Would you still go to medical school if Socialized Medicine was impending?

[DocBR]

PandaBear's latest blog post got me thinking about socialized medicine. On the one hand, medical costs in the US are getting out of control and socialized medicine may be the answer.

On the other hand, socialized medicine might kill physician income and I am not thrilled about finishing residency with 250K in debt and a severely slashed income. I am not going into medicine for the money, but if I am going to go through all this work I'd at least like to live a comfortable lifestyle (support a family, college for the kids, etc).

So - what do you all think?


http://pandabearmd.com/blog/2007/05/16/is-it-worth-it/

---

Members don't see this ad.

 

[Law2Doc]

Medicine is not as homogenous as most of you think. You do not have to give free care in most specialties, you do not have to take all comers, you do not have to take crappy Medicare reimbursements.

While you don't have to do these things, most physicians (even specialists) find that high volume business is more lucrative than not accepting medicare and insurance reimbursements.

Many many practitioners (if not most) will tell you that they believe that some form of single payor healthcare system is looming down the road. It is quite possible that healthcare reform will be a big platform in the next presidential election. The insurance companies have made huge strides in getting a stranglehold on the industry in the last decade, and one would predict they will continue to do so. So if you truly wouldn't go to med school if this was a real possibility, you may want to think hard about things. Nobody can predict the future, but this is not nearly as unlikely as it might have been in past decades.

 

[8744]

Remember that Dr. Panda is firmly entrenched in Emergency Medicine, a specialty that is actively being buttf*cked by current policies relating to reminbursement, mandatory care, EMTALA, etc.
Medicine is not as homogenous as most of you think. You do not have to give free care in most specialties, you do not have to take all comers, you do not have to take crappy Medicare reimbursements.

Non-ED physicians set up their practices as they wish. You want to treat every homeless drug addict who walks in? You can do that. You want to do a cash-only business? You can do that too. You want something in between? Go ahead.

I agree with 90% of what Dr. Panda says. But be a little weary of his drastic pronouncements about the future of medicne; his specialty is screwed, but the rest of us will probably be okay.

Whoa. Everything you say is true except the part about the anal sex. Emergency medicine physicians, on average, start in the low 200K right out of residency for the equivalent of forty hours per week. I've already been solicited by quite a few "headhunters" and recruiters for jobs which offer $160 per hour (although there are obviously going to be a few catches). One job I was solicited for (maybe they don't know I have two years left) promised $240,000 per year for eight 24-hour shifts a month (which included, as a catch, covering the ICU at night and admitting patients).

And that ain't bad.

Emergency Medicine pays more than any other three-year residency and we probably do better than most general surgeons, especially considering that our hours are way better. If I want to work as many hours as a surgeon once I finish residency (which I don't) there's no way he could touch my income.

And I wasn't aware that I had made any drastic pronouncements. I offered a few caveats is all.

 

[mlw47]

What is your definition of "socialized medicine"?

Is it where everyone over 65 is entitled to medical care?
...already have Medicare.

Is it where people who are poor receive care at reduced cost, or no cost at all?
...already have Medicaid.

Is it where Veterans and service men and women get free care?
...already have the VA and DoD plans.


What are we trying to protect? Medicine hasn't been private since doctors stopped taking apple pies for payment.

Almost 50 cents of every dollar spent on health care comes directly from either the state or federal government.

Additionally, the federal government subsidizes private health care to something of the tune of 500B a year. [The money private companies spend on health benefits for their employees is tax deductible.]

Where is this private health care economy you cling to?!

 

[notdeadyet]

Where is this private health care economy you cling to?!

The one where if you're between 18-64, not poor and not a veteran, you have to pay out of your pocket for health insurance. I'm without health problems and pay $250/month and can luckily afford it. If you have a pre-existing condition, are older than 18 and don't qualify for medicaid/medicare/tricare, woe be to you.

 

[Law2Doc]

The one where if you're between 18-64, not poor and not a veteran, you have to pay out of your pocket for health insurance. I'm without health problems and pay $250/month and can luckily afford it. If you have a pre-existing condition, are older than 18 and don't qualify for medicaid/medicare/tricare, woe be to you.

So you are for socialized medicine I guess. Perhaps a bit short sighted to focus on your $250/mo today as opposed to how it will affect you down the road. Most people going into medicine actually would look at it from the income perspective not the outflow (since most physicians anticipating getting health insurance as a benefit from their employer).

 

[Trismegistus4]

It's disgraceful that "of course" is the most popular response. I proudly chose "not a chance." It really doesn't speak well for the future of the profession that a majority of those going into it are eager to actively sign on to its destruction.

 

[Law2Doc]

It really doesn't speak well for the future of the profession that a majority of those going into it are eager to actively sign on to its destruction.

I think the choices were not adequately delineated. I suspect most people don't doubt the inevitability of change, but just want to be a doctor anyway. That's hardly being eager for change, just not sticking their heads in the sand. It is the foolish who go into something assuming it will stay the same forever, particularly in such case where there have been a number of proposals floating around the beltway each of the last few years, and where most practitioners will tell you that some form is probably coming. Given that, the "not a chance" response is the one that, if you answered it, you should start finding another career path. Because frankly there is a chance.

 

[8744]

Veterans do not get free care. It depends on how much their condition is connected to their service. If you are not or barely service connected you will wait a long, long time for services from the VA where somebody who is can get anything they need almost instantly.

Just an FYI.

 

[omegaxx]

It's disgraceful that "of course" is the most popular response. I proudly chose "not a chance." It really doesn't speak well for the future of the profession that a majority of those going into it are eager to actively sign on to its destruction.

Obviously the health care system of just about every other developed nation in the world are already piles of rabbles, by your reasoning.

No health care system is perfect, but some are less imperfect than others.

 

[Noeljan]

PandaBear's latest blog post got me thinking about socialized medicine. On the one hand, medical costs in the US are getting out of control and socialized medicine may be the answer.

On the other hand, socialized medicine might kill physician income and I am not thrilled about finishing residency with 250K in debt and a severely slashed income. I am not going into medicine for the money, but if I am going to go through all this work I'd at least like to live a comfortable lifestyle (support a family, college for the kids, etc).

So - what do you all think?


http://pandabearmd.com/blog/2007/05/16/is-it-worth-it/

I may be way off base in my ideas, but don't you guys/girls think the reason for such costly health care has to do with lifestyle choices of others? Think about the leading causes of death in the US, Heart disease and cancer. I took an 8 credit onco class this year, and I have to tell you, it is kind of aggitating that most types of cancer (especially our leading cause of death in both men and women, lung cancer) is caused 80% of the time by smoking. Now let's look at heart disease, isnt it obesity/diet, etc as well as smoking some of the big guns there?
Now of course you will find exceptions, but I would say that giving free health care to everyone really isin't going to do anything. We need to target what causes these illness in the first place to see any decline. I haven't thought enough about it to come up with a plan, and I'm not a great business person so I may be totally wrong, but it's just the way I see it. So for those reasons I do not support socialize health care. Many people feel entitled to too many free things in the US, and don't want to take responsibility for anything themself.
I am not saying all, but many. I worked as a medical assistant, CNA and nurse, many pts are not as helpless as premeds have visions of. I would say most of my pts on med surg. would be typical diabetes, very overweight, smokers, high BP etc.....I cared about all my pts, and I care about all people, but I have to say it is frustrating because you wish people had to take more responsibility for themselves. Maybe the government could worry about things like free gym memberships for everyone, or subsidizing healthier foods (bad food is cheaper), increasing taxes even further on cigs.

On the other hand, if health insurance was centralized perhaps physicians could gain back some prestige or practicing power (not worrying as much about malpractice, billing, etc) if the government was in place. I don't know?? Any current physicians want to comment? Panda what do you think?
I know my friend in the lab (she is an MD from India) told me things are different over there. She said she didn't have to pay for medical school at all, and if a patient was nasty or rude (or questioned the doctor) they were allowed to tell them "I am the doctor, I went to medical school, etc...." She also said if a pts was doing something wrong (unhealthy) you could be very very upfront with them about what they were doing to their health.

 

[mlw47]

It's disgraceful that "of course" is the most popular response. I proudly chose "not a chance." It really doesn't speak well for the future of the profession that a majority of those going into it are eager to actively sign on to its destruction.

What is your interpretation of "socialized medicine"?

Single payer, eg. Medicare-type coverage for all?

Everyone having health insurance?



I'm curious, because I suspect that everyone here has a slightly different definition of "socialized medicine".

 

[Meatwad]

I think the choices were not adequately delineated. I suspect most people don't doubt the inevitability of change, but just want to be a doctor anyway. That's hardly being eager for change, just not sticking their heads in the sand. It is the foolish who go into something assuming it will stay the same forever, particularly in such case where there have been a number of proposals floating around the beltway each of the last few years, and where most practitioners will tell you that some form is probably coming. Given that, the "not a chance" response is the one that, if you answered it, you should start finding another career path. Because frankly there is a chance.

Well said.

 

[Steve203]

I think the choices were not adequately delineated. I suspect most people don't doubt the inevitability of change, but just want to be a doctor anyway. That's hardly being eager for change, just not sticking their heads in the sand. It is the foolish who go into something assuming it will stay the same forever, particularly in such case where there have been a number of proposals floating around the beltway each of the last few years, and where most practitioners will tell you that some form is probably coming. Given that, the "not a chance" response is the one that, if you answered it, you should start finding another career path. Because frankly there is a chance.

If it were to happen I would go to law school...then I would go on law school forums and my username would be Doc2Law

 

[alwaysaangel]

I'd still do it.

 

[jochi1543]

Canada has socialized medicine. It's definitely best for the patient. It is better in some ways and worse in others for the doctor compared to the US situation. For me, the positives (extremely low malpractice which gives you the chance to work part-time if you desire, etc) outweigh the "negatives" (cap on income at around 180-400K CAD for most doctors, depending on specialty).

Also, our schools are a lot cheaper, so the issue of debt is not a huge deal if you attend school here. Quebec tuition is a joke - something like $3000 a year. I know people who worked through med school and graduated without a dime in loans. However, if I return to practice in Canada from the US where I will have paid 3x as much, I know money will be an issue for the first few years.

 

[Noeljan]

Canada has socialized medicine. It's definitely best for the patient. It is better in some ways and worse in others for the doctor compared to the US situation. For me, the positives (extremely low malpractice which gives you the chance to work part-time if you desire, etc) outweigh the "negatives" (cap on income at around 180-400K CAD for most doctors, depending on specialty).

Also, our schools are a lot cheaper, so the issue of debt is not a huge deal if you attend school here. Quebec tuition is a joke - something like $3000 a year. I know people who worked through med school and graduated without a dime in loans. However, if I return to practice in Canada from the US where I will have paid 3x as much, I know money will be an issue for the first few years.

Jochi, how exactly does physician salary work in Canada? Would you mind giving me some insight on this (I often hear from people who have never lived in a day in Canada, and while I appreciate their advice, I think it would be a tad more realistic to hear how one has experienced it)
thanks

 

[Law2Doc]

If it were to happen I would go to law school...then I would go on law school forums and my username would be Doc2Law

Easy to say, but few have the stones to do it. When you become an MD and then enroll in law school write back. Till then, I'm not buying it.

 

[jochi1543]

Easy to say, but few have the stones to do it. When you become an MD and then enroll in law school write back. Till then, I'm not buying it.

Got a friend who's got an MD-to-JD classmate at his law school. Everybody hates the guy because he insists the profs call him "Doctor" when addressing him (the couple of PhDs in the class are nowhere near as pretentious).

 

[jochi1543]

Jochi, how exactly does physician salary work in Canada? Would you mind giving me some insight on this (I often hear from people who have never lived in a day in Canada, and while I appreciate their advice, I think it would be a tad more realistic to hear how one has experienced it)
thanks

Well, I'm not a physician, so I personally have not experienced it, but first off, here are some figures.
http://www.cmpa-acpm.ca/cmpapd02/cm...iles/admin_docs/common/fees/pdf/2006cal-e.pdf

These are the malpractice rates from 2006. As you can see, ob-gyn is the major outlier, but most specialties are somewhere in the $5000 a year range.


These are some incomes - these are British Columbia only, but it's more recent than some of the country-wide I found (which was 2001-2002 - but I can still link it if you want).
http://www.healthservices.gov.bc.ca/msp/legislation/pdf/bluebook2003.pdf

Scroll down, it lists all physicians and their incomes. You can find out their specialties by typing their names into a search.



As far as the billing goes, they bill by procedure and by visit. For example, this is why ophtalmologists have incomes as high as some specialized surgeons - they can perform a large volume of procedures, and if they are willing to work longer hours, they can take their incomes into the 400K range. If there is no "procedure" performed (e.g. you went to the GP, he looked at your ear and prescribed antibiotic drops), your doctor will be billing by visit ($28 for GP, I think? Though this may vary across provinces). Some procedures are not covered by the government insurance, but there is supplemental health insurance available both through the government and through employers and private companies. For example, I have extra coverage through my employer for free. The government coverage is $44 a month for a single person in Alberta. This does not cover prescriptions, ambulance, (I THINK, but not 100% sure) abortions that are not medically required, and a small # of other services. Government health insurance basically takes care of most things - a neighbor was in a hospital for 2.5 months and did not pay a dime. For people under a certain income, the government insurance is provided for free after they apply.

 

[Noeljan]

Well, I'm not a physician, so I personally have not experienced it, but first off, here are some figures.
http://www.cmpa-acpm.ca/cmpapd02/cm...iles/admin_docs/common/fees/pdf/2006cal-e.pdf

These are the malpractice rates from 2006. As you can see, ob-gyn is the major outlier, but most specialties are somewhere in the $5000 a year range.


These are some incomes - these are British Columbia only, but it's more recent than some of the country-wide I found (which was 2001-2002 - but I can still link it if you want).
http://www.healthservices.gov.bc.ca/msp/legislation/pdf/bluebook2003.pdf

Scroll down, it lists all physicians and their incomes. You can find out their specialties by typing their names into a search.



As far as the billing goes, they bill by procedure and by visit. For example, this is why ophtalmologists have incomes as high as some specialized surgeons - they can perform a large volume of procedures, and if they are willing to work longer hours, they can take their incomes into the 400K range. If there is no "procedure" performed (e.g. you went to the GP, he looked at your ear and prescribed antibiotic drops), your doctor will be billing by visit ($28 for GP, I think? Though this may vary across provinces). Some procedures are not covered by the government insurance, but there is supplemental health insurance available both through the government and through employers and private companies. For example, I have extra coverage through my employer for free. The government coverage is $44 a month for a single person in Alberta. This does not cover prescriptions, ambulance, (I THINK, but not 100% sure) abortions that are not medically required, and a small # of other services. Government health insurance basically takes care of most things - a neighbor was in a hospital for 2.5 months and did not pay a dime. For people under a certain income, the government insurance is provided for free after they apply.

Thanks Jochi
omg that malpractice is sooo low. It also seems physicians incomes are not as doomed as people make them out to be.
thanks a lot for those links and the info.

 

[jochi1543]

Ok, I decided I'll post the comprehensive link even though this is 2001-2002.

http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf


It breaks things down by specialty/province, so it's a little better than the BC link I provided.




Anyway, as I said, since I'm not a physician, I'm not extremely well-versed on this. If you are interested in potentially practicing in Canada and would like to find out more details, I can PM you the link to our Canadian med/premed forum. There's lots of med students/residents there, as well as a few practicing doctors who still contribute. Plus it's not the evil jungle that is SDN.

 

[jochi1543]

Thanks Jochi
omg that malpractice is sooo low. It also seems physicians incomes are not as doomed as people make them out to be.
thanks a lot for those links and the info.

Malpractice is low because the government contributes to it - for most part, you are a government employee as a physician (unless as mentioned above, you perform procedures that are not considered medically necessary and thus bill privately). Also, this means that when a patient is suing a doctor, s/he is basically suing the government, and for that reason frivolous cases don't go through and compensation rarely ends up being so high as to warrant ridiculously high rates - so both the #s of lawsuits and the percentage of successful ones are a lot lower in Canada.


Yes, in Canada you have less of a potential to make tons, but it's also unlikely that you will drive yourself into bankruptcy. And you also have more control over your lifestyle because you don't have humoungous malpractice payments looming over you. If you are considering Canada for practice, I do urge you to go ahead and research more. We are desperate for physicians and while as a non-citizen, it'd take work to be able to secure employment, having a US medical degree puts you lightyears ahead of the people who got their degree in the Caribbean or other places outside of North America. I know that for the residency match, a US degree is considered on par with the Canadian MD (but I believe the first step is only open to Canadian citizens/residents), so in terms of practice, you shouldn't have difficulty obtaining the right to.

 

[notdeadyet]

So you are for socialized medicine I guess. Perhaps a bit short sighted to focus on your $250/mo today as opposed to how it will affect you down the road.

You're assuming that my politics come from my pocketbook. Further socialization of American medicine will hit me financially in my salary as a physician, but it's a paycut I'm willing to take if it means that the rest of the country will have more equitable healthcare.

I'm an older applicant; this isn't youthful zeal. I've done the spreadsheets and am aware of the risk to future earnings that universal healthcare will have. I don't believe it's the $60k/yr doom and gloom that folks on one end of the spectrum scream about, but I don't think I'll skate through it financially unscathed either like those on the other end.

If folks want to not support better healthcare coverage for reasons of their own financial earnings, that's totally within their right. But to pretend that the system we have now is working is either ignorance or delusion.

 

[Noeljan]

You're assuming that my politics come from my pocketbook. Further socialization of American medicine will hit me financially in my salary as a physician, but it's a paycut I'm willing to take if it means that the rest of the country will have more equitable healthcare.

I'm an older applicant; this isn't youthful zeal. I've done the spreadsheets and am aware of the risk to future earnings that universal healthcare will have. I don't believe it's the $60k/yr doom and gloom that folks on one end of the spectrum scream about, but I don't think I'll skate through it financially unscathed either like those on the other end.

If folks want to not support better healthcare coverage for reasons of their own financial earnings, that's totally within their right. But to pretend that the system we have now is working is either ignorance or delusion.

and looking at for example the Canadian salaries, they are not even that low. It seems you may save a lot with such low malpractice and possibly more autonomy/ professional freedom.

 

[notdeadyet]

and looking at for example the Canadian salaries, they are not even that low. It seems you may save a lot with such low malpractice and possibly more autonomy/ professional freedom.

My understanding is that private health insurance was entirely prohibited (though that's slowly changing). The fact that health insurance is entirely a government function probably allowed for a lot of savings.

You will never have this happen in American health care. Our version of universal healthcare will be a patchwork of private and public care, so the costs will still be high.

And to cut costs, don't be suprised if some of that comes from physician salaries. California's first take did just that.

 

[45408]

While I hope we don't head down that road, I'm staying the course, because I can't think of anything I'd rather (realistically) be doing.

 

[sfnix]

But to pretend that the system we have now is working is either ignorance or delusion.

absolutely agree. would further argue that the gaps that currently exist in america's health care system (the rich receiving high quality care and the poor receiving low quality) will continue to grow. this process is inevitable so long as health care and pharmaceuticals are openly traded on the free market. If the point of health care is to turn a profit, then our system is functioning great, if the point however is to provide a decent level of care to all persons (the universal declaration of human rights), then we're failing miserably.

boooooo over specialization, hoooray preventative, general practitioners. i'm definitely in for the long haul and count me in as a socialist subversive among greedy capitalists.

 

[en4ian]

I enjoyed the no BS part stating, "It's a job." It's hard to happily sacrifice so much of your own life to become a doctor so that you are given the privilege to scribble out a few orders on a chart. I just don't see why people do it for reasons other than ego because in the end, "It's just a job." If you want to help people be a trash man, people have lots of trash and you can help them by getting rid of it.

 

[notdeadyet]

I enjoyed the no BS part stating, "It's a job." It's hard to happily sacrifice so much of your own life to become a doctor so that you are given the privilege to scribble out a few orders on a chart. I just don't see why people do it for reasons other than ego because in the end, "It's just a job."

I agree, to a point. When I get my first job offer as a physician, I'll treat it like any other job offer: I'll negotiate it to the extent that I'll get the most compensation and benefits that I possibly can.

That said, I vote on issues in a way that I think will best serve my community and my country. For a physician to vote against universal coverage solely because it will hurt their pocketbook is like a police officer voting against effective crime legislation because, hey, less crime=less cops.

 

[jochi1543]

My understanding is that private health insurance was entirely prohibited (though that's slowly changing). The fact that health insurance is entirely a government function probably allowed for a lot of savings.

You will never have this happen in American health care. Our version of universal healthcare will be a patchwork of private and public care, so the costs will still be high.

And to cut costs, don't be suprised if some of that comes from physician salaries. California's first take did just that.

Yes, salaries in Canada are lower on average (though of course there's variation, there are people raking in 2+ million a year). But they are less than 10x lower (more like 30% overall, though as I said, there are outliers on both sides), while malpractice is appx 10 lower, so the net is actually higher in Canada than in the US for a large chunk of specialties.


Yes, Canada is also constantly having debates regarding introducing a greater element of private healthcare into the system. While I think this would help eliminate the wait times for the wealthier patients (here the wait time as opposed to costs is the #1 issue), truth is, these wealthier patients often end up going to the US anyway because they can afford to, and will trade an extra $10,000-50,000 for not having to wait for a life-saving procedure. I know Canadian healthcare covers you for US travels anyway, but only for the same amount that a Canadian physician would charge you (so you still have a significant balance to pay out of pocket), but I don't know whether it covers a blatant example of outsourcing as above. Anyway, outside of that, everybody's main concern is that healthcare is a universal right. While introducing a private element will not eliminate government-run healthcare, it will significantly reduce its quality. Basically, private practices with high incomes from wealthy patients will have better access to high-quality equipment and will likely generate higher incomes for the physicians, thus taking valuable resources away from the public system. In the end, this will lead to low income and underprivileged individuals (esp. Aboriginals) suffering from subpar care - and they already don't get the best care possible due to the shortage of physicians in rural areas where a large segment of Aboriginal population resides and the extremely low numbers of Aboriginal physicians who are familiar with the culture and the prevalent health concerns. Since every Canadian supports the system with his or her tax dollar, I doubt that the citizens of Canada will let any large-scale privatization of healthcare take place.

 

[Xerxes1729]

Socialized medicine is not the same thing as universal healthcare.

 

[Law2Doc]

Socialized medicine is not the same thing as universal healthcare.

They are steps in the same direction. Whether healthcare is paid through the government or insurance, we will likely get to a point (we are very close to it now) where all payments to physicians will come through reimbursement, and every citizen will have an "insurance" card through "somebody".

 

[spicedmanna]

I agree, to a point. When I get my first job offer as a physician, I'll treat it like any other job offer: I'll negotiate it to the extent that I'll get the most compensation and benefits that I possibly can.

That said, I vote on issues in a way that I think will best serve my community and my country. For a physician to vote against universal coverage solely because it will hurt their pocketbook is like a police officer voting against effective crime legislation because, hey, less crime=less cops.

Good points.

 

[8744]

Socialized medicine is not the same thing as universal healthcare.

A distinction without a difference. He who has the gold makes the rules.

 

[thewarehouse]

Further socialization of American medicine will hit me financially in my salary as a physician, but it's a paycut I'm willing to take if it means that the rest of the country will have more equitable healthcare.

I'm glad there are people out there who are willing to embrace this sacrifice (which may not be such a big sacrifice in the grand scheme of physician salaries based on the numbers provided by jochi1543) in the hopes that other people can have better access to care.

 

[pazan]

I haven't read all of the posts and I'm not sure if someone's already mentioned this:

Isn't the cost of medical school either free or highly subsidized in countries with socialized medicine? Wouldn't this be an integral step in establishing socialized medicine but not necessarily universal health care?... if I'm understanding the issue, socialized medicine kills private insurance, while universal health care just covers those unable to afford private insurance or unwilling to pay for it (that's the main difference, right?). So, universal health care would still allow doctors to make decent money, but socialized medicine probably not (due to gov. price controls).

Very few people would put in $250k and 7-8 years of their life (after residency) to make ~$50k per year... no matter how badly they wanted to be a doctor. One of the reasons there are so many PhD students in science is because tuition is pretty much covered if you work in someone's lab and TA. The pay for a PhD is crap... if the pay for a physician ever approached that, they would institute price breaks for med school as well. Anyway, they couldn't institute socialized medicine without lowering medical tuition... that's the bottom line.

 

[DocBR]

I haven't read all of the posts and I'm not sure if someone's already mentioned this:

Isn't the cost of medical school either free or highly subsidized in countries with socialized medicine? Wouldn't this be an integral step in establishing socialized medicine but not necessarily universal health care?... if I'm understanding the issue, socialized medicine kills private insurance, while universal health care just covers those unable to afford private insurance or unwilling to pay for it (that's the main difference, right?). So, universal health care would still allow doctors to make decent money, but socialized medicine probably not (due to gov. price controls).

Very few people would put in $250k and 7-8 years of their life (after residency) to make ~$50k per year... no matter how badly they wanted to be a doctor. One of the reasons there are so many PhD students in science is because tuition is pretty much covered if you work in someone's lab and TA. The pay for a PhD is crap... if the pay for a physician ever approached that, they would institute price breaks for med school as well. Anyway, they couldn't institute socialized medicine without lowering medical tuition... that's the bottom line.

Hopefully there would be some retroactive reimbursement for education.

 

[jochi1543]

I haven't read all of the posts and I'm not sure if someone's already mentioned this:

Isn't the cost of medical school either free or highly subsidized in countries with socialized medicine? Wouldn't this be an integral step in establishing socialized medicine but not necessarily universal health care?... if I'm understanding the issue, socialized medicine kills private insurance, while universal health care just covers those unable to afford private insurance or unwilling to pay for it (that's the main difference, right?). So, universal health care would still allow doctors to make decent money, but socialized medicine probably not (due to gov. price controls).

Very few people would put in $250k and 7-8 years of their life (after residency) to make ~$50k per year... no matter how badly they wanted to be a doctor. One of the reasons there are so many PhD students in science is because tuition is pretty much covered if you work in someone's lab and TA. The pay for a PhD is crap... if the pay for a physician ever approached that, they would institute price breaks for med school as well. Anyway, they couldn't institute socialized medicine without lowering medical tuition... that's the bottom line.

Yes, since I've been the Unofficial Representative of Canada in this thread, let me make yet another post re: Canadian school tuition. I think the highest med tuition out here is something like $20K a year - I think this is McGill out-of-province rate. It drops for the 3rd and 4th year because you are getting some sort of paltry stipend as a clerk. The average tuition is somewhere around $10K a year. In Quebec it's as low as $3000 a year at some school(bastards - I think this could actually be McGill again, albeit for in-province). There is this LOC (line of credit) specifically for med students and it's $150K at all banks (this can be upped to some extent, but this is the most often borrowed sum). So the $150 K will cover your tuition and living expenses for 4 years, while at a US school, you'd be happy to get that much in tuition only.


However, med tuition at a state school here in the US if you're a resident is generally not too bad either. It's mostly the private schools where things really start to go awry.

By the way, was on the U Hawaii med website just an hour ago and their tuition is expected to rise from $35,000 for 06-07 to $50,000 for 09-10. WTF? This is like a 50% increase.

 

[spicedmanna]

Hopefully there would be some retroactive reimbursement for education.

Yeah, I hope that, too.

 

[spicedmanna]

By the way, was on the U Hawaii med website just an hour ago and their tuition is expected to rise from $35,000 for 06-07 to $50,000 for 09-10. WTF? This is like a 50% increase.

That's crazy.

 

[jochi1543]

That's crazy.

Yeah, not applying there, lol.

 

[Cirrus83]

I wouldn't mind if it was Canada-style socialized medicine, they don't make that much less than us up there and one can argue that their lifestyle is better in many ways.

 

[Law2Doc]

Hopefully there would be some retroactive reimbursement for education.

I wouldn't hold my breath.

 

[lilnoelle]

I wouldn't hold my breath.

If incomes went down dramatically and there was no retroactive assistance with loans, I think there would be quite a few physicians who would leave practice and find other ways of paying back their loans. i.e. by working with pharmaceutical companies or by doing boutique healthcare (providing that is not prohibited).

A high amount of graduating seniors will leave med school with $250K in debt that will easily turn to $300K by the time residency is completed. That is one serious loan payment... Doable, even with an income in the low hundreds, but certainly difficult if income goes much lower than that. (Especially if taxes take away about 1/3)

 

[Cirrus83]

These are some incomes - these are British Columbia only, but it's more recent than some of the country-wide I found (which was 2001-2002 - but I can still link it if you want).
http://www.healthservices.gov.bc.ca/msp/legislation/pdf/bluebook2003.pdf

Technically that's only revenue and not actual income, since your income should only be your profits after you've excluded the expenses of running an office, etc.

Still, the only doctor on that list with my same last name had over 400K in revenue so I'm sure they did fine even after expenses

I've long considered moving to Canada, actually
Of course, then again I also vaguely dream of making it really big, and it's easier in general to run a business (like after you have a lot of income saved up you might want to invest it in a business, etc.) in the United States, and also the tax rates are generally more favorable compared to Canada. You might end up with similar incomes before taxes, but after you figure in income taxes and all that insane VAT you have to pay on everything you buy you probably can't buy as much random stuff as you could in the US (I don't even think Canadians get to dodge sales taxes online like Americans often can).

 

[KaraKiz]

if socialized medicine meant i could practice medicine, make less but still decent $$ (like ~100k - 150k) to support my family, the gov't paid for my education, and the people in this country got better medical care, including those who have pre-existing conditions, those who cannot pay, those who are elderly, children, etc - you can bet your ass i'd do it. i'm not in medicine for a ferrari.

 

[Doctor~Detroit]

i would go *especially* if it were impending, so long as we saw a corresponding drop in tuition (or schooling were paid by the government as in other countries). what people fail to consider in these hypothetical situations is that we would expect med school tuition to drop. it's not fair or realistic to pose one without the other.

btw, didn't read this thread and i'm not gonna start now.

 

[Law2Doc]

if socialized medicine meant i could practice medicine, make less but still decent $$ (like ~100k - 150k) to support my family, the gov't paid for my education, and the people in this country got better medical care, including those who have pre-existing conditions, those who cannot pay, those who are elderly, children, etc - you can bet your ass i'd do it. i'm not in medicine for a ferrari.

Eliminate the part about the government paying your education and it probably will happen. No one has made any buzz about funding medical education, let alone retroactively, so it's not going to be part of anyone's plan. Med students don't have any voting clout, lenders definitely do.

 

[jochi1543]

all that insane VAT you have to pay on everything you buy you probably can't buy as much random stuff as you could in the US (I don't even think Canadians get to dodge sales taxes online like Americans often can).

Yeah, unfortunately, we still get our sales taxes deducted online.

However, regarding the sales tax - I live in AB, which is in the middle of an economic boom now, and the major tax surplus has led both to a drastic drop in the provincial tax rates (down to only 10%, flat rate) and the removal of the provincial sales tax. We now have an exemption rate of $15,000 a year for provincial income tax (only about $8500 for federal taxes, which is similar to the exemption rates in other provinces), and we only pay the federal sales tax - which has also been lowered last July from 7 to 6%. 6% is very much acceptable! I was in NYC about a month ago and the tax there was 8.25%. But yes, somewhere in Toronto or BC the sales tax is up there in the 13-15% range because of the provincial sales tax.

Regarding income taxes, I punched in some numbers and with a salary of 150,000 and $10,000 RRSP (retirement savings) deduction (which might actually be higher, but I THINK it's between 5 and 10%), you'll be paying a little over $12,000 in provincial taxes here - less than 10% of your income (this is for a single person). Federal tax, however, will be just under $30,000. So in the end, you're paying $42,000 on a $150,000 income - 28%. I thought this was pretty close to US taxes.




ETA: punched in the same numbers for a US federal tax calculator and it comes out to 21% tax and just under $32,000 in deductions. Add the state tax, and you'll be at the same rate as here in Alberta, Canada or possibly even above (can't remember what the Minnesota tax rate was when I lived there).

ETA #2: Found the Minnesota tax rate - 7.85% for every dollar of your income at this income level. So about $11500 deducted from a $150K salary, so yes, you'd pretty much be paying same taxes as in Alberta.