<p>Okay, I'm going to preface by saying NO POLITICAL FLAME WARS. Please?</p>
<p>Anyways, my question: What effect do you anticipate Obamacare to have on physicians across the nation? A decrease in salary? An increase in hours? An increase in job availability?</p>
<p>In my case, I do not want to be a doctor for the money. If I am to take on $200,000+ in debts, however, I do want a pretty hefty salary to pay that off and feed my family. What do you all think will happen?</p>
<p>lol. How can this not be a political question? 
</p>
<p>You either think it’s a step in the right direction, or a step in the wrong direction but it is a step, and IMHO, it will not be decided by how doctors or doctors-to-be feel about it anymore than tort reform laws are decided by how lawyers feel about them. This is a voter issue and the security guard’s opinion counts as much as the surgeon’s. </p>
<p>1) Public opinion is that some doctors make too much for what they do. Those doctors will make less. </p>
<p>2) IMO, it would be quite difficult for most doctors to simply work more hours to make up for the changes that are coming. </p>
<p>3) Job availability? Is that an issue somewhere? I don’t know a single unemployed licensed MD or DO. Heck, in fact, I don’t know a single unemployed PA, NP, RN, Nurse Anesthetist, OT, PT, (and the list goes on).</p>
<p>I do not quite understand your second point: “It would be quite difficult for most doctors to simply work more hours to make up for the changes that are coming.” Could you elaborate it a little bit? What specific changes do you refer to here? Do you refer to the possibility that the Medicare payment to doctors will eventually be reduced to such a level that the more Medicare patients a doctor sees, the more loss he/she will have?</p>
<p>First of all, no one knows whether Obamacare will even be implemented at all. And if it is, no one can really say what the effects would be. </p>
<p>However, if it comes to pass that the government effectively pays all medical bills, doctors pay will go down. Doctors who want to be highly compensated will go into the types of care that are not covered by the government system, will care for patients outside the government system or will be in biotechnology or other private enterprise.</p>
<p>Isn’t it true that as of today, the government has already paid SOME of the bills, i.e., those Medicare patient’s bills? I think it is not an insignificant portion of all the bills that are paid to the doctors. As the population is aging, the government will likely collect more tax and pay more of this kind of bill. I think, in the near future, most private insurance companies will not care very much as long as they can keep the more profitable portion of the business: the health insurance for the working age population. The government will be stuck with the less profitable one: the Medicare for the old and sick. I think those in the government are not stupid: They want both the profitable business and the unprofitable one. They do not want to be stuck with the unprofitable one only.</p>
<p>Many doctors already limit the number of Medicare patients they take because the government reimbursement is too low; the doctors can’t make a profit on it. </p>
<p>I’ve also seen surveys that seem to indicate that many doctors in their 50’s and 60’s are simply going to retire early if the government controls more of what they can do and what they can earn. So there would be a lot of openings for new doctors; more patients and fewer older doctors in the field.</p>
<p>I mostly agree with @TatinG…there will undoubtably be a severe shortage in doctors in the future. If pay takes a cut, it will only get worse. No matter how strong ones sense to serve is, very few people will be willing to spend the first 25 years of their lives in school and the next 30 in poverty. </p>
<p>I really worry about the future.</p>
<p>Hopefully we will not need to deal with O…care. My concern is of higher level of priority than just $$ for my D. who is enetering Med. School next year (hopefully no loans). My concern is my life expectancy if O…care is not repealed/defunded. </p>
<p>I am not sure how asking very political question would not lead to political discussion, seems to be very contradictory statement.</p>
<p>Aren’t you violating the CC rules by even starting a thread like this? </p>
<p>“ObamaCare” sounds very political in nature! Politics & Election type forums were eliminated!</p>
<p>Wow…so much misinformation in here.</p>
<p>People worry about the government controlling what doctors do, but insurance companies are doing the exact same thing every single day, and in my experience they are far bigger jerks about it.</p>
<p>As a pediatrician, 95% of my patients are covered either by private insurance, medicaid or my state’s SCHIP program…I live “Obamacare” (I hate that term) as it is already. </p>
<p>My state’s surgeon general came and did a grand rounds presentation on the actual bill that passed. I was struck quite strongly at how forward thinking the bill was. This is a bill that is projecting 30 years into the future, and saying “how do we get from where we are, to our goal”. The growing pains are going suck, but we’re going to be better for it. </p>
<p>The biggest issue is this: the insurance companies were operating under free market principles. You can’t blame them for that, but I, and I believe everyone else should, have a real concern about the conflict of interests when it comes down to a corporations profits vs someone’s health. Preexisting conditions, denials of claims, preapproval for hospitalizations, cancellation of policies after getting a costly diagnosis…these are business decisions.</p>
<p>It’s funny, because what most of the polls have shown is that for each individual aspect of the HCR bill, there is an overwhelming majority who support the individual provision - we’re talking at least 65-70% in favor if not more. And yet, when you bundle the whole thing, well then people aren’t so sure…</p>
<p>Assuming the mandate is not thrown out by the courts, in my crystal ball, the US system will slowly morph into that similar to Canada’s.</p>
<p>More people covered, including undocumenteds/illegals. More services covered. A decrease in salary for some specialists – but Medicare does that today, albeit slowly. An increase in salary for primary care docs – including Peds. Direct rationing of services (ala British National Health Service), particularly for the elderly and those with chronic conditions. Less paperwork for providers as forms are consolidated. Continued closing of Level 1 ER Trauma units. Less research, particularly Pharm.</p>
<p>(One unintended consequence, will be the elimination of College Campus Health centers, unless HHS gives them a full waiver enabling them to continue to charge extra $$.)</p>
<p>Good luck on your interview.</p>
<p>If we go the way of the NHS in Britain, then there will also be a two-tiered system of hospitals and doctors. While now we have the insured (the vast majority) and the uninsured, in the future we will have the doctors and hospitals for the wealthy, who will opt-out of the government’s plan and pay cash, and the system for everyone else. </p>
<p>I also agree with bluebayou that there will be less research into expensive life-extending drugs for cancer and other illnesses. The research won’t be done because of the prospect that the government won’t pay for them if they are too expensive and only extend life rather than cure the disease.</p>
<p>Well I understand that a few opinions will be expressed, I was basically asking for a little decorum.</p>
<p>And the question is not if Obamacare is good/bad, its how it will affect doctors and premed students.</p>
<p>
A problem is: When the government controls what the doctors do, many people will start to accuse it. (“death panel!”) But when a private insurance company does the same or something even worse (a far bigger jerk), it is all of a sudden acceptable in the name of efficiency and “A freemarket is good for most people in the long run.”
I do not know which one (government or private company) should be trusted. Maybe neither. But the problem is: When there is a problem as big as this, we may need the government to step in, to some extent at least. (Just look at how big the problem those Walsreet people have created for us in recent years and they are rewarded for this – even today!)</p>
<p>wrt premed/med students: I could easily foresee a federal loan forgiveness program for those that go into primary care. It would start in rural areas, and expand into the the inner cities. I could also foresee an expansion of FMGs obtaining credentials.</p>
<p>I wrote my thesis on the Affordable Care Act. It has shockingly few provisions that directly affect doctors. It does presume Medicare reimbursement cuts, but those were overridden in June anyway.</p>
<p>It does start a few pilot programs that might eventually lead to other legislation which might affect doctors more – these pilots do include some programs that would involve much more government oversight or hospital cost-cutting. But the bill itself doesn’t actually implement any of these programs yet; it’s just studying them.</p>
<p>Some more patients will be insured, but these will largely be done via Medicaid, so for many physicians’ purposes they’re essentially still uninsured. It’s unlikely to significantly impact any practice’s bottom line.</p>
<p>So if you want to know what the ACA does for a physician’s bottom line, the answer is: basically nothing. It might open up some doors in the future, but that’s impossible to project at this point.</p>
<p>My lazy political analysis:</p>
<p>Doctors are so well-represented politically that, barring some huge shift in the political landscape, doctors won’t have to worry about the government making political decisions that would seriously hurt their interests.</p>
<p>^Lawers are represented much better. And they are on another side of political arena. You can draw conclusion yourself.</p>
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<p>1) Are there any political issues other than the medical malpractice issue that doctors’ and lawyers’ interests are at odds? I honestly don’t know.</p>
<p>2) While I’m not trying to debate the merits of or against placing caps or harsher restrictions against malpractice suits, I would like to argue/ask whether indeed the trial lawyers have more sway on this issue.</p>
<p>i) Several states have succeeded in passing laws that place caps on awards in malpractice suits.</p>
<p>ii) I might be wrong about this, but my impression is that people are generally anti-lawsuit. This popular opinion may or may not translate into policy however.</p>
<p>iii) A weak point: public opinion of lawyers is definitely much lower than that of doctors. An example of this: doctors in tv shows, movies, etc. are portrayed almost always as being altruistic (except House), while the crooked lawyer is pretty much a stock character in dramas.</p>
<p>IMO Lawyers have little power in the decisions to come re healthcare reform. Trial lawyers? None. The numbers just aren’t there.</p>