Obama's plan

[tabula0rasa]

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Okay, I just want to start off by saying that I have nothing against Obama so this is not a thread for Obama bashing. I'm just curious about what the future of health care will be like after Obama implements his plans. I understand that no one can really know the answer, but any insights you have would be helpful.

Does anyone know how specialty compensation will change? I understand that many people are saying that specialists make too much while the PCP make too little. What they don't say is that PCP need only 3 years of residency while specialists require at least 4 and many times, a lot more. They also don't mention that specialists tend to be the ones who worked harder during medical school to get better grades and board scores. Additionally, PCP can get loan repayment benefits while specialists can't. And lastly, I'm quite sure that on AVERAGE, specialists work more hours per week than PCP. I guess I just hope that the Obama administration will not try to equilibrize pay across the specialties as I believe they have done in other national health programs (e.g. UK).

 

[Steiner]

Possible inflation may be the bigger concern. If the dollar crumbles in a few years that will make everyone's salary fall. I've heard some economists predict a large inflation about 2 years from now based on the increased government spending that is outlined.

 

[tabula0rasa]

Well, I've also heard economists predict deflation in the near future due to less spending and more saving. . I don't know what to think about the economy anymore.

 

[The Empiricist]

Without taking a side in the argument, here's what I think an argument for a more equal distribution of pay among specialties might look something like: While it is true that in general, PC residencies are less competitive and require less training, it is also important to keep a large number of PCPs around. Currently in the US we have a PCP shortage and maybe better pay is needed to entice future generations of doctors into choosing PC specialties. There are studies out there that argue that the shortage of PCPs is driving up the cost of healthcare for the consumer and straining the system. So while it may be somewhat unfair from the perspective of a pay/(competitiveness of med student) ratio, it may turn out to benefit the US healthcare system as a whole. And those in support may argue that this will benefit specialists in the long run, too, when they or their families/friends find themselves as patients.

 

[fun8stuff]

NPs and PAs will continue to do more and more of the PCP work. They can do the job just as well and it takes less time to train them and costs less money to keep them around. I would hope to God they do not try and "equalize pay", but it seems almost inevitable they salaries will be cut across the board. However, if they really wanted to train more PCPs, the solution would be simple: accept people into medical school and have them sign a contract on day 1 stating they complete a primary care residency.

 

[powermd]

I would hope to God they do not try and "equalize pay", but it seems almost inevitable they salaries will be cut across the board.

They already tried this with the resource based relative value scale. It was set up with the idea that physician work should pay about $100/hr regardless of specialty.

Gee, I wish I only had to pay my lawyer $100/hr.

 

[niranjan162]

NPs and PAs will continue to do more and more of the PCP work. They can do the job just as well and it takes less time to train them and costs less money to keep them around. I would hope to God they do not try and "equalize pay", but it seems almost inevitable they salaries will be cut across the board. However, if they really wanted to train more PCPs, the solution would be simple: accept people into medical school and have them sign a contract on day 1 stating they complete a primary care residency.

I dont think this is the best course of action. Once NPs and PAs take over PC, its just a matter of time before they start to try and expand. Nursing groups are highly political and thanks to the ability to unionize are much more organized the doctors.

Id say more debt forgiveness programs would be a good way to increase PCPs. Also schools could make fast tracks for med students who know they want to do PCP, i.e. three years instead of 4.

 

[fun8stuff]

I dont think this is the best course of action. Once NPs and PAs take over PC, its just a matter of time before they start to try and expand. Nursing groups are highly political and thanks to the ability to unionize are much more organized the doctors.

Id say more debt forgiveness programs would be a good way to increase PCPs. Also schools could make fast tracks for med students who know they want to do PCP, i.e. three years instead of 4.

NPs and PAs taking over is definitely not the best option, but I am afraid it is what will eventually happen. I agree though; I think the best remedy for the PCP shortage would to be have a fast-track such as a 5 year med-school/family med residency that students are accpeted into from day 1. Devote a percentage of the incoming class to these spots. Debt forgiveness and salary incentives (sign on bonus) for underserved areas.

 

[filter07]

My suggestion is to make first year 6 months. Second year 1 year. 4 months for electives, choosing either medicine vs surgery pathway. Medicine pathway includes 1-2 months of medicine with 1-2 week blocks of subspecialty/elective. Same for surgical pathway. 2 months for interview/match. Remove intern year. Start with PGY2 of chosen field.

The rest is all just a huge waste of time.

Think of all the time wasted during first year with biochem, cultural sensitivity stuff, infectious disease lectures, and complex pharmacology. Second year is pathophys so that's important. Third year you're holding retractors for hours and hours or you're trying to stay awake during 3-4 hour sit-down medicine rounds and following the intern around on nights. Not to mention all the horrific hours spent in OBGYN and a bunch of other rotations that are of no interest to most. Neurology/FM/Peds???

And what exactly do you do as an intern? Paperwork and getting yelled at by everyone from the janitor to the hospital CEO.

 

[fun8stuff]

My suggestion is to make first year 6 months. Second year 1 year. 4 months for electives, choosing either medicine vs surgery pathway. Medicine pathway includes 1-2 months of medicine with 1-2 week blocks of subspecialty/elective. Same for surgical pathway. 2 months for interview/match. Remove intern year. Start with PGY2 of chosen field.

The rest is all just a huge waste of time.

Think of all the time wasted during first year with biochem, cultural sensitivity stuff, infectious disease lectures, and complex pharmacology. Second year is pathophys so that's important. Third year you're holding retractors for hours and hours or you're trying to stay awake during 3-4 hour sit-down medicine rounds and following the intern around on nights. Not to mention all the horrific hours spent in OBGYN and a bunch of other rotations that are of no interest to most. Neurology/FM/Peds???

And what exactly do you do as an intern? Paperwork and getting yelled at by everyone from the janitor to the hospital CEO.

yeah, i agree that there is so much wasted time... on top of this, most have a 4 year degree which will be "wasted" and never used again. I think med schools should start accepting the best students after the first 2 years of undergrad (max), then if you aren't accepted you can continue along to get your bachelors and continue to reapply. Then, as filter suggested, shorten or at least offer the option of testing out of first year coures since it is basically a repeat of the premed prereqs.

 

[duncan11]

Okay, I just want to start off by saying that I have nothing against Obama so this is not a thread for Obama bashing. I'm just curious about what the future of health care will be like after Obama implements his plans. I understand that no one can really know the answer, but any insights you have would be helpful.

Does anyone know how specialty compensation will change? I understand that many people are saying that specialists make too much while the PCP make too little. What they don't say is that PCP need only 3 years of residency while specialists require at least 4 and many times, a lot more. They also don't mention that specialists tend to be the ones who worked harder during medical school to get better grades and board scores. Additionally, PCP can get loan repayment benefits while specialists can't. And lastly, I'm quite sure that on AVERAGE, specialists work more hours per week than PCP. I guess I just hope that the Obama administration will not try to equilibrize pay across the specialties as I believe they have done in other national health programs (e.g. UK).

This link has data from a JAMA 2003 article:
http://www.medfriends.org/specialty_hours_worked.htm
Internists (my field) worked 57 hours a week for $158,000
Radiologists worked 58 hours a week for $263,000

The data do not seem to support your assertion about specialist work hours particularly if you include the fields of dermatology, ENT, ophtho.

FYI: There are many, many smart and hard working general pediatricians, internists and family medicine physicians who performed quite well in medical school.

Physician compensation is an interesting issue. What do we really deserved to be paid relative to our colleagues? I work pretty hard in internal medicine, many months, 80 hours a week. I think the surgeons work harder than me, they do the same thing but for 2 more years, and therefore I am okay with their making more money. Does a plastic surgeon or a radiologist deserve to make 2x as much money as a general surgeon or 4x as much as a primary care physician? I am not so sure about that. I don't know what the numbers should be, but my gut feeling is that there should be at least a bit more salary equality.

 

[Doublecortin]

This link has data from a JAMA 2003 article:
http://www.medfriends.org/specialty_hours_worked.htm
Internists (my field) worked 57 hours a week for $158,000
Radiologists worked 58 hours a week for $263,000

The data do not seem to support your assertion about specialist work hours particularly if you include the fields of dermatology, ENT, ophtho.

FYI: There are many, many smart and hard working general pediatricians, internists and family medicine physicians who performed quite well in medical school.

Physician compensation is an interesting issue. What do we really deserved to be paid relative to our colleagues? I work pretty hard in internal medicine, many months, 80 hours a week. I think the surgeons work harder than me, they do the same thing but for 2 more years, and therefore I am okay with their making more money. Does a plastic surgeon or a radiologist deserve to make 2x as much money as a general surgeon or 4x as much as a primary care physician? I am not so sure about that. I don't know what the numbers should be, but my gut feeling is that there should be at least a bit more salary equality.

I agree that there are many very smart peds, internists, and family docs out there. And I agree that there needs to be more salary equality, but NOT by bring specialists' pay down but by paying primary care people more

 

[tabula0rasa]

Internists (my field) worked 57 hours a week for $158,000
Radiologists worked 58 hours a week for $263,000

Thank you for supporting my claim. Radiologists do work more than internists; and for that extra hour, I do think they deserve the extra 100k. 😀

Okay, I was wrong about the work hour. But radiology is 5 years and internal is only 3. Plus you got to admit the average radiologist did better in med school than the average internist. Now this may not necessary mean that they deserve 100K more a year, but they do deserve more. This is not a socialistic society and people should be able to make more if they are ambitious enough to work for it.

 

[NPR]

my gut feeling is that there should be at least a bit more salary equality.

I don't think this will sit well with those who busted their humps to get into a more competitive field.

 

[fun8stuff]

I agree that there are many very smart peds, internists, and family docs out there. And I agree that there needs to be more salary equality, but NOT by bring specialists' pay down but by paying primary care people more

salary equality??? how about we all live in a commune and share each others food as well??? what ever happened to the free market??! what about those baseball players... a guy I went to high school with just signed a 3 year $15 million contract... how about some equality there!

 

[Poitiers2]

salary equality??? how about we all live in a commune and share each others food as well??? what ever happened to the free market??! what about those baseball players... a guy I went to high school with just signed a 3 year $15 million contract... how about some equality there!

Be careful about running around and chattering about the free market. There are plenty of radiologists in India...and plenty that could be produced who would work for 1/5 of what many here would be willing to work for.

Just sayin'...

You seem quick to let NPs and PAs take over primary care. I think docs need to provide a much more unified front against any impingement upon our domain, training, and expertise. All kinds of cracks start emerging if you align any other way. And if you're willing to let some brat in Washington, DC, regulate your professional identity, well, we stand on different shores, my friend. (Not saying you were, but you caved pretty quick up there.)

That $263,000 per year for a radiologist also seems more than a bit of a lowball to me, as an aside..

 

[NPR]

Be careful about running around and chattering about the free market. There are plenty of radiologists in India...and plenty that could be produced who would work for 1/5 of what many here would be willing to work for

Ahh, the one time malpractice lawyers help doctors. Not gonna happen.

 

[greenergrass]

just to be sure this doesn't go unanswered: myself, along with many accomplished classmates have chosen IM over radiology... AOA/240-260's most will go to UCSF/MGH/etc but nonetheless much more talented/ambitious than a run of the mill rads resident.

 

[lilo426]

just to be sure this doesn't go unanswered: myself, along with many accomplished classmates have chosen IM over radiology... AOA/240-260's most will go to UCSF/MGH/etc but nonetheless much more talented/ambitious than a run of the mill rads resident.

Was there a question in there to be answered? 😉

I wonder how many of your classmates will end up as general internists versus, for example, in GI or cardio fellowships?

http://www.medicalnewstoday.com/articles/121102.php

 

[Labslave]

just to be sure this doesn't go unanswered: myself, along with many accomplished classmates have chosen IM over radiology... AOA/240-260's most will go to UCSF/MGH/etc but nonetheless much more talented/ambitious than a run of the mill rads resident.

The simple fact that you feel as if you need to point this out says a lot. You are clearly preoccupied with your colleagues' perception of your chosen field.

To clarify, I think anyone who has an opinion that actually matters accepts that there is a broad range of intrinsic capability present within each field of medicine.

 

[raddoc25]

This link has data from a JAMA 2003 article:
http://www.medfriends.org/specialty_hours_worked.htm
Internists (my field) worked 57 hours a week for $158,000
Radiologists worked 58 hours a week for $263,000

The data do not seem to support your assertion about specialist work hours particularly if you include the fields of dermatology, ENT, ophtho.

FYI: There are many, many smart and hard working general pediatricians, internists and family medicine physicians who performed quite well in medical school.

Physician compensation is an interesting issue. What do we really deserved to be paid relative to our colleagues? I work pretty hard in internal medicine, many months, 80 hours a week. I think the surgeons work harder than me, they do the same thing but for 2 more years, and therefore I am okay with their making more money. Does a plastic surgeon or a radiologist deserve to make 2x as much money as a general surgeon or 4x as much as a primary care physician? I am not so sure about that. I don't know what the numbers should be, but my gut feeling is that there should be at least a bit more salary equality.

Has anybody heard of defensive of medicine? I hate to say it but internist and PCP are driving up Radiology cost because in fear of a lawsuit if they misdiagnose.

Also, is the hospital open 24 hours? PCP restrict their patient hours and have deals with hospitals to work around their call. I do agree PCP are under paid but some choose their lifestyle over work.

What about Cardiology, the chief of all medicine, in which they dictate and threaten CEO administration and receive everything they want including hiring and firing doctors they choose not to work with in the hospitals.

Radiologist do not have this power!! You should not envy Radiology, I work very hard. I work holidays, 7am to midnight, work 14 days straight with no time off, depending on my rotation for the month, and still receive little respect by Hospital Administration.

Duncan11, I just noticed you are a Resident. Residency is a complete different environment than private practice. Everybody is on the same page, working a lot of hours for little money, but when you enter private practice you are entering the lion's den. Note: you work for yourself and your patients but hospital administration will make your life hell. I will not encourage my children to seek a degree in medicine. Maybe i should encourage my children to receive a Bachelors in ART APPRECIATION (4 year degree) and work for Wall Street.

 

[raddoc25]

Imaging is abused in all specialties. Radiologist do not refer imaging to themselves. Cardiologist self refer by completing Cardiac Ct in their offices, which was a battle we lost in my practice because the Giants did not want us to have any control of heart studies. The cardiologist wanted to read the heart section of the study and have the radiologist read the lungs and surrounding area for free. Did not happen! we refuse any part because of liability. Orthopedics self refer by completing images in their offices. All the unnecessary knee and shoulder surgeries and studies completed by the orthopedic doctor. PCP and internist have self referred in the business of workmens compensation. Oh, how many normals I read moonlighting for a MRI center for workmen compensation. Did the patient really need a full body scan? The cost of Radiology has escalated because of other specialties, not because of Radiologists. Self referral is a dangerous business and needs to stop.

 

[Doublecortin]

salary equality??? how about we all live in a commune and share each others food as well??? what ever happened to the free market??! what about those baseball players... a guy I went to high school with just signed a 3 year $15 million contract... how about some equality there!

Look, what I am saying is that PCPs should get paid more than they do now.

I strongly disagree with the notion that all the "smart" students go into rads or derm or what not. I myself want to do derm, but I don't have a superiority complex.

Look, if you love working with kids, why would you go into rads? so that you can make more and hate yourself and your life for the next 30-40 years? It makes no sense. I think it's a tragedy that a general peds can make as little as 90K in some places.

That's why all the doctors need to band together and take back our profession from scum like policians, lawers, and insurance companies

 

[Bombrainiac]

Doctors are, as a whole, very smart and very hard-working...and very, very competitive with each other. That is the problem. Insurance companies, hospital administrators, lawyers, and, yes, even patients take advantage of the fact that doctors are just over-grown pre-med students who can't seem to work like a league. Each specialty looks out for their own interests only.

Compensation is a very complicated beast that I do not pretend to fully understand. The smartest doctor I ever met was a general internest...until I met an even smarter doc who was a neurosurgeon...and then, once again, that doc was outdone by a hematogist/oncologist. Obviously, being the "smartest" does not equate to getting paid more (I would argue that there are ICU nutritionists who are better thinkers and are smarter than most NPs and even some docs, but don't get paid more).

35% of all healthcare dollars are spent on administrators that have absolutely nothing to contribute to patient care. If you're wondering where all the money is going, I wouldn't look to your colleagues. I'd look at insurance companies, lawyers, administrators, and, yes, your patients who don't comply with their medications, don't exercise, engage in risky behavior, etc.

There are no hand-outs in medicine. Every specialty has its heyday, and then Medicare catches up, or the competition undercuts you, or another specialty straight up jacks yours trade (i.e. cardiology to the CT surgeons). But, as a group, doctors need to defend each other and fight for each other, not just their own respective specialties. It's the old divide and conquer scheme to which doctors have fallen victim.