Future Doctor Incomes, the threat of socialized medical care

<p>Hi there,</p>

<p>I have been a devoted pre med for a very long time, but I am getting a little worried about the news articles about Obamacare and the slow transition America will probably have to a fully socialized healthcare system.</p>

<p>My question is, although I am not at all wanting to into medicine for money, I do want to be able to send my kids to college and have a good amount of retirement savings, is it unreasonable to expect an income of at least $400,000 for being a specialty surgeon (orthopedics, neurosurgery, urology)? and at least $250,000 for a non-surgical specialist, like an oncologist, gastroenterologist, or cardiologist?</p>

<p>Again, i am not wanting to go into medicine for money, at all. But when I hear things like, internists will make less than $100,000 on average in the future, it really makes me sad.</p>

<p>This refers to after residency/fellowship is complete, of course.</p>

<p>I don’t think it’s unreasonable to expect the incomes that you’ve listed, especially if you do private practice. My father’s a physician and I’ve heard him and his partners discuss it, paychecks will be lowered but it’s still going to keep certain (most I think) specialties in the top tax bracket. </p>

<p>It is hard to swallow the idea that Obamacare is socialized medicine then private health insurance is the way that we Americans are covered. Physician reimbursement is determined by the government for Medicare and by private health insurers so the free market may bring salaries down.
That said, Canadian doctors earn about the same as US doctors and have lower malpractice insurance and administrative costs. So even if we go to “socialized medicine” exclusively physicians should be able to enjoy a comfortable living. </p>

<p>That is why you do whatever to make sure that you do not have huge loans and go from there. Have to work anyway, at least an MD has a job security, you do not have a question if you are going to have a job. This question is a priority #1 for any non-MD, many do not work after college, some will never work in what they are trained in UG, some will live in parents’ basements for many years. So, be thankful and plan not to have huge loans and take it from there. I do not think anybody could rely on haveing $250k, you will have $50 - $60k for your residency years, later, who knows, but you WILL HAVE A JOB.</p>

<p>"So even if we go to “socialized medicine” exclusively physicians should be able to enjoy a comfortable living. "
-is it coming from your experience? I can only LOL…since it does not sound like experience has anything to do with this statement.</p>

<p>Regardless of what people call the recent and future changes in medicine, there are changes. Its good that you are thinking about this before you sign on for years of training and possible debt. Despite some exceptions and possible impressions, most doctors do not go into medicine only for the money. However, they also want to feel that they are compensated fairly for the years of training, long hours, and risks they take doing their job. Salary is an important component of job satisfaction, but there is more than that that doctors, in general, enjoy: autonomy, the ability to decide the best treatment and more. Perhaps a decreasing salary is not enough to cause unhappiness, but increasing paperwork and dealing with third party payers adds to that.</p>

<p>There may be some pros to the changes as well. Doctors will likely always have a job. One reason that certain specialists make high salaries in addition to the long training and high risk work, is that they work extremely long hours and are also on call. The next generation of doctors might be on salary and work more regular hours. You might not have as much money to send your kids to college, but again, you might also see them more before they go. Newer doctors might be trading some autonomy for less responsibility running a practice. </p>

<p>Regardless of the changes to come, pre-med doesn’t seem to be getting less competitive. Perhaps it is attractive to applicants with different visions and goals for themselves, but they seem to be just as academically excellent as their predecessors. The most important question for you to ask is if the new changes in medicine are going to be something you are happy with. Shadowing doctors looks good on an application, but the greater benefit is to you. Shadow different specialties and also different types of practices. Talk to doctors of all ages, not just about medicine but about their lives- and families- and if they are happy. You might find the sort of practice that fits you, or learn it isn’t for you.</p>

<p>"-is it coming from your experience? I can only LOL…since it does not sound like experience has anything to do with this statement."</p>

<p>MizzB clearly stated in the sentence prior to the one you quoted (did you miss it?) that Canadian doctors earn about the same as American doctors. Actual facts are more relevant than anyone’s singular personal experience. </p>

<p>

@Jweinst1: Define “a very long time.” A person has to jump through a number of hoops in order to get into med school…but I don’t know if I would refer to it as “a very long time.” If you feel that way about it, the career might not be a good match for you.

Physicians, particularly certain specialists, will continue to make a “comfortable” salary…even after the changes to the healthcare system in the U.S. It’s ludicrous to think that doctors won’t “be able to afford” to send their kids to college.</p>

<p>If you’re that concerned about physician compensation as an aspiring medical student, I don’t think you should pursue a career as a physician. There are many other ways to make a comfortable living.</p>

<p>@Bartleby007,</p>

<ol>
<li><p>I do not think it is ludicrous that doctors wont be able to afford to send their kids to college, as in paying for it and not taking loans for it. I know an attending pediatric hematologist/oncologist who makes around $300,000 yearly loses well over half to taxes and malpractice insurance, and its tough for her to send two kids to private colleges. And this is not the future though.</p></li>
<li><p>A long time is since my dad died of stage 4 melanoma with brain metastasis when I was 14, now 20 years old. </p></li>
</ol>

<p>Also, I do not appreciate you telling me that I should not pursue a career as a physician, at all. The question was not asking if I should be a physician or not. In any job, it is absolutely normal to enquire about the future financial benefits of the profession, and to have expectations that fit your career. I think of a physician as a highly respected job, that has both it’s emotional and financial rewards, just like a lawyer, banker, dentist etc. I do not think of a doctor as being a community service participant that is “fortunate” to be getting paid for what they do.</p>

<p>To be fair, you said that “it really makes [you] sad” which makes it seem like you care deeply about the amount of monetary compensation which is not a good attitude, IMO, for a good doctor. </p>

<p>Also try to put that $300,000 a year in perspective please, that is a lot more than most anyone in this country makes and you complaining about that paycheck is appalling. </p>

<p>I think DS, an MS3, has been further along into the medicine career as compared to OP. Not longer ago, he said that after he becomes a doctor, he wishes his annual income would be about $150K as some kind of specialist so that he will be able to pay back his student loans (he does not know which kind of specialist as of today though.) He is so naive about the finance/taxes/etc. that he thinks he could pay back the loans in a year if he could live in our home rent-free for a year!</p>

<p>Is his goal realistic?</p>

<p>If he has any complaint, it is likely not about the compensation. It is about the “tough” life - probably as a result of sleep starvation in this clinical year. Last time we had a phone call, we could tell he was tired. But he told us he needed to get off the phone and study before he went to bed.</p>

<p>camom,
'Actual facts are more relevant than anyone’s singular personal experience." - not singular, but global. Actual facts from the internet asnd such are irrelevant without experience. It reminds me of current events that are discussed over and over by all media without any first hand knpowledge vs talking to people who are actually living these events right now as we speak. Picture is soo distorted in all kind of media (EVERY kind of media), that as much as I never beleived anybody entirely, as of now I do not believe anybody at all. To find out, one basically has to live in certain place / country for some time. And I refer to this kind of experience. </p>

<p>mcat2,
I personally do not believe that paying loans in one year is possible. However, if one lives on complete financial support and has about $70k in loans, that it is a reasonable goal. Say, one lives with the parents / spouse and spends ALL of his salary (about $70K after taxes, some insurance payments and other expenses not covered by other family member(s). It is all relative. Knowing my D’s expeses (singe we cover hers 100%), in her particular case, it would be comletely IMPOSSIBLE. I hope that she can merely survive (she is planning to live in relatively cheap area, she is not even going to apply in expensive locations such as CA or NYC) on the resident’s salary (I have some reservations though, remain to be seen, maybe living on her own will change certain habits. D. is very very responsible, she takes care of everything on her own, but not the financial side. She has been a responsible person since the kindergarten in everything that she was involved not just academics. But we have been supporting her financially.</p>

<p>Dina4119,</p>

<p>What I am trying to ask is that, not whether the physician will make an X amount in the Year Z, but rather will the government, hospitals, and insurance companies slowly devalue a physician over time, where they are always expected to perform at their very best despite decreasing rewards, possibly in terms of what means they have to treat the patient (obamacare might not be authorizing the best, life-saving procedures and medications due to cost) and financial rewards.</p>

<p>I do not think I am asking an unreasonable question, is that will physician’s salary be pushed down by socialized healthcare to sub-standard, lower-middle class levels, or will physicians level out at a compensation similar to that of Canada, and other developed countries.</p>

<p>Also, I was not implying $300,000 a year is not a good enough salary. I am just trying to point out that many government regulations, and frivolous lawsuits placed against doctors that have no validity greatly increase the cost of malpractice insurance and other legal fees, which would greatly reduce the availability that future physicians might have to send their kids to college.</p>

<p>

</p>

<p>You seem to be confused about what “Obamacare” is. It is a new law that sets a new minimum level of benefits that must be included in private healthcare insurance policies, and helps states that choose to do so, set up exchanges where they can purchase private insurance. Your coverage is determined by the private insurance you purchase. I suggest you check out the Kaiser Family Foundation website for information about the PPACA.
<a href=“http://kff.org/”>http://kff.org/&lt;/a&gt; </p>

<p>

</p>

<p>If you want information on socialized medicine, then check out the website for the NHS of the United Kingdom. They have everything on the web, including pay rates. </p>

<p><a href=“The NHS website - NHS”>The NHS website - NHS;

<p>Canada has a private system of healthcare with a single payer insurance system. </p>

<p>I think you are asking about a future that nobody knows exactly what will happen. If you look at the trend over the part several years, the overhead costs of running a practice: rent, utilities, office salaries, insurance… etc, have been going up while reimbursement is going down. Many changes, such as codes for diagnoses and payment set according to codes have been implemented since the 80s and these have changed the business side of medicine. Electronic medical records is another change.
More hospitals are hiring doctors on salary which relieves doctors of the time and expense of running a practice, but they also lose some autonomy. A parent who wishes more regular hours might welcome these changes, while the old time solo practitioner will not.
I don’t think doctors will starve any time soon, however the potential for medicine to be very lucrative has been declining since the 80’s. Many will tell you that they are getting paid less for what they bill than they did ten years ago. Some are having to see more patients in less time than they used to, It isn’t just about salary. Even if paid fairly, some older doctors enjoyed the way medicine was practiced. They liked the autonomy, the time spent with patients. being self-employed.
The next generation of doctors will need to be happy with what is to come, not what used to be. It isn’t just about salary. The question you need to answer is if this is for you.</p>

<p>“I do not think I am asking an unreasonable question, is that will physician’s salary be pushed down by socialized healthcare”</p>

<p>The reason the question seems unreasonable is that there are mistaken assumptions in the question. Socialized medicine is a fair description of what they have in the UK, where most doctors are either employees or contractors of the National Health Service, a government entity. That is different from Obamacare, and a change to socialized medicine is politically impossible in the United States in the foreseeable future, so any questions about “socialized medicine” belong in a discussion about medical practice outside of the US.</p>

<p>If there is any industrialized country where physicians’ salaries are at “lower-middle-class levels,” I don’t know about it.</p>

<p>No where with an adequate health care system (that I know of) are doctors in substandard, lower middle class.
I’m not trying to insult you or be rude, but if you were only paid 80k and expected to do all you can for patients, would you still want to be a doctor? If your answer is no, then you need to rethink your choice in career.</p>