<p>Since the reform started, everyone in the field knows that Doc's social status and pay will keep decreasing every year. But the workload and requirements will keep going up due to medical institutions revenue push.</p>
<p>oh thanks to cheer. we didnt know that. no one did. you’re very informative. no one should go into this field because of the affect their income and social status will have. you do this because you love what you do.</p>
<p>Even if your reasons to be a doctor are purely because you love medicine, I think its smart for any current doctor or future doctor to understand how health reform will affect them.</p>
<p>That being said, health care reform is massively beneficial to patients and the country, but that’s a debate to be had another time.</p>
<p>As for doctor compensation, if you can point to where in the law it says that doctors’ incomes will go down, kudos to you. It actually increases income for primary care docs by increasing payments from Medicare/Medicaid and does not affect specialist pay whatsoever. And by increasing the number of patients who are insured by 32 million (16 million via Medicaid, 16 million via private insurance), hospitals will finally start collecting revenues on patients that are currently uninsured and they basically treat for free in most cases. But because medicare will also be paying less to hospitals as part of the reform package, this effect will largely be neutralized and not affect hospitals positively or negatively.</p>
<p>Since most doctors are paid via private insurance, the health care law really can’t affect physician income. </p>
<p>That being said, there is a push at the CMS to increase primary care compensation more than specialist compensation during the yearly revisions of rates for procedures and such. But that is largely unrelated to the health care law. Secondly, the law does allow for a few pilot programs to test out new methods of compensation (fee for service + quality bonuses, capitation, etc) but these will be limited in scope and will just shift the incentives — not actually decrease compensation.</p>
<p>So. You’re still going to make a ton of money as a doctor, end of story.</p>
<p>How incredibly clueless and ignorant students are. Yes, not only is the income for physicians going down, the cost of education is going up, so unless your parents or you are paying in full without loans, the burden is going to be extreme.</p>
<p>We have two physicians in our immediate family. One is not currently working, left practice because the income did not justify the work load and the call was too excessive. The other is still making a very good income as a surgical subspecialist, the only field that income is still considered high, except for radiology and possibly anesthesiology.</p>
<p>The social status of physicians will always be the nearest to a deity of any profession, since responsible for saving lives. That is justified, yes. With great talent comes great responsibility, and physicians are the most talented, intelligent individuals we know. They are also the most hard working. Your 20’s and part of the 30’s will disappear with studying and on call. If you can’t forsee this, it’s not for you.</p>
<p>But please, students, enter medicine because you are gifted, science oriented, love to take tests and study all the time for life, love to help others and as an aside, want to make a decent living. The physicians we know now in pediatrics, family medicine, ob/gyn, neurology and other specialties except for the above listed high income earners will NOT make a super income. It may not even be enough to pay off your loans and still afford a mortgage. Not to mention private schools for your children, vacations and second homes.</p>
<p>To the students who think doctors are making a boatload of money these days, you are WRONG. Most physicians are deeply dissatisfied, would not do it again, and for sure wouldn’t let their children apply to medical school (including us). We as physicians are split down the line 50:50 on the “would you do it again” question.</p>
<p>As two physician parents, we would advise to choose a different field like dentistry, science research, even nurse anesthetist or practitioner or physician assistant. The ancillary health professions are blossoming as more healthcare is needed and still not have all the problems of the M.D., especially the high price tag of med school. If you can afford med school without loans, know your income will be limited and still are dead set on becoming a physician, good luck and welcome to the club. If you are only interested in the money, field like investment banking and business will pay off more in the end. </p>
<p>We started out in medicine because of our love for science and helping others. Now we can honestly say that Medicine in this country is broken. The new healthcare mandates, insurance red tape, malpractice through the roof and no cap on awards, all have contributed to this. This is the reality. Sorry to burst the bubble, but it no longer is the golden ticket to riches.</p>
<p>well said!! Having a internist in the family I agree with you 100% You hit EVERY nail on the head!!</p>
<p>I agree with you CTMOM that you should enter medicine for the reasons you stated, and I agree doctors practicing family medicine are underpaid (compared to other docs of course) and that docs, depending again on what specialty you pick, work very hard. And yes a medical education is ridiculously expensive.</p>
<p>However, plain and simple, what other career do you know where the average graduate now graduates with $160k in debt (according to the AMA) and less than 0.5% of these students have to default on the debt? Salary.com will give you a quick rundown of just how much physicians make — its a lot more than most anything else.</p>
<p>And no, physician income is not going down. Yes, its not rising as fast as it used to. Between 1980-1989, the inflation adjusted salary growth of docs was 23%. It was 9% for all occupations combined and 12% for college grads. In 2005 and 2006, 90% of medical specialties experienced a growth in income (average overall increase was 6 percent in 2005). These are the facts. I can find citations for these numbers if you want but, in the end, doctors really aren’t doing making out as bad as some may have you believe haha.</p>
<p>Johnstoops, I don’t know who you are, or where you live, or what your age is, but you are simply not correct. You are blind. You are wishfully thinking this problem away, possibly because you are pre-med. We are PHYSICIANS. Our friends are PHYSICIANS. We go to the hosptial with PHYSICIANS and most of our friends are in medicine. We are living your “dream.” We live in a town with lots of other physicians and we are not out in some remote area practicing medicine. We are in the highest income earning state in the US, and when we tell you that the income is going down, the education cost is going up, the job satisfaction rate is going down, we would not for the most part do it again, you should believe us. Why? Because we are the doctors. We are the practitioners. You are not. We are the ones you are so skillfully guessing about. You are getting first hand knowledge here, not just some numbers you happened to be quoting on a subject you know nothing about.</p>
<p>The physicians we know are dissatisfied. Their incomes have gone down. Family physicians, internists, ob/gyn, pediatricians all are making less money. Surgical subspecialists, radiologists and anesthesiologists still make a good living, but still have tons of overhead expense and are working harder than ever to maintain their salary. The new healthcare mandates are viewed as great by people who have no insurance. For the physicians, it means more patients in the same amount of time in the office with reimbursement that is close to ridiculous and overhead expenses that have gone through the roof. It is the closest to socialized medicine we have come. The overhead in offices is going up, the malpractice insurance is going up, the cost of education is up, the reimbursement for visits and procedures is way down, and the red tape is insurmountable. There are large organizations for primary care who now manage physicians and if you don’t belong to them, you can’t get call coverage. These facts, my uninformed students, are the reality.</p>
<p>Go into medicine if you have a calling, want to make a decent, if not great living, want to help people and can do it without a lot of debt. In these times, if you are taking on the entire education in loans, I would think twice. Yes, it was possible years ago to do that. I did it. But today, it’s not. You will move idealistically into a debt ridden future for many years, and will question if it was worth it. Until medicine in this country is fixed, the future doctors will enter the field with a huge problem which may not be fixed in their lifetime.</p>
<p>And to Johnstoops, it seems from other postings that you are already in an accelerated program, so I can understand your wanting everything to be great. You are already on a path to medicine and hopefully have done it for the right reasons. If it’s to make a great salary and you are already in this program, my advice to you would be to pick a surgical subspecialty, radiology or anesthesia. These are high income earners still, and will cushion the blow of debt, call and overall dissatisfaction somehow.</p>
<p>To the other students who have not made up their mind yet, there is still time. Everything you are reading is true. We have made it to the end. Lots of us are not happy. Our salaries for the most part are dwindling. We are retiring early. The doctors in this country have many challenges. If you choose medicine, you should know what lies ahead. The glitz and the glamour and huge paychecks and yachts are gone. Medicine is broken, and it’s going to take awhile to fix it.</p>
<p>Please keep posting because you are absolutely correct CTMOM56.</p>
<p>Well said CTMOM!! The kids that are going into medicine do not understand the situation of being a Dr. today. They think they do but unless someone in their family is a Dr. they have no clue! Graduating with huge debt that you will not be able to pay off for a very long time is not worth it. If you took the cost of the education and invested it wisely you would be ahead of the game without even working. Think carefully before pursuing what you think you love. For kids who do not qualify for financial aid as an undergrad this route might be a losing proposition!</p>
<p>CTMOM56, i think your posts are very good, and it brings down to earth of the expectations of prospective doctors. but then, i wonder if you have seen any other professions than medicine? i had many friends in the eighties and nineties who got hired in firms as engineers after their phds. in the 2000s none of these firends remained with the same firm. their job lifespan was ~5 years with any given firm and they had to move on searching for new jobs. well, i can see that you became disillusioned with your profession in medicine (what specialty r u in?) but yet have two children as mds too. i say, still, mds have a better stability than engineers or research scientists. [phds take 5-6 yrs beyond college, mds 6-8 yrs maybe? both are equally hard working. but phds are paid at 50-20% level of mds, i think] your posts do alert the students to the cold realities of the profession, but i think the choice should be made in view of other alternatives for life with the given strength that these kids have – smart brain, strong work ethic, etc. the choices may be doctors, engineers, investment bankers, academicians, … the career in medicine may still be a better choice if you factor in other career alternatives. Perhaps in this country, the main problem is not the system of medicine, but it is in the concentration of national wealth. When so much wealth is focused to a small fraction of population, the rest of the system will be under stress with the remaining small amount, how to keep satisfied the doctors, engineers, etc. Maybe its far fetched, but if you think of this as a systemic problem, the growing dissatisfaction among doctors with decreasing income, increasing workload and cost, etc. will not easily go away when the vast majority of population have to live with a small fraction that is left over!</p>
<p>In an article to be published in Perspectives on Psychological Science, by Michael I. Norton, Harvard Business School, Dan Ariely, Duke University, this is what is presented: Actual is the actual wealth distribution, Estimate is what the people who participated in the survey thought, and Ideal is the consensus among survey participants as ideal.</p>
<p>Actual [top20%=~84% of national wealth; 2nd 20%=~11%; middle20%=~4%; 4th20%=0.2%; bottom20%=0.1%] … this is the fact</p>
<p>Estimated(perception of survey participants)[top20%=~58% of national wealth; 2nd20%=~40%; 3rd20%=~12%;…] … this is what people think it is</p>
<p>Ideal(as expressed by survey participants)[top20%=~33% of national wealth; 2nd20%=~21%; middle20%=~20%; 4th20%=~12%; bottom20%=~11%] … this is what people think it ought to be</p>
<p>[note: numbers are what I estimated from a graph, so its rough]</p>
<p>“Abstract: Disagreements about the optimal level of wealth inequality underlie policy debates ranging from taxation to welfare. We attempt to insert the desires of “regular”
Americans into these debates, by asking a nationally representative online panel to
estimate the current distribution of wealth in the United States and to “build a better
America” by constructing distributions with their ideal level of inequality. First,
respondents dramatically underestimated the current level of wealth inequality. Second,
respondents constructed ideal wealth distributions that were far more equitable than
even their erroneously low estimates of the actual distribution. Most important from a
policy perspective, we observed a surprising level of consensus: All demographic
groups – even those not usually associated with wealth redistribution such as
Republicans and the wealthy – desired a more equal distribution of wealth than the
status quo.”</p>
<p>Brief reply: Physicians as a group are educated the longest, have the largest workload, spend the most nights awake taking care of others, and as such we do expect to be reimbursed for that sacrifice. </p>
<p>Who do you know other than physicians who go to 4 years of college, 4 years of medical school, then do 3-5 years of residency as a MIMIMUM to enter their field? Not engineers, not teachers, not investment bankers, etc. The profession of medicine has the longest education and training of ANY profession. Period.</p>
<p>Let’s say you take out loans. It will be a miminum of all that time just to start paying for it. Let’s say the income is good (greater than 100,000) but not great (greater than 250,000). You come out of residency, start paying huge loans, are still up every third night on call every week and are starting a family. The family and home generates costs, and you still have this incredible loan burden to pay. And you are the smartest, most caring individual who is entrusted to save lives of sick individuals, children, do surgery on critically ill patients. Where is the justice if you are not reimbursed generously? At least your family can benefit from your sacrifice, even if you can’t. That is what we experienced.</p>
<p>Yes, we all go into medicine to help others. It’s a fact. Am I disillusioned with medicine? As a profession, No. As a business, Yes. It doesn’t pay anymore for some physicians to work because of overhead and malpractice insurance. One of us is in primary care. The other physician in our family is a surgical subspecialist. The surgical subspecialist is the most disillusioned with medicine right now, works like a dog just to keep overhead paid and malpractice insurance paid and after all that, would not do it again. Would go into business. So when we counseled our children which profession to choose, none chose medicine. Other professional schools we were fine with. But not medicine. As we said, it is broken. They are very happy in other fields, and so are we.</p>
<p>You must know everything to make a logical choice. All the business paragraphs, income in the US, political rhetoric, unfortunately I did not digest from the last poster’s note. But in general, physicians should be reimbursed very generously, have a superb social status, not be taxed prohibitively because they are working like a dog while generating income in our ideal world. Right now one out of three of these still remains, the social status. That’s about it. Students, pre-meders, please make a choice based on your situation. Everyone has different circumstances. Would I personally do it again? Probably. But with a lot of trepidation. My spouse would not. Our children are not.</p>
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<p>Scientists, engineers, academicians in sci and eng: 4 years of college, 5 years of graduate school, 1-3 years of posdoctoral training (not as a minimum, but common). Please don’t feel only MDs are studying long and working hard. PHDs do too. But paid at a fractional level of MDs and not much respect at all unless you make breakthroughs in research and get a Nobel prize.</p>
<p>Yes, I am in an accelerated program and I’m sure as doctors, you have a lot more firsthand insight into your own experiences as a doctor. And I agree that, especially for high caliber students, other careers such as investment banking would probably yield a much higher income — I like the fact that doctors for the most part have a comfortable reason but that certainly isn’t the reason I’m going into medicine. Funny though, I personally know someone whose dad is an investment banker and whose mother is a doctor and although the father made a sizable income, he got burned out by the work in investment banking…and partially because of experience from his parents, he chose medicine. haha so I think its a stretch to always assume that ibanking and other professions are inherently easier than medicine - especially if you want to be at the top of those other professions.</p>
<p>Although my parents are not doctors, I do have many aunts and uncles in the profession. I guess I was lucky (or woefully misinformed depending on your point of view) that all of them do like what they are doing and encouraged me to pursue medicine when I talked to them about my own aspirations. On the whole, most of them would also be considered pretty well off financially as well.</p>
<p>I’m not basing what I say on what people tell have told me but on facts published in studies because I am fortunate enough to receive funding to conduct research in areas of health policy. So, here are some facts:
- The number of hours worked by physicians is going down. Between 1996-2008, the average hours worked went from 55 to 51 per week.</p>
<p>2) The income story is mixed. During the 80s, income growth for physicians was phenomenal compared to most other professions. Since then, income has been stagnant or steadily decreasing, after adjusting for inflation. Between 1995 and 2003, income adjusted for inflation decreased by 7% (fees decreased by about 20% during the same time, but doctors have been making up for that by “reducing the proportion of time spent in non–patient care activities, increasing ownership stake in ancillary services, and increasing the intensity of services provided, or spending less time per patient.”)</p>
<p>3)Income has been going up for most specialties in the most recent data (89% in 2005 with average increase being 6%)</p>
<p>4) Average debt for graduating medical student is 160k</p>
<p>Individual doctors will have different experiences I’m sure, and I definitely talked to a lot of doctors and people in other professions before deciding to pursue medicine. But it is important to have an objective understanding of the field you’re going into as well, medicine or any other field.
Here are a few of my sources:
[Trends</a> in the Work Hours of Physicians in the United States, February 24, 2010, Staiger et al. 303 (8): 747 ? JAMA](<a href=“http://jama.ama-assn.org/content/303/8/747.full?sid=79a469d6-6953-4fac-9fde-73b5d9cf2ea8]Trends”>http://jama.ama-assn.org/content/303/8/747.full?sid=79a469d6-6953-4fac-9fde-73b5d9cf2ea8)
<a href=“http://content.healthaffairs.org/content/11/1/181.full.pdf[/url]”>http://content.healthaffairs.org/content/11/1/181.full.pdf</a>
[Physician</a> Compensation Trends](<a href=“http://www.nejmjobs.org/physician-compensation-trends.aspx]Physician”>http://www.nejmjobs.org/physician-compensation-trends.aspx)</p>
<p>Also, the rise in education costs vs. income has been seen across the board, not just in medicine. During the 90s and 2000s, the growth in public university costs has been three fold compared to median income growth and the change in private university cost has been two times higher than change in income. In addition, the median household income decreased by 4.2% across the United States between January 2001 and January 2009.</p>
<p>Physicians (and other health professionals) also have much better job security than almost anyone else, as unemployment data during the latest downturn will readily show.</p>
<p>So, while you have to consider a lot of factors, its not strictly true that students who are going into medicine are going to be all-sacrificing for their love of medicine. On the whole, doctors still have it pretty good compared to many. Just my two cents.</p>
<p>As I could have predicted, nothing will stop the premed/future physician from pursuing the ultimate goal of being a doctor. No amount of reasoning, experience or discussion can dissuade the future doctor from reaching the finish line, wearing the evergreen sash at graduation that says “you made it.”</p>
<p>I am happy that the idealism exists. I am thrilled that future doctors out there want it so much. I hope that the idealism never fades. As a physician, you will never want for a job, a paycheck, patients, or money. But after all is said and done, please know that there are other options. Many other options. Medicine is broken, I can’t emphasize this enough. Until you realize this, take the blinders off, talk to other physicians about the problems in this country right now in healthcare, you won’t understand. How could you? You are simply students. Students who have a dream. It’s nice to have dreams. But don’t say someone didn’t warn you about this. It should come as no surprise when you are finished that the profession that you pursued so doggedly and intensely for that many years is not everything you thought it would be. Good luck, I have said everything I can to you all.</p>
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<p>In this economy, that kind of job security is freaking golden. Plenty of people in other professions would give their eyeteeth for never having to worry about any of that.</p>
<p>Complain about scary “socialized medicine” all you want - Canadians seem to like it just fine. Why should insurance middlemen take billions of dollars of profit out of the system that could be used to pay for care?</p>
<p>“In this economy, that kind of job security is freaking golden. Plenty of people in other professions would give their eyeteeth for never having to worry about any of that.”</p>
<p>-exactly!!! I was unemployed 9 times and consider myself very lucky to be working in economically depressed region. In addition, you need to be of certain personality to not give up, get depressed, and willing to be re-trained (on your own) as new position in any proffessional field will reguire.</p>
<p>Interesting article in yesterday’s nytimes if anyone is interested:
<a href=“More Physicians Say No to Endless Workdays - The New York Times”>More Physicians Say No to Endless Workdays - The New York Times;