The end of medicine as we know it ...

[PrincessFiona]

and ... is the light at the end of the tunnel really just the *new* healthcare train prepared to run you over?

Consider this fact: While our government continues to debate the different versions of the health care bill currently preparing to go through reconciliation and then be signed into a law that will require every American to purchase health care insurance from a private insurance company, our government has snuck in the back door and cut the salaries of specialists and generalist alike by abolishing consultation codes for specialists, and drastically cutting payments across the board for a variety of procedures in specialties from oncology to neurology to dermatology to cardiology. If you have seen a patient for any problem in the last 3 years (or that patient has been seen at another facility and has been seen by a physician in your area of specialty within the last 3 years) you may not bill a new patient visit...even if the problem is a brand new one.

Medicare cuts began effectively dismantling the payment structure for specialists on Jan 1, 2010 this year and it is an across-the-board cut. The impact of this will be felt by generalists as well, who may end up having to round on patients and not be able to bill. Hospitalists may not be able to bill for H & P's. Bonuses for all practitioners will go down if they are there at all.

Our hospital has projected cost cuts. They will be closing the free outreach clinic and inpatient psych beds now ... another meeting coming this week.

What say you?

[Thirteen]

This is my DH's soapbox, for a variety of reasons. I hear about it almost daily, but will talk to him about it again tonight, so I can chime in bullet-point style re: his concerns.

We are very concerned about what healthcare reform will bring. My husband wasn't originally going to do a fellowship but now he is planning on doing a pain fellowship. That way he has the option of accepting cash only, if he has to. As greedy as insurance company's can sometimes be I don't want them drove out of business and replaced with government run insurance only. They will reimburse at a much lower rate, as you see with Medicare currently. My opinion is they are trying to put the insurance companies out of business so they can take over. The insurance companies will have to raise the rates so high to compensate for the patients that are now allowed to wait until they have a terminal illness to get insurance. It is the same thing as calling to get fire insurance while your house is in fire. I know there is a $750 fine if you don't have it but it will be cheaper to pay the fine and wait until you need it.

The goverment has many other options to drive down the cost of healthcare, but they fail to go the routes that make most sense. They refuse to consider tort reform, or allow insurance companies to compete across state borders. Instead they want to go with the option the majority of Americans are fighting against. Not only is it scary from a medical families perspective, it is scary for everyone b/c now we all see the constitution no longer means anything to them. Senators no longer represent their constituents as they are being extorted.

[Pollyanna]

What say you?

I have been and continue to be beyond disgusted. Honestly I can hardly put together a coherent sentence because I am so angry. I hope everyone loves the "change" that has come with this new administration.

[GrayMatterWife]

I have been and continue to be beyond disgusted. Honestly I can hardly put together a coherent sentence because I am so angry. I hope everyone loves the "change" that has come with this new administration.

Ditto and a big "told you so."

[PrincessFiona]

Re: The end of medicine as we know it ...

Well, at least they abolished student loan debt and passed solid tort reform so that doctors will be able to afford to work more for less!!!!

Oh. Wait. Are those trial lawyers in their pockets? I guess I was wrong after all!




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[ladymoreta]

Ditto and a big "told you so."

Me too...

We've stopped talking about it because I just hate seeing the defeat in DH's face when I know he's thinking that he won't be able to provide for us in the way he thought when he chose medicine. No doctor goes into it just for the money, but it's a huge gamble that is no longer paying off in financial terms or in terms of personal satisfaction.

They really have doctors right where they want them - they're not allowed to strike, and they have too many loans or are too far behind on retirement to quit. But this can only last so long. As soon as the economy picks up, more will be able to retire, and as compensation and job satisfaction goes down, fewer students may choose to make that commitment. That, to me, sounds even more dangerous than a strike, because of the extensive training required once people start getting back into the field, if they ever do.

[SoonerTexan]

Anybody know of a good website or article that explains the changes? To be honest I'm too confused to really understand it.

[Thirteen]

Me too...

We've stopped talking about it because I just hate seeing the defeat in DH's face when I know he's thinking that he won't be able to provide for us in the way he thought when he chose medicine. No doctor goes into it just for the money, but it's a huge gamble that is no longer paying off in financial terms or in terms of personal satisfaction.

My DH has even talked about "paying off his loan debt" and then attending night school for an MBA, "just in case" he needs to change careers. It breaks my heart. He does the SAME thing, Laurie - the exact same thing.

[PrincessFiona]

Anybody know of a good website or article that explains the changes? To be honest I'm too confused to really understand it.

http://www.healthleadersmedia.com/co...ecialists.html

http://www.medscape.com/viewarticle/713597

http://blogs.theheart.org/melissa-wa...ad-man-walking


Enjoy!

Kris

[Amiens]

My DH has even talked about "paying off his loan debt" and then attending night school for an MBA, "just in case" he needs to change careers. It breaks my heart. He does the SAME thing, Laurie - the exact same thing.

We have looked at the same option...paying off his student loan debt and looking at a career change.

[Rapunzel]

They really have doctors right where they want them - they're not allowed to strike, and they have too many loans or are too far behind on retirement to quit. But this can only last so long. As soon as the economy picks up, more will be able to retire, and as compensation and job satisfaction goes down, fewer students may choose to make that commitment. That, to me, sounds even more dangerous than a strike, because of the extensive training required once people start getting back into the field, if they ever do.

What I worry about is that the above scenario will cause such a shortage of doctors that the "solution" to the pending shortage will be to lower medical school entry standards (thus allowing in more students). Not good if that happens.

[bokelley]

So which specialties are going to be hurting the most from this? I can see surgery being hurt, but is this going to hurt derms and rads? Sorry I haven't kept up with it much more than it sucks....

Told you so, doesn't even being to cover it....Sometimes being right sucks!!

[v-girl]

I'm so thankful that DH did the MSTP so there are no student loans to pay back. He has his PhD to fall back on (do strictly research) but grants/funding would have to come from somewhere. I can't see my husband doing anything other than medicine and research (his plan is to do both always).

[SuzySunshine]

To be honest DH and I have paid attention peripherally but not in detail because regardless of what is flying around now there is no way to know what it really be like when he's done in 2 1/2 years. One saving grace is that he wants to do academics but that will be affected too but probably not as much, our other saving grace is that we're lucky he doesn't have any school debt and mine is relatively small.

When everything gets passed and changes start happening (which for some I'm sure it already has) then we'll get concerned about it. But like v-girl I can't see him doing anything else which is fine with me, either way we'll make it work.