with the disaster the obamacare will be for doctors, why are there still so many applicants ?

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Are you kidding? I mean I'm as against the ACA as much as anyone, but the reasons are clear.

1. You'll still get paid well as a doc. It's a very stable, economy-resistant job.
2. People still care about people and want to go into medicine for "all the right reasons."
3. Prestige associated with being a doc.
4. See the "will hot women flock to you when you become a doctor" thread.

The ACA just further undermines doctors' autonomy. That's really nothing new.
 
Gut Shot said:
Yeah: 0/10.
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Why does everyone take as a given that the ACA will be a disaster for doctors? It may turn out to be the case, but I think that's far from a given.
A larger percentage of your patients will be covered by insurance. That's bad?
Sure, insurance companies will negotiate discounted rates, sometimes deeply discounted rates. Is anyone under the impression that they don't do this already?
You'll be required to treat patients for free under certain circumstances? Aren't doctors already required to do this?

While NPs and PAs may provide more routine care, doctors will still have a monopoly on providing high level medical care. Doctors drive the 'revenues' so doctors will always have a high stake in the decisions. Who is it that runs most hospitals? Doctors, right? I don't think they'll shoot themselves in the foot.
 
Rik1111 said:
Are you kidding? I mean I'm as against the ACA as much as anyone, but the reasons are clear.

1. You'll still get paid well as a doc. It's a very stable, economy-resistant job.
2. People still care about people and want to go into medicine for "all the right reasons."
3. Prestige associated with being a doc.
4. See the "will hot women flock to you when you become a doctor" thread.

The ACA just further undermines doctors' autonomy. That's really nothing new.
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Doctors will still be leaders of the inter-professional health care team. If anything, I would say the ACA means less personal responsibility but the same autonomy. I'm not sure if this would apply to PCPs though.
 
bargostovan2 said:
any thoughts ?
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Premeds are usually the last to grasp the realities of the real practice of and the business of medicine and the great effect Obamacare will have on salaries of physicians. This isn't surprising as there is a lot of delayed gratification in medicine, so many believe either they won't be affected or it won't be that big. Many of these premeds think that having a high GPA and MCAT score somehow makes them "smart", when they're actually not. Booksmart definitely, common sense smart or economics savvy, no. When banks come knocking on your door for the loans you took out, you can bet compensation (and current decreasing reimbursement) will definitely mean a lot to you.

See the difference in mentality between the threads on the premed forums vs. the threads in the residency forums with residents and attendings and you'll see the difference in reality based thinking vs "save the world"/"healthcare is a human right" parrots. Right now, Obamacare has not fully taken effect so the effects won't be seen for about a decade. A loss of autonomy automatically results in decrease in salary bc you no longer call the shots. Will applications stop? No. Will students be of lower and lower caliber? Yes.
 
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DokterMom said:
Why does everyone take as a given that the ACA will be a disaster for doctors? It may turn out to be the case, but I think that's far from a given.
A larger percentage of your patients will be covered by insurance. That's bad?
Sure, insurance companies will negotiate discounted rates, sometimes deeply discounted rates. Is anyone under the impression that they don't do this already?
You'll be required to treat patients for free under certain circumstances? Aren't doctors already required to do this?

While NPs and PAs may provide more routine care, doctors will still have a monopoly on providing high level medical care. Doctors drive the 'revenues' so doctors will always have a high stake in the decisions. Who is it that runs most hospitals? Doctors, right? I don't think they'll shoot themselves in the foot.
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A larger percentage of your patients will be covered by insurance. That's bad?
Uh, if a lot of your "new" patients are covered by Medicaid then yes it is bad. This has already started happening with the Obamacare exchanges.

While NPs and PAs may provide more routine care, doctors will still have a monopoly on providing high level medical care.
You apparently haven't been following the NP movement who want independent practice, same parity of pay for services, and have started infiltrating specialty medicine such as Derm, Anesthesia, GI, etc.

Doctors drive the 'revenues' so doctors will always have a high stake in the decisions. Who is it that runs most hospitals? Doctors, right? I don't think they'll shoot themselves in the foot
Um, you actually think doctors "run" hospitals? They don't. Hospital CEOs do and most are NOT doctors (and this isn't by coincidence). Every doctor knows that when you work for a hospital that you lose autonomy and the ability to make all the decisions.
 
In my experience in medical school, most premeds and medical students are extreme leftists who proudly proclaim their willingness, nay, desire, to spend a lifetime bending over backwards to treat the underserved in exchange for nothing more than a can of beans. Most of them also come from quite well-off parents and simply assume the level of material comfort in which they grew up as a backdrop--they really have no idea what it takes to procure the upper-middle-class lifestyle to which they are accustomed. They assume that BMW's just materalize in the driveway and aren't concerned that the aforementioned can of beans will not be sufficient to afford one.
 
DokterMom said:
Why does everyone take as a given that the ACA will be a disaster for doctors? It may turn out to be the case, but I think that's far from a given.
A larger percentage of your patients will be covered by insurance. That's bad?
Sure, insurance companies will negotiate discounted rates, sometimes deeply discounted rates. Is anyone under the impression that they don't do this already?
You'll be required to treat patients for free under certain circumstances? Aren't doctors already required to do this?

While NPs and PAs may provide more routine care, doctors will still have a monopoly on providing high level medical care. Doctors drive the 'revenues' so doctors will always have a high stake in the decisions. Who is it that runs most hospitals? Doctors, right? I don't think they'll shoot themselves in the foot.
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Fundamentally, ACA attempts to take away the ability for an MD to practice independently. This has been a premise in medicine as long as it has existed, only recently has it been common that doctors group together to form a practice, or multi-disciplinary clinic. To stake a corollary, imagine if a lawyer had to join a practice after graduation from law school. The ability to hang a shingle, in and of itself, is powerful. There is no reason the government should have to be involved, but instead it has interjected itself in medicine and created it as a business.
 
neusu said:
Fundamentally, ACA attempts to take away the ability for an MD to practice independently. This has been a premise in medicine as long as it has existed, only recently has it been common that doctors group together to form a practice, or multi-disciplinary clinic. To stake a corollary, imagine if a lawyer had to join a practice after graduation from law school. The ability to hang a shingle, in and of itself, is powerful. There is no reason the government should have to be involved, but instead it has interjected itself in medicine and created it as a business.
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You honestly think the ACA is taking this away doctor's independence to a degree that insurance companies didn't?

It's impossible to say how the ACA is going to play out in the next few years but the erosion of physician-as-independent-businessman is much, much older than anything the ACA did. The growth of group practices and hospital conglomerates was not triggered by the ACA.
 
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I'm concerned why doctors are enemy number one, when politicians make more and are obviously destroying this country I love. People have to be realistic. Medicine is a career that takes time to finish. I don't see want is wrong with getting paid well from that sacrifice and frankly I believe hard work should be rewarded. Medicine like anything is still a job, and one that many can argue should pay well. I don't think it's greedy to pay all medical professionals a salary that is respectable. But working for peanuts in debt is not wise.
 
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But I do think everyone is overplaying it a little. It's good that the sick could get insurance, but for a lot of people, it's hardly affordable. Another issue I have is paying for things you may not need like maternity care. I'm a man and I'm not planning on having kids with anyone, so maybe they should be an elective type of insurance in these plans to cut cost. But the big issue I see with medicine itself is insurance.
But to be fair, Insurance has always been the problem. Then look at our medicine versus everywhere else.
 
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I wonder what would happen if we kept the system of private insurance in place, but simply modified it by making insurance companies non-profit and requiring everyone to purchase health insurance.
 
TheRobin said:
I wonder what would happen if we kept the system of private insurance in place, but simply modified it by making insurance companies non-profit and requiring everyone to purchase health insurance.
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As long as the government "regulated" the industry and insurance companies couldn't make money on basic coverage, but could on "premium packages" then we would be Switzerland. And IMO that would be a much better situation to be in.
 
Whether or not it makes doctors make less money, doctors will still always make plenty. Also, trying to change insurance policy in any way is better than going back to what we had previously.

Life Sucks said:
But I do think everyone is overplaying it a little. It's good that the sick could get insurance, but for a lot of people, it's hardly affordable. Another issue I have is paying for things you may not need like maternity care. I'm a man and I'm planning on having kids with anyone, so maybe they should be an elective type of insurance in these plans to cut cost. But the big issue I see with medicine itself is insurance.
But to be fair, Insurance has always been the problem. Then look at our medicine versus everywhere else.
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Unless you are planning on never having sex how do you know youll never need maternity care? Its an extreme example, but letting people pick plans that cover little to nothing will result in persistence of "but I never thought it would happen to me" situations
 
Because some of us are going into medicine not for the money. Don't get me wrong, the money is great but that's not the primary reason.
 
The government loves to talk about making primary care more attractive, and increasing the role of mid-levels as cost control measures. I guess if worst comes to worst, I'll match FM and build a $500k/yr primary care practice with a legion of NPs working under me.
 
Life Sucks said:
But I do think everyone is overplaying it a little. It's good that the sick could get insurance, but for a lot of people, it's hardly affordable. Another issue I have is paying for things you may not need like maternity care. I'm a man and I'm planning on having kids with anyone, so maybe they should be an elective type of insurance in these plans to cut cost. But the big issue I see with medicine itself is insurance.
But to be fair, Insurance has always been the problem. Then look at our medicine versus everywhere else.
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(??!)
 
SN12357 said:
You honestly think the ACA is taking this away doctor's independence to a degree that insurance companies didn't?

It's impossible to say how the ACA is going to play out in the next few years but the erosion of physician-as-independent-businessman is much, much older than anything the ACA did. The growth of group practices and hospital conglomerates was not triggered by the ACA.
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The ACA is greatly accelerating the eating up of physician private practices bc private practices don't have the manpower to follow all the mandates, regulations, and rules in the 2,500 page behemoth of a law. It was already bad before - but the ACA has made it even worse now.

Hospitals on the other hand can follow these new regulations and mandates, bc they have enough lawyers, administrative middlemen, and money on staff. So what happens? Hospitals incorporate small private practices making those doctors employees, and thus consolidating and getting more market share, thus monopolizing the market. So both the doctor loses, bc now he/she is an employee and the patient loses bc now the hospital can charge MUCH MORE for the same service that would normally be provided cheaper by a private practice 1) bc they now may be the only ones offering that service within miles and 2) they can charge big facility fees to Medicare and private insurance.
 
DokterMom said:
Why does everyone take as a given that the ACA will be a disaster for doctors? It may turn out to be the case, but I think that's far from a given.
A larger percentage of your patients will be covered by insurance. That's bad?
Sure, insurance companies will negotiate discounted rates, sometimes deeply discounted rates. Is anyone under the impression that they don't do this already?
You'll be required to treat patients for free under certain circumstances? Aren't doctors already required to do this?

While NPs and PAs may provide more routine care, doctors will still have a monopoly on providing high level medical care. Doctors drive the 'revenues' so doctors will always have a high stake in the decisions. Who is it that runs most hospitals? Doctors, right? I don't think they'll shoot themselves in the foot.
Click to expand...
Rose-tinted glasses much?

OP, the effects of the ACA (and future likely HC reform) will more likely than not reduce physician autonomy and salaries while increasing hours. However, these effects aren't going to be fully felt, much less appreciated by 20-year-old pre-meds who generally speaking aren't interested in HC policy, for quite a while. Further, it's possible that even when they are appreciated, people will still flock to medicine, as they continue to do to law, despite astronomical attrition rates and legal unemployment. I guess this is because the "prestige" of a venerable professional school education is considered before the actual job prospects after completing it. So I think it's quite possible applications will continue to increase.
 
Life Sucks said:
I'm concerned why doctors are enemy number one, when politicians make more and are obviously destroying this country I love. People have to be realistic. Medicine is a career that takes time to finish. I don't see want is wrong with getting paid well from that sacrifice and frankly I believe hard work should be rewarded. Medicine like anything is still a job, and one that many can argue should pay well. I don't think it's greedy to pay all medical professionals a salary that is respectable. But working for peanuts in debt is not wise.
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The average person believes doctors are greedy, rich bastards. Don't believe me? See most of the comments left by readers on NY Times articles demonizing doctors and their salaries. Left wing bloggers (see Matt Yglesias) have done the same regarding doctors salaries. The problem is these liberal elite have the ear of Democratic policy makers.

Guess what? They don't care how much of a time or money commitment you've put into becoming a doctor, bc all they see is the six figure salary at the end not realizing, that this is after years of investment of college, 4 years of med school, 3-7 years of residency, and 1-2 years of fellowship, and that you have to pay federal income tax, state income tax, make payments on your >$200,000 school loans, after which whatever you have left, you have to pay for your personal expenses and your family (assuming you can afford to have one).

Then when President Obama goes on tv (see Youtube) where he talks about ENT docs pulling people's tonsils to make money or that surgeons would rather make $30,000 amputating a diabetic's leg rather than having that person control their blood sugars, then it's not surprising that this anti-doctor/class warfare sentiment revvs up even further.
 
ninjaman22 said:
Because some of us are going into medicine not for the money. Don't get me wrong, the money is great but that's not the primary reason.
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Going into medicine ONLY for money is not a good reason to go into medicine. But don't think for one second that you won't be thinking about money, when you're making less than minimum wage as a resident, and the bank comes knocking on your door monthly for loan repayments, which you'll only be able to pay on the interest. For get making money, you'll want to keep from defaulting on your "mortgage" of student loans 1st, of which you can no longer get Stafford subsidized loans so now interest is accruing during medical school.
 
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circulus vitios said:
The government loves to talk about making primary care more attractive, and increasing the role of mid-levels as cost control measures. I guess if worst comes to worst, I'll match FM and build a $500k/yr primary care practice with a legion of NPs working under me.
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You do know that NPs are fighting and have been successful at the local state level of getting independent practice rights, correct? NPs don't want to play under a team model, as anesthesiologists are figuring out with CRNAs. NPs are also fighting for the same level of reimbursement for services as well. The only way you will make $500,000 in primary care is if you're in a very successful concierge practice, and that will work in very few locales.
 
DermViser said:
You do know that NPs are fighting and have been successful at the local state level of getting independent practice rights, correct? NPs don't want to play under a team model, as anesthesiologists are figuring out with CRNAs. NPs are also fighting for the same level of reimbursement for services as well. The only way you will make $500,000 in primary care is if you're in a very successful concierge practice, and that will work in very few locales.
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Using Nevada as an example, NPs need 2 or more years of experience before they can practice independently. Set up a revolving door of NPs, hired on a 2 year contract.
 
Gene Parmesan said:
Just read all of DermViser's posts. He's the expert on the "disaster" that is ACA.
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Yes, bc instead we should take your "expert" opinion on ACA/Obamacare as an illustrious premed. I'm sure we can all pay for healthcare and health insurance with unicorn farts as currency in your utopia.
 
TheWeeIceMan said:
I love these threads. Everyone always walks out with a new and different opinion on the ACA/Obamacare than they came in with. Wait, no they don't.
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Well considering the audience is "Pre-Medical Allopathic" students [which for many is synonymous with being pre-unemployed], a change of opinion is a lot to ask for. The best one can realistically expect, is for that person to actually research the topic more thoroughly rather than bury their head in their Campbell's Biology 101 textbook and just repeat to themselves, that everyone else knows less than they do.
 
DermViser said:
Well considering the audience is "Pre-Medical Allopathic" students [which for many is synonymous with being pre-unemployed], a change of opinion is a lot to ask for. The best one can realistically expect, is for that person to actually research the topic more thoroughly rather than bury their head in their Campbell's Biology 101 textbook and just repeat to themselves, that everyone else knows less than they do.
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Is it lonely there up on your high horse?
 
http://www.nejmcareercenter.org/article/physician-compensation-update-big-picture-shows-stability/

"On the national level, movement toward new payment methodologies for health services, such as the emergence of accountable care organizations (ACOs) and bundled payments for certain costly diagnoses and procedures, will soon affect compensation. “We’re seeing more factors such as cost of care, and quality metrics such as patient outcomes creeping into compensation design now — even in specialties where that hasn’t been as common, as in primary care,” said Brad Vaudrey, a principal with the independent consulting firm Sullivan, Cotter, and Associates, which produces the annual compensation survey for the American Medical Group Association (AMGA) and develops physician compensation programs.
1. This trend — particularly individual-physician performance metrics — hasn’t amounted to a substantial shift in physician compensation yet, Mr. Vaudrey observes, but he expects it soon will. “We will see more of this movement toward value- and outcomes-based physician compensation in the next few years,” he said. The cumulative effects of changing compensation components likely will become more pronounced, he added, as hospitals and large groups acquire practices or directly employ more physicians.
2. Even large physician organizations whose economic underpinnings are stable are anticipating these changes and are adjusting their compensation structures to respond to the changes ahead. “All of these developments — ACOs and bundled payments, and line-of-treatment plans — are designed to limit expense and improve care quality, but they also will affect physician compensation in the future,” said Richard Nesto, MD, executive vice president and chief medical officer for the Lahey Clinic in Burlington, Massachusetts.
The 520-physician clinic, one of the country’s largest practices, is revising its compensation structure to move toward leaner staffing and higher productivity, and to incentivize improved outcomes. “The base for what we get paid [as an organization] is shrinking, so we are preparing ourselves for the uncertainty out there,” Dr. Nesto said. “We are working to make our physicians more aware of the finances of the organization because some specialists, I think, have unrealistic expectations regarding earnings,” he said.
 
DermViser said:
Yes, bc instead we should take your "expert" opinion on ACA/Obamacare as an illustrious premed. I'm sure we can all pay for healthcare and health insurance with unicorn farts as currency in your utopia.
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Notice I haven't given any of my own opinions on the ACA in this thread. But I will accept your appeal to authority, as you are older and smarter than me. I'm just so blessed to be able to learn everything about the ACA from someone as wise as you.
 
SunsFun said:
http://www.nejmcareercenter.org/article/physician-compensation-update-big-picture-shows-stability/

"On the national level, movement toward new payment methodologies for health services, such as the emergence of accountable care organizations (ACOs) and bundled payments for certain costly diagnoses and procedures, will soon affect compensation. “We’re seeing more factors such as cost of care, and quality metrics such as patient outcomes creeping into compensation design now — even in specialties where that hasn’t been as common, as in primary care,” said Brad Vaudrey, a principal with the independent consulting firm Sullivan, Cotter, and Associates, which produces the annual compensation survey for the American Medical Group Association (AMGA) and develops physician compensation programs.
1. This trend — particularly individual-physician performance metrics — hasn’t amounted to a substantial shift in physician compensation yet, Mr. Vaudrey observes, but he expects it soon will. “We will see more of this movement toward value- and outcomes-based physician compensation in the next few years,” he said. The cumulative effects of changing compensation components likely will become more pronounced, he added, as hospitals and large groups acquire practices or directly employ more physicians.
2. Even large physician organizations whose economic underpinnings are stable are anticipating these changes and are adjusting their compensation structures to respond to the changes ahead. “All of these developments — ACOs and bundled payments, and line-of-treatment plans — are designed to limit expense and improve care quality, but they also will affect physician compensation in the future,” said Richard Nesto, MD, executive vice president and chief medical officer for the Lahey Clinic in Burlington, Massachusetts.
The 520-physician clinic, one of the country’s largest practices, is revising its compensation structure to move toward leaner staffing and higher productivity, and to incentivize improved outcomes. “The base for what we get paid [as an organization] is shrinking, so we are preparing ourselves for the uncertainty out there,” Dr. Nesto said. “We are working to make our physicians more aware of the finances of the organization because some specialists, I think, have unrealistic expectations regarding earnings,” he said.
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I think a lot of this is probably true -- But where was healthcare in our country going before the ACA? Bundled treatment plans, outcome-based quality measures -- those aren't a result of the ACA.
Not every trend in healthcare is a direct result of the ACA, and not all of them will be bad. Of course, not all will be good either.

If you're in it primarily for the money, now would be a good time to leave. (Yesterday would have been good also. And last year. Last decade also. Those are not the doctors we need.)
But if your motivations are a little more altruistic, those rewards will still be there. (Maybe even better as more people are able to get medical care and insurance standardizes more from the zillion+ plans out there now.)
The money is likely to still be darned good - even if not quite as stratospheric as the $500K+ incomes that some physicians make now.

What I'm saying is that I don't believe the sky shows any signs of falling.

And I also don't think the educated liberals have it out for doctors. I think we have it out for ridiculously overpaid CEOs and athletes/entertainers. I think most of us (yes, I'm one of them) would rather see scientists and educators paid more rather than less, and see physicians paid darned well ($200K+) because their skills and knowledge are worth paying for.
 
Oh, I just brought it up since it related to the general discussion about compensation. I am pretty liberal myself so not disagreeing with any of your point here.
 
It's interesting that premeds think they are so smart and clever when the vast majority really don't know much about anything at all.
 
When obama care takes effect, how much will the average "regular" doc earn? And by regular, I mean right now the average salary of a doc in a NON-competitive specialty or primary care is about 200k. (Non competitive includes things like PMR, neurology, psychiatry, etc.). How much will the "right now 200k" doc earn after obama care takes effect?
 
Cmdr_Shepard said:
Canada.
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Incorrect.

In Canada basic coverage is covered by by the Provinical Health Insurance. You can buy private plans for things like dental, vision, and what not, but the basics are covered by the government.

An entirely privatized non-profit insurance system would be more like Switzerland's, where the private insurance systems provide both the basic level of health coverage, which they are not allowed to make a profit off of, and also have premium packages for things like dental and vision which they are allowed to profit on.
 
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Psai said:
It's interesting that premeds think they are so smart and clever when the vast majority really don't know much about anything at all.
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I can't wait to come back to this thread next year when I am a medical student and join you in scoffing at the unenlightened plebs known as "pre-meds" in this thread.

I must ask you, will I become omniscient and pompous as soon as I step foot into my first class, or must I wait until my first year is over to achieve your status?
 
Also another question, if you finish medical school in the US, and complete a residency in the US, what other countries are you allowed to practice in without doing any additional residencies/internships? And I'm talking about countries that pay you at least 6 figures if translated to dollars. I heard that places like somewhere in africa or saudi arabia (?) pay a lot. But not sure
 
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