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Doctors Fire up the Obamacare Waaambulance

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  • Doctors Fire up the Obamacare Waaambulance

    I think it's time for us to talk about physician pay under Obamacare. Here where my husband practices, changes are already starting to sweep in and the future doesn't look good from where we sit for the medical students coming out with a lot of medical school debt. I thought this article was a good place to start!


    http://www.slate.com/blogs/moneybox/...e_whining.html

    Medical doctors are highly paid professionals. They earn more money—a lot more money—than your average American. What's more, American doctors get paid more than doctors in any other country. Given how much of health care is financed either directly (Medicare, Medicaid, Veterans Affairs, public-sector workers) or indirectly (tax subsidy for employer-provided insurance) by the federal government, it's natural to make restraining doctors' income part of any program for making health care more affordable. So when you read stories about doctors whining that Affordable Care Act exchange plans don't pay them enough, please throw up a little in your mouth and proceed to ignore the doctors' complaints. The only practical reason to worry about low compensation for doctors in the ACA exchanges is it may cause them to boycott exchange patients. If that happens, the solution is to reduce doctors' payment rates elsewhere in the system. If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we've squeezed too hard. Until that happens, forget about it.

    But also spare a thought for the journalists. The Affordable Care Act is a big deal. ACA implementation is a big deal. People should write stories about how much doctors get paid in ACA plans. But people who write stories on this subject without noting the yawning pay gap between American doctors and doctors in Canada, France, Germany, etc. are doing their readers a disservice.

    What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were 30 years ago. But that's not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.



    Matthew Yglesias is Slate's business and economics correspondent. He is the author of The Rent Is Too Damn High.
    Last edited by PrincessFiona; 11-23-2013, 11:01 AM.
    ~Mom of 5, married to an ID doc
    ~A Rolling Stone Gathers No Moss

  • #2
    Sob.

    I find this train wreck of obamacare so very confusing. How are doctors even going to be paid? The govt eventually can just not allow docs licenses (DEA cert, etc) unless the docs take a certain amount of obamacare pts.

    And does this biased article touch on malpractice? The cost of medical school? Let's compare the doctor compensation to college educated level federal workers in the bureaucracy... After 8 years of post grad education for a doc, they start with a mountain of debt. The fed worker has worked his way up the pay scale and gets really nice benefit, matching 401K, and consistent pay raises and bonus compensation. So if they want to go after the doctor salary (which is if course where they go) then they should at least take away the burden of the cost of med school, call docs public servants like fed workers, and make it virtually impossible to sue them for any case where they are working for the government. As in, any case where they are caring for an ACA client.

    Blah. I just don't see any way this will work at all when the employer mandate time is over--- and all those millions will be dropped from their insurance. It makes no sense how there are really only 3 options for insurance plans. I'm sure most 20 something's will just pay the tax for not joining an exchange and just sign up when they need it. Like when a girl gets pregnant, if someone needs a surgery, etc etc.

    If anyone has an unbiased reference point, a medical journal piece or anything-- that would be so helpful. It's so hard to sift through the polarized info bc it seems to be either from the very-pro angle or the very-anti angle.
    Peggy

    Aloha from paradise! And the other side of training!

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    • #3
      Yep I'm worried

      Yes, I am truly worried for those of you just starting out in medicine. Right now medicare does not reimburse the cost of anything. Docs lose money on medicare patients. It is looking like these new health care plans are heading toward that level of reimbursement. ( From what hubby has seen in his practice.) When we went to med school, it was much more possible to graduate with little debt. I think it is harder now and looking at your loan thread, many of you are holding 300000 to500, 000 in debt... I'm not sure how they expect you to repay that... So yes, it looks like it will eventually have to go to government paying for med school and then being an employee of the government. For s, we'll just go ahead and retire. I fear for those of you caught in this transition.

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      • #4
        I think the most troubling thing is no one realizing what things actually cost money in healthcare. They aren't doctor's salaries. Actually, we could double physician salaries and not see much increase in healthcare costs. We are bleeding money in administrative costs, new buildings and technologies, pharmaceuticals, end of life care (I know, death panel debates, here we come), etc. To me, talking about salaries is just a convenient distraction from these very real issues.
        -Deb
        Wife to EP, just trying to keep up with my FOUR busy kids!

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        • #5
          Originally posted by Deebs View Post
          I think the most troubling thing is no one realizing what things actually cost money in healthcare. They aren't doctor's salaries. Actually, we could double physician salaries and not see much increase in healthcare costs. We are bleeding money in administrative costs, new buildings and technologies, pharmaceuticals, end of life care (I know, death panel debates, here we come), etc. To me, talking about salaries is just a convenient distraction from these very real issues.
          +1


          Sent from my iPhone using Tapatalk
          Wife to Family Medicine attending, Mom to DS1 and DS2
          Professional Relocation Specialist &
          "The Official IMSN Enabler"

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          • #6
            Articles like this and the insightful views of the previous posts (mostly made so far by those of you already out of medical school and into the attending years, so you actually have some factul evidence and know how the hell this whole thing works, unlike the author of the article) make me want to curl up into a ball and cry. No fucking wonder my anxiety is through the damn roof when I take the time to think about what the hell we've signed up for.
            Wife, support system, and partner-in-crime to PGY-3 (IM) and spoiler of our 11 y/o yellow lab

            sigpic

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            • #7
              Originally posted by WolfpackWife View Post
              Articles like this and the insightful views of the previous posts (mostly made so far by those of you already out of medical school and into the attending years, so you actually have some factul evidence and know how the hell this whole thing works, unlike the author of the article) make me want to curl up into a ball and cry. No fucking wonder my anxiety is through the damn roof when I take the time to think about what the hell we've signed up for.

              Don't let that stop you from living!
              We maximize our budget by making choices that give us breathing room, and trimming the fat where we can.
              Like any other career, make the most of it, but err on the side of caution, rather than buying into a lifestyle. You are your best financial advocates.
              Keep an eye on your loans and credit cards: consolidate (if federal), and choose repayment that works for you, when applicable. e.g. Our repayment plan has us paying more interest overall, but our rate and monthly payment is fixed, and we can afford it.
              The world may not understand ("He's a Dawkter!") but we do.
              There are many financial saavy people on here, and books/sites to help.


              Sent from my iPhone using Tapatalk
              Wife to Family Medicine attending, Mom to DS1 and DS2
              Professional Relocation Specialist &
              "The Official IMSN Enabler"

              Comment


              • #8
                Originally posted by Thirteen View Post
                Don't let that stop you from living!
                We maximize our budget by making choices that give us breathing room, and trimming the fat where we can.
                Like any other career, make the most of it, but err on the side of caution, rather than buying into a lifestyle. You are your best financial advocates.
                Keep an eye on your loans and credit cards: consolidate (if federal), and choose repayment that works for you, when applicable. e.g. Our repayment plan has us paying more interest overall, but our rate and monthly payment is fixed, and we can afford it.
                The world may not understand ("He's a Dawkter!") but we do.
                There are many financial saavy people on here, and books/sites to help.


                Sent from my iPhone using Tapatalk
                I know our financial life will involve lots of planning, sacrifices, and management. I've learned lots since being on here! It's just very sad to see articles like this - and there are hundreds more out there, circulating like wildfire on FB, etc - and to know so many people have this idea and are convinced that doctors are overcompensated, money grubbing assholes. When really, they have no idea of even a fraction of what goes into this for the doctor or the family. Monetarily or otherwise. And that's not even speaking towards the real reasons healthcare costs so much. Your kid needs a $25,000+ hip surgery due to a birth defect (like my brother did in 2007)? Well, obviously your money is going straight into the ortho's bank account. What bullshit. Who honestly thinks this way? They see a $2 charge on a hospital bill for one ibuprofen and think the doctor is an underhanded sneak who's counting his dolla dolla bills sitting in his mansion - and that he's the one who decided it should cost so much...for his own gain.
                Last edited by WolfpackWife; 11-23-2013, 01:57 PM.
                Wife, support system, and partner-in-crime to PGY-3 (IM) and spoiler of our 11 y/o yellow lab

                sigpic

                Comment


                • #9
                  Originally posted by Deebs View Post
                  I think the most troubling thing is no one realizing what things actually cost money in healthcare. They aren't doctor's salaries. Actually, we could double physician salaries and not see much increase in healthcare costs. We are bleeding money in administrative costs, new buildings and technologies, pharmaceuticals, end of life care (I know, death panel debates, here we come), etc. To me, talking about salaries is just a convenient distraction from these very real issues.
                  +2. DH said he's yet to meet a patient who is looking forward to the ACA. Interesting how the author of the article doesn't compare the educational debt burden or hours of American doctors to their Canadian and European counterparts.

                  Sent from my SAMSUNG-SGH-I337 using Tapatalk

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                  • #10
                    You know what else is funny, I read the comments where someone mentioned that the article's author had recently purchased at $1.2 million dollar DC condo. He's clearly qualified to and deserving of high pay, but doctors are not.
                    Wife, support system, and partner-in-crime to PGY-3 (IM) and spoiler of our 11 y/o yellow lab

                    sigpic

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                    • #11
                      What a poorly researched article. Man, I hope that was an op-ed.

                      FWIW, we're not seeing any issues with diminishing compensation. Actually, we're experiencing the opposite. As always, rural FM is a weird outlier.

                      Like everything else in medicine, impact really depends on location and specialty.

                      Comment


                      • #12
                        Originally posted by spaz View Post
                        Yes, I am truly worried for those of you just starting out in medicine. Right now medicare does not reimburse the cost of anything. Docs lose money on medicare patients. It is looking like these new health care plans are heading toward that level of reimbursement. ( From what hubby has seen in his practice.) When we went to med school, it was much more possible to graduate with little debt. I think it is harder now and looking at your loan thread, many of you are holding 300000 to500, 000 in debt... I'm not sure how they expect you to repay that... So yes, it looks like it will eventually have to go to government paying for med school and then being an employee of the government. For s, we'll just go ahead and retire. I fear for those of you caught in this transition.
                        I'm a facts kind of girl. In that thread I see 11 people who shared figures or ranges for their original household student loan burden (not including other debt like mortgages, not including folks who've been paying for years and are nearly done, but including two-professional families with law school debt etc.; also, no one shared in a 'student loan' thread if they graduated with *no* remaining debt for either partner). Of those who shared, 5 are below $200k, 3 are between $200 and $300, and 3 are $300k or higher. So "many hold 300 to 500,000 in debt" is a bit of a stretch.

                        I'm also not seeing any factual support for your claims that "a lot of people are just racking up the debt thinking that once they are a doctor the whole thing will be solved" or that "once you start practice with this kind of a mindset, then you think you have to live in the big mansion and have the fancy cars that all the other docs have and I'm not sure you ever catch up on the debt".

                        Anyway, regarding the OP, we're still feeling like reimbursements could potentially rise with the ACA, as we get more insured and fewer written-off visits. Fingers crossed. Even if reimbursements drop we'll be OK financially, so we're pretty chill I guess about waiting to see where the cards fall.
                        Alison

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                        • #13
                          Originally posted by Deebs View Post
                          I think the most troubling thing is no one realizing what things actually cost money in healthcare. They aren't doctor's salaries. Actually, we could double physician salaries and not see much increase in healthcare costs. We are bleeding money in administrative costs, new buildings and technologies, pharmaceuticals, end of life care (I know, death panel debates, here we come), etc. To me, talking about salaries is just a convenient distraction from these very real issues.
                          Amen.
                          Who uses a machete to cut through red tape
                          With fingernails that shine like justice
                          And a voice that is dark like tinted glass

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                          • #14
                            By going to a single payer that functions like Medicare (that is, no need for prior authorizations or referrals) would wipe out 1/3 of my job. Perhaps half. It is mind boggling the administrative hoops that I jump through on a daily basis.
                            Kris

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                            • #15
                              FWIW, I saw this article a few days ago and not many people (in the comments at least) seemed to take it seriously. It's crappy journalism.

                              That being said, say what you want about Texas, but we are so very grateful for the cheap medical education my husband has received. It's going to make a big difference.
                              Married to a newly minted Pediatric Rad, momma to a sweet girl and a bunch of (mostly) cute boy monsters.



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