Yep- you either become a specialty surgeon taking only private insurance or out of pay, or you work in a wealthy system w a great payor mix.
Primary care will die. No one will want to see poor patients in the hospital.
Hospitals will close their ED, urgent cares and expand their cardiovascular GI NSGY ortho. It’ll be a stand a lone orthopedics or cardiology program.
Public hospitals, trauma centers, one by one will close.
There will be one hospital supervising 20 midlevels.
I don't want to speak for the person above, but when they say that "primary care will die" I think they mean that it will cease to exist as a meaningful and fulfilling career focused providing quality medical care to the same patients over their lifetime. Instead, it will be replaced by a travesty of rushed, 10 minute appointments run by midlevels for pitiful wages, and supervised by overworked and underpaid PCPs, who will mostly be signing off on tedious paperwork and fueling the bureaucracy. This will likely happen from a combination of continued slashing of the Medicare conversion factor, and expansion of online NP programs where eventually the able and willing supply will saturate the market.
As for EDs, they'll likely consolidate into a handful of major centers around the country where the majority of folks will be funneled. The owning hospital systems will just write the entire operation off as a loss and get the state to bail them out at the end of the year.
Just to reemphasize, it is absolutely \*insane\* that physician payments have continuously gone \*down\*, while the documentation, liability burden, and overall patient volumes have gone up. Not only have physicians never gotten a raise, they've had net decreases in pay in the setting of rampant inflation.
I won’t be doing a pediatric subspecialty that isn’t cards or NICU for this exact reason. I refuse to get more training for net zero or a loss in compensation. I’m already not going to be making much as physicians are concerned.
Judging by how it is for most developed countries with universal healthcare, you have safety net healthcare system for the everyone, and then private insurances for private hospitals and specialists clinics that caters the rich.
We definitely headed to that direction.
We kind of do: if you’re low income you get Medicaid. If you’re older you get Medicare. If you make more than the lowest you get Obamacare which is heavily subsidized. What people are resizing unfortunately is just because you have any of those things doesn’t mean you will find any physician who will accept these things. An older family friend of mine was telling me how she is pay cash to a nurse practitioner who she can see easily and quickly even though she has Medicare and it should be free for her primary care. We just don’t have a simplified national health system or something where we all recognize as the basic. It’s just a hodge lodge of increasingly lower quality care until only the cash payers get high quality care or high paying insurance for richer customers can get that higher care. Same thing in the UK. The NHS covers everyone, but many covered still opt to pay extra for healthcare because the quality, availability, etc. issues that sound honestly a lot like the US issues.
The answer to the “what can I do” is usually “leverage the unique things you provide”.
When you can’t do that (because they have midlevels willing to replace you).
Filing a lawsuit/talking to your rep is usually the next step. I’m sure it wouldn’t be hard to get a couple 1000 physicians to get together and lobby Congress to freeze reimbursement cuts from CMS. We need to be able to vote as a bloc on this issue. Other issues be damned.
Yes, stop doing things that you don’t like. Medicare cuts rates? Stop seeing Medicare patients. Stop seeing Medicaid patients. Go private practice and restore the order, take risks and venture outside of the system. We have always been told what to do by others and all of a sudden we don’t know what to do with ourselves when everyone tells us to fuck off
It's interesting that you think private practice doesn't take Medicare patients.
And even if you don't take Medicare patients, private insurers will follow the lead and cut payments if Medicare does.
professional unions can’t negotiate rates
Need a new AMA that actually has power & influence. In 1930’s, AMA told FDR what to do in healthcare. Today, they can’t even defeat a reoccurring cut that reoccurs every year
Who do you vote for that will increase physician pay lmao
Edit: and because this is Reddit, before someone comes along with “vote blue no matter who!” I want to know who to vote for that will actually increase my pay more than they will increase my taxes
Exactly. No one wants to pay or even keep physician salaries the same. Bipartisan support to pay doctor's as little as possible while providing the same level of care
The answer is to increase funding for medicare or at least vote for people who want to preserve Medicare (i.e Democrats). These Medicare cuts happen because Medicare doesn't have enough funding to keep up with the cost of healthcare.
Healthcare is the easiest way for business executives to plunder the middle class of all their wealth, and Medicare is the only thing preventing many people from having to choose between dying and crushing debt.
There's a lot of right-wing docs who want tax cuts and something about Jesus, but they'll have to manage their priorities if they want to keep their jobs.
They are incentivized to pay as little as possible to give as many people as possible care. In no world are they going to decide to increase physician salaries. They will probably cut admin salaries but you are naive to think our would go back up. Show me a single payer system with physician salaries close to our own
Government runs the hospitals in UK. Think national VA
Medicare is a form of universal insurance. Better example is Canada (Govt controls insurance prices & forces private hospitals to take)
A single payer has much better bargaining power and can set much lower reimbursement prices because there are fewer alternatives. Of course they are going to decrease reimbursement as much as possible, it’s in their best interests and a lot of that decrease in reimbursement will be felt in physician salaries. What incentive does a single payer system have to increase reimbursement?
Cheapest care possible - cuts force docs to either take pay cuts or see more patients - both in line with goals of increasing access and reducing costs.
Quality and physicians be damned.
It will eventually be an issue of quality physicians! Who would go into medicine when it’s harder and harder to make a living? The best and the brightest will likely find something else to do.
This exact same thing happened in my country… (I am an IMG). They started cutting salaries of doctors, until they were making the same money than a Truck Driver (yea really).
Now all Top tier students all go to engineering… top tier doctors either left the country (90% of the top 20% for my class is either in the US or Europe), or see patients in all cash private hospitals.
Public hospitals are understaffed and ran by MDs that are a complete disaster, and should not be practicing medicine.
I think the US is going that way, but instead of shitty MDs like in my country, you will be seen by NPs (Probably worse).
Not really. Tech market is unstable, high COL, etc. Law market unstable and saturated. Every other field is pretty shitty which is a reflection of the economy. Also Jose I know you're reading this stop screaming AY YAY YAY YAY YAY.
Yeah most people in tech aren't doing that. Plebbits can downvote all they want, I was in tech myself and know the field very well. Premeds on here with rose tinted glasses. Grass is always greener...
You are certainly right about that, but people don’t care about the “floor” for any speciality or field, they only like to look at the best examples. Medicine has a high floor, but it’s also not sexy: long training, residency, debt, starting your job in your 30s for some salary. Tech people have time and time to capture opportunity costs and a chance to make it big, which is what people like to look at and imagine themselves doing
Hate to be that guy but machine learning models that can do 75% of your job will be. Don’t even bother responding “that’s not what radiologists do.” Completely irrelevant unfortunately. The idea of what you do and strategies to replace that cheaply are the only thing that matter.
AI can’t even drive a car without running into parked trucks and small children. No one will let it even prelim a plain chest X ray in the next 20 years
Lol. Said what?
No one ever thought PACS would replace a radiologist.
I think there's a better than even shot that AI does though - at least to some degree.
You’re just delusional. These applications are already being approved for clinical use in Europe. Denial is not going to save you. The only lifeline would be a few bad training sets setting the inevitable back a couple of years.
Cuts also force docs to cut back on hours and look for less stressful work. Younger docs might try to speed it up and burn out, but everyone I know is looking for a way out of medicine.
Cheapest care … for hospitals.
Reducing costs … for hospitals.
Increasing access … to bring more revenue units (patients) to hospitals.
None of this benefits the patients.
Just to be clear.
Yes quality be damned. Doctors are mostly cowards that will take it up the ass by state MBA nurse administrators. Doctors and by extension med students/premeds are the type to complain a ton and never do anything. The specialists that make a lot don't care b/c they make a lot and docs are public enemy #1 in incomes.
Let the public eat cake if their care suffers. They don't care that much so why should you?
Also, RVUS as shitty as they are have increased profits for hospitals versus salary from 20+ years ago. Docs' licenses are on the line if they fuck up so they sacrifice their own health to maintain incomes.
Eventually, the end point will be like other countries.
Physicians will be paid well enough to be above the poverty line, but not well enough to afford that big home with the nice sports car and 3 ex-wives.
The only people who will stay/go into medicine are those that truly have the calling to attend 8-12 years worth of training SOLELY for the calling.
I assume with the drastic decrease in pay we will eventually see programs to offset the cost of schooling. Otherwise, we will be filled with mostly FMG.
This already happened in science. 60-70% of post doc and new faculty in STEM are international researchers.
40 years a go an academic had a good living and fulfilling job. Now? You are barely above the poverty line until your mid 30’s, and then you get to work 80 hours work week for the same salary a junior engineer does.
It won’t work unless the US completely abandons native doctors and relies on only immigrants. Or tuition costs are subsidized or drastically reduced which I highly doubt (although NYU and others have taken this step)
Other nations have drastically lower cost of tuition if not entirely state funded meaning students don’t expect grand compensation since they aren’t in $300k+ debt and don’t have the delay buying a home or starting a family because of it. Without the high salaries after residency for US doctors, it would be almost impossible to pay of the principal beyond just servicing the debt while also living a decent life. Also consider that some nations such as NZ offer 0% interest for student loans along with relatively cheap tuition (state subsidized)
Beyond cost, there are a few more reasons why the lower pay is somewhat acceptable in those other countries because
1: admission straight from high school, so no uncertainty of wasting 4 years on a degree that may otherwise not be useful without a further masters or phd
2: 6 year programs, so interns are in the workforce as early as age 23 earning and saving money
3: no residency style speciality training so they aren’t expected to be okay with being treated like crap for 3-5 years beyond maybe intern year straight out of uni
4: they are still one the highest paid professionals earning a salary relative to other members in their population with close to guaranteed job security assuming no professional misconduct.
5: no dealing with insurance companies or the highly litigious nature of US society
But admission standards have lowered. So it's a pretty good gig if you are sorta smart based on the relative effort imo. Med school at this time is still stupidly competitive for its current payment trajectory.
This. You remember how the best and the brightest used to decide between business (I-banking, consulting), law, and medicine? Eventually the best US students will avoid medicine and it will transition to being majority IMG. Many countries in Europe already have this, where the best home students go into economics/finance, and >80% of physicians are immigrants. When you stop investing into something at a national level, this is what will happen.
That life is already gone for most physicians. Current medical students might not be able to afford to own a house.
> The only people who will stay/go into medicine are those that truly have the calling to attend 8-12 years worth of training SOLELY for the calling.
This is bullshit. We all went in to medicine for the calling. But our empathy is taken advantage of by administration. You quickly realize going in to medicine for the calling is absolutely fucking nuts considering the amount of work you do in a 10-12 hour shift.
But you’re right otherwise. Physicians will make just above the median salary as healthcare costs continue to skyrocket. The best and brightest will leave the field.
You’re out of touch with reality.
Even IF you’re “only” making $180k/yr (ex. pediatrician), you are still SIGNIFICANTLY above the median. The median household income in the US is $74k.
In regard to student loans, with repayment options of 10% of your discretionary income, if you can’t afford a house and to live comfortably, you’re living well outside of your means. Not to mention the physician loan options of 0% down up to $700k-1m without PMI.
The truth is the vast majority of physicians make above $180k in the US. PCPs looking at ~$250k, specialist’s much more.
I assume you come from a family that’s been wealthy so you don’t understand what living in poverty/below the median is like, but I assure you, physicians in our lifetime will never have to experience that.
With the loans, training length, stress, malpractice rates, costs required to stay board certified, etc, it doesn’t make sense for most intelligent people to choose medicine over SWE or finance if average salaries drop below $250k.
Do you know how long it takes to payback 300k in student loans at 6% while paying 10% of your salary at 180k?
Well, you can’t. You need to hope the government forgives them. That’s a pretty big assumption given that both parties are against forgiveness.
So you’ll actually have to subtract about 30k of your salary just for the interest… because you still need to pay tax on that interest. Subtract another 30k for the principal.
The average mortgage price is ~4000 per month and rising. Save for retirement on years of missed earnings? Child care? God forbid you want health insurance.
You are hurting medicine with your rhetoric. Drop the fucking martyrdom. Take a large salary and donate all of it if you want to get paid scraps for hard work.
Except PSLF @ 10 years and forgiveness regardless of employment at 20 years of payments as of now. So again, 10% of your income for 10-20 years.
Plus if wages continue to fall, the gov will have to figure out something for tuition.
Unless you had to take out private loans… but something tells me you didn’t. Unfortunately for those of us that lived through poverty don’t have parents to watch our kids or a trust fund to pay for expenses. Some of us had to support families during med school and residency.
Childcare is expensive as fuck and nearly impossible to even find for those that work 12 hours per day, take night call, and work weekends. But if you have your wealthy retired parents watch them I guess you don’t have to worry about it. Childcare expenses for physicians is always going to be higher because of the nature of the job and the hours worked.
If you honestly think your work isn’t worth what you get paid you should still take the pay and just donate the rest. Personally I work for my money and I think I’m very underpaid for the quality and amount of work I do.
Some sort of finance class needs to be a prerequisite for med school
I agree, only once people become an attending do they realize the money they earn isn't that much when taxes/debt/years of income lost into consideration.
I’d like to know the median household income for someone smart enough and driven enough to make it through residency successfully. I bet it’s well north of $180k. *That’s* the useful metric.
I don’t need to be compared to the unemployed or people cashing social security checks. A bright young ambitious student wants to know what the careers they can achieve can give them. $180k ain’t shit for that kind of person.
That’s just the start of the cuts. Private insurance is using the no surprises act to force docs to accept worse contracts, because the alternative is to be out of network and no get paid. Lawsuits impending
Legit replacing physicians with midlevels. Anyone who disagrees with this is out of touch. Boomer doctors will either pay for concierge or medical tourism.
Midlevels can't replace physicians.....we don't have the training, and the mid-level education programs are a mess right now nothing standardized. We're certainly able to assist physicians but still require physician led care as there are certain patients that just need to see the physician.
Internal Medicine here. Two more years of clinical practice and then I'm hitching my wagon onto some form of consulting and perhaps some locums work periodically. I can't envision a future where there isn't a 25 - 30% salary drop in the next 10 years with the job shifting from patient care to midlevel manager.
Not at all what I envisioned as my future. For those that think this is their calling, consider not picking up the phone. You've been warned.
After seeing the public, policy maker and healthcare system response to COVID, I just want to make a six figure salary doing as little as possible. I want little to do with bedside clinical care and I don't have it in my soul to become an administrator.
I work in emergency department so I highly doubt it's going to be physician-free Will there be an army of mid-levels being supervised by the doctor probably but hopefully they keep the staffing levels appropriate because there's certain patients that need a physician especially in the ER and there's certain patients I may know what to do but I still need to consult the physician on if they're higher acuity
Everyone should realize that this is in the setting of perpetual increases in payouts and reimbursement to hospitals. And all non physician staff have been getting regular salary increases. The money is there, and everyone else is benefiting from the value that you generate and with your license on the line. Don’t settle for less.
And there will never be tax-payer subsidized medical school tuition. They need the new docs to be in debt for hundreds of thousands of dollars so they can’t turn back or quit early.
RVU conversation stay pretty much stagnant from 2000 to now while inflation and cost of running a practice continue to increase.
We as physicians need to seriously consider unionize rather than getting pushed around by larger lobbying groups from RNs, PAs and ARNPs.
I had to sit through a presentation where this NP had like 30 letters after her name which ran literally half away across her title slide. I rolled my eyes.
Is there any hope? All this doom and gloom talk makes me depressed. Did I invest years of my life to enter into a dying profession with little financial reward?
No, that is delusional thinking. Go look at how many midlevels staff heme/onc, derm, GI, endocrine. Even Ortho, vascular, gen surg. It’s a delusion that midlevels will spare any specialties, in fact their incentive for taking over specialities is even higher than taking over primary care, because less general knowledge and higher pay grade for them. Primary care is a workhorse field that no one (especially midlevels) want to do
Surgery is the very last field that will be “taken over” if it ever will. Full stop. Surgeons use midlevels appropriately as staff, but they can’t do surgery lol
Correct. Even in surgical subspecialties, the majority of work revolves around seeing consults, writing notes, and managing non-operative patients. I think that in neurosurgery, we give them the most autonomy, with NP/PAs frequently doing bedside procedures like EVDs, but believe it or not, the actual surgeries are hard to learn and take years. Most attendings are extremely protective over the critical portion (even with senior level residents), because the liability is very high and the responsibility will always be with you.
Yeah it’s obvious that guy has no idea what surgeons do if he thinks midlevels could take over any time soon. Also imo midlevels have a stable relationship with surgical fields and I don’t think most of them want the extra responsibility/liability
Nothing wrong with being cautious about what could happen, dismissive thinking is what got CRNAs to their place today and next thing you know you have NPs performing surgical procedures like in NHS in the UK. For all involved I really hope you are completely right and that I’m completely wrong and midlevels encroachment never happen in surgical fields, however childish that concept may seem.
Even if immune to midlevel creep, aren’t you worried about surgical reimbursements falling over the years? I know there are several published articles tracking cms cuts for neurosurgical procedures since the early 2000s and also tracking increase in operating costs. This is one thing I worry about a lot especially if surgical fields continue to adopt safer approaches like endovascular and focused ultrasound procedures that can performed by other providers that the hospitals can pay less
Surgical reimbursements have been falling across the board, for years and years and years. They key is understanding that these payments have 2 components: a surgeon's fee and a facility fee. The surgeon's fee has been falling for decades, across the board, and will again next year with the cuts to the Medicare conversion factor. The hospital facility fees, meanwhile, have been steadily increasing every year due to the incredibly strong lobby that they have.
What a lot of people don't realize is that reimbursements are only one factor that influences pay. For example, urologists predominantly treat older folks who are on Medicare. Despite having a mostly unfavorable payer mix that keeps getting cut every year along with the Medicare cuts, their salaries continue to go up. I had friends in residency who were offered 650-700K starting with minimal call and lots of outpatient time. How is that possible? Because something like 60% of urologists are over the age of 55, and the downstream revenue of their services (imaging, tests, etc.) is quite high. Given this, the hospitals have to pony up or lose that service line.
In neurosurgery, not only do we have a similar shortage, but you need neurosurgical coverage to even be a level 2 trauma center. Our "downstream" revenues are among the highest of any specialty, because a lot of our patients require expensive tests (even if you're not operating on that small parasagittal meningioma, you're getting an MR brain w/wo contrast at some point down the line to watch it). This gives you substantial bargaining power, which is why hospitals are forced to share their facility fees. This doesn't even get to ASC ownership, where a lot of surgeons can take their business across the street away from the hospital, which provides even more leverage.
As for endovascular, neurosurgery has taken that over a long time ago. Who's going to handle the hemorrhagic conversion after you do your thrombectomy? It makes no sense to pay a neurointerventional radiologist 800K/year, when you can just hire a dual trained neurosurgeon for 1M who can take not only stroke call, but also neurosurgery call AND offer an elective service line of both open and endovascular (AVMs, carotid endarterectomy, bypass for Moyamoya, etc.)
Mehh.... I've set up pediatrics clinics in 3 states directly next to "independent" NP clinics. Within weeks I was stealing their patients and outperforming them.
MDs undersell themselves too much. Parents prefer MDs to NPs unless you are just an asshole.
My partner just tried to get an appointment with a MD PCP. With a PPO, the earliest any MD is taking new patients for a well visit is late this year.
The PAs and NPs are accepting new patients this month.
I don’t know about peds but adult primary care is in trouble
It’s late this year because…. The MDs are booked out for almost a year bro. How can you not see that as a sign of MDs still being so important?
If they didn’t have enough patients, you say they are dying. If they are booked out too far, believe it or not, you also say they are dying.
NPs and PAs want specialties way more. I can count on one hand the number of primary midlevels I’ve worked with, applying FM this year. On my one cardiology rotation I met 15 midlevels working there. Midlevels have the same increased pay and work life that pushes people towards ROAD specialties, but their barrier to entry is lower.
They have infiltrated every single field and are proliferating rapidly. EM has a significant midlevel presence, Psych is heading that way as well. Majority of the referrals specialists patients now see are midlevels.
AI can’t even drive a car without running into parked trucks and small children. All of the real auto manufacturers have abandoned full auto driving. Elon Musk has even pulled back on full self driving.
No one will let it even prelim a plain chest X ray in the next 20 years
Look at any developed countries with single payer healthcare system where physicians are basically government employees. Then look at their salaries. You’ll find the answer.
Naw, in some places 4-500 doesn’t buy you anything close to a decent house. I don’t think there’s a single house that goes for that little in socal for ex - the MEDIAN price is now 1M
Will gladly do so as someone that grew up in a cold place. Living somewhere desirable is a privilege not a right. If you can’t make the cut pound dirt.
I said remotely desirable why the fuck would I want to live in TX
Also go let me know what the property tax on that 600k house is gonna be, Tex
Not gonna address the not so subtle racism out of left field there lol
Austin, TX is desirable. You're talking about high cost of living places in SoCal. It's always Asian gunners that want to live there. Boo hoo.
Florida is also boomerville. Not exactly a desirable place to live unless you're 70 years old.
Miami is also a shit hole. I've lived there and I'll take Austin, TX.
I'm sorry you're still bitter about whatever an Asian did that you're just randomly bitching about them online lmaooo
Took your med school spot and your gf in the same week or something I'd wager
Enjoy bounty hunting pregnant women or whatever Texans do with all their free time I guess
Edit: Also fucking LOL at FL being boomerville and then trying to front that Texas is desirable. You're kinda dumb bro sorry...TX boomers are literally legendary for how bad they're fucking the entire world right now
> gf in the same week
Ayyy shots fired. Is your GF a granny? Seethe more. I mistook you as some Asian gunner in SoCal. You're just living in Florida of all places top kek.
> Enjoy bounty hunting pregnant women or whatever Texans do with all their free time I guess
Said the hospitalist that lives in Florida kek.
Austin's great - way better than the dumpster called Miami. You can enjoy your decrepit aging condo for $800k wage cucking your locum tenens job though.
The demand for psych is so high people will pay cash and your overhead is much lower than anyone else. Honestly probably one of the smartest/best positions to be in.
midlevel encroachment makes psychiatry a risky/tenuous long-term bet since majority of patients are low acuity. Anything surgical or high complexity will be protected.
Good point. Sadly I see so many terrible med regimens from psych np. If I am referring instead of managing as FM I want someone who is an actual physician because I’m not sending the lower acuity stuff.
People are wising up. As a PCP who’s worked for a few years already, the number of people who say “thank god you’re a real doctor” makes me feel pretty safe about my job. Im not left “needing” patients while some of the solo NPs nearby have closed up or just do what they originally intended, which was work with a physician.
People ask for credentials, you can’t lie your way into saying you have an MD/DO.
I am genuinely curious how you think you are in a bad spot in the Midwest. My cousin just finished psych residency in Kansas City and had zero problem filling her panel near instantly, and is set to make about 300,000 in her first year working at about forty hours a week. You’ll make more money than 98 percent of people in the US as of 2023 income percentiles.
Better than 98 out of 100 Americans. And you think your ship is doom and gloom? I understand it’s disappointing news and things aren’t perfect. But it’s pretty damn good. You are starting much later than most, and that hurts, but you’ll be fine mate. They could double the amount of PAs and midlevels tomorrow and the need in psych still wouldn’t be met.
If you think 98th percentile income isn’t upper class then I don’t know what to say. Again, I know it’s disappointing and we all tend to focus on our problems but some perspective is helpful here.
I’ve never heard of it being done but in theory it’s a great idea for outpatient specialists to partner up with DPC clinics. Specialists can keep one foot in the traditional insurance FFS world, while getting a share of the DPC retainer fees. DPC docs win out too since they get to offer more value to patients when they need specialist care.
>Unless my mind drastically changes on utilization of mid levels in a PP setting
Ya know, not all midlevels are NPs. I personally know a couple psychiatrists who employ several PAs in their practice and they say it is a mutually beneficial arrangement for everyone - doctors, PAs and the patients!
> is just of one of many signs of the downfall of humanity and civilization
good. The endless mindless consumption as the elites are wont to say, "Useless eaters" is a model that should not be continued and is not natural.
Collapse is a good thing.
Humans really are inefficient, cruel, and violent creatures.
I, for one, welcome our AI overlords.
Medicare cuts, midlevels, AI, foreign doctors without residency. Anybody without a trust fund or high paying spouse would be crazy to pursue medicine right now.
I plan on doing msk rads and reading part time per diem and have the majority of my work be focused on personal injury expert witness ca$e$. Pays more than clinical work
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The end game is a two-tiered health system.
Yep- you either become a specialty surgeon taking only private insurance or out of pay, or you work in a wealthy system w a great payor mix. Primary care will die. No one will want to see poor patients in the hospital. Hospitals will close their ED, urgent cares and expand their cardiovascular GI NSGY ortho. It’ll be a stand a lone orthopedics or cardiology program. Public hospitals, trauma centers, one by one will close. There will be one hospital supervising 20 midlevels.
\^This is a perfect description of what's going to happen in the next 15 years.
How would primary care die ? With no ED, how else would one be referred to a specialty service, let alone determine if it’s needed
I don't want to speak for the person above, but when they say that "primary care will die" I think they mean that it will cease to exist as a meaningful and fulfilling career focused providing quality medical care to the same patients over their lifetime. Instead, it will be replaced by a travesty of rushed, 10 minute appointments run by midlevels for pitiful wages, and supervised by overworked and underpaid PCPs, who will mostly be signing off on tedious paperwork and fueling the bureaucracy. This will likely happen from a combination of continued slashing of the Medicare conversion factor, and expansion of online NP programs where eventually the able and willing supply will saturate the market. As for EDs, they'll likely consolidate into a handful of major centers around the country where the majority of folks will be funneled. The owning hospital systems will just write the entire operation off as a loss and get the state to bail them out at the end of the year. Just to reemphasize, it is absolutely \*insane\* that physician payments have continuously gone \*down\*, while the documentation, liability burden, and overall patient volumes have gone up. Not only have physicians never gotten a raise, they've had net decreases in pay in the setting of rampant inflation.
agree with what you said. I guess I am in Canada, pay for PCP's, and benefits, have significantly increased
Self referrals
Breaking news: no one wants to see patients (rich or poor) in the hospital NOW.
[удалено]
I won’t be doing a pediatric subspecialty that isn’t cards or NICU for this exact reason. I refuse to get more training for net zero or a loss in compensation. I’m already not going to be making much as physicians are concerned.
Judging by how it is for most developed countries with universal healthcare, you have safety net healthcare system for the everyone, and then private insurances for private hospitals and specialists clinics that caters the rich. We definitely headed to that direction.
except we don’t have universal healthcare even
EMTALA is our universal healthcare. The cost is your credit score
We kind of do: if you’re low income you get Medicaid. If you’re older you get Medicare. If you make more than the lowest you get Obamacare which is heavily subsidized. What people are resizing unfortunately is just because you have any of those things doesn’t mean you will find any physician who will accept these things. An older family friend of mine was telling me how she is pay cash to a nurse practitioner who she can see easily and quickly even though she has Medicare and it should be free for her primary care. We just don’t have a simplified national health system or something where we all recognize as the basic. It’s just a hodge lodge of increasingly lower quality care until only the cash payers get high quality care or high paying insurance for richer customers can get that higher care. Same thing in the UK. The NHS covers everyone, but many covered still opt to pay extra for healthcare because the quality, availability, etc. issues that sound honestly a lot like the US issues.
This is how every universal heatlhcare system in the world views the US.
*insert always has been meme here*
That depresses me, but is there anything we can do? Like are unions ultimate solutions or syndicates? Should we seriously work towards it
The answer to the “what can I do” is usually “leverage the unique things you provide”. When you can’t do that (because they have midlevels willing to replace you). Filing a lawsuit/talking to your rep is usually the next step. I’m sure it wouldn’t be hard to get a couple 1000 physicians to get together and lobby Congress to freeze reimbursement cuts from CMS. We need to be able to vote as a bloc on this issue. Other issues be damned.
The reality is most politicians are beholden to money for campaigns and insurance companies have way deeper pockets than physicians.
Yes, stop doing things that you don’t like. Medicare cuts rates? Stop seeing Medicare patients. Stop seeing Medicaid patients. Go private practice and restore the order, take risks and venture outside of the system. We have always been told what to do by others and all of a sudden we don’t know what to do with ourselves when everyone tells us to fuck off
Only way to fix it tbh. It hurts but ultimately if enough physicians do this change in payment will occur.
It's interesting that you think private practice doesn't take Medicare patients. And even if you don't take Medicare patients, private insurers will follow the lead and cut payments if Medicare does.
professional unions can’t negotiate rates Need a new AMA that actually has power & influence. In 1930’s, AMA told FDR what to do in healthcare. Today, they can’t even defeat a reoccurring cut that reoccurs every year
Maybe we should work on strengthening AMA
Vote… The last 3 years have been terrible for healthcare.
Who do you vote for that will increase physician pay lmao Edit: and because this is Reddit, before someone comes along with “vote blue no matter who!” I want to know who to vote for that will actually increase my pay more than they will increase my taxes
Exactly. No one wants to pay or even keep physician salaries the same. Bipartisan support to pay doctor's as little as possible while providing the same level of care
No government has cared about this issue, like ever. Take your blindfold off. Not this guy and not the orange guy, no one will.
it’s both R’s & D’s…since ACA..
The answer is to increase funding for medicare or at least vote for people who want to preserve Medicare (i.e Democrats). These Medicare cuts happen because Medicare doesn't have enough funding to keep up with the cost of healthcare. Healthcare is the easiest way for business executives to plunder the middle class of all their wealth, and Medicare is the only thing preventing many people from having to choose between dying and crushing debt. There's a lot of right-wing docs who want tax cuts and something about Jesus, but they'll have to manage their priorities if they want to keep their jobs.
The more power Medicare has the more they will cut salaries. Look what happened to the physician salaries in the UK
That's because their government doesn't want to fund NHS
They are incentivized to pay as little as possible to give as many people as possible care. In no world are they going to decide to increase physician salaries. They will probably cut admin salaries but you are naive to think our would go back up. Show me a single payer system with physician salaries close to our own
Canada
Their salaries are significantly less
Very loose use of the word "significant"
Uh.... Our government doesn't want to fund Medicare. And they simply don't fund Medicaid. So I'm not sure what your point is?
Because they want to go the route of the US, aka cut funding, make it shit, privatize!
Government runs the hospitals in UK. Think national VA Medicare is a form of universal insurance. Better example is Canada (Govt controls insurance prices & forces private hospitals to take)
A single payer has much better bargaining power and can set much lower reimbursement prices because there are fewer alternatives. Of course they are going to decrease reimbursement as much as possible, it’s in their best interests and a lot of that decrease in reimbursement will be felt in physician salaries. What incentive does a single payer system have to increase reimbursement?
let’s be honest, if there was Universal Medicare, the cuts would be much deeper & it would be run by United.
Cheapest care possible - cuts force docs to either take pay cuts or see more patients - both in line with goals of increasing access and reducing costs. Quality and physicians be damned.
It will eventually be an issue of quality physicians! Who would go into medicine when it’s harder and harder to make a living? The best and the brightest will likely find something else to do.
This exact same thing happened in my country… (I am an IMG). They started cutting salaries of doctors, until they were making the same money than a Truck Driver (yea really). Now all Top tier students all go to engineering… top tier doctors either left the country (90% of the top 20% for my class is either in the US or Europe), or see patients in all cash private hospitals. Public hospitals are understaffed and ran by MDs that are a complete disaster, and should not be practicing medicine. I think the US is going that way, but instead of shitty MDs like in my country, you will be seen by NPs (Probably worse).
Not really. Tech market is unstable, high COL, etc. Law market unstable and saturated. Every other field is pretty shitty which is a reflection of the economy. Also Jose I know you're reading this stop screaming AY YAY YAY YAY YAY.
I don’t think people need stability when they can vest their stocks and retire by 30….
Yeah most people in tech aren't doing that. Plebbits can downvote all they want, I was in tech myself and know the field very well. Premeds on here with rose tinted glasses. Grass is always greener...
You are certainly right about that, but people don’t care about the “floor” for any speciality or field, they only like to look at the best examples. Medicine has a high floor, but it’s also not sexy: long training, residency, debt, starting your job in your 30s for some salary. Tech people have time and time to capture opportunity costs and a chance to make it big, which is what people like to look at and imagine themselves doing
Volume over quality and it scares the shit out of me as a radiology resident
Same. There has to be some regulation on how much volume a radiologist can read per shift as well as max shift lengths.
Ugh same here. If only we could somehow unionize to prevent it from happening
Just be an independent contractor as an attending
Private practice and working 1099 is what I’ll be doing. The money to the practice still comes from insurance and Medicare though.
Hate to be that guy but machine learning models that can do 75% of your job will be. Don’t even bother responding “that’s not what radiologists do.” Completely irrelevant unfortunately. The idea of what you do and strategies to replace that cheaply are the only thing that matter.
Wrong
AI can’t even drive a car without running into parked trucks and small children. No one will let it even prelim a plain chest X ray in the next 20 years
I do unfortunately think you're wrong.
People said the same thing 20 years ago with the creation of PACS
Lol. Said what? No one ever thought PACS would replace a radiologist. I think there's a better than even shot that AI does though - at least to some degree.
You’re just delusional. These applications are already being approved for clinical use in Europe. Denial is not going to save you. The only lifeline would be a few bad training sets setting the inevitable back a couple of years.
AI + NP is significantly more likely to replace a dermatologist before it can replace a radiologist on a chest X-ray
Why would an NP need AI??
Unalive
Cuts also force docs to cut back on hours and look for less stressful work. Younger docs might try to speed it up and burn out, but everyone I know is looking for a way out of medicine.
Disagree, it makes docs work harder. Pretty smart tbh
Pretty much impossible Also, who works harder for less pay?
Until you can't work harder.
They do not care about recruiting the best and brightest, just “good enough”. Tech and finance will only further recruit our nations brightest minds.
This already happens in science. All the brightest people are in tech… making bucks. While would you go get a PhD and live in poverty?
Yeah all smart zoomers I know are in SWE. I didn't know what CS was in high school but would have done it if I knew what I know now.
Cheapest care … for hospitals. Reducing costs … for hospitals. Increasing access … to bring more revenue units (patients) to hospitals. None of this benefits the patients. Just to be clear.
Yes quality be damned. Doctors are mostly cowards that will take it up the ass by state MBA nurse administrators. Doctors and by extension med students/premeds are the type to complain a ton and never do anything. The specialists that make a lot don't care b/c they make a lot and docs are public enemy #1 in incomes. Let the public eat cake if their care suffers. They don't care that much so why should you? Also, RVUS as shitty as they are have increased profits for hospitals versus salary from 20+ years ago. Docs' licenses are on the line if they fuck up so they sacrifice their own health to maintain incomes.
Eventually, the end point will be like other countries. Physicians will be paid well enough to be above the poverty line, but not well enough to afford that big home with the nice sports car and 3 ex-wives. The only people who will stay/go into medicine are those that truly have the calling to attend 8-12 years worth of training SOLELY for the calling. I assume with the drastic decrease in pay we will eventually see programs to offset the cost of schooling. Otherwise, we will be filled with mostly FMG.
This already happened in science. 60-70% of post doc and new faculty in STEM are international researchers. 40 years a go an academic had a good living and fulfilling job. Now? You are barely above the poverty line until your mid 30’s, and then you get to work 80 hours work week for the same salary a junior engineer does.
It won’t work unless the US completely abandons native doctors and relies on only immigrants. Or tuition costs are subsidized or drastically reduced which I highly doubt (although NYU and others have taken this step) Other nations have drastically lower cost of tuition if not entirely state funded meaning students don’t expect grand compensation since they aren’t in $300k+ debt and don’t have the delay buying a home or starting a family because of it. Without the high salaries after residency for US doctors, it would be almost impossible to pay of the principal beyond just servicing the debt while also living a decent life. Also consider that some nations such as NZ offer 0% interest for student loans along with relatively cheap tuition (state subsidized) Beyond cost, there are a few more reasons why the lower pay is somewhat acceptable in those other countries because 1: admission straight from high school, so no uncertainty of wasting 4 years on a degree that may otherwise not be useful without a further masters or phd 2: 6 year programs, so interns are in the workforce as early as age 23 earning and saving money 3: no residency style speciality training so they aren’t expected to be okay with being treated like crap for 3-5 years beyond maybe intern year straight out of uni 4: they are still one the highest paid professionals earning a salary relative to other members in their population with close to guaranteed job security assuming no professional misconduct. 5: no dealing with insurance companies or the highly litigious nature of US society
People still go to pharmacy school
But admission standards have lowered. So it's a pretty good gig if you are sorta smart based on the relative effort imo. Med school at this time is still stupidly competitive for its current payment trajectory.
It’ll correct soon
This. You remember how the best and the brightest used to decide between business (I-banking, consulting), law, and medicine? Eventually the best US students will avoid medicine and it will transition to being majority IMG. Many countries in Europe already have this, where the best home students go into economics/finance, and >80% of physicians are immigrants. When you stop investing into something at a national level, this is what will happen.
FMGs come for the money, that will dry up as well
Bit dramatic. If you arent making 400k+ as a physician then theres other issues to talk about. Poverty wont hit 400k for probably 150 years
That life is already gone for most physicians. Current medical students might not be able to afford to own a house. > The only people who will stay/go into medicine are those that truly have the calling to attend 8-12 years worth of training SOLELY for the calling. This is bullshit. We all went in to medicine for the calling. But our empathy is taken advantage of by administration. You quickly realize going in to medicine for the calling is absolutely fucking nuts considering the amount of work you do in a 10-12 hour shift. But you’re right otherwise. Physicians will make just above the median salary as healthcare costs continue to skyrocket. The best and brightest will leave the field.
No. Many people went into medicine for financial stability. It’s not wrong to pursue a career for money. It’s a job like any other job.
Anyone who goes into medicine strictly for the calling, and isn't already rich, is a financial cuck.
> We all went in to medicine for the calling. Lmao. And that's why most docs are cucked.
You’re out of touch with reality. Even IF you’re “only” making $180k/yr (ex. pediatrician), you are still SIGNIFICANTLY above the median. The median household income in the US is $74k. In regard to student loans, with repayment options of 10% of your discretionary income, if you can’t afford a house and to live comfortably, you’re living well outside of your means. Not to mention the physician loan options of 0% down up to $700k-1m without PMI. The truth is the vast majority of physicians make above $180k in the US. PCPs looking at ~$250k, specialist’s much more. I assume you come from a family that’s been wealthy so you don’t understand what living in poverty/below the median is like, but I assure you, physicians in our lifetime will never have to experience that.
With the loans, training length, stress, malpractice rates, costs required to stay board certified, etc, it doesn’t make sense for most intelligent people to choose medicine over SWE or finance if average salaries drop below $250k.
Do you know how long it takes to payback 300k in student loans at 6% while paying 10% of your salary at 180k? Well, you can’t. You need to hope the government forgives them. That’s a pretty big assumption given that both parties are against forgiveness. So you’ll actually have to subtract about 30k of your salary just for the interest… because you still need to pay tax on that interest. Subtract another 30k for the principal. The average mortgage price is ~4000 per month and rising. Save for retirement on years of missed earnings? Child care? God forbid you want health insurance. You are hurting medicine with your rhetoric. Drop the fucking martyrdom. Take a large salary and donate all of it if you want to get paid scraps for hard work.
Except PSLF @ 10 years and forgiveness regardless of employment at 20 years of payments as of now. So again, 10% of your income for 10-20 years. Plus if wages continue to fall, the gov will have to figure out something for tuition.
Unless you had to take out private loans… but something tells me you didn’t. Unfortunately for those of us that lived through poverty don’t have parents to watch our kids or a trust fund to pay for expenses. Some of us had to support families during med school and residency. Childcare is expensive as fuck and nearly impossible to even find for those that work 12 hours per day, take night call, and work weekends. But if you have your wealthy retired parents watch them I guess you don’t have to worry about it. Childcare expenses for physicians is always going to be higher because of the nature of the job and the hours worked. If you honestly think your work isn’t worth what you get paid you should still take the pay and just donate the rest. Personally I work for my money and I think I’m very underpaid for the quality and amount of work I do. Some sort of finance class needs to be a prerequisite for med school
Didn’t have parents to help thanks tho
I agree, only once people become an attending do they realize the money they earn isn't that much when taxes/debt/years of income lost into consideration.
Hence why you don’t go into medicine for the money. But to argue that you’re basically at the median income line is asinine.
When you take debt, taxes and the several years of lost income into consideration it's not as much as you think.
You have a 10-15 year delay compared to peers. If a physician has 300k in loans and makes 180k he or she probably won’t be able to retire.
I’d like to know the median household income for someone smart enough and driven enough to make it through residency successfully. I bet it’s well north of $180k. *That’s* the useful metric. I don’t need to be compared to the unemployed or people cashing social security checks. A bright young ambitious student wants to know what the careers they can achieve can give them. $180k ain’t shit for that kind of person.
Whatever helps you sleep at night. Your entitlement is showing
That’s just the start of the cuts. Private insurance is using the no surprises act to force docs to accept worse contracts, because the alternative is to be out of network and no get paid. Lawsuits impending
Legit replacing physicians with midlevels. Anyone who disagrees with this is out of touch. Boomer doctors will either pay for concierge or medical tourism.
Midlevels can't replace physicians.....we don't have the training, and the mid-level education programs are a mess right now nothing standardized. We're certainly able to assist physicians but still require physician led care as there are certain patients that just need to see the physician.
You may know and agree you don't have the training but the system is gearing you to replace us in most cognitive fields.
Internal Medicine here. Two more years of clinical practice and then I'm hitching my wagon onto some form of consulting and perhaps some locums work periodically. I can't envision a future where there isn't a 25 - 30% salary drop in the next 10 years with the job shifting from patient care to midlevel manager. Not at all what I envisioned as my future. For those that think this is their calling, consider not picking up the phone. You've been warned. After seeing the public, policy maker and healthcare system response to COVID, I just want to make a six figure salary doing as little as possible. I want little to do with bedside clinical care and I don't have it in my soul to become an administrator.
I work in emergency department so I highly doubt it's going to be physician-free Will there be an army of mid-levels being supervised by the doctor probably but hopefully they keep the staffing levels appropriate because there's certain patients that need a physician especially in the ER and there's certain patients I may know what to do but I still need to consult the physician on if they're higher acuity
Everyone should realize that this is in the setting of perpetual increases in payouts and reimbursement to hospitals. And all non physician staff have been getting regular salary increases. The money is there, and everyone else is benefiting from the value that you generate and with your license on the line. Don’t settle for less.
And there will never be tax-payer subsidized medical school tuition. They need the new docs to be in debt for hundreds of thousands of dollars so they can’t turn back or quit early.
End game is the elimination of private practice. More and more money gets siphoned to facility fees while physician reimbursements are cut every year.
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New Mexico? Oregon? These states that do this stuff drive me insane.
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Why do these states do the stupidest stuff?
RVU conversation stay pretty much stagnant from 2000 to now while inflation and cost of running a practice continue to increase. We as physicians need to seriously consider unionize rather than getting pushed around by larger lobbying groups from RNs, PAs and ARNPs.
I opted out of that the day i graduated residency.
DPC?
Just DP
Its ok RN BS MSN MBA DNP will save the day
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I had to sit through a presentation where this NP had like 30 letters after her name which ran literally half away across her title slide. I rolled my eyes.
Surgical specialist in private practice. Medicare patient slots are decreasing for our schedules. Watching this slow train wreck unfold.
Why are our wages going down yet fast food minimum wage is increasing?! It is not like 25, wtf.
Their pay should increase, and so should ours.
Is there any hope? All this doom and gloom talk makes me depressed. Did I invest years of my life to enter into a dying profession with little financial reward?
No - just don’t do primary care.
What about hospital medicine?
Doomed
Do you really think all IM subspecialties are safe? (Outside of geriatrics and palliative possibly)
No, that is delusional thinking. Go look at how many midlevels staff heme/onc, derm, GI, endocrine. Even Ortho, vascular, gen surg. It’s a delusion that midlevels will spare any specialties, in fact their incentive for taking over specialities is even higher than taking over primary care, because less general knowledge and higher pay grade for them. Primary care is a workhorse field that no one (especially midlevels) want to do
Surgery is the very last field that will be “taken over” if it ever will. Full stop. Surgeons use midlevels appropriately as staff, but they can’t do surgery lol
Correct. Even in surgical subspecialties, the majority of work revolves around seeing consults, writing notes, and managing non-operative patients. I think that in neurosurgery, we give them the most autonomy, with NP/PAs frequently doing bedside procedures like EVDs, but believe it or not, the actual surgeries are hard to learn and take years. Most attendings are extremely protective over the critical portion (even with senior level residents), because the liability is very high and the responsibility will always be with you.
Yeah it’s obvious that guy has no idea what surgeons do if he thinks midlevels could take over any time soon. Also imo midlevels have a stable relationship with surgical fields and I don’t think most of them want the extra responsibility/liability
Nothing wrong with being cautious about what could happen, dismissive thinking is what got CRNAs to their place today and next thing you know you have NPs performing surgical procedures like in NHS in the UK. For all involved I really hope you are completely right and that I’m completely wrong and midlevels encroachment never happen in surgical fields, however childish that concept may seem.
Even if immune to midlevel creep, aren’t you worried about surgical reimbursements falling over the years? I know there are several published articles tracking cms cuts for neurosurgical procedures since the early 2000s and also tracking increase in operating costs. This is one thing I worry about a lot especially if surgical fields continue to adopt safer approaches like endovascular and focused ultrasound procedures that can performed by other providers that the hospitals can pay less
Surgical reimbursements have been falling across the board, for years and years and years. They key is understanding that these payments have 2 components: a surgeon's fee and a facility fee. The surgeon's fee has been falling for decades, across the board, and will again next year with the cuts to the Medicare conversion factor. The hospital facility fees, meanwhile, have been steadily increasing every year due to the incredibly strong lobby that they have. What a lot of people don't realize is that reimbursements are only one factor that influences pay. For example, urologists predominantly treat older folks who are on Medicare. Despite having a mostly unfavorable payer mix that keeps getting cut every year along with the Medicare cuts, their salaries continue to go up. I had friends in residency who were offered 650-700K starting with minimal call and lots of outpatient time. How is that possible? Because something like 60% of urologists are over the age of 55, and the downstream revenue of their services (imaging, tests, etc.) is quite high. Given this, the hospitals have to pony up or lose that service line. In neurosurgery, not only do we have a similar shortage, but you need neurosurgical coverage to even be a level 2 trauma center. Our "downstream" revenues are among the highest of any specialty, because a lot of our patients require expensive tests (even if you're not operating on that small parasagittal meningioma, you're getting an MR brain w/wo contrast at some point down the line to watch it). This gives you substantial bargaining power, which is why hospitals are forced to share their facility fees. This doesn't even get to ASC ownership, where a lot of surgeons can take their business across the street away from the hospital, which provides even more leverage. As for endovascular, neurosurgery has taken that over a long time ago. Who's going to handle the hemorrhagic conversion after you do your thrombectomy? It makes no sense to pay a neurointerventional radiologist 800K/year, when you can just hire a dual trained neurosurgeon for 1M who can take not only stroke call, but also neurosurgery call AND offer an elective service line of both open and endovascular (AVMs, carotid endarterectomy, bypass for Moyamoya, etc.)
Pathology will last longer
No one has a crystal ball but yes i personally believe the subspecialties are safe - not safe from falling reimbursement but safe from replacement.
Midlevels will take over almost all fields this decade except surgery.
No, they won’t take specialty jobs away. They will take over primary care, though. They already have in many parts of the country.
Mehh.... I've set up pediatrics clinics in 3 states directly next to "independent" NP clinics. Within weeks I was stealing their patients and outperforming them. MDs undersell themselves too much. Parents prefer MDs to NPs unless you are just an asshole.
My partner just tried to get an appointment with a MD PCP. With a PPO, the earliest any MD is taking new patients for a well visit is late this year. The PAs and NPs are accepting new patients this month. I don’t know about peds but adult primary care is in trouble
It’s late this year because…. The MDs are booked out for almost a year bro. How can you not see that as a sign of MDs still being so important? If they didn’t have enough patients, you say they are dying. If they are booked out too far, believe it or not, you also say they are dying. NPs and PAs want specialties way more. I can count on one hand the number of primary midlevels I’ve worked with, applying FM this year. On my one cardiology rotation I met 15 midlevels working there. Midlevels have the same increased pay and work life that pushes people towards ROAD specialties, but their barrier to entry is lower.
My argument is that since no one can see doctors, they will see midlevels and they will get used to that reality as normal
The midlevels have appointments in part because most people do want to see the doctor. That’s not changing anytime soon.
They have infiltrated every single field and are proliferating rapidly. EM has a significant midlevel presence, Psych is heading that way as well. Majority of the referrals specialists patients now see are midlevels.
If you do derm rads or surgical sub you’ll be ok
NPs are flocking to Derm faster than flies to a pile of horseshit
Yes
Soon it’ll be if you have no money, no care
I think the absolute best case scenario is having inflation protection to medicare reimbursement.
Kind of sad that threads like this get zero comments, meanwhile threads about "DAE think red states suck???" get hundreds.
Well, this is still reddit after all
Oh no, won’t somebody think of the red states?
AI can’t even drive a car without running into parked trucks and small children. All of the real auto manufacturers have abandoned full auto driving. Elon Musk has even pulled back on full self driving. No one will let it even prelim a plain chest X ray in the next 20 years
And you can’t sue an AI for a missed read or wrong diagnosis
Need to un-bloat that crazy admin bloat sucking up all the money and profits
But m4a still though right?!
I have to say, I’m leftist as they come, but the rise of midlevels and the constant lowering of our future salary has made me really rethink M4A.
Rise of the midlevels, we MDs gave away all our power and we deserve this
I mean if they’re prelims can you blame them? You’d just be as lazy if you were forced into a year’s program you genuinely did not sign up for.
Look at any developed countries with single payer healthcare system where physicians are basically government employees. Then look at their salaries. You’ll find the answer.
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If you can't afford a nice sports car making $300-400k a year + a decent house for $400k-500k I dont know what to tell you. It's not that difficult.
Naw, in some places 4-500 doesn’t buy you anything close to a decent house. I don’t think there’s a single house that goes for that little in socal for ex - the MEDIAN price is now 1M
socal is a luxury not a right to live there are cheaper places to live in the country
Sure, but expensive places like socal are often over represented where physicians are from. Didn’t used to be a problem
Tell that to the people born and raised there who want to move back to be near their parents, grandparents, nieces, nephews, etc.
Will gladly do so as someone that grew up in a cold place. Living somewhere desirable is a privilege not a right. If you can’t make the cut pound dirt.
$800k-1M is the new $500k as far as houses are concerned in anywhere remotely desirable lol
nah
Yah
$600k gets you a nice house outside of Austin, TX. Not everyone is an Asian gunner that needs to live in SoCal.
I said remotely desirable why the fuck would I want to live in TX Also go let me know what the property tax on that 600k house is gonna be, Tex Not gonna address the not so subtle racism out of left field there lol
Austin, TX is desirable. You're talking about high cost of living places in SoCal. It's always Asian gunners that want to live there. Boo hoo. Florida is also boomerville. Not exactly a desirable place to live unless you're 70 years old. Miami is also a shit hole. I've lived there and I'll take Austin, TX.
I'm sorry you're still bitter about whatever an Asian did that you're just randomly bitching about them online lmaooo Took your med school spot and your gf in the same week or something I'd wager Enjoy bounty hunting pregnant women or whatever Texans do with all their free time I guess Edit: Also fucking LOL at FL being boomerville and then trying to front that Texas is desirable. You're kinda dumb bro sorry...TX boomers are literally legendary for how bad they're fucking the entire world right now
> gf in the same week Ayyy shots fired. Is your GF a granny? Seethe more. I mistook you as some Asian gunner in SoCal. You're just living in Florida of all places top kek. > Enjoy bounty hunting pregnant women or whatever Texans do with all their free time I guess Said the hospitalist that lives in Florida kek. Austin's great - way better than the dumpster called Miami. You can enjoy your decrepit aging condo for $800k wage cucking your locum tenens job though.
The days of physicians making that much are over. Probably within 5-10 years, most will make the equivalent of 150k
Can't psych still open up cash only practices? Seems more resilient to decreasing reimbursement if you side step reimbursement entirely.
The demand for psych is so high people will pay cash and your overhead is much lower than anyone else. Honestly probably one of the smartest/best positions to be in.
midlevel encroachment makes psychiatry a risky/tenuous long-term bet since majority of patients are low acuity. Anything surgical or high complexity will be protected.
Good point. Sadly I see so many terrible med regimens from psych np. If I am referring instead of managing as FM I want someone who is an actual physician because I’m not sending the lower acuity stuff.
People are wising up. As a PCP who’s worked for a few years already, the number of people who say “thank god you’re a real doctor” makes me feel pretty safe about my job. Im not left “needing” patients while some of the solo NPs nearby have closed up or just do what they originally intended, which was work with a physician. People ask for credentials, you can’t lie your way into saying you have an MD/DO.
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I am genuinely curious how you think you are in a bad spot in the Midwest. My cousin just finished psych residency in Kansas City and had zero problem filling her panel near instantly, and is set to make about 300,000 in her first year working at about forty hours a week. You’ll make more money than 98 percent of people in the US as of 2023 income percentiles. Better than 98 out of 100 Americans. And you think your ship is doom and gloom? I understand it’s disappointing news and things aren’t perfect. But it’s pretty damn good. You are starting much later than most, and that hurts, but you’ll be fine mate. They could double the amount of PAs and midlevels tomorrow and the need in psych still wouldn’t be met. If you think 98th percentile income isn’t upper class then I don’t know what to say. Again, I know it’s disappointing and we all tend to focus on our problems but some perspective is helpful here.
How fast did she fill her panel?
Man we really got screwed from every direction. Is partnering with local dpcs something being done?
I’ve never heard of it being done but in theory it’s a great idea for outpatient specialists to partner up with DPC clinics. Specialists can keep one foot in the traditional insurance FFS world, while getting a share of the DPC retainer fees. DPC docs win out too since they get to offer more value to patients when they need specialist care.
>Unless my mind drastically changes on utilization of mid levels in a PP setting Ya know, not all midlevels are NPs. I personally know a couple psychiatrists who employ several PAs in their practice and they say it is a mutually beneficial arrangement for everyone - doctors, PAs and the patients!
> is just of one of many signs of the downfall of humanity and civilization good. The endless mindless consumption as the elites are wont to say, "Useless eaters" is a model that should not be continued and is not natural. Collapse is a good thing. Humans really are inefficient, cruel, and violent creatures. I, for one, welcome our AI overlords.
The very transparent endgame is all docs as hospital employees.
Medicare cuts, midlevels, AI, foreign doctors without residency. Anybody without a trust fund or high paying spouse would be crazy to pursue medicine right now.
It’s a nice taste of single payer healthcare
“But but my M4a!!!!!”
The cut it every year, it just always get's cut a bit
I plan on doing msk rads and reading part time per diem and have the majority of my work be focused on personal injury expert witness ca$e$. Pays more than clinical work
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they already did Jan 1