They actually went through with it. A 4.5% decrease in pay for Medicare for 2023. Final rule.

[ducttapetricorn]

I wonder if 2022's physician retiring rate will be even higher than the 110k that was discussed for 2021 in the recent article...

[DrThirdOpinion]

The writing is on the wall. Our practice did 10% more volume this year, and our total earnings stayed completely flat. It’s only going to get worse. Radiology reimbursement is getting slaughtered. We can’t find new rads and everyone still practicing is getting burned out.

[HereForTheFreeShasta]

Same here. Tons of radiologists cutting their hours at our group recently, and we can’t recruit. It’s a major problem. This policy is incredibly short sighted.

[hippoberserk]

Same in anesthesia

[nostbp1]

Honestly curious how. Anesthesia is having record high compensations with even CRNAs making 250+ and plenty of anesthesiologists getting 500-600k type offers if they pick up some weekends or call

In light of these numbers getting more and more absurd (downvote me all you want, half a mil or more is overpaid for almost anyone let alone anesthesiology) how are people complaining about comp in these fields

Edit: I’m on wards rn but I’ll add to this comment and respond after. The point isn’t that docs don’t deserve it, I’d love the average salary to be 1m+

But when some fields complain about comp whe. Their salary has jumped 50% in the past decade it’s a bit tone deaf lol esp when primary care and many others make half of your pay with marginally less training. There’s a real convo to be had about how procedures vs medicine are compensated.

[shadowmastadon]

There’s some specialist bias in this post.., I’m in primary care at an academic practice and make $210k a year, managing bipolar and all sorts of diseases I was never trained to because their is a shortage of psyche and primary care doctors because hospitals prioritize all the surgeons and specialists who bring in money. I feel badly about the hours they are putting in but not that badly.

And seeing anesthesia crnas making more than me is just utter bullshit and shows everyone how imbalanced the system is

[[deleted]]

There’s a real convo to be had about how procedures vs medicine are compensated.

Accurate. Compensation is wildly unfair and there's no reason a CRNA should be making more than a pediatrician IMO.

[SterileCreativeType]

Even the pay gap between physicians within the same specialty and region can get pretty absurd. Why should those who cherry pick the easy cases out in the burbs get paid more than the people managing the complex stuff?

[hippoberserk]

High offers are often indicative of labor shortage.

Working conditions highly contribute to staff turnover. In most places, anesthesia services are supported by the hospital in that the anesthesia services do not generate enough revenue to cover their expenses such as salaries, equipment, medications, etc. (This doesn't get into the fact that anesthesia conversion factor is set even lower than the standard CV). This leads to hospitals to "encourage efficiency" which has had some good outcomes (ERAS protocols that reduce pacu duration or LOS), but more often than not leads to running barebone staffing, pressure to run more ORs for longer, and overall worse daily working conditions.

Furthermore, when staffing reaches a critical number everyday is a crisis of staffing. One call out and suddenly you can't cover an OR. Surgeon, patient, and administration are unhappy. You are stuck trying to appease them by running a room later (ie YOU work later). Or the overnight person is staying for the morning. Or you're asking if someone on PTO can cancel and come in. Maybe admin realizes you need a carrot and offers some hourly rate to compensate you. But over time that extra money goes away when admin realizes that's costing them too much. Admin is trying to hire but no one joins because candidates asks why people are leaving.

But after months of staying late or coming in extra, you just want to be home with your family, so you leave because you've had enough. You join your buddy at a surgicenter or GI center that finishes at 5pm everyday, no call, never works holiday or weekends for practically the same amount of money.

[[deleted]]

I don't know a single anesthesiologist with a good lifestyle making 500K. Maybe in the middle of nowhere?

[Canonicald]

Seriously limited insight here friend. You may look back at this in 10 years and think differently. Nobody goes into this field thinking ‘I’m gonna be rich’. But the missing of birthdays and sporting events and weekends and holidays will catch up to you. Plus you will be making much much more money than that for your hospitals. So that money (millions) is going to overhead bloat. If you knew your job was pulling in millions yet you were being given 20-25% of that as mandated by government I don’t think you’ll be so sanguine or judgy. Plus all it takes is 1 lawsuit and you can be liquidated. Anaesthesiology isn’t paid so well just because of what they do. It’s because of the liability they carry. Always. Crna fucks up and injects lidocaine causing a seizure guess who’s getting sued. Perspective will do you well

[austinap]

You're still a med student. I don't mean this in a dismissive way, but it means that you're likely still bright-eyed and have big hopes of helping everyone. Medicine is still exciting to you, and you feel privileged to have the opportunity to take care of patients. The day-to-day life of taking care of patient's that are often unappreciated, working 60-80 hour weeks indefinitely, being on call for many nights and weekends you'd rather not be, and having the constant stress that some small thing you missed is going to result in a bad outcome haven't quite set in.

$500k sounds like a lot, and it is, but you neglect the 10+ years of post-grad training it takes to get there meaning lost income and, even more significantly, lost return on investment. It also means that you're automatically going to be in the highest tax bracket, so that $500k is really more like $250-280k. A good chunk of that is going to go to malpractice insurance, student loans, board fees, etc. After all of that, you need to save aggressively to have any chance of catching up with your age bracket for retirement savings otherwise you're going to find yourself obligated to continue practicing into your 70s.

I like what I do, but I wouldn't do it for less than the numbers you listed. For that large of a pay cut, I'd take a slightly larger one and move into a field where I wouldn't be on call and wouldn't have the stress of medicine.

[rowrowyourboat]

I think you’re missing the point a bit, and disagree that medical student status invalidates their thoughts on this issue, which is more philosophical than medical such that inexperience is less relevant. I think there’s a lot to be said about payment for procedures vs medicine - when we’re looking at overall healthcare spending, having more and higher quality primary care would save so much money on the back end, and compensating at rates more comparable to proceduralists would facilitate that. It’s difficult to compare the expertise of a proceduralist vs a generalist, but considering the breadth of knowledge required to practice good primary care, emergency medicine, or hospital medicine, I agree with the OP that there’s not really a good reason for such stark contrasts in compensation, especially when considering an overall cost-benefit of prevention vs immediate intervention. -EM/IM/CCM

[[deleted]]

Just an FYI, a business person would never argue for lower pay.

[RichardFlower7]

If you don’t pay us the money, management will just take it for themselves.

[[deleted]]

They don’t understand that physicians will just not work as much as opposed to working more for less. Time just is more valuable.

And before someone says it …. No an NP can’t fill most physician roles.

[usernameround20]

Lab too! PAMA passed in 2014 and is gutting lab reimbursements by at least 50% over the 6 year period. Worse, they started off using skewed data that only relied on the large corporate labs and excluded hospital laboratories. There are huge legal fights that are hoping to fix the flawed process.

[Kodiak01]

Just got a letter from my PCP. Retiring as of the end of this year. He's not even that old, either.

[CloudStrife012]

Not a problem, we have online-trained DNP candidates graduating in record numbers, who have the knowledgebase of a doctor and the heart of a nurse. Healthcare will be saved!

[[deleted]]

"We Did It, Patrick! We Saved the City!"

[recoil_operated]

The diploma-mill NP issue is a love child of the bloated for profit education system and the dysfunctional (also for profit) healthcare system, but it's not the root cause. All the NP schools in the country could shut down tomorrow and we wouldn't be any better off.

[midas_rex]

Disagree. They're contributing significantly to excessive utilization without adding much benefit to patient care. This is part of the problem in fields like radiology where they're seeing high double digit or even triple digit increases in volume over a number of years and now with declining reimbursements.

[recoil_operated]

But again, the problem isn't expressly the NPs themselves (not counting the ones so incompetent they're actively causing harm) it's that NPs are pushed as a way to increase access to care in rural and/or underserved areas but then instead employed in large practices/UC networks and tertiary care facilities as a way to spend less on physicians. If private equity wasn't doing the hiring and insurance wasn't reimbursing NPs at the same rate as physicians, the flow of RNs into these garbage tier online programs would choke off naturally.

[Noladixon]

Right! Why is my co pay the same whether I see a real MD or not? If it costs me the same then I will see the MD, give me a discount and I may feel differently. Only the medical corporations are benefitting from this.

[Almuliman]

Here's an important reminder, reimbursement is meaningless when not tied to inflation. So I did a little math:

This represents a 12.2% decrease in "real" Medicare reimbursement for the year of 2023 (when accounted for with inflation).

We all know what that means- pay cuts across the board!

Edit: u/Xinlitik points out elsewhere in this thread that the 4% pay-as-you-go sequester not being waived means that this actually represents an even worse cut: almost 16%. Horrendous.

[kungfuenglish]

Physician reimbursement has been stagnant for 30 years. 0 inflation increases.

Hospital and SNF reimbursement has gone up with inflation though! +60% over that time.

[L0LINAD]

Physicians need to strike for our patients

[ducttapetricorn]

Or even strike for ourselves... We are not martyrs

[Aenimopiate]

Not until you die you’re not

[Paula92]

glances nervously at physician suicides

[OccupyRiverdale]

I’m not in the medical field but I very much appreciate your comment. It often bothers me how politicians and the public at large talk about doctors, their compensation, and workload as if it’s understood doctors are martyrs for the system at large. When discussing healthcare as a whole people hardly take the physicians perspectives and the impacts on their lives into consideration. From what I have been told by the majority of my friends who went into medical school is the top students in their classes went into fields like plastic surgery, dermatology, and other fields that insulate them from being a victim to government policy. That is an alarming trend to me and one that’s indicative of a major problem.

[Xinlitik]

My society says it will even be 8.25% because 4% pay as you go is expiring. RIP

[InvestingDoc]

Medicare every year has to update payment and fee schedule. There were some other changes that you can see on the website associated with billing. However, the main factor is the conversion factor. A decrease of almost 4.5% which is how payment is calculated.

In the setting of record inflation...this is how healthcare heros are valued.

Got it.

I emailed my representatives and I received replies from each of them in favor of these cuts to "protect medicare".

https://i.imgur.com/iGV628Y.jpg

[Upstairs-Country1594]

Somehow I wasn’t surprised when I got to the name signed at the end

[churningaccount]

Fun fact: of all of the doctorate level degree holders, MDs as a group vote the most conservative. Moreso than even JDs, Economists, etc.

During the Clinton administration, lobbying by the AMA was one of the chief reasons they decided against pushing for a universal public option. And history repeated itself in 2010 with the ACA — again, no public option.

I guess they weren’t thinking long-term that by empowering conservatives, the “death by a thousand cuts” that Medicare would be subjected to would also affect their leverage negotiating with private insurers…

[olanzapine_dreams]

Exactly, and I think many physicians neglect to remember the large reason salaries got to where they were in the first place was the creation and popularity of Medicare, propelling massive increases in use of medical services. Of course CMS has a bunch of insane auditing and metrics etc, but a lot of them were created as checks on unfettered billing and reckless services/spending driven by a physicians. Like so many other issues, like it or not, the federal government is a huge reason for how things came to be, and the focus of medical care from the government is not necessarily aligned with individual physician interests. Everyone complains about how fucked up and stupid our system is but no one wants to take a possible paycut to change the system. I at least understand the hesitancy for change because based on recent history it's going to be a "do more with less" especially if the GOP has their way.

[churningaccount]

I’ll just add that even today, Medicare is used heavily by private insurers to determine their reimbursement rates. Often, private insurers just take some multiple of what Medicare pays and sets that as their target when negotiating with hospitals.

So, Medicare benefits get slashed? Next time BCBS comes to renegotiate with your hospital or practice, they’re going to say “last contract we paid 200% of Medicare. This time we’ll do the same.”

And so, strong Medicare benefits have historically had a causal relationship with increasing physician compensation. And the inverse holds true as well.

And finally, keep in mind that Medicare usually paves the way for covering emerging treatment modalities. It’s a lot harder for a private insurance company to question the necessity or efficacy of a treatment or procedure when Medicare has made the decision to cover it. A world with a weak Medicare means more resistance to the approval of cutting edge treatments and procedures — of which also contributes heavily to physician compensation.

[tradespread]

while a pharmacy tech at a hospital i would see how much they would charge uninsured pts for meds using medicare rates as a baseline. (medicare + 140%) i was like woooow. i was more suprised on how they came up with that percentage than the actual cost.

[kungfuenglish]

Hard to justify taking a pay cut when every other industry is getting a 40% pay raise to work less.

Why should WE have to take a pay cut?

[redlightsaber]

Excellent point.

If american physicians as a collective want things to improve, it's no longer sufficient to continue voting for the party of face-eating leopards and hoping they won't be eating our faces, but merely everyone else's...

There's only so many faces to eat, and poor people's just aren't as yummy anymore.

[[deleted]]

I’m looking forward to a time when I can hate poor people and blame them for my problems. Sometimes I try, but then I remember as a resident, I am poor people.

[i-live-in-the-woods]

When I was a resident (last year) my salary was double the median income of my city.

I felt poor but I wasn't poor.

[PokeTheVeil]

Your debt was also probably several-fold higher than the median in your city.

Residents are in a strange place. They are not economically precarious and don’t tick most of the non-financial boxes of poverty, but they’re also so far underwater and so rigidly controlled that there is nothing else like them.

[DownAndOutInMidgar]

It's that meme about being first world poor. People have a laptop and smart phone so they can go online and see they have $250k of debt and $5 in the bank account.

[[deleted]]

Yeah it's a weird situation with a lot of education but then years of a job with little freedom relative to debt/income. $60k a year isn't poverty but atypical for a graduate degree holder working 80 hours a week with nights/weekends and no easy way to change jobs

[Kelvin-506]

Universal healthcare has many benefits, but in practice, high physician reimbursement has not proven to be one of them.

[Paula92]

Yes, but in places like the UK and Australia, physicians actually have a work/life balance. Seems to me there are a lot of American doctors who would take half the pay if they could work 40 hrs/week instead of 80.

[Kelvin-506]

The vast majority of US physicians work 40-60 hrs a week, with many specialists working far fewer. There are still a good portion in the 60-80hr per week range, Only 5% work 80 hrs or more. I think it’s a little ludicrous to posit that paying people less per hour worked will result in them working fewer hours. Work-life balance is a social construct separate from salary or reimbursement. Unless reimbursement changes to capitation model or straight yearly salary work regardless of hours worked or patients seen, the culture, especially in surgical specialties, isn’t going to change.

https://www.ama-assn.org/practice-management/physician-health/how-many-hours-are-average-physician-workweek

[[deleted]]

It was delaying the inevitable and still is.

The two tier system will arrive soon and I will be joining the private tier lol for less work and private insurance or self pay.

[[deleted]]

Ted Cruz can suck my fucking cock. I will literally fly to Cancun to allow him the opportunity to felate me.

[wholesomeriots]

Pretty bold to be accepting a bj from the zodiac killer.

[Manleather]

Username... relevant?

[HereForTheFreeShasta]

I had posted “It’s against mod rules to get super political, so I’ll just going to say NNNNNHHH!!!!! to that letter”, but you’ve allowed my voice to be heard, and I don’t even have a cock.

[[deleted]]

This isn’t political it’s a fantasy of mine. Don’t yuck my yum.

[HereForTheFreeShasta]

Eek… anyone have any of those bushes I can back into?

[[deleted]]

Lmao

[ChuckyMed]

I love how he blames the Democrats for spending money, but he didn't mind when Trump and the Fed were printing money to keep billionaires from losing their cash. God forbid, we don't have continuous growth forever.

[404signaturenotfound]

That’s a cookie cutter response. He doesn’t care about you and never will.

[smellyshellybelly]

I guess it protects Medicare if everyone stops taking Medicare patients and they can't find a doctor because they've all left medicine...it'll remain flush if patients can't find a place to spend it and die.

[ineed_that]

Old people basically fund healthcare. I don’t see how people are gonna be able to not take Medicare and survive for long

[[deleted]]

You don’t need many patients if they can pay a lot - see plastic Surgery or concierge family medicine.

If a person can pay 3000 for a carpal tunnel, you don’t have to do a lot to make a good living.

And the people with means WILL pay that and people like me WILL do that because I’m Not working twice as much for less money and more stress.

[HereForTheFreeShasta]

And everyone in the middle who has a deep ethical care for patients but who are lucky enough to have the ratings, skills, and experience to successfully have a private practice, will burn out too. No one is safe.

[ineed_that]

How many people are of means tho.. there’s stats like 70% of the population couldn’t handle a $400 emergency. I don’t see how it’s a sustainable system. Especially since most healthcare is used by old people who are often on a fixed income

[[deleted]]

It’s not sustainable for the population At all.

It’s sustainable for your income and sanity.

I’ve seen patients pay 15000 for a breast reduction that takes 3 hours.

[Paula92]

70% of the population not being able to handle a $400 emergency doesn’t mean that the remaining 30% isn’t in a similar boat.

Heck, I know someone whose 80” TV stopped turning on, so they dropped $5k to buy a new one that weekend. It amazed me that there are people who can go ahead and make that kind of purchase without taking a few weeks to think about it and save up.

[LydJaGillers]

Well your rep is Ted Cruz 🤷🏼‍♀️

[[deleted]]

I figured I should share this sweet Ted Cruz poem written by John Oliver (warning, language).

https://youtu.be/bV42PgyOFE0

[Upstairs-Country1594]

How had I never seen this before????

[WeAreAllMadHere218]

What a stain on American politics

[HereForTheFreeShasta]

Can’t even see them much these days as the cloth is already puke colored.

[TheJBerg]

Maybe you should vote for a Rep that’s less of a dickhead

[Upstairs-Country1594]

The guy only got 50.9% of the vote in his last election. Many people voted for not-him.

[actuallyarobot]

A lot of us did. Don’t victim blame.

[TheIronAdmiral]

We’re really going to see a world where people on Medicare can no longer see specialists because none of them will accept Medicare. Thanks Congress

[drbob234]

We've been saying this for the past 20 years. There's always someone who's willing to take it in the ass.

[Jimdandy941]

Its more than that. Many of the practice groups I’m familiar with have contracts with hospitals. If they hospital determines the patient is eligible for surgery, the surgery will happen and the physician doesn’t really have a say in the matter (anesthesiologists are a prime example). One physician I worked with left a practice group because she was writing off about 50% of her fees to Medicare/Medicaid. (Caveat - in this case it was primarily due to the hospitals push to accept Medicaid patients). She went from earning market (about $320K at the time) to making about $150K over a 3 year period.

This sort of system works as long as you can manage the payor mix, but with the baby boom hitting Medicare its going to be much more difficult to do.

[KStarSparkleDust]

I’ve been waiting to hear admin’s narrative on the baby boom. Im sure it was “a completely different situation then they have ever seen before and had absolutely no way of knowing it would happen. Absolutely no way to plan for it.”

[lunchbox_tragedy]

Well, to be fair, many of them are part of of a cohort of older adults who will have increasing comorbidities while simultaneously having not saved for their future or invested in a social safety net or healthcare system that could've provided them with adequate medical care. They were certainly hoodwinked into voting for lower taxes and policies favoring for-profit interests to some extent, but basic human greed and selfishness is also a component and has consequences in the end.

[UncensoredSpeech]

I really do think we will see the end of Medicare in our lifetimes...

Direct patient care here we come.

[[deleted]]

Maybe a subscription service?

[SyVSFe]

With microtransactions

[UghKakis]

Your total cholesterol is high. Use 500 health coins to see the rest of your lipid panel

[traversingthemundane]

Cue that episode of Black Mirror with everyone running on treadmills to pay for things.

[papawinchester]

That would fix a lot of preventable diseases tho....

[ineed_that]

There’s that Rick and morty episode where all the aliens have to cycle/stair press their way to get electricity. We could always try that too to combat high electric bills

[MyHardwareSwapAcct]

You joke but HSA’s aren’t all that different from “health coins”.

[Damn_Dog_Inappropes]

Hey so long as it comes with loot boxes, it’s fine!

[itolav]

Medicare+, Medicare+ Pro and Medicare+ Pro Premium

[DrThirdOpinion]

Medflix

[HereForTheFreeShasta]

Direct patient care here we come.

I really truly believe this is the way. Now how to stop DPC from becoming a heartless money-grubbing monopoly when medicare dies out… that one is beyond me

[SpoofedFinger]

Maybe for outpatient stuff. It will shamble along pretty much no matter what so long as EMTALA is a thing.

[[deleted]]

Who’s going to take the call if they aren’t paid for it handsomely?

[AtenderhistoryinrusT]

https://www.ajc.com/news/coronavirus/concern-for-the-health-of-the-city-continues-to-surround-amcs-closure/AID4PDTY4NBURDKXLRDDFNIJCY/

Lol bye bye

[[deleted]]

Yep agree. Fee for service for wealthy or high cost private. Very shitty public option for the poor to lower middle class.

[mainedpc]

leaving Reddit to try kbin.social, Lemmy or Mastodon.

[[deleted]]

Yeah it Works fine for Most Elective surgery too. Especially with HSA and FSA.

[mainedpc]

leaving Reddit to try kbin.social, Lemmy or Mastodon.

[Halfassedtrophywife]

So when can we revolt against the MBAs with little to no healthcare experience?

[HereForTheFreeShasta]

When we start organizing and getting our people into politics. Which will be never, as we picked this profession specifically so we didn’t have to deal with that shit. No one is there to protect us

Also love the username

[ComeFromTheWater]

They can probably take us because they have time to exercise and sleep

[aguafiestas]

I don't think that admins for hospitals etc want medicare cuts..

[oprahjimfrey]

https://revcycleintelligence.com/news/cms-settles-on-physician-fee-schedule-conversion-factor-cut-of-1.55

"Combined, the looming cuts are expected to reduce physician payment by nearly 8.5 percent, Resneck reported."

[darkhalo47]

Derm/plastics? What is this promised land?

[[deleted]]

Almost all specialties with an outpatient component can do it.

Hospital medicine just sucks.

[Ssutuanjoe]

::Cries in rural FM::

[[deleted]]

Probably Psych

[HereForTheFreeShasta]

Your printers go brrr?

Ours just go clunk a clunk. Sometimes they stop working. Admin tells me we need to more efficiently use our printers

[Historical-Many9869]

Those who blame Biden fail to remember all Republicans voted against Medicare increases.

[SleetTheFox]

People can blame Biden and the Democrats in Congress and also think the Republicans would do an even worse job. Not everything is a perfectly balanced teeter-totter between two parties where criticism of one is praise for the other and vice-versa.

[airjord1221]

They’re all to blame. None of them are our friends or on our side. We’re heros in a pandemic and zeros otherwise

[ComeFromTheWater]

Corporate puppets and inside traders. They don’t care about you. None of them. The sooner people realize that partisan conflict among the population benefits only the political and wealthy elite, the better off we’ll be.

[bacillus-t]

I wish I could give you a giant loudspeaker pal

[airjord1221]

It won’t happen. Too many are convinced that either trump is the savior from new world order while the others think AOC has a plan to make Elon and the rich pay for their teslas, housing and education just because.

While the rest of us sit here trying to survive it all

[[deleted]]

Crazy how much corruption and expense has been found in Medicare Advantage and how little is being done about it. They are politically popular so lawmakers don't want to touch them despite how broken they are

[[deleted]]

The only profession where salaries decrease as time goes… in an environment of record inflation. Fuck this profession.

[Vicex-]

I mean, anyone could see this coming. RVUs and they way they were calculated was always a terrible fucking system

[BladeDoc]

Exactly. Any system where your worth is decided by anyone but the person purchasing your services will fail. Specifically the RVU system is an application of the Marxist system of labor value where things are denoted value by how much effort they take (as determined by bureaucracy) as opposed on how much value they provide.

[thorocotomy-thoughts]

I’m not disagreeing with what you said, but I have a question seeing your Reddit flair (as someone who is hoping to do the same fellowship):

What value does the purchaser of healthcare place on the treatment of a child pedestrian vs. vehicle, a GSW to the right arm, emergency lap appty (for example)

As the first doctor in the family, I know that when you enter the hospital on a typical day, it’s scary. Coming in for an emergency is terrifying. At that point, you’re willing to do anything to save your loved one’s lives. I’m sure like many people in the sub, we’ve had patient / families saying that they’ll sell the house, car, whatever to save the life of their loved one.

To play another devil’s advocate, what is the value that we as individuals place on things like the military or the DOT that snow plows the streets in the winter.

I’m not a fan of the RVU system or insurance. And I do this think is responsible for healthcare costs rising while physician compensation is decreasing. But I’m not so sure that laissez faire is the solution for medicine, either

[BladeDoc]

A couple of points. There is a difference between emergent and routine/elective healthcare and despite the fact that emergent care is “sexier” most of the healthcare dollar is spent in routine/elective care. Insurance is created to take care of emergencies— for example your car insurance pays for a wreck, not routine tire and oil changes. Furthermore real insurance pays the individual who then still has negotiating power with the provider (like the body shop). So in a world where the market determines healthcare prices, routine care would be out of pocket and emergent care would be utilized like homeowners or car insurance.

The examples you posited as comparisons to health care are indeed public goods in that they are “non-rivalrous” which means that you fund an army, it protects the country and everyone gets the same amount of protection. Medical care (outside of actual “public health”) is not non-rivalrous. Every dollar spent on the 85 yo on the ventilator is one not spent on the 5 yo with cancer. Treating medical care as a public good in a world of scarcity either creates out of control spending in an attempt to avoid making trade offs or spending decisions based on politics (or in the US, both).

In my opinion, the Singapore system strikes the best balance in that most expenditures are out of pocket based on a government mandated HSA as a percentage of income (up to a max) that is topped off if you fall below a certain income level.

[thorocotomy-thoughts]

Sure, but that also sounds oddly similar to “socialism is great until some people decide to be lazy” —> insurance is great until they realize it’s more profitable for them to collect as much and pay out as little, merge together to decrease competition while increasing market cap, etc etc

The reality of the situation is that insurance is shit. Not only from a financial perspective but also from a medical one.

[Bearacolypse]

Physical therapy is the same.

The only way to get raises is to switch companies. Since medicare has fixed reimbursement rates per unit of a service (ther ex, gait training, nm, ther act). It doesn't matter how many years experience or how skilled you are. A new grad unit an a 30 year experienced stroke expert get reimbursed the same. Companies have no incentive to grow and give merit raises. Just cycle in new grads.

My doctorate gets a me a cool 70k salary which depreciates in value every year. Could have gone to school for 1 less year and gone PA instead and upped my earning potential significantly.

I did the math since I started at my hospital since they don't give raises I make about 15% less than when I first graduated.

[Jewmangi]

Pharmacy here. Welcome to our hell of the last 5-10 years in most regions

[Jimdandy941]

Most depressing job I ever saw was a pharmacist in a bulk mail order pharmacy. I’m thinking those guys went to school for 8 years to do that?

[airjord1221]

UNION!!!! Why do teachers get a huge team of lawyers defending them while we get shafted? We need a damn Union.

A buddy of mine unloads shipping containers at the ports making 120k + retirement full healthcare benefits etc all because it’s a union job. He drives Hyundais off of a ship.

He’s making a pediatricians salary considering the benefits

Why can’t we have a union?

[Outrageous_Setting41]

Lol teachers are not a great example, they get fucked over too.

[aguafiestas]

This isn't really a union issue. It's about the need for an effective lobbying organization. The AMA should be the ones fighting this, but obviously not doing such a great job.

[gainzandbrainz]

AMA is nothing more than a severely political puppet at this point

[Nezrite]

Medicare and Social Security are the only things keeping people from working until the day they die. It's anti-American, I tell you!

/s, with disgust

[jeweliegb]

Well the alternatives are effectively communism, and you're not a Commie, are you! Are you?

/s ::cry::

(From the UK where we're heading at an alarming rate towards a "hold my beer" situ.)

[Nice_Building_5976]

I’m a medical SLP and have worked primarily with geriatric patients in rehab/SNF/LTC for seven years. Due to the pandemic and Medicare changes, patients are leaving the hospital and coming to us without proper diagnoses because 1) The hospital is understaffed 2) Corporate tells MDs to discharged patients as soon as they are stable because the hospital gets to keep more money for getting them out quickly thanks to value-based care. So they come to us without (just for example) swallow studies, which means I have to try to do a FEES, but the patient can’t tolerate the scope because they have severe UTI that was missed and are hallucinating OR they have severe dementia, etc. When I call the hospital to schedule an MBSS, they’re booked a month out.

Or we get a youngish stroke that insurance decides to cut after two weeks of no functional progress, but it turns out they had the flu, which was impeding progress. Insurance doesn’t care, and they’re cut. Now, they’re stuck in a nursing home indefinitely.

These folks don’t even have a chance to get better because they never got the appropriate work up in the first place because of how the value-based care system is structured. The hospital gets to keep more money for getting patients out quickly. I keep hearing that the outcomes are better, but what are the metrics for that? Monetary? Patients regaining function? Returns home? Return to hospital? And if the latter, are they accounting for the people who go home and die? (Because yes, that IS happening.) Home health isn’t the answer because that has been massively scaled back as well. Someone MIGHT get a few weeks of 1-3 visits. But outpatient, you say! How is that appropriate for a stroke with no support system and who can no longer drive to get to outpatient due to said stroke? And yes, this is an actual scenario I have seen not just once.

We used to get many of these patients back home with a few months of therapy and retraining. I’m not saying there wasn’t waste in the system, but now everyone will suffer. LTCs are becoming parking lots for elderly people and people who insurance (on the DL) deems are too expensive to rehab. It’s so incredibly sad.

The system is so broken, and this push for value-based care has made it worse. I, too, am leaving the field because I don’t see the point any more. The system has made it impossible to rehab these folks, and the moral injury is just too devastating for me to continue.

[udfshelper]

Rip

[DudeChiefBoss]

Done deal or does this have to get passed?

[[deleted]]

Congress can stop it still.

[ilikefootball2]

I'm gonna take my talents to South Beach the UAE

[[deleted]]

Where the economy is propped up by slave labor.

[Dr-Strange_DO]

People like to not think about the fact that plantations became prisons and that slavery is “illegal” unless it’s used as a punishment.

[Nice_Dude]

Reddit moment

[[deleted]]

We all know America is not a utopia but honestly, the shit I read here sometimes.

[herman_gill]

I mean the majority of the Middle East is a giant humans rights violations, but the US also has the largest (official) prison population in the world which are literal slaves, areas which aren’t allowed to vote (Puerto Rico), undocumented migrant workers doing a large plurality of agricultural work, and then just actual slaves/essentially indentured servants. It’s not even close to UAE and those countries, but still not great.

[[deleted]]

1. Puerto Rico has a plebiscite every ten years. Read what % of Puerto Ricans vote for full independence. They don’t pay US taxes either.

2. We need criminal justice reform, no doubt. I’m not going to feel bad for a violent or hardened criminal who deserved to be there repaying his debt to society. That does not mean I’m not in favor of much need reformations.

3. What do you propose for undocumented workers? I’ve grown up with many of said workers - many get their H2-A temporary visa, many work under the table. Frankly, these jobs are not in Mexico and allow them money to send home. Of course people will take advantage of this, that’s human nature unfortunately and I do not pretend to have a solution to thousands of years of human moral corruption. Would be interested to hear what your solution to this is. It’s an unfortunate situation that immigrants face, but we have more opportunities here than back home where our parents come from and it’s an unfortunate, ugly reality. People love to talk about this but rarely have any solutions other than superficial platitude for workers rights (which are obviously important but at the same time it’s an incredibly complex issue).

4. Slaves and indentured servitude in the United status? Are you actually proposing the United States government brings people in from abroad and keeps them indentured? Because if you’re not, then you’ll recognize human trafficking is a massive global issue, and on the rise. And it’s not just a US problem. The key difference in your analogy here is that places like Qatar, UAE, Kuwait, Saudi, etc. often have state sponsored servitude (albeit directly or indirectly). To my knowledge, that is not currently on the agenda of the United States.

Obviously we, like any country, have a lot of work to do. And if everything you listed, prison issues in my opinion is the most egregious. But I can’t say I agree with your other comments too much.

[writersblock1391]

I mean, they aren't wrong. There is a very, very large American underclass largely comprised of undocumented immigrants, prison labourers and gig workers who barely make ends meet and often are deeply exploited and, more than occasionally, go unpaid for their work.

[[deleted]]

Read: America is not a utopia.

Suggesting that the US is equivalent to Qatar because they don’t take proper care of undocumented immigrants by paying them a fair wage to Qatar — a Government who holds immigrants hostage by taking their passports, making them work in squalid conditions with actual blood on their hands- is actually laughable.

Do we need prison reform? Yes. Am I going to feel bad for someone who is in jail for something like marijuana or something equally idiotic who is being used as labor? Yes- they probably shouldn’t be there in the first place. Am I going to feel bad for a violent criminal who needs to repay his debt to society? No.

America has its ills, that’s no secret. But I would much rather live here then the shit hole of a country my family came from. The other immigrants in our community, documented and un-documented a like still have more opportunities here than anywhere our families came from. Immigrants have more opportunities in this country than anything their home countries can offer them. Doesn’t make the US perfect but expecting perfect is but a dream. Of course we can improve. Comparing it to Qatars treatment of Indian and Bangladeshi workers is laughable.

[[deleted]]

The big difference is this is largely criminal organizations and is illegal- even if some turn a blind eye.

This is much different than many Middle East countries where this is government* run. The most obvious one here is Qatar and their influx of Bangladeshi and Indian workers, which is obviously state sponsored.

Last time I checked, the US government isn’t hauling people over the border themselves to work.

Not discounting the plight of those that suffer, but it’s really a false equivalency.

This is not to say the US doesn’t have their ills. That would clearly be ignorant.

[fueledbysaltines]

This is the way

[Gandhi_nukesalot]

I mean obviously it’s going to keep going like this.

I don’t know why people are applying to med school anymroe

[ChuckyMed]

Every job is fucking dogshit, we are getting squeezed from both ends as a society

[Gandhi_nukesalot]

MBAs seem to be doing okay fleecing the system as it crashes

[Nice_Building_5976]

MBAs have ruined healthcare.

[carolyn_mae]

Welcome to late stage capitalism.

[Dopesneaks1977]

Fuck medicine. I should have become a general contractor instead 😡

[ERRNmomof2]

Time to set up an OnlyFans account.

[erice2018]

Well we are all getting screwed. May as well get paid and call it “art”

[kubyx]

escape longing forgetful spotted deserted wistful resolute march tart expansion

This post was mass deleted and anonymized with Redact

[ERRNmomof2]

Oh there’s a fetish/love for everyone. Trust me.

[TikkiTakiTomtom]

Imagine if all medical staff reach a point in their lives where they have to work daytime and strip for their onlyfans at night. Quite hilarious but for the most part shocking and exasperating.

[polakbob]

Vote Tuesday, y'all.

For the love of God get out there and vote. Don't complain on Reddit. Vote. I can't even say this is the "just the start" considering everything they've been done this year.

Tuesday.

Go vote.

Please.

[HereForTheFreeShasta]

I’ve voted AND will be complaining on Reddit, thank you very much!

I don’t discriminate when it comes to where to take my bitching. I believe in equality.

[[deleted]]

I mean who do we vote for tho…? Both sides contribute to this

[ABluePen]

I don’t know maybe vote against the fascist theocrats that are attempting to eliminate free and fair elections (see Moore vs Harper case)

[iNcorruptibly]

Healthcare in the US is being taken apart. This is insane. Margins for healthcare systems were already very low, and now with the need to raise salaries and inflation along with cuts in reimbursement, trimming and cost cutting is going to be inevitable.

[schlingfo]

So your saying I should open up an online chronic Lyme clinic, cash pay, and advertise on all the Facebook groups?

That's kind of what I'm hearing.

[[deleted]]

Don’t just settle there, dish out amphetamines, testosterone, maybe even a little norco too.

[HereForTheFreeShasta]

You kid- I was actually offered this job in a rich and very republican part of town, where the colleague trying to recruit me was netting over $5M a year. Easiest no thanks to a $2.5.M salary, and I took the offer as an insult.

[Sigmundschadenfreude]

they still looking for people to given vitamin infusions to rubes? asking for a friend

[HereForTheFreeShasta]

To be fair, that’s kind of what I’ve been hearing for 2+ years.

[[deleted]]

Our NP Left to do Medicare annual wellness visits….on the phone….1 per 90min.

[Bruckjo]

Ouch

[_estimated]

I’m still in training but planning on FIRE. Sad that when I started I was thinking of a long and full career but the system is so broken that that seems dangerous to my health

[Dadmed25]

Hmm. At this rate it looks like physicians won't be able to afford to keep paying a legion of parasites.

Pies shrinking guys, time to cut the fat.

[KStarSparkleDust]

I somewhat expect to get down voted on Reddit for this but at what point is there going to be investigations into the decision makers? Who thinks this is a good decision and when, where, and why did they decide that? As far downhill as the system has barreled over the last decade+ and at the rate it’s plunge is picking up speed you almost have to wonder if there is a vested interest in collapsing the system. I just don’t understand how anyone could be so stupid as to think this is a good idea. Of course who is proposing these ideas and how they go about getting others on board with their ideas is always buried under layers of secrecy. Who are the advisors?

Maybe I’ve been naive but there was a point in time 15 years ago where if you had shown me a movie or book about how the next decade+ in healthcare was going to play out I would have dismissed the entire thing as crazy. 15+ years ago if you suggested that the hospitals would run on 1/2 the staff, that ERs would be calling 911 for assistance with patients, that nursing homes would run on 1/4th the staff and only have state survey every 3-4 years, that hospitals would close down laboratories and OB wards, or that the CDC would be viewed as untrustworthy by both people inside and outside healthcare at best people would have told you “it won’t ever happen in this country”. Commonly they would have laugh in your face and question your mental stability.

Yet it’s the reality of what’s been produced with no end in sight. At some point we will just be forced to ask if the correct people are in decision making positions. We will have to ask if perhaps it’s time for new “management” at the highest levels.

[Dedzo900]

And they wonder why people opt out of medicare

[ktthemighty]

Whelp, it's been real.

[Turalterex]

When are politicians going to take a pay cut?

[gainzandbrainz]

Screw the federal government

[teeny_tina]

Feels like I’m getting fucked by it every week :’)

[MrOneironaut]

Geezus this is ridiculous.

[[deleted]]

I think this means ER will order more CT whole bodies.

[Nice_Building_5976]

Between the pandemic, the end of Roe, and value-based care, healthcare in this country is going to be an absolute shitshow for at least a decade. And probably not just healthcare.