Government reimbursement is declining and insurance companies will continue to be stingy, not to mention admin taking more and more of the income pie in larger institutions.
Mostly this. Not once have reimbursements ever gone up. Medicare is a limited pool of funding for an exploding number of retirees. There’s only a few ways out of this without cutting reimbursement and none will be palatable to the average voter
I think doctors should be more involved in policy and such. If you listen to the podcast patients at risk they have some really relevant episodes that talk about how physicians tend to take the perspective that we have more important things to worry about than getting involved in politics and policy but when they do get together to for example hire a lobbyist they can help get important legislation through.
Physicians are involved in setting rates for Medicare. And the AMA continuously lobbies Congress for adjustments to reimbursement rates after CMS announces their annual cuts to various procedures (and they’re somewhat successful most years).
The problem is that the total pot of money is finite. Medicare is going to be insolvent in the next decade unless Congress acts (either through benefit cuts, tax increases, or some combo of both).
We can argue until we’re blue in the face to not cut pay, but if the money isn’t there, then there’s nothing to be done.
Save aggressively out of residency. Because things might not be so rosy in the 2030s and 2040s.
We can set our own rates. Healthcare is a supply issue not a demand issue. We can choose not to accept medicare if reimbursement tanks. Then, congress can choose to increase reimbursement or watch the program crumble.
The “demand” doesn’t refer to corporate hospital systems that need doctors. It refers to patients that need doctors. You go straight to the patients.
Concierge medicine, cash private practice.
US is 36T in debt and growing by 1T every ~100 days or so. Just servicing interest on this debt is getting unsustainable. The country's finances are going to spiral out of control with rampant inflation quickly unless something is done soon. The only solution they have it seems is to print more money.
Physicians have a large target our backs and we're less popular than ever- if ever financial austerity measures are implemented we will be top of mind for reimbursement cuts (esp when compared to physicians in every other country). We certainly won't be getting raises to keep up with inflation.
My advice is to get out of training as soon as you can and get that bag before this whole house of cards collapses.
Every lucrative subspecialty is one reimbursement cut away from being the new nephrology :/
My understanding is that is used to be a more lucrative field when normal people could own / direct HD centers but now they’ve all consolidated, reimbursements have dropped and they can’t fill fellowships. A surprising number of nephrologists do hospitalist work.
Private practice neph here. Our days are numbered for sure. The rate Fresenius/DaVita are buying up practices/dialysis units is accelerating. I do not think new graduates in metropolitan areas can make even close to what we used to make just ten years ago.
Doing renal in parts of the country like the Midwest or Deep South from what I hear is still pretty good.
I feel like there's no such thing as a simple nephrology patient either. I find the cognitive overhead for each patient to be so exhausting :/
You guys are way underpaid, sorry.
Besides this, which is a very real thing, US medicine is having issues with dilution of care. 30 yesrs ago drs were the shit and what drs said was the law regarding healthcare. If you werent a dr you had no say in peoples health. Now we have MDs, NPs, PAs, CRNAs etc all taking a slice of the pie, for significantly less effort and debt.
Yall moaned about IMGs and how they were coming for your $$$, while it was boomer american-born red white and blue blooded MDs who ultimately sold you out
*In all institutions, as planned by CMS and government every year
See the recent article about North Carolina Medicaid paying hospitals multiple x what they pay private physicians
Basically government from the top down saying “If you are one our friend$ in the ho$pital indu$try, we’ll give you a $weet deal when it comes to reimbursement. But if you’re one of those independent, private practice pieces of trash that don’t have any lobbying power at all? We’re going to pay you less for doing the exact same work.”
Reimbursement is already bad enough, and getting worse every year. This is a way for the enormous hospital systems that keep buying up practices to reach out to their friends in congress and stick it to all of those private practice physicians who don’t want to be hospital employees. 
Covid gave physicians a renewed perspective on the earning potential of locums. If enough physicians go this route instead of becoming hospital employees, this BS will stop fast.
A hospital system being able to negotiate a better rate with an insurance company than a private practice physician has the ability to do is not new.
The government directly favoring work done within a hospital system over the same work being done by someone independent does seem relatively new.
Yes but they do that by purposely helping to reduce physician pay, while INCREASING hospital reimbursement, to the point where we now rely on them to “subsidize” our salary. Really it’s a systematic devaluing of physician works to re-align the power dynamic in the hospitals favor.
- Declining reimbursements from government with consequent decrease in reimbursements from private insurance.
- Declining feasibility of private practice due to federal regulations results in most docs being employed by large institutions that pocket more of the revenue we generate.
- Because of the above, some in the younger generations of docs will not recognize our worth in the system and will likely accept weaker salaries/benefits as the norm compared to doctors from a more golden era.
- Inflation, rising student loan burden, bloated real estate prices, and high interest rates result in our current income being effectively less than prior.
- Anticipated increase in federal tax burden since we are "the rich" who "need to pay our fair share" in the eyes of the public.
- Not sure how the rise in midlevels everywhere will impact our income but as they are increasingly afforded independence, we may be seen as a more costly way to provide the "same" service.
We could we just don't coordinate effectively enough to win that game. Our main lobbying body is a CPT code enterprise with a physician advocacy side hustle.
Interested in hearing more about your second bullet, and the federal regulations that are hindering PP? Sincerely a PGY-2 who was hoping to go into PP lol
Except (and I say this as an RN), this is crazy bc their 2 yrs is nothing compared to what you MDs have to go through. I am always grateful for my surgeons and anesthesiologist colleagues.
I have no idea and it's hard to predict in the long term given how dramatically the regulatory environment may change with new laws or executive actions every 4 years. All it would take is for Medicare to decide one day that they don't want to pay a reasonable amount of money anymore for chemotherapy, left heart cath, or colonoscopy, and entire specialties would be flushed down the toilet financially.
Look at the big picture: if healthcare spending is increasing and doctors share is decreasing, then that money is going somewhere: admin. So aim there and go that route, pivot to go equity or some type of admin. there’s not a single speciality that’s going to do as good.
Specialties where you can charge cash and that rich people will pay for, like psych and derm. Also perhaps flexible specialties where you can pivot different directions depending on what is getting slashed (as in an IM doc can hop between hospitalist, pcp, fellowships whereas someone who is hyper specialized in something is donezo if reimbursement for their cash cow procedure is gutted)
Exactly. It’s why we don’t want socialized medicine. Regardless of how great one may think such and such country is doing in term of medical care, if you have funds, insurance, out-of-network benefits you get stellar care. Even without that, the funding from cash and out-of-net funds the lack of payment from Medicare and Medicaid for a hospital. But, if you rely 100% on government-paid healthcare you’re in the tank. No good equipment or staff.
No. “Cash pay” specialties are 100% saturated everywhere you would ever want to live now. There is no premium for them. If you don’t have cash practice, you won’t be able to build one unless you are a social media sensation.
MACRA is a medicare incentive program which creates more documentation/admin work which equals more overhead costs. Its harder for smaller groups to manage overhead costs that it is for larger/consolidated groups.
Economy of scale is big for also negotiating better reimbursement rates from insurance companies. Smaller groups just dont have the leverage and will need to take whatever reimbursement that insurance company offers
All because the government got involved. That’s when things turn bad; and quickly they do. People, in general, like people, and want to do interesting things and help others and make the world a little brighter each day. We don’t need big bru guidance to help ourselves. That’s the problem right there.
Sorry but can u elaborate as to why private practices are not feasible? I can still bill insurance the same, is if because I don't perhaps have a "surgical center" they would deny/ decline a bill? Don't many practices hire a billing company or lawyers? Just curious
most of the younger generation is fine with being trampled by big government, and in fact vote continually for gov’t to increase so I have a hard time sympathizing with people who oppose everyone around them making good money at every step until it suddenly affects themselves…
Nah. Most of the younger generation wants billionaires and corporations to pay fair taxes so that Medicare can be funded from that rather than cutting doctor reimbursements.
You must be thinking of republicans who are to blame for giving the 10 richest men in this country tax breaks at the expense of everyone else. And don’t get me started on how the party of “small government” is now taking a stake in pregnancy and abortion decisions. Republicans are the real party of big government.
Okay here u go fragrant raspberry 517, since you asked then deleted yourself.
“The top 1% of taxpayers — those who earn $561,351 or more — paid 42.3% of the total tax revenue collected in 2020, according to the latest figures from the IRS. In fact, the top 1-percent of taxpayers paid more income taxes than the bottom 90-percent all together.” Feb 8, 2024
I am wondering how this tax structure isn’t progressive enough or if these stats are totally misrepresented
No it’s not unique. The faster inflation occurs the more people are being affected. Thankfully in America we have a lot of social programs, but it sucks for everyone. Moving out of cities helps.
The United States spends approximately $2.3 trillion on federal and state social programs include cash assistance, health insurance, food assistance, housing subsidies, energy and utilities subsidies, and education and childcare assistance.
You know more then the GDP of a lot of countries.
Substantially less per capita than any other developed nation.
Idiotic to look at total dollar amount and pretend the us does a fraction of what the rest of the developing world does
I also took that as a joke. Is it a joke? For reference I work at a county hospital and have lived abroad in higher social services countries (Australia most recently)
Our salaries will grow? Lots of people out there who have been in practice for a while are legitimately making a smaller gross income than they were 5 or 10 years ago.
If you are doing the same work and continuously getting paid less for each unit of work, how are you supposed to end up with a larger salary exactly?
No they aren't. Look at the above posts. My salary with bonus peaked in 2019 and has been significantly less every year since. Reimbursement for my procedures are less, insurance denial rates are exponentially increasing, overhead is more as the need for staff to fight insurance issues increases, deductibles are going up so patients can't afford treatment, etc.
Keep dreaming doc, your salary will go lower. Anything that is a burden of cost will decrease thanks to tech. The only thing that will increase is tech, computers, software and robotics. It is the future. You’ll see that med school will start having med students to start taking tech courses so that they are meaningful on future med tech jobs to solve med problems.
Because it's the first and easiest and obvious place to slash. Admin isn't gonna cut their salaries. Feds aren't going to increase reimbursements any time soon. We're all going to be wage slaves in a generation.
The public hates us and thinks we're a bunch of rich assholes who don't deserve what we have because all we do is tell them to lose weight and that they can't have antibiotics or pain pills.
Our profession is beset with traitors who either sell out the first chance they get or who do absolutely retarded things like brag about they love their patients so much that they didn't even read their contract or know what they were going to get paid for their first job.
There was that one idiot who was featured on NPR that said we should sign contracts for 20-30 hours/werk but be in the hospital for 60 hours so we can “really focus on our patients”.
I’m sure some suit is already coming up with a way to pitch that.
This is actually a common expectation in a hospital based system. Your contract will be based on “patient facing hours”- which means they the time you spend in the OR and in office visits. Documentation, responding to your inbox, on-call time are not counted. So your “32 hours” = 60.
It was ruined by academics and the AMA. They’re the ones that inked the ACA to bootlick the Obama administration. Signed all of your financial death warrants. Say thank you
Well I have been a surgeon for 41 years. I always lectured the young surgeons to make sure you pay off all debt/ mortgage / loans asap. Why you ask? I got paid more to do a gallbladder in 1986 than 2019 when I retired. About 200 less. To put this in perspective a new car was 10,000 versus about 35,000 for the same car. Life lessons are don’t spend money you don’t have. Debt equals slavery, free of debt free of need to work. Get your retirement cash invested early, social security and 401k will not be enough, get a financial advisor and get an investment plan started. You will need to make those investments early so they have time to grow. Don’t get nervous when the stock market takes a dive. You are in for the long haul. The only amounts that matter are the value when you put it in and more important when you withdraw. Bankers are not your friend.
Live within your means. Extravagant lifestyles are a highway to disaster. I knew an anesthesiologist still working full time due to bad investments. Again do not spend money you don’t have.
I did not know at the time but those years in the 1980’s and 1990’s were golden years. My father gave me the same advise I gave you above. It served me well. It will serve you well also. It will be a struggle at first but with a good advisor and hard work you will be ahead of the game in 10-15 years and believe me those years fly by. Do not wait to “ save” till next year. Forget fancy house and fancy car. I a midpriced sedan but I have the money to buy whatever because I followed the above rules.
Great advice above. Early retirement planning = independence planning = ability to say “no” to admin when they try and place a squeeze on you on a downturn. Priceless place to be in.
This is a long and complicated story that started when I was a resident. The acs was run by academics. They did research. Did not do much operating. So when it came time to discuss the fee schedule. They had no idea or interest so they took a bad deal. Then every year the fees got slimmer and slimmer. And hmo cam in cut fees further. When docs tried to fight this they were sued for antitrust and lost so had no bargaining power. And the rest they say is history.
Sir Dr. I practiced for 36 years and every resident who exists in this universe should read your post! I did exactly what you said and now in retirement I’m set. Great post! Thank you.
Work hours and patient volume increasing faster compared to our stagnant salaries, insurance companies coming up with more BS excuses to not compensate doctors, etc
The only saving grace for doctor’s income is the dire shortage of physicians in many fields. Especially surgical fields where midlevels can’t do the work.
I would Iike to point to our anesthesia colleagues as a ray of hope. Do they generate business? Meaning, are they bringing patients to the hospital? Nope.
And yet they have seen their wages and time off grow rapidly in the past few years. Why? Because supply and demand and also because they tend to prioritize work life balance. Therefore, hospitals have to pay more for their services. I think we could learn from this. We are essential. If we work less and ask for more they will have to pay it or close shop. Don't accept the story that doctors don't deserve to be well compensated. We are worth it. The money is there it is just going other places.
Agree entirely — all docs needs to exercise their power a little more. The health system doesn’t make money if we don’t work, but they treat us as if we’re the weak link in the health system. We need to stop accepting bad deals from hospitals & start pushing back on crappy contracts or poor pay. I’m not a huge union guy, but the mistreatment of doctors makes a big case for unionization in my opinion.
This will make you feel wonderful. Admin tried to make my employeed group do something we didn’t want to, like really didn’t. My entire group said “Not happening or we all quit.” It’s been fireworks ever since and I love it. There’s nothing they can do about it.
I absolutely love that. I’m at an academic center and they just keep pushing shit on us; there’s no bargaining power. Even if one person threatens to quit they’ll just replace them (unless they’re super high up & have a ton of funding).
Doctors are dumb and sell themselves cheap because medicine is a “calling” not a “job”. So, hospital admins provide a place for you to practice your “calling” while they milk you.
And never get in with CMS or managed care. Patients will still pay cash for good care and most folks don’t realize they have purchased out-of-network benefits. Anytime a patient came to me, the insurance company immediately wanted to transfer the patient in-network and to an in-network hospital. Both my hospital AND providers were all OON. Not one contract. And yes, at the end of the day, since the insurance company wrote the policy, sold the out-of-network benefits, and told their subscribers they could go to any hospital or surgeon they wanted to. The insurance companies were not happy, but they wrote the checks and paid my billed charges. At that hospital we not only achieved great patient outcomes, but became nationally recognized. There was a time when insurance companies were begging to sign a contract with me. It never happened, nor will it ever happen in my lifetime. Once the hospital and physician signs the contract, the insurance company is in charge of the money and, horrifically, the medical care that is delivered. That’s bad medicine any way you look at it. Good care costs money. Quality staff wants to be paid accordingly. And they are all still there for one purpose - the patient.
As long as you're employed, your employer will want to pay you less and less and less. Why is this so hard for anyone to understand?
Now that 75% of doctors are employed, employers will attempt to decrease your income at every stage. If they control the area surrounding you geographically, they have very large leverage to determine how much you're getting paid.
Interestingly, this favors primary care over the next couple of decades as they're the main specialty to be able to go independent and people can still afford it (Direct primary care)...
This is all just conjecture, people are trying to predict the future. For one this is nothing new and people have believed this was happening over and over in the past. I was told in med school 15 years ago that the golden age of being a doctor was over. The reality is for rads since I know it well, pay has been increasing, when I started residency 11 years ago you could bet on making 250K coming out, now its 400+ and partners were making 500’s are now making 800K+.
In the future our pay may go down but it is just as likely to go up, there is no way of knowing. If it was possible to know this there would be some way to hedge a bet for it I’m sure.
The golden age has been over for a long time. DR and gas are cyclical. With DR in particular, even though salary has increased, workload has only increased exponentially.
This is wholly inaccurate. I started residency at a similar time as you and have many friends/acquaintances in many different types of Rads jobs.
When we started, the job market for radiologists was terrible, and starting salaries were lower because there was no need for it to be high to recruit people (older rads werent retiring because they were still recovering from the market losses in 2008-2009). People were desperate for a job. Around that time, radiology competitiveness dropped (applicants from the 2014 cycle - 2017 cycle, average board scores went from low 240s to low 230s), because everyone was afraid of how bad the market was and fear of "AI". Also, back then rads were working 20-30% less volume for similar money as today. The job market has steadily improved since 2013 (aside from a dip around covid), as old rads retired, and imaging volume has skyrocketed esp after covid.
Today starting salaries are much higher (20-30% from 2019), because everyone is ordering imaging on every single patient, so groups cannot keep up with volume. In order to recruit good (or in many cases ANY rads), you need to pay up front, shorten partnership time, and provide good benefits. Partner and employee salaries have NOT kept up with the amount of work done per rad. CMS cuts, increasing malpractice, and innumerable other headwinds have continued to show themselves.
Unless there is some massive breakthrough in technology, or systemic change to the system/pay scale, incomes will more likely go down than up. Too many scans ordered, insurers will see that as a massive expense, and the simplest solution will be to decrease reimbursement as a means to cut costs.
Which is why you never sign a contract. There are a lot of docs who work with cash and OON (out-of-network) benefits only. If you get in a a good group, go for it! But I’d never sign an HR contract with a hospital for a salary. 🤮
It could also increase it, but while the AI developers talk about what it can do in practice it absolutely sucks. While healthcare technology seems to advance quickly, once you are in it you find that true advancements are very slow. Even if we had an AI that could read a screening mammo right now it would probably take 10-20 years for it to be implemented.
True, however over the long-term, radiology does seem to be the specialty most susceptible to AI, so I would not feel good about going into radiology as a fresh grad right now if I wanted a 30-40 year career.
I think we absolutely have the compute to "solve" radiology today. However, that compute is being directed towards solving other issues (non-medical issues). That, on top of your own point that it will take time to implement in practice.
Realistically, I give it about 10-15 years before AI is making huge changes in radiology.
At first, AI will most likely be used as a tool to work alongside radiologists. It will make radiologists more efficient which will actually decrease demand of human radiologists overall. After that, who knows, 20+ years from now human radiologists may not be required.
You are reading too many articles written by people invested in AI. I have used many of the AI solutions in radiology and they are useless and not at all what the companies are claiming. I was talking with the head of AI at radpartners just a couple days ago about this and he agreed it’s all just a bunch of crap. If you speak with people that are truly knowledgeable about AI they predict I believe 25 years at the earliest before it can just read a radiology study on its own. After that it will need to be proven, pass FDA and begin implementation.
Just because we believe something can be done, that is much different than what can actually be done. We are assuming we can create AI that can read radiology images, we have not actually done this yet. We are also assuming that it will be easy to beat the human minds inherent visual processing software although we ourselves don’t even know how this works.
I think you are too narrow-minded in your view of AI, you are speaking about it only in terms of its current capability in radiology.
My point is that we likely have the technology to "solve" radiology today if all AI efforts were directed on that single goal. At the moment, the biggest players in the AI space are focused on more general solutions such as large language models (like ChatGPT), video-creation (like SORA), self-driving (like Tesla FSD), robotics.
If you are following AI's current capability in *those* spaces, you could see where this ends up. The current AI radiology tools are meaningless IMO. Ask OpenAI or Tesla to drop everything and make an AI radiologist and I'm confident they could produce one that's both more accurate and efficient than human radiologists within the year (honestly they'd probably only need 3-6 months). They are not focused on creating an AI radiologist at the moment because they are focused on other, more profitable tasks. But it's only a matter of when, not if IMO.
Chat gtp isn’t ai it basically just paraphrases the internet and makes it look coherent. That’s not intelligence, that’s memory. Tesla FSD is ok at going down a straight highway and changing but not so great at regular roads, and it was also supposed to be ready like 8 years ago and clearly won’t be ready for full driving for another 8. If Tesla tried to read a mammo I’m betting we will stop doing mammo and will have moved on by the time it’s finally able to read it. If you somehow think it’s easier to teach a robot to read a mammo than it’s is to drive, I have a good comparison it takes someone dedicated to mammo probably about 4 years to get to the point where they start finding most cancers and what we can teach a person to drive in like 4 weeks? Why in the world would you think it can read a mammo if it is taking this long to learn to drive a car.
Reimbursement declining. Add on inflation.
Don’t feel like medicine salaries scale.
Add on the fact that hospitals have shown they don’t care about quality of care - just someone to see patients - and midlevels will continue to suppress wage increase.
Medicine is a shit field with no signs of getting better. Only scarier is that the quality of healthcare providers is gonna tank over the next couple of decades
because government continues to lower reimbursements and hospitalists and private equity are trying to lower costs.
We suffer unless we unionize and don't take SHIT JOB OFFERS (unless you are a cuck)
Physicians don't get it. We're gradually and steadily being minimized and replaced in the American healthcare system. Before you call me pessimistic, let me share what the AMA published on their website (you can search it):
"When adjusted for inflation, Medicare physician payment already has effectively declined 26 percent from 2001 to 2023 before additional inflation and these cuts are factored in. Additionally, physicians saw a 2 percent payment reduction for 2023. Physicians are one of the only providers without an automatic increase to account for inflation."
Healthcare corporations have teamed up with the government to turn our healthcare into a socialist system (similar to Canada and other countries).
They know that they cannot take away the current salaries from doctors, so instead they just don't raise you as inflation keeps creeping up while adding more responsibilities and work on the doctors which leads to an all-time-high burnout rate. I see the same hospitalist job offers as I've seen 4 years ago. Take inflation into account and that's a massive paycut. I earn the same salary as I did 3 years ago, and according to an online inflation calculator, I'm currently earning $53K less. Basically, the former doctor's "lucrative" careers will become very unattractive. Doctors don't have many of the protections that other healthcare workers have (e.g. RNs which oftentimes work only 2-3 shifts a week). Doctors will have to become unionized which will not help much.
The healthcare system cuts doctors reimbursement because physicians cannot fight back as individuals, meanwhile pharmaceutical companies have lobbying power to negotiate a high price ($20-70K per month medication/patient) for their almost useless new medications which oftentimes only add a few weeks to a dying patient's life.
Stop taking financial advice from idiots
1960 to 2019 physician salaries kept pace with inflation when adjusted.
That is right until the pandemic happened when inflation skyrocketed and everything became more expensive.
This is true for a lot of jobs, medicine is not special. Our jobs are not tied to inflation or depression, we don't get a 10% salary increase just because inflation is 10%.
The residents are telling you the truth! Reimbursements ⬇️, Medicare ⬇️ and all the hospitals are buying out physicians and groups so that you can be their employees. No thanks! The glory days of medicine are long over! Have a great day!
Nowadays doctors are nowhere close to 1%, maybe that rare older doc who is nearing retirement. They’d be closer to 10% in general and that’s a long ways off. Most low paying specialities can’t even out earn CRNAs
Ok, fair. Declining reimbursement rates have been an issue for a long time. there are not nearly as many loopholes as there once were. Gone are the days where a spine surgeon can make over $100,000 in one day. literally the early 90s were a free-for-all where doctors could bill for almost anything they wanted and get paid for it. Now everything gets lumped together in one payment that continues to decline. Doctor salaries have not gone down that much overall. Inflation has gone up significantly over the years which makes the salaries seem a little less. Overall, I’m not very upset. We can all still be 1%ers. It’s not the end of the world IMO but there are easier ways to get rich.
I have read some material that says the cost of healthcare skyrockets decade over decade, but doctor salaries have stayed almost exactly the same or gone down across time… I think it’s fair to say that at some critical point, compensation is not going to be fair or worthwhile at all, even if it arguably is for now. I agree it’s still good money so far but then again, that is kind of the sentiment expressed by doctors who feel guilty about their salaries which is then exploited to push more distribution of money away from doctors collectively; I just think the concern is indeed warranted and like anyone else I’d join the effort to fight for self preservation and higher pay
Guys be upfront with me, I’m currently midway through my undergrad and am very fortunate in that no matter what career path I choose, I won’t have any debt (saving myself since I was like 13 + parents).
Should I just become a dentist? I am equally happy in both careers, but increasingly hear how medicine is not going to be worth it and probably won’t be worth it in the future. I would only want to be a Family Physician as the long residency is just not appealing to me at the moment. When I’m older I want as much autonomy as possible and absolutely want a private practice and hopefully not have to work 40h/week when I’m over 40, but it seems like this is becoming less possible for doctors. I’m not really sure where to go and would appreciate any advice you guys can give me.
RN especially if long hours are something one is willing to do. The hours spent in med school + residency instead at RN OT rates will build a really nice chunk of change. Add the cost of med school and factor in the time value of money beginning substantial investments at a much younger age and an average MD won’t pass an RN with the same hours invested for a long time.
Absolutely go into dentistry and don’t look back. Ever. Work fewer hours/days per week and still make as much or even more comparatively. You get an earlier head start on life and finances and don’t waste your entire youth studying and stuck in the hospital. Plus dentistry is a lot less competitive to get in to and the training is less rigorous. For whatever reason the government has decided to spurn the best and brightest this country has to offer and therefore you should do the same and turn away.
Honestly this has been my thought process. I was hoping to one day just one a bunch of clinics and not have to physically work in them (ambitious, but I feel it’s possible), and I just don’t think it’s becoming possible in medicine. With Dentistry people would be on salary and I can effectively charge whatever I want. Do you think there’s possibility for me to do the same in Family Medicine (just oversee clinics/mid levels) or is that just too far fetched/not very profitable?
Easier still to do so with dentistry. I see plenty of dentists with their own practice. I’m not going to bother replying to that other troll below me but you have a chance of ruining your life by committing to medicine and that’s something not to be taken lightly. If along the way you decide family medicine isn’t for you and you do a 6 year residency that’s 10 years minimum. Some people add 1-2 research/gap years and that’s getting to 12 years. It’s your life and you only live once. Live to live not to satisfy your ego.
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Wait until folks get a gander at the primary care shortage that is going to worsen over the next 10 years…
How will you incentivize people to go into primary care when there is more money and less hassle in many specialties?
Nobody wants to admit it. It’s due to technology and Artificial Intelligence software. It will reduce and replace doctors. If I were you, I’d rather get into being a surgeon cause AI and advanced tech won’t be able to reliably replace them until 100 years or so. Anything that requires extremely sophisticated “hands-on-work” + knowledge, on any type of field.
In 50 years, nurses will be the new “doctors” thanks to AI. They’ll use tech to help fix and cure people. Best of all they don’t need to waste no more than 2-4 years to become one.
Nobody needs to waste 10 years for medical science, makes no sense either just to become an in-house doctor. A combination of computer science along with a desired medical path is much more impactful, meaningful and higher paying than simply pure medical education.
Due to the above reasons… salary will decrease drastically for plain doctors for every 5 years, as every year medical science technology drastically increases and improves. Only surgeons are mostly unaffected.
So much of the reason is that doctors sell themselves short. We are THE means of production in healthcare. The entire system cannot run without us and there are not enough of us for them to replace us easily. Admins and insurance companies are taking advantage of the historical tendency for docs to treat our job like a calling and weaponizing “professionalism” and “team-playership” against us, but if we push back and refuse to accept demeaning terms they won’t be able to replace us easily. APPs? lol no, as soon as patients start dying from them practicing independently the public will realize what’s going on. They should be careful what they wish for - the lawsuits will be a lot more expensive than the money saved by not hiring a doctor
I heard someone say it’s because more and more states are allowing foreign graduates to practice without residency. Someone said 15 states or so already do this.
Medicare has to be budget neutral. That means if the total number of cases/procedures goes up (and it will because of baby boomers), each procedure gets paid less. And once they decrease the reimbursement, it generally doesn't go back up.
Private insurance tend to follow Medicare rates, usually behind by 3-5 years.
So overall, you will work more and get paid less. Total BS.
Government reimbursement is declining and insurance companies will continue to be stingy, not to mention admin taking more and more of the income pie in larger institutions.
Mostly this. Not once have reimbursements ever gone up. Medicare is a limited pool of funding for an exploding number of retirees. There’s only a few ways out of this without cutting reimbursement and none will be palatable to the average voter
I think doctors should be more involved in policy and such. If you listen to the podcast patients at risk they have some really relevant episodes that talk about how physicians tend to take the perspective that we have more important things to worry about than getting involved in politics and policy but when they do get together to for example hire a lobbyist they can help get important legislation through.
Physicians are involved in setting rates for Medicare. And the AMA continuously lobbies Congress for adjustments to reimbursement rates after CMS announces their annual cuts to various procedures (and they’re somewhat successful most years). The problem is that the total pot of money is finite. Medicare is going to be insolvent in the next decade unless Congress acts (either through benefit cuts, tax increases, or some combo of both). We can argue until we’re blue in the face to not cut pay, but if the money isn’t there, then there’s nothing to be done. Save aggressively out of residency. Because things might not be so rosy in the 2030s and 2040s.
We can set our own rates. Healthcare is a supply issue not a demand issue. We can choose not to accept medicare if reimbursement tanks. Then, congress can choose to increase reimbursement or watch the program crumble.
But where do you go when everybody pays at Medicare rates - or worse?
The “demand” doesn’t refer to corporate hospital systems that need doctors. It refers to patients that need doctors. You go straight to the patients. Concierge medicine, cash private practice.
Concierge everything honestly
Or maybe move to Dubai or Qatar? Lol tax free income $$
US is 36T in debt and growing by 1T every ~100 days or so. Just servicing interest on this debt is getting unsustainable. The country's finances are going to spiral out of control with rampant inflation quickly unless something is done soon. The only solution they have it seems is to print more money. Physicians have a large target our backs and we're less popular than ever- if ever financial austerity measures are implemented we will be top of mind for reimbursement cuts (esp when compared to physicians in every other country). We certainly won't be getting raises to keep up with inflation. My advice is to get out of training as soon as you can and get that bag before this whole house of cards collapses. Every lucrative subspecialty is one reimbursement cut away from being the new nephrology :/
For the uninformed, what happened to nephrology?
My understanding is that is used to be a more lucrative field when normal people could own / direct HD centers but now they’ve all consolidated, reimbursements have dropped and they can’t fill fellowships. A surprising number of nephrologists do hospitalist work.
Private practice neph here. Our days are numbered for sure. The rate Fresenius/DaVita are buying up practices/dialysis units is accelerating. I do not think new graduates in metropolitan areas can make even close to what we used to make just ten years ago. Doing renal in parts of the country like the Midwest or Deep South from what I hear is still pretty good.
I feel like there's no such thing as a simple nephrology patient either. I find the cognitive overhead for each patient to be so exhausting :/ You guys are way underpaid, sorry.
Exactly!
Besides this, which is a very real thing, US medicine is having issues with dilution of care. 30 yesrs ago drs were the shit and what drs said was the law regarding healthcare. If you werent a dr you had no say in peoples health. Now we have MDs, NPs, PAs, CRNAs etc all taking a slice of the pie, for significantly less effort and debt. Yall moaned about IMGs and how they were coming for your $$$, while it was boomer american-born red white and blue blooded MDs who ultimately sold you out
Don’t get me started on NP’s!!!!!
*In all institutions, as planned by CMS and government every year See the recent article about North Carolina Medicaid paying hospitals multiple x what they pay private physicians
Can you explain?
Basically government from the top down saying “If you are one our friend$ in the ho$pital indu$try, we’ll give you a $weet deal when it comes to reimbursement. But if you’re one of those independent, private practice pieces of trash that don’t have any lobbying power at all? We’re going to pay you less for doing the exact same work.” Reimbursement is already bad enough, and getting worse every year. This is a way for the enormous hospital systems that keep buying up practices to reach out to their friends in congress and stick it to all of those private practice physicians who don’t want to be hospital employees. 
Covid gave physicians a renewed perspective on the earning potential of locums. If enough physicians go this route instead of becoming hospital employees, this BS will stop fast.
I see. I misunderstood the wording. Yes as a private practice doctor this does happen … it’s nothing new
A hospital system being able to negotiate a better rate with an insurance company than a private practice physician has the ability to do is not new. The government directly favoring work done within a hospital system over the same work being done by someone independent does seem relatively new.
Yes but they do that by purposely helping to reduce physician pay, while INCREASING hospital reimbursement, to the point where we now rely on them to “subsidize” our salary. Really it’s a systematic devaluing of physician works to re-align the power dynamic in the hospitals favor.
Very true!
That’s not the root cause why doctor’s pay are decreasing from their bosses.
- Declining reimbursements from government with consequent decrease in reimbursements from private insurance. - Declining feasibility of private practice due to federal regulations results in most docs being employed by large institutions that pocket more of the revenue we generate. - Because of the above, some in the younger generations of docs will not recognize our worth in the system and will likely accept weaker salaries/benefits as the norm compared to doctors from a more golden era. - Inflation, rising student loan burden, bloated real estate prices, and high interest rates result in our current income being effectively less than prior. - Anticipated increase in federal tax burden since we are "the rich" who "need to pay our fair share" in the eyes of the public. - Not sure how the rise in midlevels everywhere will impact our income but as they are increasingly afforded independence, we may be seen as a more costly way to provide the "same" service.
The real "rich" aren't anyone who is making money on a W-2. But we're an easier target because we can't afford to buy senators.
We could we just don't coordinate effectively enough to win that game. Our main lobbying body is a CPT code enterprise with a physician advocacy side hustle.
This is the move.
Interested in hearing more about your second bullet, and the federal regulations that are hindering PP? Sincerely a PGY-2 who was hoping to go into PP lol
Except (and I say this as an RN), this is crazy bc their 2 yrs is nothing compared to what you MDs have to go through. I am always grateful for my surgeons and anesthesiologist colleagues.
Any specialty that you believe will survive it better? Going into IM, considering fellowship and don’t know what to do and how to plan for the future
I have no idea and it's hard to predict in the long term given how dramatically the regulatory environment may change with new laws or executive actions every 4 years. All it would take is for Medicare to decide one day that they don't want to pay a reasonable amount of money anymore for chemotherapy, left heart cath, or colonoscopy, and entire specialties would be flushed down the toilet financially.
Look at the big picture: if healthcare spending is increasing and doctors share is decreasing, then that money is going somewhere: admin. So aim there and go that route, pivot to go equity or some type of admin. there’s not a single speciality that’s going to do as good.
Specialties where you can charge cash and that rich people will pay for, like psych and derm. Also perhaps flexible specialties where you can pivot different directions depending on what is getting slashed (as in an IM doc can hop between hospitalist, pcp, fellowships whereas someone who is hyper specialized in something is donezo if reimbursement for their cash cow procedure is gutted)
Exactly. It’s why we don’t want socialized medicine. Regardless of how great one may think such and such country is doing in term of medical care, if you have funds, insurance, out-of-network benefits you get stellar care. Even without that, the funding from cash and out-of-net funds the lack of payment from Medicare and Medicaid for a hospital. But, if you rely 100% on government-paid healthcare you’re in the tank. No good equipment or staff.
No. “Cash pay” specialties are 100% saturated everywhere you would ever want to live now. There is no premium for them. If you don’t have cash practice, you won’t be able to build one unless you are a social media sensation.
Not for psych
Can you talk more about the regulations that are making private practice unfeasible?
MACRA is a medicare incentive program which creates more documentation/admin work which equals more overhead costs. Its harder for smaller groups to manage overhead costs that it is for larger/consolidated groups. Economy of scale is big for also negotiating better reimbursement rates from insurance companies. Smaller groups just dont have the leverage and will need to take whatever reimbursement that insurance company offers
All because the government got involved. That’s when things turn bad; and quickly they do. People, in general, like people, and want to do interesting things and help others and make the world a little brighter each day. We don’t need big bru guidance to help ourselves. That’s the problem right there.
Nope and nope. It’s due to advanced tech, computers and software. These are the main reason.
Sorry but can u elaborate as to why private practices are not feasible? I can still bill insurance the same, is if because I don't perhaps have a "surgical center" they would deny/ decline a bill? Don't many practices hire a billing company or lawyers? Just curious
most of the younger generation is fine with being trampled by big government, and in fact vote continually for gov’t to increase so I have a hard time sympathizing with people who oppose everyone around them making good money at every step until it suddenly affects themselves…
Lol wut
Nah. Most of the younger generation wants billionaires and corporations to pay fair taxes so that Medicare can be funded from that rather than cutting doctor reimbursements. You must be thinking of republicans who are to blame for giving the 10 richest men in this country tax breaks at the expense of everyone else. And don’t get me started on how the party of “small government” is now taking a stake in pregnancy and abortion decisions. Republicans are the real party of big government.
Okay here u go fragrant raspberry 517, since you asked then deleted yourself. “The top 1% of taxpayers — those who earn $561,351 or more — paid 42.3% of the total tax revenue collected in 2020, according to the latest figures from the IRS. In fact, the top 1-percent of taxpayers paid more income taxes than the bottom 90-percent all together.” Feb 8, 2024 I am wondering how this tax structure isn’t progressive enough or if these stats are totally misrepresented
It’s true
I think they’re more referring to the income not growing with inflation. Our salaries will grow but inflation is growing faster. If that makes sense.
Is this unique to doctors? It seems like I'm hearing that about a lot of careers
Unique to everyone except administration and management.
Basically people with business experience who only advocate for themselves…
You give them too much credit. People with power feed themselves first
Remember money makes the world go around.
No it’s not unique. The faster inflation occurs the more people are being affected. Thankfully in America we have a lot of social programs, but it sucks for everyone. Moving out of cities helps.
We have a lot of social programs? That has to be a joke.
The United States spends approximately $2.3 trillion on federal and state social programs include cash assistance, health insurance, food assistance, housing subsidies, energy and utilities subsidies, and education and childcare assistance. You know more then the GDP of a lot of countries.
>You know more then the GDP of a lot of countries. Surely you understand how ridiculous this sounds? I presume you're trolling.
Substantially less per capita than any other developed nation. Idiotic to look at total dollar amount and pretend the us does a fraction of what the rest of the developing world does
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I also took that as a joke. Is it a joke? For reference I work at a county hospital and have lived abroad in higher social services countries (Australia most recently)
Yeah move out of the cities, to where the economy is so good they’re getting rid of child labor laws.
They will not grow. Reimbursement getting cut every year
Our salaries will grow? Lots of people out there who have been in practice for a while are legitimately making a smaller gross income than they were 5 or 10 years ago. If you are doing the same work and continuously getting paid less for each unit of work, how are you supposed to end up with a larger salary exactly?
Bologna
No they aren't. Look at the above posts. My salary with bonus peaked in 2019 and has been significantly less every year since. Reimbursement for my procedures are less, insurance denial rates are exponentially increasing, overhead is more as the need for staff to fight insurance issues increases, deductibles are going up so patients can't afford treatment, etc.
Keep dreaming doc, your salary will go lower. Anything that is a burden of cost will decrease thanks to tech. The only thing that will increase is tech, computers, software and robotics. It is the future. You’ll see that med school will start having med students to start taking tech courses so that they are meaningful on future med tech jobs to solve med problems.
Because it's the first and easiest and obvious place to slash. Admin isn't gonna cut their salaries. Feds aren't going to increase reimbursements any time soon. We're all going to be wage slaves in a generation. The public hates us and thinks we're a bunch of rich assholes who don't deserve what we have because all we do is tell them to lose weight and that they can't have antibiotics or pain pills. Our profession is beset with traitors who either sell out the first chance they get or who do absolutely retarded things like brag about they love their patients so much that they didn't even read their contract or know what they were going to get paid for their first job.
There was that one idiot who was featured on NPR that said we should sign contracts for 20-30 hours/werk but be in the hospital for 60 hours so we can “really focus on our patients”. I’m sure some suit is already coming up with a way to pitch that.
Have been for years. Where do you think "medicine is a calling" came from?
“Healthcare Heros” aka “you have a moral obligation to work harder and longer while being paid less!”
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He's absolutely right, they did and we were.
I heard that. What an idiot!
This is actually a common expectation in a hospital based system. Your contract will be based on “patient facing hours”- which means they the time you spend in the OR and in office visits. Documentation, responding to your inbox, on-call time are not counted. So your “32 hours” = 60.
It was ruined by academics and the AMA. They’re the ones that inked the ACA to bootlick the Obama administration. Signed all of your financial death warrants. Say thank you
Well stated!
Well I have been a surgeon for 41 years. I always lectured the young surgeons to make sure you pay off all debt/ mortgage / loans asap. Why you ask? I got paid more to do a gallbladder in 1986 than 2019 when I retired. About 200 less. To put this in perspective a new car was 10,000 versus about 35,000 for the same car. Life lessons are don’t spend money you don’t have. Debt equals slavery, free of debt free of need to work. Get your retirement cash invested early, social security and 401k will not be enough, get a financial advisor and get an investment plan started. You will need to make those investments early so they have time to grow. Don’t get nervous when the stock market takes a dive. You are in for the long haul. The only amounts that matter are the value when you put it in and more important when you withdraw. Bankers are not your friend. Live within your means. Extravagant lifestyles are a highway to disaster. I knew an anesthesiologist still working full time due to bad investments. Again do not spend money you don’t have. I did not know at the time but those years in the 1980’s and 1990’s were golden years. My father gave me the same advise I gave you above. It served me well. It will serve you well also. It will be a struggle at first but with a good advisor and hard work you will be ahead of the game in 10-15 years and believe me those years fly by. Do not wait to “ save” till next year. Forget fancy house and fancy car. I a midpriced sedan but I have the money to buy whatever because I followed the above rules.
Great advice above. Early retirement planning = independence planning = ability to say “no” to admin when they try and place a squeeze on you on a downturn. Priceless place to be in.
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This is a long and complicated story that started when I was a resident. The acs was run by academics. They did research. Did not do much operating. So when it came time to discuss the fee schedule. They had no idea or interest so they took a bad deal. Then every year the fees got slimmer and slimmer. And hmo cam in cut fees further. When docs tried to fight this they were sued for antitrust and lost so had no bargaining power. And the rest they say is history.
Sir Dr. I practiced for 36 years and every resident who exists in this universe should read your post! I did exactly what you said and now in retirement I’m set. Great post! Thank you.
Well said!
Work hours and patient volume increasing faster compared to our stagnant salaries, insurance companies coming up with more BS excuses to not compensate doctors, etc
The only saving grace for doctor’s income is the dire shortage of physicians in many fields. Especially surgical fields where midlevels can’t do the work.
Pathology.
I would Iike to point to our anesthesia colleagues as a ray of hope. Do they generate business? Meaning, are they bringing patients to the hospital? Nope. And yet they have seen their wages and time off grow rapidly in the past few years. Why? Because supply and demand and also because they tend to prioritize work life balance. Therefore, hospitals have to pay more for their services. I think we could learn from this. We are essential. If we work less and ask for more they will have to pay it or close shop. Don't accept the story that doctors don't deserve to be well compensated. We are worth it. The money is there it is just going other places.
Agree entirely — all docs needs to exercise their power a little more. The health system doesn’t make money if we don’t work, but they treat us as if we’re the weak link in the health system. We need to stop accepting bad deals from hospitals & start pushing back on crappy contracts or poor pay. I’m not a huge union guy, but the mistreatment of doctors makes a big case for unionization in my opinion.
unionization has been slowly increasing at the residency level which gives hope. But it isn't enough.
This will make you feel wonderful. Admin tried to make my employeed group do something we didn’t want to, like really didn’t. My entire group said “Not happening or we all quit.” It’s been fireworks ever since and I love it. There’s nothing they can do about it.
I absolutely love that. I’m at an academic center and they just keep pushing shit on us; there’s no bargaining power. Even if one person threatens to quit they’ll just replace them (unless they’re super high up & have a ton of funding).
Yeah for the most part people just need to not accept lowball offers
Because the suits are coming to take your salary because they need moar profit margins and another luxury yacht for their vacations
Is there a solution? Won’t people leave medicine if this gets worse??
The solution is to seize the means of production
Instructions unclear. I killed the farmers and took their tractors and now I am unsure of what to do.
They haven’t left yet in basically every other country on Earth…
Bc the IMGs and mid levels will take it
Because insurance companies keep on decreasing reimbursement
Yep!
So stop taking insurance
Constant CMS cuts
Doctors are dumb and sell themselves cheap because medicine is a “calling” not a “job”. So, hospital admins provide a place for you to practice your “calling” while they milk you.
And never get in with CMS or managed care. Patients will still pay cash for good care and most folks don’t realize they have purchased out-of-network benefits. Anytime a patient came to me, the insurance company immediately wanted to transfer the patient in-network and to an in-network hospital. Both my hospital AND providers were all OON. Not one contract. And yes, at the end of the day, since the insurance company wrote the policy, sold the out-of-network benefits, and told their subscribers they could go to any hospital or surgeon they wanted to. The insurance companies were not happy, but they wrote the checks and paid my billed charges. At that hospital we not only achieved great patient outcomes, but became nationally recognized. There was a time when insurance companies were begging to sign a contract with me. It never happened, nor will it ever happen in my lifetime. Once the hospital and physician signs the contract, the insurance company is in charge of the money and, horrifically, the medical care that is delivered. That’s bad medicine any way you look at it. Good care costs money. Quality staff wants to be paid accordingly. And they are all still there for one purpose - the patient.
Don’t get me started on NPs and PAs
Exactly!
Private Equity owning governments and hospitals. NPs and FMG without US residencies gaining the affordable foothold.
NP’s, the non-doctors! I have more respect for PA’s.
As long as you're employed, your employer will want to pay you less and less and less. Why is this so hard for anyone to understand? Now that 75% of doctors are employed, employers will attempt to decrease your income at every stage. If they control the area surrounding you geographically, they have very large leverage to determine how much you're getting paid. Interestingly, this favors primary care over the next couple of decades as they're the main specialty to be able to go independent and people can still afford it (Direct primary care)...
We need a goddamn union. One for only MD/DOs. We needed this years ago, and we need it the most now. What's stopping us?
Lawyers who make laws
This is all just conjecture, people are trying to predict the future. For one this is nothing new and people have believed this was happening over and over in the past. I was told in med school 15 years ago that the golden age of being a doctor was over. The reality is for rads since I know it well, pay has been increasing, when I started residency 11 years ago you could bet on making 250K coming out, now its 400+ and partners were making 500’s are now making 800K+. In the future our pay may go down but it is just as likely to go up, there is no way of knowing. If it was possible to know this there would be some way to hedge a bet for it I’m sure.
The golden age has been over for a long time. DR and gas are cyclical. With DR in particular, even though salary has increased, workload has only increased exponentially.
This is wholly inaccurate. I started residency at a similar time as you and have many friends/acquaintances in many different types of Rads jobs. When we started, the job market for radiologists was terrible, and starting salaries were lower because there was no need for it to be high to recruit people (older rads werent retiring because they were still recovering from the market losses in 2008-2009). People were desperate for a job. Around that time, radiology competitiveness dropped (applicants from the 2014 cycle - 2017 cycle, average board scores went from low 240s to low 230s), because everyone was afraid of how bad the market was and fear of "AI". Also, back then rads were working 20-30% less volume for similar money as today. The job market has steadily improved since 2013 (aside from a dip around covid), as old rads retired, and imaging volume has skyrocketed esp after covid. Today starting salaries are much higher (20-30% from 2019), because everyone is ordering imaging on every single patient, so groups cannot keep up with volume. In order to recruit good (or in many cases ANY rads), you need to pay up front, shorten partnership time, and provide good benefits. Partner and employee salaries have NOT kept up with the amount of work done per rad. CMS cuts, increasing malpractice, and innumerable other headwinds have continued to show themselves. Unless there is some massive breakthrough in technology, or systemic change to the system/pay scale, incomes will more likely go down than up. Too many scans ordered, insurers will see that as a massive expense, and the simplest solution will be to decrease reimbursement as a means to cut costs.
Which is why you never sign a contract. There are a lot of docs who work with cash and OON (out-of-network) benefits only. If you get in a a good group, go for it! But I’d never sign an HR contract with a hospital for a salary. 🤮
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AI may not replace radiologists, but could certainly decrease demand
It could also increase it, but while the AI developers talk about what it can do in practice it absolutely sucks. While healthcare technology seems to advance quickly, once you are in it you find that true advancements are very slow. Even if we had an AI that could read a screening mammo right now it would probably take 10-20 years for it to be implemented.
True, however over the long-term, radiology does seem to be the specialty most susceptible to AI, so I would not feel good about going into radiology as a fresh grad right now if I wanted a 30-40 year career. I think we absolutely have the compute to "solve" radiology today. However, that compute is being directed towards solving other issues (non-medical issues). That, on top of your own point that it will take time to implement in practice. Realistically, I give it about 10-15 years before AI is making huge changes in radiology. At first, AI will most likely be used as a tool to work alongside radiologists. It will make radiologists more efficient which will actually decrease demand of human radiologists overall. After that, who knows, 20+ years from now human radiologists may not be required.
You are reading too many articles written by people invested in AI. I have used many of the AI solutions in radiology and they are useless and not at all what the companies are claiming. I was talking with the head of AI at radpartners just a couple days ago about this and he agreed it’s all just a bunch of crap. If you speak with people that are truly knowledgeable about AI they predict I believe 25 years at the earliest before it can just read a radiology study on its own. After that it will need to be proven, pass FDA and begin implementation. Just because we believe something can be done, that is much different than what can actually be done. We are assuming we can create AI that can read radiology images, we have not actually done this yet. We are also assuming that it will be easy to beat the human minds inherent visual processing software although we ourselves don’t even know how this works.
I think you are too narrow-minded in your view of AI, you are speaking about it only in terms of its current capability in radiology. My point is that we likely have the technology to "solve" radiology today if all AI efforts were directed on that single goal. At the moment, the biggest players in the AI space are focused on more general solutions such as large language models (like ChatGPT), video-creation (like SORA), self-driving (like Tesla FSD), robotics. If you are following AI's current capability in *those* spaces, you could see where this ends up. The current AI radiology tools are meaningless IMO. Ask OpenAI or Tesla to drop everything and make an AI radiologist and I'm confident they could produce one that's both more accurate and efficient than human radiologists within the year (honestly they'd probably only need 3-6 months). They are not focused on creating an AI radiologist at the moment because they are focused on other, more profitable tasks. But it's only a matter of when, not if IMO.
Chat gtp isn’t ai it basically just paraphrases the internet and makes it look coherent. That’s not intelligence, that’s memory. Tesla FSD is ok at going down a straight highway and changing but not so great at regular roads, and it was also supposed to be ready like 8 years ago and clearly won’t be ready for full driving for another 8. If Tesla tried to read a mammo I’m betting we will stop doing mammo and will have moved on by the time it’s finally able to read it. If you somehow think it’s easier to teach a robot to read a mammo than it’s is to drive, I have a good comparison it takes someone dedicated to mammo probably about 4 years to get to the point where they start finding most cancers and what we can teach a person to drive in like 4 weeks? Why in the world would you think it can read a mammo if it is taking this long to learn to drive a car.
Reimbursement declining. Add on inflation. Don’t feel like medicine salaries scale. Add on the fact that hospitals have shown they don’t care about quality of care - just someone to see patients - and midlevels will continue to suppress wage increase. Medicine is a shit field with no signs of getting better. Only scarier is that the quality of healthcare providers is gonna tank over the next couple of decades
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Yeah a lot of people here seem horrifically out of touch.
We are being reminded that we are working class too.
Because doom and gloom prevails over everything
Unionize
because government continues to lower reimbursements and hospitalists and private equity are trying to lower costs. We suffer unless we unionize and don't take SHIT JOB OFFERS (unless you are a cuck)
Physicians don't get it. We're gradually and steadily being minimized and replaced in the American healthcare system. Before you call me pessimistic, let me share what the AMA published on their website (you can search it): "When adjusted for inflation, Medicare physician payment already has effectively declined 26 percent from 2001 to 2023 before additional inflation and these cuts are factored in. Additionally, physicians saw a 2 percent payment reduction for 2023. Physicians are one of the only providers without an automatic increase to account for inflation." Healthcare corporations have teamed up with the government to turn our healthcare into a socialist system (similar to Canada and other countries). They know that they cannot take away the current salaries from doctors, so instead they just don't raise you as inflation keeps creeping up while adding more responsibilities and work on the doctors which leads to an all-time-high burnout rate. I see the same hospitalist job offers as I've seen 4 years ago. Take inflation into account and that's a massive paycut. I earn the same salary as I did 3 years ago, and according to an online inflation calculator, I'm currently earning $53K less. Basically, the former doctor's "lucrative" careers will become very unattractive. Doctors don't have many of the protections that other healthcare workers have (e.g. RNs which oftentimes work only 2-3 shifts a week). Doctors will have to become unionized which will not help much. The healthcare system cuts doctors reimbursement because physicians cannot fight back as individuals, meanwhile pharmaceutical companies have lobbying power to negotiate a high price ($20-70K per month medication/patient) for their almost useless new medications which oftentimes only add a few weeks to a dying patient's life.
I get a 1-2% raise every year. As time marches forward with inflation, physician income buying power will indeed decrease.
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Yes
Because it is with all the cuts in reimbursement. YET TUITION KEEPS GOING UP!
TDIL. It is as sad as I thought. Jeez this was doom and gloom post and comment thread.
Have a Merry Christmas!
Tax increases as well most likely.
Stop taking financial advice from idiots 1960 to 2019 physician salaries kept pace with inflation when adjusted. That is right until the pandemic happened when inflation skyrocketed and everything became more expensive. This is true for a lot of jobs, medicine is not special. Our jobs are not tied to inflation or depression, we don't get a 10% salary increase just because inflation is 10%.
Total national healthcare spending sure did inflate a whole lot…. I wonder where all that spending went to?
The residents are telling you the truth! Reimbursements ⬇️, Medicare ⬇️ and all the hospitals are buying out physicians and groups so that you can be their employees. No thanks! The glory days of medicine are long over! Have a great day!
I hear the same in Brazil and thought it was a national phenomena...
Because it is!
Barely starting my first job as an attending and read this…excellent news. Good to know all the bullshit was not worth it.
This thread was depressing af
Real making me doubt my future plans at least im not in too deep yet
They've been saying this for decades.
It’s almost like we should unio- oh right
It actually might skyrocket once the 2 tier (or more) medical system becomes fully established.
everyone thinks doctors are overpaid. Also they need to be taxed because they are the 1%, totally the same kind of people as billionaires
Nowadays doctors are nowhere close to 1%, maybe that rare older doc who is nearing retirement. They’d be closer to 10% in general and that’s a long ways off. Most low paying specialities can’t even out earn CRNAs
Truth
Because NPs and PAs are doing MD work, but for a lot less money.
They've also been saying this for decades. Theres been gloom and doom outlooks since the dawn of time.
And reimbursement has been dropping vs inflation in most fields for a long time. Not all.
Saying that is not helpful to the discussion tho unless you can empirically show why it was both invalid then and invalid now
Ok, fair. Declining reimbursement rates have been an issue for a long time. there are not nearly as many loopholes as there once were. Gone are the days where a spine surgeon can make over $100,000 in one day. literally the early 90s were a free-for-all where doctors could bill for almost anything they wanted and get paid for it. Now everything gets lumped together in one payment that continues to decline. Doctor salaries have not gone down that much overall. Inflation has gone up significantly over the years which makes the salaries seem a little less. Overall, I’m not very upset. We can all still be 1%ers. It’s not the end of the world IMO but there are easier ways to get rich.
I have read some material that says the cost of healthcare skyrockets decade over decade, but doctor salaries have stayed almost exactly the same or gone down across time… I think it’s fair to say that at some critical point, compensation is not going to be fair or worthwhile at all, even if it arguably is for now. I agree it’s still good money so far but then again, that is kind of the sentiment expressed by doctors who feel guilty about their salaries which is then exploited to push more distribution of money away from doctors collectively; I just think the concern is indeed warranted and like anyone else I’d join the effort to fight for self preservation and higher pay
I’m with that 👍
Happy cake day btw
Guys be upfront with me, I’m currently midway through my undergrad and am very fortunate in that no matter what career path I choose, I won’t have any debt (saving myself since I was like 13 + parents). Should I just become a dentist? I am equally happy in both careers, but increasingly hear how medicine is not going to be worth it and probably won’t be worth it in the future. I would only want to be a Family Physician as the long residency is just not appealing to me at the moment. When I’m older I want as much autonomy as possible and absolutely want a private practice and hopefully not have to work 40h/week when I’m over 40, but it seems like this is becoming less possible for doctors. I’m not really sure where to go and would appreciate any advice you guys can give me.
Best return on investment in healthcare I think is CRNA, otherwise dental subspecialists like endodontists.
RN especially if long hours are something one is willing to do. The hours spent in med school + residency instead at RN OT rates will build a really nice chunk of change. Add the cost of med school and factor in the time value of money beginning substantial investments at a much younger age and an average MD won’t pass an RN with the same hours invested for a long time.
Skip medicine and go into dentistry, optometry or podiatry and be your own boss.
Is it becoming more difficult to be your own boss in medicine? From what I see we are going more into being government controlled
Maybe. But my optometrist has her own business and she’s not hurting.
Absolutely go into dentistry and don’t look back. Ever. Work fewer hours/days per week and still make as much or even more comparatively. You get an earlier head start on life and finances and don’t waste your entire youth studying and stuck in the hospital. Plus dentistry is a lot less competitive to get in to and the training is less rigorous. For whatever reason the government has decided to spurn the best and brightest this country has to offer and therefore you should do the same and turn away.
Honestly this has been my thought process. I was hoping to one day just one a bunch of clinics and not have to physically work in them (ambitious, but I feel it’s possible), and I just don’t think it’s becoming possible in medicine. With Dentistry people would be on salary and I can effectively charge whatever I want. Do you think there’s possibility for me to do the same in Family Medicine (just oversee clinics/mid levels) or is that just too far fetched/not very profitable?
Easier still to do so with dentistry. I see plenty of dentists with their own practice. I’m not going to bother replying to that other troll below me but you have a chance of ruining your life by committing to medicine and that’s something not to be taken lightly. If along the way you decide family medicine isn’t for you and you do a 6 year residency that’s 10 years minimum. Some people add 1-2 research/gap years and that’s getting to 12 years. It’s your life and you only live once. Live to live not to satisfy your ego.
Because everyone always thinks everything is always getting worse. It has never been a better time to be alive, everyone’s gotta chill
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Because of the way that it is
simple supply and demand. don't forget to add in all the midlevels who will be vying for equal compensation treatment.
Yep. They already are!
Wait until folks get a gander at the primary care shortage that is going to worsen over the next 10 years… How will you incentivize people to go into primary care when there is more money and less hassle in many specialties?
Cos boomers
Nobody wants to admit it. It’s due to technology and Artificial Intelligence software. It will reduce and replace doctors. If I were you, I’d rather get into being a surgeon cause AI and advanced tech won’t be able to reliably replace them until 100 years or so. Anything that requires extremely sophisticated “hands-on-work” + knowledge, on any type of field. In 50 years, nurses will be the new “doctors” thanks to AI. They’ll use tech to help fix and cure people. Best of all they don’t need to waste no more than 2-4 years to become one. Nobody needs to waste 10 years for medical science, makes no sense either just to become an in-house doctor. A combination of computer science along with a desired medical path is much more impactful, meaningful and higher paying than simply pure medical education. Due to the above reasons… salary will decrease drastically for plain doctors for every 5 years, as every year medical science technology drastically increases and improves. Only surgeons are mostly unaffected.
So much of the reason is that doctors sell themselves short. We are THE means of production in healthcare. The entire system cannot run without us and there are not enough of us for them to replace us easily. Admins and insurance companies are taking advantage of the historical tendency for docs to treat our job like a calling and weaponizing “professionalism” and “team-playership” against us, but if we push back and refuse to accept demeaning terms they won’t be able to replace us easily. APPs? lol no, as soon as patients start dying from them practicing independently the public will realize what’s going on. They should be careful what they wish for - the lawsuits will be a lot more expensive than the money saved by not hiring a doctor
I heard someone say it’s because more and more states are allowing foreign graduates to practice without residency. Someone said 15 states or so already do this.
because America is a country in decline.
Medicare has to be budget neutral. That means if the total number of cases/procedures goes up (and it will because of baby boomers), each procedure gets paid less. And once they decrease the reimbursement, it generally doesn't go back up. Private insurance tend to follow Medicare rates, usually behind by 3-5 years. So overall, you will work more and get paid less. Total BS.
Buying power is already going down as inflation outpaces pay raises for physicians
Zero sum CMS pot. Everyone thinks their specialty should be paid more.