People, whether you are in academics, work for a big hospital or HMO as an employee, or are in private practice- cuts are cuts. You think that the research position isn't going to have a trickle down cut?

I agree completely, just was pointing that salaried positions would be more immune to the month to month shenanigans that congress pulls

I want to be! Apps are in ATM. I did work in a few labs and I was taught by quite a few MDs as a Biomed engineer.

renodoc,

Do you have any plans to move more of your practice away from Medicare patients?

Ah nice, I was a bioengineer major before starting medschool, I think you will be surprised to see how many MDs in academics do almost entirely clinical work once you get into medschool. As an undergrad you have little reason to have much interaction with docs in that role and you tend to see the hardcore researchers more.

I'm in the worst demographic to do so. 67% of my patients are >65 years old. Many of them require injections of drugs for their macular degeneration that can run $50 (which you would think most could afford, but its every 4-6 weeks) up to $1950 (which is basically unpossible for this population)

If I opened up say X slots to new medicare patients per day or per week, then there will always be X+1 and that one will come from a friendly referring doctor who is going to be pissed if I don't take the patient. Referring docs can be fickle and might start sending more patients elsewhere.

I think just going snowboarding on Fridays would solve the problem in the short term.

Remember kids, govt provides no value whatsoever, and everyone who relies on govt money is a blood-sucking leech. Renodoc stop stealing my tax dollars. Also Merry Christmas.

The Republican Party is for men of great personal character who favor individual responsibility and rugged self-sufficiency, but also if they don't get enough money from the government they will take their ball and go home.




renodoc, we're never going to be "OH NO PLEASE DON'T, WE NEEEEED YOU", so you can stop fishing for that. Like you've been doing in the forum for like the last 3 years? We don't need you, we don't care, if you don't like your extremely cushy well paying job just quit.

Yeah, considering the huge shortage of doctors that already exist, you really do need him.

While this might be somewhat true, this is also somewhat a misconception and is blown out of proportion which causes the real "problem" to be missed. There are tons of doctors, but many are just choosing the "wrong" specialties and living in the "wrong" places. For example in many major metropolitan areas you have an excess of opthos/rads/gas to the extent that it may be tough to find a desirable job there right out of residency.

If these people were instead choosing FM/Peds/Psych/GenSurg or living in the rural south or midwest, there would not be as significant a "doctor shortage". You hear about people in Rads having to do a fellowship to find a "good" job, but then at the same time residents in the FM program are getting called constantly by headhunters trying to offer them jobs in towns that had 1 of their 2 docs die last year and now the 1 doc can't care for all the town.

The real problem isn't the quantity of doctors, its their practice type and most significantly where they choose to practice.

You're missing the problem surf. The problem isn't that doctors are choosing the wrong specialty, it's that the pay sucks for those specialties. A big part of that is due to the effed Medicare pay rules that value procedures much more than visits. If you spread that pay issue to other specialties, the shortage of docs will follow.

No, he's a lawyer.

No wait, that's riverman.

This is certainly not true until you do something absurd like pay docs 50k, you could cut all specialty pay down to 150k and surgeons to 200k, you would still have an excess of Pre-meds. Have you seen the stuff people do to get into med school? You could kick out every single person from my medschool and fill it up with another class and there would hardly be a noticeable decline in talent.

Cutting pay might even increase the talent of my class, when I look around at my class I can definitely see people who are "in it for the money" and don't give a damn about caring for patients. If some of these people chose to do law or MBA instead, it would probably be a pretty good thing for the profession. Many of the most brilliant docs already take huge pay cuts to work in academia, so its obvious that money is not the only thing drawing top talent.

Surely I am not the only one who wants doctors paid a lot of money, right? I want the smartest and most motivated people to become doctors. I want them to be happy, because happy doctors are better doctors. Like it or not, people are motivated by money.

I understand that liberals hate anyone who they believe they are smarter than that does better financially than them, but come on guys.

I run a large multi-specialty medical practice. The current system of going after Medicare and insurance companies for payments is a joke. Patients got treatment and three months later we need to revise bill and add .02 to the diagnosis code.

This Medicare cut would have forced some layoffs. 27.4% of our staff to be exact . Will probably have to in 2 months.

Hasn't this SGR nonsense been going on for nearly 15 years?

What makes you think the cut is going to happen this time, when it hasn't been implemented...well...ever?

This is wildly exaggerated.
Talent follows the money. It costs a ton of money to go through medical training and doctos won't practice if they can make more money elsewhere. Cut the pay and less MDs stay doctors.

It gets closer each time. This time they wrapped it with the payroll tax issue. Wtf? And the cut gets bigger each year. It got close enough one year that Medicare delayed payments.

We will probably join a Medicare advantage plan and go to a capitation model. You will also start seeing physician assistants/nurse practitioners more. You really don't need doctors anyway for 80 percent of stuff. The rich will see concierge doctors. The lack of doctors will be filled by immigrants. I got scores of resumes everyday from Indians and Iranians.

That's what I thought. Maybe it should be easier to be credentialed as a primary care physician. Cut the cost and time required to become a primary care physician.

Yup 100% agree. There's no reason to go to post grad for 8 years plus a 3 year training program to be a pcp.

Lol, then you don't know how to run a business.

I'm still curious what the actual numbers are related to this 27.4% cut. What does this actually do to your bottom line for these services? Does it make them unprofitable, does it make them marginally profitable but not worth doing, does it make them profitable but no where near as profitable as non-medicare patients, or does it make a crazy-profitable service into a less crazy-but-still-crazy-profitable service.

They are also using them for specialties.

? There's a lot more training required to be a specialist.

Medicare is about 30% of our practice. We do well with Medicare because we own our lab and have X-ray too. So everyone gets blood and X-ray . We also have our own dispensary (pharmacy.)

Cuts would hurt. The issue with Medicare is the patients are sicker and it takes a lot time to see them. We are using EMR so it also takes forever to document. EMR is another story I will save for later.

The overall problem with healthcare in this country is that you get paid to treat sick people, not keep healthy people healthy. They are trying to go to performance criteria but that is also challenging.

I can go into EMR, insurance companies, pharmacy companies, pre-auths, stark laws (self-referral), crazy patients, and all the BS I live with.

Absolutely. That is why it pays more.