Global Fee

Picking the right specialty is Important

This country really faces a dilemma in its attitude towards healthcare.  Patients keep getting sicker, fatter, more complex, and more demanding, while doctors keep losing ground to managed care, Medicare, and Medicaid.  Most of us are too busy and too in debt to make much of a stand. 

Physicians are facing pressure from many different directions and it really amazes me.  I don't know how we got to be such as target, but we have.  It is interesting that people have not put together the facts that healthcare costs keep going up, but doctors' incomes slowly decline.

Mid-level providers are making their inroads just like  drug-eluting stents.  It will be interesting to see if they make the difference, both in terms of quality and cost savings that people think they will over the long-term.  I think mid-level providers serve an important role in healthcare, but I rarely hear an overhead page for "Mid-level provider to the ICU stat."  Or when somebody has cancer, do you hear, "I have this terrible cancer growing in my brain, I better call the nurse practitioner."  The question is not whether four years of medical school and another 3 to 9 years of additional training make a difference, but whether or not America values that training. 

As far as the future value of an MD degree, medical students and residents need to take a carefully look at the market and talk to many people about different specialties.  Unless you have low student debt, I really don't see how you can make it in this country as a primary care doctor.  The cost of living is just through the roof here. 

At the same time, other specialties have their issues.  I keep hearing people at my hospital talking about outsourcing radiology and even sending patients to India for elective total joints.  The problem is that India has a booming population and are there enough doctors in India to handle extra volume from the US?  With the falling dollar, is it still economically advantageous to send patients overseas?

Pick a good specialty like heme/onc, orthopedics, general surgery, pediatric anesthesia, gastroenterology, or invasive cardiology.  They are good bets to retain the value of your MD degree.  Also, take on as little debt as possible and think about business issues.  Strongly consider the fact that you will change jobs within 2 years of finishing training, so use that time to pay off debt, not accumulate huge mortgages and trinkets.

Doctors need to be financially responsible

Many physicians talk about getting the government or a some other third party to solve our economics woes.  Neither our government, nor an outside entity is going to rescue physicians from the economic problems. The key is to be independent and have enough money in the bank to float one's living expenses for 6 months so low paying insurance companies and Medicare/Medicaid can be dropped.

It is not easy for physicians to be fiscally responsible. Everybody tells us we're supposed to be rich and the constant delayed gratification makes it even worse. When most of us finish, we have mounds of debt and either have just started a family or are preparing to start one. Then, many doctors leverage themselves to the max with big houses, fancy cars, and other trinkets. Anybody who wants to see how not to handle their finances, check out this recent article from CNN Money.

What really needs to happen is physicians need to live modestly the first 2 or 3 years out of residency and save up some money and pay off debt. It is a very un-American idea, but it does work. During this time, physicians need to save up a legitimate 6 months of living expenses. At this point, if they are in private practice, they can start dropping low paying plans. It is hard to bargain from a position of weakness, which is the position in which most docs place themselves. I know way too many doctors who are 5-10 years out of training and have maxed out credit cards and no money in the bank.

During medical school and training, I kept my expenses low, mostly by living in cheap places and having roommates.  Yes, it was difficult, but I finished with only $60,000 of debt.  I lived in an average apartment and kept my same car from beginning of residency and paid off my debt in 10 months.   It was very satisfying.

Most dentists I know do exactly that. They work for somebody else for 2 or 3 years and save their money, then they start their own practice. They generally require payment at the time of service and regard insurance as the patient's insurance, not the doctor's insurance.

As far as care for the poor goes, hospitals can pay doctors an hourly or "by the case" rate for taking care of uninsured patients. It is already happening across the country. Let the hospitals collect whatever pittance Medicare throws them.

Fiscal responsibility is the key to solving our problems. Expecting anybody else to solve our problems will result in the same situation as welfare recipients waiting for the government to lift them out of poverty....it ain't gonna happen.