was one of the shortest residencies available (stupid I know, but that is how I felt.) I'm glad I figured out that length of residency was a really stupid reason to choose, and I actually found FP rather boring and stressful (as many of you find anesthesia boring). I am very happy to have found something that for me is thrilling to do.
Finally, I just had to mention that it is very strange that JPP asked a question about primary care (about 3 fields...IM, FP, Peds) vs all the other (about 30 or so fields), yet many of the posters turned it into a FP vs Anesthesia thing. That is very, very strange.
Oh, I guess one more thing. Someone on the last page suggested that FP uses more brain power and works much harder than anesthesiologists. That has seriously got to be one of the dumbest, ******ed things I have ever seen written. How much someone works or how much they use their brain on a daily basis has absolutely nothing to do with one's chosen specialty.
- Joined
- Jul 27, 2007
- Messages
- 1,221
- Reaction score
- 203
This is quite the interesting discussion.
I can see no reason to currently go into FM in the present time.
I'm from Canada, so its a little different here. However, we are following the same path as the US: specialization of FM leads to those who do FM being tied down to the lowly-paid and respected field. Thus, with no options to leave FM for richer, better pastures, less people go into it in the first place. Once our healthcare becomes privatized, and it will, we will be in the exact same situation as the US.
Also, the advent of evidence-based medicine also bolsters the medical malpractice and insurance industries. Since "evidence" implies that there is a universal standard to which all patients must be treated, it is far safer to follow this evidence "cookbook" than to actually use brainpower to think of management plans. Thusly, FM becomes a "cookbook" specialty: if anything falls outside of the cookbook, it is referred to a specialist.
Now, "cookbook" medicine is essentially a trade: with enough training anyone can do it. This is where NPs, PAs, and the dreaded future DNPs come in. They follow the "evidence-based" protocol for the general patient without regard to true medical knowledge. Since it is cheaper to hire them, and they are willing to work "cookbook", their demand increases. Heck, in the nursing class they teach at my school, the students are taught that nurses can legally do 70% of what an FP does in his office.
Soon enough there will be no place for FPs except for in the most isolated of burgs.
The FP may wax prophetic about how a future without FPs is dismal, and that specialists will be forced to take up the general workload of the FP. This is untrue. The "mid-levels" mentioned above will pick up the slack, and in far greater numbers since you can hire 2 to 4 mid-levels for the price of one FP. If anything, people will have more access to primary care. More access to doctors? No. But more access to primary care? Yes, even if it is of lower quality. But that doesn't matter, since the people who count(rich people) will be able to afford a real doc at one of those concierge clinics.
The only solution for the FP is to politick the government heavily to increase reimbursements and to wall-off the influence of "mid-levels": however, you're gonna need a huge Libby Zion-like malpractice case to win that battle.
Sure, there are going to be some paltry interventions: debt relief for those who choose FP. Horrible idea. This walls off the most lucrative specialties to all but the most wealthy of medical students, since tuition will be (is?) too expensive for the non-rich to afford medical school - especially a good one.
FP is a dying field. Jump ship while you can.
I can see no reason to currently go into FM in the present time.
I'm from Canada, so its a little different here. However, we are following the same path as the US: specialization of FM leads to those who do FM being tied down to the lowly-paid and respected field. Thus, with no options to leave FM for richer, better pastures, less people go into it in the first place. Once our healthcare becomes privatized, and it will, we will be in the exact same situation as the US.
Also, the advent of evidence-based medicine also bolsters the medical malpractice and insurance industries. Since "evidence" implies that there is a universal standard to which all patients must be treated, it is far safer to follow this evidence "cookbook" than to actually use brainpower to think of management plans. Thusly, FM becomes a "cookbook" specialty: if anything falls outside of the cookbook, it is referred to a specialist.
Now, "cookbook" medicine is essentially a trade: with enough training anyone can do it. This is where NPs, PAs, and the dreaded future DNPs come in. They follow the "evidence-based" protocol for the general patient without regard to true medical knowledge. Since it is cheaper to hire them, and they are willing to work "cookbook", their demand increases. Heck, in the nursing class they teach at my school, the students are taught that nurses can legally do 70% of what an FP does in his office.
Soon enough there will be no place for FPs except for in the most isolated of burgs.
The FP may wax prophetic about how a future without FPs is dismal, and that specialists will be forced to take up the general workload of the FP. This is untrue. The "mid-levels" mentioned above will pick up the slack, and in far greater numbers since you can hire 2 to 4 mid-levels for the price of one FP. If anything, people will have more access to primary care. More access to doctors? No. But more access to primary care? Yes, even if it is of lower quality. But that doesn't matter, since the people who count(rich people) will be able to afford a real doc at one of those concierge clinics.
The only solution for the FP is to politick the government heavily to increase reimbursements and to wall-off the influence of "mid-levels": however, you're gonna need a huge Libby Zion-like malpractice case to win that battle.
Sure, there are going to be some paltry interventions: debt relief for those who choose FP. Horrible idea. This walls off the most lucrative specialties to all but the most wealthy of medical students, since tuition will be (is?) too expensive for the non-rich to afford medical school - especially a good one.
FP is a dying field. Jump ship while you can.
- Joined
- Jul 17, 2004
- Messages
- 7,250
- Reaction score
- 6
1) This IS the family practice forum.
2) JPP claimed to be targeting students, yet he posted in a forum for FP residents and practicing family physicians.
It's also really not surprising that this thread degenerated into a flame war of sorts, given the title (which seemingly suggests the most important aspect of choosing a specialty is salary).
Again, it's hard to predict the future. I have no doubt that NPs and PAs will start to take on more of the load of primary care. However, just for comparison, I would never go into anesthesiology for similar reasons; I find it boring AND... if we convert to a national system of health care, I can see CRNAs taking over that field. Why pay an anesthesiologist all that money when its so much easier just to change the law and allow CRNAs to do more of the work?
The end solution? Do what you want. People who did not like family practice are going to be more likely to listen to these types of arguments than people who love it.
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
- Joined
- Oct 5, 2007
- Messages
- 354
- Reaction score
- 1
I stopped reading right there
Just kidding. It's funny you mention that Canada is moving to a privatized system. Because I really do think the US will move to a system like Canada's in the not to distant future. In general people in the US are more likely to support a free market but when the economy is so in the dumps and people are losing their jobs "free health care" and cheap medications sound pretty damn good.
- Joined
- Jul 27, 2007
- Messages
- 1,221
- Reaction score
- 203
I stopped reading right there
It's funny you mention that Canada is moving to a privatized system. Because I really do think the US will move to a system like Canada's in the not to distant future. In general people in the US are more likely to support a free market but when the economy is so in the dumps and people are losing their jobs "free health care" and cheap medications sound pretty damn good.
If anything, I think the US will have a low-tier public system mostly run by PAs, NPs, and any other cheaper primary-care providers courtesy of Wal-Mart. This system will be for the have-nots. Free/cheap for patrons, but lower quality.
There will also be a very private high-tier system for those who can afford it. The real doctors will be housed here. Perhaps FPs will be able to make a bit of an inroad here, but why pay for an FP when you can have a general internist?
Canada is so going to go private. Our system is collapsing: patients are getting older and interventions are getting more expensive. Wait times are astronomical. Many are complaining that they should be able to cut to the front of the line if they have the money to do so. Mark my words, we're going to end up private.
- Joined
- Sep 1, 2007
- Messages
- 1,009
- Reaction score
- 8
YES.
- Joined
- Oct 5, 2007
- Messages
- 354
- Reaction score
- 1
As kent mentioned above their care is not actually cheaper for the patient. What they are doing is filling niche FM docs refuse to fill.
What they offer
Quick visits, no appointments, and a convenient location for the cost of $60. If a mid level saw 4 patients an hour (not hard when you cater to people who want to get in and out and not talk about their cat or whatever) then worked 7 hours a day, 5 days a week, 11 months a year he would generate 370K in CASH. Lets say they lose half to taxes and overhead thats still 185K which is more than the average FM doc in take home salary. The difference between the doc and Wal Mart is that Wal Mart pays the NP or PA about 80K and pockets the other 100K for themselves.
Theres nothing to stop a FM doc from having the same type of practice.
The key is to offer patients convenience, quality care, and affordable prices. The problem is that in medicine people refuse to fill this niche. They want the patient to come see them their way, the way their attendings and their attendings before them did it, and gosh dang it they are going to come do it our way because thats how medicine is done.
Good question and I have a good answer. The traditional IM residency is very inpatient heavy. While FM is outpatient heavy. If your going to pay someone for outpatient services shouldn't it be someone who specializes in it?
It's nice that Dr so and so was on the sepsis team when he was a chief resident but does that mean he is going to manage your HTN well? The common misconception is that if a physician is well versed in exotic diseases and critical patients then outpatient medicine should be a breeze for him. Not true, case in point my ICU attending once told me "You know a patient comes in with DKA or full blown sepsis I can handle half asleep. But if you got the sniffles or a head ache and I have no clue what to do for you." It's not about being "smart enough" as the truth is that 99% of med students could go into any field and handle it intellectually. What it is about is seeing the patient volume in whatever field you go into.
Now lets look at a typical outpatient service.
-You have things like HTN, DM, HL which IM and FM see roughly the same number (with an edge going to FM simply due to our clinic hours)
But then you look at the following
-Simple sprains, strains, and other various ortho problems. Pretty much every FM grad will have experience here both in clinic and orthor/sports med rotations. IM will have little if any exposure.
-Derm again FM grads will most likely have had a large number of skin cases seen in clinic as well as a derm rotation. Again IM may have a little training in this.
-Simple GYN visits ie Birth control, paps, culps, UTIs: FM again has tons of exposure. IM aside from UTIs probably have no experience in the above.
Given that why wouldn't you want to see a FM doc for your outpatient care?
You do know the difference between Internal Medicine and Family Medicine training/scope, right?
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
1) If you were a med student interested in primary care, dontcha think you'd visit a primary care forum? 🙄 Or do med students interested in specialties just routinely visit and contribute to specialty forums, and primary care forums prohibit med student visits?
2) I suggested that money is a huge issue for debt laden med students, no matter how much you choose to ignore it. Educational debt continues to spiral outta sight. Many students/residents lose sleep over their huge debt load, much in contrast to various rose-colored glasses opinions.
WOW!! >10,000 views! Hmmmm... somebody thinks its relevant, huh?
😕
So, what should we do, Jet? Should we just leave our FM residency programs (which we enjoy), and switch to Anesthesia residency (which we do not enjoy)? Should we force ourselves to like Anesthesia because it is better paying? Should we really go into a specialty that we do not like, or care about, just for the money?
Most of us are in FM because we like FM. We do NOT care for IM, Peds, Psych...or Anesthesia. FM is a UNIQUE S-P-E-C-I-A-L-T-Y, and we like it. It is the BEST and most challenging medical SPECIALITY as far as we are concerned. And if we only get 150,000 for something we enjoy, then so be it.
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
Sorry you choose to see it that way. Simply responding to comments.
BTW, I love McDonalds.
Their grilled chicken classics are the bomb! You should try one sometime.
Quick, and healthy.
And their premium coffee tastes almost as good as the more expensive coffee houses.
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
I respect that.
Not fair, though, if you're one of the dudes/dudettes in the >200K student loan debt club.
Something needs to change, dontcha think?
How many med students do you think look at future reimbursement when selecting a specialty, and are swayed away from primary care because of debt load?
Why isnt there some kinda automatic debt forgiveness for students going into primary care?
This country is big on making statements.......the US needs more primary care docs.......but this country is invisible when it comes to student loan debt issues.
Call me cynical. Call me a troll. Whatever. Why arent more people going into primary care?
Kent, BTW, the New York Times thinks its an issue.
I'm not being argumentative. Just keeping a salient issue alive.
I think you deserve more money, Dude.
But if you wanna post McDonalds pics instead of yelling HEY INSURANCE/POLITICAL/MEDICARE DUDES!!!! I DESERVE MORE!!!!, thats OK too.
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
HUH? DUDE, YA GOTTA PUT DOWN THE BLUNT.
Its my opinion that primary care attracts fewer med students because of spiraling student loan debt.
Admit it or not, like it or not, many, many med students don't even consider primary care because of their debt load.
Many, many med students would consider primary care if they didnt owe so much to Sallie Mae.
I fail to see how debt forgiveness is a bad idea. I certainly think it would go a long way in attracting more students into primary care specialties.
BTW, you comment on going to a good med school. What does that mean? Pragmatically, if one goes to a U.S. MD/DO school, by definition, thats a good one.
Residency and subsequent practice endeavors make a clinician.
Not the med school.
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
Uhhhh, Dude, you used DUDE in a sentence....
something I think you blasted me for doing on one of the countless previous posts....
rolls off the tongue/keyboard pretty eloquently, huh?
Butcha definitely cant wear a bow tie to work and use dude in your vocabulary.😉😉😉😉😉😉😉
- Joined
- Feb 22, 2003
- Messages
- 175
- Reaction score
- 1
I like the specialists I know in IM, they are great to go and see. Plus! they seem super nice. 👍
I have an IM for a general physician and she doesn't seem to remember me from visit to visit. Plus, I usually walk out feeling like I have just been yelled at on rounds. I feel depressed and a little sore.
I grew up with an awesome FM doc, she was great. My whole family goes to FM docs, except for the specialists we might have to see. I was delivered by a FM doc. 😀
I am thinking: I am going to dump my IM person and get me a FM for my regular doctor. Why? most FM types actually remember you from visit to visit, they also remember to ask about things, and for the most part they do not make you feel like you have just been scolded on rounds. Ok, I still suffer PTSD from third year alright?
It can be hard to find a good general internist, one you can talk to and feel comfortable with. FM docs are usually pretty nice. I think people are attracted to the different specialties because of their personalities and what fits them best. I like anesthesia, but I would miss the patient contact. Hard to decide.
I have an IM for a general physician and she doesn't seem to remember me from visit to visit. Plus, I usually walk out feeling like I have just been yelled at on rounds. I feel depressed and a little sore.
I grew up with an awesome FM doc, she was great. My whole family goes to FM docs, except for the specialists we might have to see. I was delivered by a FM doc. 😀
I am thinking: I am going to dump my IM person and get me a FM for my regular doctor. Why? most FM types actually remember you from visit to visit, they also remember to ask about things, and for the most part they do not make you feel like you have just been scolded on rounds. Ok, I still suffer PTSD from third year alright?
It can be hard to find a good general internist, one you can talk to and feel comfortable with. FM docs are usually pretty nice. I think people are attracted to the different specialties because of their personalities and what fits them best. I like anesthesia, but I would miss the patient contact. Hard to decide.
- Joined
- Dec 26, 2004
- Messages
- 717
- Reaction score
- 3
A few things. Med students by nature are competitive. Thus, when you leave residency, and see your colleagues (some of whom you were better than) earning more, and dealing with less than you, it bothers you.
Veterinarians don't deal with anywhere near the hostile environment doctors do. We endure lots more of everything.
People are much less uptight about their animals then they are about themselves. Again, this creates a much more stressful environment.
That said, I agree that many medical people do indeed have a very strong sense of entitlement that is regrettable. Honestly, I think there is a good number of people who start out in medicine with good intentions. However, through years of hostility, noncompliant patients, and deferred gratification, decide it might be just better if I advocate for myself and stop fighting the system. Basically, I put in all this work, I might as well start getting paid for it. Right? I don't know. But I think it's true.
- Joined
- Jul 17, 2004
- Messages
- 7,250
- Reaction score
- 6
Newsflash: I AM a medical student interested in primary care, but I spend a lot more time in the medical student forums. I also spend quite a bit of time in the lounge (where this thread would fit in quite nicely).
You claim this thread was aimed at students interested in any type of primary care, and yet only posted in this forum. If you want to reach all medical students, in the future why don't you try allo/osteo/clinical?
Wow. Yeah. I'd never thought about that before! In fact, NONE of my fellow medical students had ever thought about that before. We just thought the money was magically appearing in our accounts. But now that you've so kindly pointed out that we actually have to repay it, I'd better go into urology (they make like half a mil per year, don't they?). 👍
- Joined
- Mar 12, 2005
- Messages
- 5,863
- Reaction score
- 143
What year med student are you?
- Joined
- May 7, 2005
- Messages
- 22,783
- Reaction score
- 346
Please address the topic of the thread, not the posters in the thread.
Stop taking shots at each other.
Fair warning. 🙂
Stop taking shots at each other.
Fair warning. 🙂
- Joined
- May 22, 2007
- Messages
- 64
- Reaction score
- 0
I've unfortunately seen many friends/colleagues develop cynicism despite none exisiting prior to medical school. The health care system really needs some work, I think it's disappointing that it seems to be working increasingly against rather than for patients and their doctors.
- Joined
- Jul 27, 2007
- Messages
- 1,221
- Reaction score
- 203
DUDE! Molson is piss. It's almost as bad as Coors!!! hahaha
- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
I've never met a nurse who could be a doctor and I've seen some really lousy PAs who didn't want to be a doctor. I've also seen some pretty admitedly ignorant nurses who recognized there own ignorance and wanted no part of doing the job of a doctor. As for midlevels taking over FP I think anesthesia is in much more danger of this as the practice of anesthesia has become much safer with improvements in technology hence the nurse anesthetist. Soon they may even train monkeys to push the buttons with one actual person sitting in an outside room monitoring the monkeys administering anesthesia. Also, when you use the future tense to state that specialties will have to take up the slack of primary care you are incorrect. It has already happened and it is costing alot of money and the problem is recognized. There is a shortage of primary care and the reason salaries aren't going up is because reimbursements are tied to the medicare. Something has to give. Medicine and remibursements have always shifted and hopefully they will shift in the right direction. It just doesn't make sense that a nurse who just got by in school or was hardly stellar can go get a two year community college degree and pull down more than an MD with 4 years of training on top of a residency and 150,000 dollars in debt especially with how dependent the system is by necessity on good primary care. People don't want a nurse for a doctor. There are already enough bad doctors and people know it. Think how bad it would be if your nurse was now your doctor. It takes knowledge to know when something is serious and needs extensive workup. Workup is expensive. The trend is toward reimbursing good physicians for knowing when a million dollar workup is required.
- Joined
- Jul 27, 2007
- Messages
- 1,221
- Reaction score
- 203
I suppose debt-relief for the primary care fields is a double-edged sword.
It seems that in the future, med school tuition will increase to the point where only the most affluent of individuals will be able to afford it. Even with loans, medical school will be out of reach for students whose families don't routinely shop at Nieman-Marcus; unless of course they go into primary care like it or not.
As for my good school comment: some schools are better than others. For instance, it appears that most of the top schools are privately-owned and therefore far more expensive than state run schools. Granted, I'm not saying a non-top-20 school is a bad one, but I doubt I'd be wrong in saying that those who go to top schools have far more professional opportunities than those that do not. It would be highly unfortunate that an excellent candidate would be unable to attend one of these top schools solely on the fact that they are not rich and do not want to do primary care.
- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
Apparenly Jet likes to poke his FM counterparts with this thread. However, he has a point and it is good that it is recognized by all. I don't think you speak for all or even a minority of primary care physicians when you say "so be it". I for one and will continue to push for fair and equitable compensation given the time commitment and my student loan debts. There is a shortage of primary care physicians and it is only getting worse. Cost effective medicine requires good primary care physicians. We should have them by the "short hairs" so to speak. It is up to us to make our voices heard and move the system in the right direction. We don't need any "martyr" docs going around saying I don't care if I'm treated fairly. We need people who are willing to make our case.
- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
One novel and possible solution is a "primary care tax" to be placed on specialist receiving these 450,000 dollar salaries on the basis of primary care referrals.
- Joined
- Dec 21, 2007
- Messages
- 805
- Reaction score
- 38
Novel is debateable. It's definitely pretty radical. How would it work? And since anesthesia is the 'dark specialty' du jour what would we do about them, since they do not receive referrals from primary care providers?
Would the tax be levied based on the number of referrals a specialist received? This might create conflict of interest problems and would open the door for corruption and underhanded dealings. Specialists might incorporate with primary care providers to avoid paying the tax, or more specifically, to have the tax simply be reinvested in the practice. Take, for instance, a physician multispecialty group -- perhaps Kent can shed some light on that.
You might also want to beware that this could easily backfire on primary care physicians. Specialists will (obviously) not want to pay this tax, so they may lobby and find ways around the necessity of a referral. My insurance, for instance, allows me to see a specialist without a referral -- more insurance companies could pick up on that, if it's financially and politically saavy. Though I'd say wholesale extinction is unlikely, taxing specialists might mean they find a way to do without you.
- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
I used the word tax because of it's inflammatory connotations. The medical system isn't as simple as a tax but it all comes down to equitable distribution and whether it is a tax or a change in reimbursement patterns it is really the same thing. Just because primary care has been the favorite physician to screw and it has been going on so long that specialist feel entitled doesn't mean it should continue. Specialist are as beholden to whatever system that may exist as primary care. I think everyone recognizes the problem and the need for a solution given the importance of primary care physicians in creating an affordable health care system that delivers quality care. As far as specialist finding ways to get around utilizing primary care physicians think about it like this? Is grandma going to know to go to a neurologist rather than a rhematologist? Does grandma know the differnece between a neurosurgeon, a neurologist or an orthopedic surgeon or which of these she requires? Would a neurologist, neurosurgeon, orthopedist, endocrinologist be able to screen patients and determine which specialist to send patients to and then send them away for the correct specialist. No way. It just doesn't work that way. Patients need to be diagnosed before a specialist is employed. It would be incredibly expensive and ineffficient any other way.
- Joined
- Apr 9, 2008
- Messages
- 10
- Reaction score
- 0
why exactly are you posting on a Physician forum? That is the question of the day. Please enter medical school first, before you comment on the intricacies of Medicine and General Practice.
- Joined
- Nov 27, 2006
- Messages
- 224
- Reaction score
- 8
I think the question has already been answered pretty well, but I'll add my thoughts.
I was poised to make a pretty good living as a ob/gyn specializing in mfm. Not a bad average salary for them (certainly not $450K but in the $300s)
In any case, I found out that I hate being in the OR. When I did my surgery rotation, I had a week of anesthesia, and I must admit I had fun. The residents were all so happy, and the attendings let me do so much. But it never was for me, though I respect all of you, because the amount of drugs you have to know is just astounding! It's just not for me.
After a few months of my ob/gyn residency, I knew a life in surgery was also not for me. And I was sad because everything else about ob/gyn is absolutely wonderful to me, and is a big part of why I went into medicine. But then I remembered my other love-peds- and that's how I came to decide on switching to FP. I get to have all the stuff I love, none of the stuff I hate, and a few things I could do without, but will deal with (geriatrics for example). And fortunately for me, I am one of those with an NHSC scholarship so the med school debt was never a worry.
I will admit that the idea of possibly making less than half of what I was going to make was kind of a bummer....then I remembered I would never have to be on call again after residency if I didn't want to be, and I pretty much got happy all over again!
I was poised to make a pretty good living as a ob/gyn specializing in mfm. Not a bad average salary for them (certainly not $450K but in the $300s)
In any case, I found out that I hate being in the OR. When I did my surgery rotation, I had a week of anesthesia, and I must admit I had fun. The residents were all so happy, and the attendings let me do so much. But it never was for me, though I respect all of you, because the amount of drugs you have to know is just astounding! It's just not for me.
After a few months of my ob/gyn residency, I knew a life in surgery was also not for me. And I was sad because everything else about ob/gyn is absolutely wonderful to me, and is a big part of why I went into medicine. But then I remembered my other love-peds- and that's how I came to decide on switching to FP. I get to have all the stuff I love, none of the stuff I hate, and a few things I could do without, but will deal with (geriatrics for example). And fortunately for me, I am one of those with an NHSC scholarship so the med school debt was never a worry.
I will admit that the idea of possibly making less than half of what I was going to make was kind of a bummer....then I remembered I would never have to be on call again after residency if I didn't want to be, and I pretty much got happy all over again!
- Joined
- Dec 21, 2007
- Messages
- 805
- Reaction score
- 38
Man, I can't catch a break on this forum.
To answer your question, it seems to be widely agreed that medical school does not prepare you for the financial aspects of medicine -- in fact, that's one of the top complaints of practicing physicians. As such, being a med school graduate wouldn't prepare me to discuss such issues. At least not as much as my experience working for the National Institutes of Health and a private physician consulting firm.
I'm a big advocate of the free exchange of ideas. You're more than welcome to come post on the post-baccalaureate forum, if you have something intelligent to say. These issues FPs face now are the issues I'll be facing in a few short years, so I'd like to stay connected. Plus, Kent and I are Tidewater brothers.
My questions regarding the proposed tax were completely logical and appropriate. MedicineDoc understood that, and answered politely and intelligently. Ad hominem attacks are the lowest common denominator of human intellectual capacity. If you are, as you say, a med school student or physician, I hope you would expect a bit more of yourself.
- Joined
- Dec 22, 2007
- Messages
- 4,379
- Reaction score
- 1,645
Actually,it does work that way a lot of the time (it just doesn't work that well). People refer themselves to specialists all the time. And the specialist then sends them to another specialist if necessary.
- Joined
- Apr 9, 2007
- Messages
- 34
- Reaction score
- 0
The RVU system? Why? Why fight for it? It is a lost cause. I may be just a second year student, but one of the things we are frequently taught is to treat the underlying cause of the symptoms/signs. CMS is the tumor and its controlling influences in the healthcare market. Am I the only one who sees that every specialty is on the same sinking ship? Primary care just happens to be the chair closest to the sea water. General surgery is next. The whole thing is bankrupt things are only going to get worse playing the reimbursement game. Why are people still trying to patch the ship with lobbying for increases in something that is bankrupt? Why aren't more docs jumping ship and converting to more direct patient care models? Eliminate the insurance billing. Eliminate the office billing staff. Eliminate the headaches. Spend more time with patients. Be free of any perceived need for midlevels. It seems so obvious!
- Joined
- Sep 1, 2007
- Messages
- 1,009
- Reaction score
- 8
Yeah, try being my vet school class where the average entering GPA was only a few short ticks off from the average entering GPA of Harvard Medical School with virtually identical pre-reqs (except pre-vet requires biochem). And I'm not going to Cornell or UPenn even! The average overall national acceptance rate into both vet school and med school are virtually identical as well (46% vs 44%). Yeah, we're not competitive at all. Surely not. 🙄
Ah ha, I knew there was a reason that our mnemonic in immunology for learning what immunoglobulins are made by what cells when: NAIVE B lymphocytes make Ig M and D. I love it when people who have no idea what they are talking act like they do. I find more people give more of a crap about animal's health than they do about their own. Here's the deal...contrary to popular belief, we do more than play with puppies and kitties, give shots, and do spays and neuters. Just because not everyone can pay for the procedure in their animals, doesn't mean it can't be done. There is one medicine, just different species.
I'm not saying you all shouldn't be getting paid. Of course not. I was pre-med myself for a long time, I know how it goes. However, I dislike this cry baby "OMG, I can't afford private school tuition, the country club, the Rolex, the BMW SUV, etc etc" attitude that you correctly pointed out when I'll be a veterinary medical doctor and will have had a fairly similar education. Well, to a degree...God, what I wouldn't give to NOT have a full year of in detail anatomy of over half a dozen species. That must have been nice for you all. I'm not begging for 450K. I just want enough to live comfortably, pay off my student loans, and have a nice well-equipped practice.
- Joined
- Aug 16, 2007
- Messages
- 274
- Reaction score
- 211
I don't really know how vet services are financed but I'm guessing that the low pay that you're complaining about is determined largely by market forces which by definition is fair. Physician's have a little more right to bitch and moan about pay as their fees are set by a third party, largely medicare, which can arguably be unfair.
- Joined
- Apr 9, 2008
- Messages
- 10
- Reaction score
- 0
why in the world would I want to post on the post bac form, or Bryn Von Mar forum where you clearly belong?
- Joined
- Dec 21, 2007
- Messages
- 805
- Reaction score
- 38
why in the world would I want to post on the post bac form, or Bryn Von Mar forum where you clearly belong?
Welcome back, andwhat. I'm sorry your last account got banned. If you could leave me alone, I'd be appreciative. I've tried to reason with you, but this is bordering on creepy.
- Joined
- Apr 9, 2008
- Messages
- 10
- Reaction score
- 0
?? come again?
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
You do remind me of someone else with a different screen name.
- Joined
- Nov 17, 2001
- Messages
- 1,039
- Reaction score
- 95
Hmmm. . . not sure andwhat got banned. But anyhow.
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
No, he didn't get banned...good thing too, that guy's hilarious!
- Joined
- May 22, 2007
- Messages
- 64
- Reaction score
- 0
Thanks for adding a series of logical and well written posts to the thread. I'm disappointed that some students/MD's would think they have a monopoly on valid inference for all things medical.
Looking again at JPP's original question brings up a series of thoughts for me:
1) These figures of 150K, 450K, etc. are averages collected on surveys.
2) If you prefer a salaried position over ownership or part-ownership of a private practice, these averages are more likely to apply to your future income.
3) In private practice there is a greater variance in income, and there must be a logical reason for this variance.
4) My best explanation to date for this variance is that medicine is a business, and some businesses are simply run in a much more profitable manner than others.
This goes to the heart of what you touched on, which is understanding the financial aspects of medicine. Doing so may just permit you to chose the specialty you enjoy most AND make more than you otherwise would.
- Joined
- Aug 5, 2003
- Messages
- 649
- Reaction score
- 3
FYI
Friend just took a starting salary job in FM of $190,000 + benefits. 0 call. Completely salaried, no ownership in TX. I didn't ask other details, but it seems pretty decent to me.
Friend just took a starting salary job in FM of $190,000 + benefits. 0 call. Completely salaried, no ownership in TX. I didn't ask other details, but it seems pretty decent to me.
Similar threads
