IP laws.

Movies. 1st run always cost the same.
Songs or tunes. Always cost the same.
Prescription drugs. Always cost the same.

The law of supply and demand has been repealed.

What the **** are you talking about?

Edit: And try using complete sentences.

So I go away for ten days and return to SGRmageddon?!

Awesome???

So I'm open to suggestions. "renodoc makes too much money and should suck it up" isn't an answer. They are cutting fees for 2/3 of my patients by 27%. What other small businesses could sustain that kind of hit?

Should I layoff some employees? Stop seeing new Medicare patients? Let grandma go blind?

I think this is a death panel by any other name.

Talk to your republican buddies. This thing would have been done a long time ago if the dems were in charge and we didn't have a completely psychotic wing of the House right now.

In before massive cognitive dissonance that this is somehow happening because of Obamacare.

If you want my expert consulting input I bill at $250/hr. PM me for bulk rate discounts.

renodoc you didn't really buy any of that ballyhoo about rebublicans championing small business did you? Hah hah oh wow.

All I've bought into is that I am a slave to this system without an obvious exit strategy.

Some of you people are smart, most of you seem brighter than I am.

What can I do?

There still isn't anyway to pay for it though.

I guess it's less than 400 days till prez RP and I can start doing some private contracting with grandma.

A big chunk of your income comes from tax dollars. Republicans keep cutting taxes in an effort to "starve the beast". In case you haven't figured it out, you are the beast.

I will let you connect the dots as to what you might do in this scenario.

renodoc,

The short answer is to "let grandma go blind."

This situation is a demographic problem. The old system of paying for whatever seniors needed is just too expensive in the future where a much larger fraction of the population receives Medicare.

If I were you, I would start making long term plans about moving my practice away from Medicare patients, because these types of cuts are going to have to happen. I imagine the government is going make them on the back end because it is too difficult politically to tell old people they aren't going to receive the same care. Much easier to just cut doctors' payments and let scarcity work it's magic.

What are the numbers? How much do you get paid for these services and how much do they cost you to provide?

Interesting timeline of health care in America...

http://www.pbs.org/healthcarecrisis/history.htm

welcome to the machine

Why must healthcare be insurance based? Preventative care should be subsidized by the govt.

Well good news renodoc, the repubs caved. So now you get to go through this all over again in 2 months, and maybe every 2 months next year. Then the tea party republicans who caused all this in the first place will say "see, govt just doesn't work".

yep, no random christmas firings this week. oh well.

Take an academic clinical position... but that salary cut is probably more than if they cut medicare 27%.

academic clinical position? que? most academic positions are lab trolls, never to see the light of day.

Not for MD's, almost all the docs that treat patients in academic hospitals (any associated with a medschool) are holding clinical/instructor positions that require no lab research and only a minimal amount of clinical research.

Every academic institution is different but for an MD there are a couple typical tracks

1) Non-tenure track clinical - they are pretty much at like an MD at a normal hospital, but they also teach residents/medstudents.

2) Tenure track teaching/administrative - Same as above but they also hold administrative positions

3) Tenure track- Clinical research. They are treating patients a couple days a week, but their main role is getting grants for and conducting clinical research projects.

4) Tenure Track- Basic Science, you only minimally treat patients and the rest of your time is doing lab research. This is more common in some specialties, but almost non-existent in others.


All of these tracks are going to be making SIGNIFICANTLY less money than someone in private practice unless you work your way up to really high level administrative positions.

For example, I think renodoc is optho, where the median assistant professor (probably someone doing track 1/2 above, and they have already been promoted from associate) makes 200k, but in non-academic practice the median is 330k.

Those people do clinical work, but not much except #1. A lot of people, myself included, really hate research.

I guess it really depends on the institution, my research PI is an MD with NIH grants, but still sees non-research patients 3 days a week.

I was under the impression that there are a lot more MDs on the teaching/clinical tracks than hardcore research, but I could easily be wrong.

Probably varies some, was more research based at my college.

sounds reasonable, mine is more clinical than some, are you an MD?

Isn't there also some substantial loan forgiveness associated with committing to a research track?

I think this changes every year, but I believe they are really competitive and not many people get them. (The loan forgiveness grants)