The fallout is already occurring.
I have had a half-dozen students that I advise tell me that they are dropping pre-med due to the One.  These aren't run-of-the-mill freshmen.  All of them are in their third year, and all of them could make med school and become fantastic physicians.  Two of them stated that they WANTED to have a rural practice.  

That opens their seats up to the next half-dozen that are "not quite the best".  Thanks, Dear Leader!

Not a big deal, there are still many times more med school applicants than seats.

Also, doctors should consider themselves lucky as shit that what happened to the lawyer field did not happen to doctors.  Namely, a bunch of T4 law schools flooding the market with applicants bringing down lawyer salaries to 40-60k for the ones lucky enough to get a job.  But doctors have their guild/union to thank for the artificial restrictions.  Fuck 'em, Obama should build a shit ton more medical school slots if he thinks it's a permanent shift, and allow immigration of qualified doctors from overseas to meet any baby-boomber "surge"

And the public's desire for "affordable healthcare for all" will end when they realize  qualified physicians don't grow on trees either.

I have a friend who is a nasal surgeon, he's in his early 40's makes $500k a year and has been doing so for the last 15 years. There is no reason he has to work any more.

-JTP

Future of the OBAMA health care plan.

Attorneys who did well in school have no problem acquiring a well paying job.  Sorry, I don't want a shitty lawyer representing me, and I sure as hell don't want shitty doctors working on me.  If a foreign doctor can pass USMLE part 1, 2, and 3 and then completes a residency/fellowship, then fine.  Otherwise, no thanks.

Um yes they do have a hard time finding a well-paying job.  Even attorneys with years of solid experience and credentials are getting washed out.  The market for lawyers is realizing there is no reason to pay 350 per hour for someone just out of law school, or multiples of that for a partner-level position.

Also, it's hilarious you think that foreign doctors are inferior when the biggest area of medical tourism has involved going to Singapore/Asia to get work done.  In Singapore, medical costs are much lower, and doctors/hospitals advertise prices up front, which is illegal in the US from what I understand (thanks AMA).

Exactly. See quality go down. Also, yet another post out of our resident socialist's area of knowlege. We do have manyforeign physicians coming over here. The "artificial barriers" that are placed in their way is called qualifications. Most have to re-train and re-test to qualify to work here. Do you want to lower the standards to increase the number of bodies in the profession?

From Atlas Shrugged, Ayn Rand foresaw this 52 years ago:

“I quit when medicine was placed under State control some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but ‘to serve.’ That a man’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.”

ETA: I didn't read the OP carefully enough.  Looks like that author already drew the connection.

The is no guild/union. The AMA represents less than 20% of physicians.
You haven't the faintest clue.

Actually they will quit.    

Medicine has changed a lot in the last 20 or 30 years.   Reimbursements have gone way down, costs have gone up.   20 Years ago, a Podiatrist (using my field) could bill $2000 for a Bunion surgery and get paid that much.   Same surgery now goes for $200 (Medicaid)––$550 (Medicare)––$700(Private Insurance).   The guys that have been doing it for 25+ years (...call it 30 y.o. when they got out of Med School...so 55+ Y.O. now) ALWAYS complain about the reimbursements.   They will often own their own building (and the practice rents it from them).    

They could easily quit and live on their "retirement" (even with the stock market problems), the rent from their properties, etc.

AFARR

Wife and I recently had a baby. Since her labor and delivery went very well, we spent most of the time talking to the OB, the nurses, and our Anesthesiologist about obama care.

Nurses: A few would quit, but most we talked to just hated the idea because they knew they'd lose all the good doctors.

Our OB: Been practicing for about 12 years. He said he'd be screwed, as medicare patients already eat a lot of his profits. He said he'd try to go to only private (no insurance), or try to retire early.

Our Anesthesiologist: He's older, been practicing for almost 40 years. He said he'd quit the next day, which would suck. He was an EXCELLENT doctor.

My brother works as a ER doc in detroit. He still has one year left of residency, then $300,000+ of student loans to pay off. He's pissed, and worried that he'll never be able to pay off his loan and provide the life for his family that they had expected.

MOST of the doctors I've talked to are very worried. Most that are older, are planning on leaving. Granted, Utah is very conservative so it's a little different, but still.


ETA:


I was pre-med. Still might do it, but I'm really starting to lean away from it. IF I stay in the medical profession route, I'll probably do PA since there's not as much $$ that's invested into a career I may not want to do anymore. I'm not the only one either. I graduate next semester, so my major counselor asked if I was still planning on medical school. I told her that it was unlikely that I would with the threat of socialized health care. She told me that she has heard that from hundreds of students in my program (microbiology) since obama was elected. Of the 3 people I'm good friends with who could go to medical school (good enough grades, strong applicants), only one still is. The other two said screw it, and I'm very close to saying the same thing.

He's completely FOS, as usual.

Google "Canada medical school shortage"

Has VERY little to do with the AMA, etc.    Med Schools don't open because they are VERY expensive to run.   Look at what a Law School costs to open (and they get in tuition) vs. what a Med School costs to open.  


Here's a quick search:



Here's a quote on a Law School that recently opened:


In another quick search....Law School Tuition runs about $20k (there are some much lower, but most are around that figure).   Med School (Public) is about $20k (varies, but around that range––private is about $30 to 40K).  

Now, if you can build a Law School, staff it with local lawyers, use a few class rooms and a few dedicated rooms (courtrooms, etc.) vs. a Med School (Classrooms, specialized Cadaver labs..and the Cadavers ain't cheap, regular labs, clinic rooms, etc.) that costs considerably more to build and maintain (not to mention pay the local Physicians enough to make the time to teach some classes)...which would you choose...since you get the same tuition for each...

There's a reason there were 19k Med School (+ some Osteopath and Podiatric..total is still well under 23k) graduates last year vs. 48K Law School Grads..and it wasn't the AMA (or APMA, or AOA) holding the numbers back.

AFARR

I have no problem with this....as long as they can speak clear English.   I've know some brilliant doctors from foreign countries...yet you couldn't understand them worth a damn when they were speaking.    (Their written reports were very, very good).

AFARR

I am going to Galt Gulch for my health care....

And then they would do what - dig ditches for 120K, go into real estate?  Its not like they have a skill set that will convert to other occupations.  Whatever - It takes an above average person to take a cut in the quality of life and the style of life on principle alone.  I will believe it when I see it.

They have already thought of this.  It will be unlawful to pay for medical treatment under some of the plans being floated about.  The gubernit will even have access to bank accounts and credit card transactions......making sure nobody is paying.  Cause dats racist.

Their salaries will be plateaued out in months and gradually lowered as will be virtually everyones income in the medical field.  

The ones who are planning on quitting are the ones who have been in the field for years. They have no debt, and lots of $$. They will retire. IF my brother is able to make the average salary for an ER doctor in a medium sized town, he said he could be debt free, have a nice house, and over 1M in the bank within 10 years of finishing residency. Think of the doctors who have been working for 30+ years, also keeping in mind that they only paid 20K for med school, not 200-300K. They don't need to work, they do because it's what they love, and they're just getting richer every day.

Also, there are many options for doctors who no longer want to practice. You can be a professional witness for trials, teach (most good universities pay over 100K/year for their teachers), do research, write medical school books etc.

There is a fallacy that you see in management, that young cheap workers are "better" than the older more expensive ones.



In policing, that was seen in the NYPD, their average length in service dropped to something like 3-4 years, and they ended up with lots of problems with corruption, bad shootings, mangled investigations etc. The departments where the average length in service is 20 years +, don't have those problems.





In Software Engineering, I had senior managers tell me that I shouldn't hire "old guys" but get a bunch of cheap kids straight out of university.

I resisted this, brought in some "old guys" first, then added the younger folks. Old guys know stuff and get stuff done. They are much more productive.They teach the younger ones how to be productive and not screw up.



You will see  the same thing with doctors. When lots of the doctors with 15+ years experience retire, the average experience level will drop dramatically, and the average cost per doctor will drop, but problems with malpractice will increase a lot, and overall costs will climb.

yea they will quit, and flush that education down the toilet and work at micky D's

Its a bluff and bullshit.
And even if they do quit, a new field of doctors will crop up willing to work for less.
THe countys will pay for a doctors education and requir them to give so many years back etc..
THey wont do it when the bullet hits the meat
Money talks bullshit walks

No offense but a few of you don't know what you're talking about.  

Hopefully some current physicians will come along to give their perspective and help explain to some of the people on here why it is realistic that many doctors would quit their current practice or retire early.  I'll try to explain it as best I can as a pre-med college senior who has been around the medical field for years and has a family member who is a physician.  I'm going to try not to repeat the figures that have already been cited on this thread or get too detailed but here is what I have learned from talking to many doctors and looking at the data out there.

The current medical system has been paying doctors, especially those in speciality fields, less and less over the last few decades.  Many doctors are getting paid substantially less for the things they do compared to the 1980's.  The bunion operation that was mentioned in a post before mine is an example of this.  The are many more examples of these across all specialities of medicine.  Not only are they getting paid less, but that doesn't even account for inflation.  Your cardiologist is getting less in 2009 dollars to save your life by doing angioplasty if you have a heart attack than he was paid in the 1980's using 1980's dollars for doing the same thing.  It has gotten to the point that many doctors can make very little on treating medicare patients and some others.  Many specialists actually lose money on office visits after their practice costs are accounted for.  

Furthermore, malpractice insurance has skyrocketed.  While the rates for lower risk specialties, such as family practice, might "only" be $10K or $20K, insurance costs can reach over $100K a year for some surgical specialties in some parts of the country.  This is driving up the cost of healthcare to the consumer and driving doctors out of medicine.

Not every doctor makes 200-300 thousand a year.  Peds and family practice can make in the low 100's in many parts of the country before taxes.  So take away about 50% of what it says the salary is for taxes and make sure to take out the tens of thousands for malpractice insurance and you now have some doctors taking home less than 70K a year.  Now I'm not saying thats a horrible salary but its not what everyone thinks doctors make.  

Many of the top specialties are experiencing a shortage of doctors and/or are about to in the next 5-10 years.  Many of the old doctors were around for the hayday of medicine, as far as pay and respect is concerned.  They don't really need the money but enjoy practicing medicine.  Most are very financially secure.  They are the ones who will retire if Obama passes his health care.  So we will lose many of the most qualified doctors from the fields experiencing the worst shortages with replacements taking 12 years to come through the pipeline after graduating college for many of these specialties.  Many of the ones who will stay will do so to pay off their debts and then some of them will move on.  Qualified students will be less likely to apply to medical school and less willing to take on the massive debt and time commitment to enter the complex specialties.  So we'll continue to see a massive shortage of doctors in some specialties for decades to come.  The ones that come out will likely not be as good on average because medical schools will have to accept lower quality students due to the increasing demand for doctors combined with the decreasing interest in the medical field due to increased regulation and lower salaries.  


Another consideration to think about is the MASSIVE financial sacrifice people have to make to become a doctor in this day in age(yes I said MASSIVE financial sacrifice).  Think about this for a second.  To become a doctor, you have to

-attend 4 years of undergraduate studies at a university(age 18-22).  Cost anywhere from $0 for those on scholorships to $200,000 for a private university
-attend 4 years of medical school(age 22-26).  Cost anywhere from $0(however full scholorships for med school are rare) to $300,000 for a private medical school
-3 years of residency(age 26-29).  You get paid during this time but you often work 6 days a week or more,have a 80 hour work week, and get paid about $39,000 a year.  That works out to just under $10 an hour pretax.  So now you're making about as much as an assistant manager at your local gas station and still have massive debt.

So now you are 29 and finished up with residency.  However, most specialities require another 1-8 years of fellowship training.  For example, to be a regular cardiologist who doesn't do surgery or any operations, its another 3 years.  If you want to be a cardiologist who does the operations too, such as angioplasty and stents , its another 1-2 years after that.  If you want to be able to put in pacemakers and heart defibrillator implants like Dick Cheney has, thats another 1 year or so.  To summarize this, by the time doctors are 30, the first ones are just finishing up training and getting out into the workplace.  Depending on the speciality, you might not be done until you are 35 or older.  

So lets compare that 32 year old new doctor to others in the workforce or other college graduates.  For the last 10-14 years, their peers have been working, earning money, and not taking on hundreds of thousands of dollars in debt.  They should already have nice nest eggs building up and probably bought a home.  Now you have to spend the next few years paying off that massive debt from college and medical school.  At the same time, you're getting paid less and less for the services you perform and your insurance rates and going up every year.  So by the time you are reaching your upper 30's and maybe into your 40's, you are finally debt free and can start saving money for your kids college, your retirement and other things.  By now you have given up 15-20 years of your employment life and you're net worth is not much higher than a 19 year old that has worked for a year at wal-mart.  

Granted, from this point on you should be making a good income.  However, unless you plan on working past 60, you only have about 20 years of work left.  Furthermore, lets hope that you didn't change your mind partway through this journey, become disabled somehow, or flunk out and end up with $200,000 of debt with no large future salary to pay it off.


Thread/

ehunter:

How LONG do you think it takes to make a Doctor?   I'm 3 years out of Podiatry School and Residency (7 years there already), and I still farm stuff out to other guys who have done a lot more of it than I have.     That's like saying "oh, the Air Traffic Controllers won't go on strike", or "oh, the UAW won't drive the car makers bankrupt", or "oh, the Iranians won't build a nuke if we negotiate fairly with them".     I know of more than a few guys that have good solid investments that have been in the field 20+ years that would walk away from the hassles.

AFARR

I don't doubt that over time the medical profession will become a wasteland.  But it won't happen overnight despite threats to quit.  Some doctors will retire early, some find commercial jobs, etc.  But the real effect won't be until much later when A students stop going into the profession.

That stopped being true several years ago.  I went to a top 10 liberal arts college, top 10 law school, was in the top 1/2 of my law school class, worked for a big firm for five year, and cannot find shit.  Laid off six months now.  

I thought about quiting 3 times today, and that was before I made it to work.  Doesn't mean its going to happen.

Maybe some will quit, but I can't imagine 45% of doctors just quiting all at once if mandated health care gets forced on us.

You are correct, 45% of doctors will not just quit all at once.  However, I would guess that at least 10% of doctors would be gone with a year of obamacare, mainly the ones don't need the money.  I would guess another 30% or more would end up retiring earlier than they otherwise would.  We are already experiencing shortages in some specialties with these shortages expected to get more severe as the old baby boomer doctors retire without enough replacements in the 12-18 year pipeline.  If we lost just 5% of doctors across the board, this would cause massive shortages of doctors.  Combine that with the 47,000,000 new patients added by obama care and now you have a 3 month waiting list to see your regular doctor and 18 months to get that operation.  The remaining doctors will be overworked, trying to provide the best care they can.  The burnout rate will increase, further decreasing the number of doctors.

That's ok, because the state run system will only hire state trained and certified docs that come out of state approved (and funded) programs!

If you think health care is bad now (I don't, but...) then just wait until the *full* end-to-end, education to grave .gov solution comes into play.  "I'm sorry comrade, but it can't be malpractice, because your doctor was trained, certified, and employed by the state and the state doesn't make mistakes, and you didn't need that extra kidney anyway."

As I said before, if Obamacare comes to pass, I'll forget about going to med school.  If I'm going to suck on the government's teat, I'm certainly not going to go into debt to do it.  The Army has a great PA program that I'm eligible to apply for right now.  The only reason I haven't is because I'd like to become a doctor instead.  If I went the PA route, I could retire at 45 years of age.  If I go the MD route, I'll be working much longer.  I know I'd rather become a doctor than a PA despite the hardships it entails, but I simply cannot stomach the thought of sacrificing so much only to work for a broken system.

Let them go to work for a while, they will be right back.

exactly.

Well they overcharge enough already they can afford to quit.

What do you think the AMA is?   It's a union created by doctors and sponsored by the government to keep down the number of doctors eligible to practice,  through licensing requirements.
It artificially affects supply and demand in the medical field to keep prices up.   You never hear about that, do you.

I don't think everyone realizes how close most doctors are to quiting already due to everything that has changed in medicine so far. (declining reimbursements, massive paperwork, weasels/lawyers, less time with patients, patients who just want to sue, HIV/ hepatitis risks, ETC, ETC)

ObaminationCare is going to be not just the straw that breaks the camels back, but a 10-ton lead pipe.

Good luck when your medical care is deliver by the bottom half of the class instead of the top half.

Medicine isnt like McDonalds where any idiot can hand out burgers. (apologies to McDonald's workers this offends)

I'm already making alternate plans if this passes and almost every other doc I know is starting to think seriously about it as well.

It was to be banned under the proposed HillaryCare in the 1990s.

Medicare is a large portion of what's wrong with our medical system.

The government randomly dictates what it should cost to perform procedures, and doesn't allow doctors to charge less than this amount to non-Medicare patients.  To make ends meet, doctors must charge multiples of Medicare to other patients (2x or 3x...).  They then make deals with insurance companies to only charge them a little over the Medicare price (ex. 115% of Medicare).

What this means is that doctors lose money for every Medicare patient they take, and end up charging those without insurance the highest fees.

Doctors see that Medicare is the problem, and making it larger will make the problem worse.

Bull S#!^.  They said they would take early retirement so they have already fleece the system far enough to fund their lifestyle until death. Its all crap next time you go to a doctor ask for an itemized bill of procedures being billed to your insurance companies. They are worse than car sales men and the documentation fee and transfer of information fee and stuff they never even did. They like things exactly where they are because they are making out while we have to pay  such high cost to insurance companies. Most feel so strongly about the health care debate but never ever took the time to reada proposal or investigate what the claims for and against it are. My grandfather said his country is now filled with lemmings who follow that ever the Zenith tells them too ( never had the heart to tell him Zenith doensnt make anything anymore) . I am beginning to believe he was right.

Thou speakest the truth...all need to take heed, especially the slack-jawed ones out there that think doctors overcharge....

Of course, all of this will make no difference to the moochers out there and their looting politicians...

Here's a tidbit question: can we have a list of the other 29% so those of us looking for smart doctors can avoid them.

A good number of them won't retire..the best will band together, find a investor or two, and build a top notch medical treatment center...in the Bahamas or somewhere like that close to US that has no .gov health care. They will then offer their service for $$ only.

Want to see how fast the waiting list to get in goes to 1+ years?

.gov health care is going to kill our dominace of the Medical field.

You do not need to be fucking Nostradamus to figure this out.  This "problem" already been worked-out in England.  A ridiculous percentage of doc's are from India, Pakistan, Iran, and Russia.  I am sure OUR new doctors will be very fluent in Spanish.  Welcome to the future.........Comrade.

You know why they charge so much and "fleece" the system? They get less than HALF of what they charge from insurance co/medicare. You do realize that all the equipment/pay of trained staff/insane malepractice insurance/etc has to be paid for by someone right?

I bet if I needed my finger stitched(non-major injury..like a bad knife cut when cooking in the kitchen) and called a local doctor telling him I was paying him then and there, I bet I could get it done for less than $300. If I walk in to a ER, it is over $1000..why? See statment above.

Alright guys, I know I haven't posted a lot on these forums, but I'm a longtime lurker and feel the need now to chime in.

A lot of people seem to think that there will always be a crop of young people willing to become MD's even as stress and demands increase and pay potentially decreases.  

I'll tell a bit about myself: I busted my ass in college.  I had around a 3.75 (science more like 3.85) gpa.  2 of my closest college friends had one A- their entire college career.  In 4 years both of these guys triple majored in math, chem, and biology.  On Friday nights, you'd find them in the library.  Same thing on Sat.  These guys were not just naturally gifted, they worked damn hard.  Worked hard for years.  

A group of 4 of us all took the MCAT...which is the most grueling mental test that I've ever seen.  I've taken the DAT (dental test) also, and will tell you that the MCAT blows it out of the water.  When I finished it felt like I was almost drunk, I was that mentally drained.  Anyways all of us did well.  Some background on the test: 45 is the top score, although a 40 is still the 99.9 percentile.  My friends got a 37, 35, 35 and I got 33.  The average score for the entering med student that year in MN was a 30.  The standard deviation is around 2.  

Two of my buddies are in their second year of a path residency (5 years total) and the other is doing ophthalmology.   I've been predicting this sort of socialized medicine for a long time...so 6 years ago, I decided that I would go to dental school instead of med school.  

My point is: if you want the best people looking at your tissue, screening it for cancer...etc, don't take away the reward at the end of the long hard tunnel.  All of us could have gone into computer science, or banking, but instead we all chose some area of medicine.  

If Obama manages to push this thing through, and starts capping pay for docs, he's going to lose the next generation of the brightest and hardest working.  God only knows who we will get to replace them.  It won't happen overnight, but it WILL happen.  We don't want to repeat what happened in Germany: their best docs get trained and then leave to go to either the UK or the US...then Germany has to replace them with Turkish docs (this info first hand from a 4th year med student in Berlin-I told to come live in the states, she's smoking hot).  No offense, but I won't be surprised if I go sometime into the ER and some Mexican doc comes up and speaks Spanish to me.

"Fleecing the system"?
"Make them work for a living"?

Some of you so-called Capitalists need to take a good long look in the mirror, as it appears you have been chugging the Class-Envy Kool-Aid.

Many, not all,  will quit because they won't make the money in medicine than that they do now, so they won't be necessarily looking for the salary range you specified.



Obama said the same thing about the Wall street brokers and bankers that actually made money.  They all moved to other firms without salary caps.



Doctor's have brains and talent and that gives them choices.  They don't have to do what you or obama say they do.





 

That's enough.  



 

I have always found older workers are crucially important.  A degree just opens the door, brains learn from experience.  Engineers, doctors, etc. learn most of what they know by experience.





 

What? Plenty of great doctors support this.