Global Fee: Does Our Government Want to Eliminate Doctors?

November 17, 2007

Does Our Government Want to Eliminate Doctors?

The more I get into my website, MDJobexchange.com and recruiting for my hospital, I do wonder if our government really just wants to eliminate doctors. It is truly mind-boggling. Medicare persists with cutting physician pay, while pay to hospitals has not been decreased nearly to the same degree as doctors. Some malpractice reform has occurred, but is really just scratching the surface. Regulation and irritation continue to increase at an alarming pace. Credentialing and licensing have become cottage industries unto themselves. It is nearly impossible to change jobs as a physician without planning 6 months in advance. Real physician income has dropped significantly over the last 10 years. Salary surveys report about static incomes, but this has mainly due to increased productivity by physicians. Federal loan programs are now requiring immediate repayment of loans, whereas they used to allow a grace period of about 4 years. How does a resident making $40,000 per year make payments of $1800 per month on their salary while also paying their rent, car payment, etc.

Things that can't go on generally don't. If things don't make economic sense in this country, they tend to implode (unless you have high friends in our government to toss you some choice contracts.) It is interesting that medical school applications are up this year, but that may be due to a change in the application process which made it easier for students to apply to multiple medical schools. Perhaps the numbers may not be changing, as medicine is still a tube career, where if you put in the required number of years, you will be guaranteed to make an above average income. Nonetheless, if students look at medicine as see that they will be finishing school with $250,000 of debt, only to make $125,000 per year, I don't consider that a good deal and most students will figure that out and go to dental school.

I like medicine. I enjoy my job, but when I look at it from a college student's perspective, the numbers just don't add up. This becomes even more so If they knew what I know, that Medicare has it out for them. It really is amazing that our government will spend $700 to $800 per hour for lawyers to protect Senators and Presidents who commit unsavory behavior, but then they will pay me $60 per hour to administer anesthesia to a Medicare patient, or $1200 to a surgeon to do a radical prostatectomy, which when you consider that is a 90 day global fee, the urologist is getting about $100 an hour when you consider the 50% overhead, preop visit, the 3 hour surgery, rounding,and the post-op visit. The lack of respect is glaring.

It is going to be interesting to see how it plays out over the next 3 to 7 years. Either the number of people going into medicine is going to decrease, or physicians are going to throw off the chains of managed care and Medicare and become nonparticipating providers. The new generation of physicians might just do it.

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