I received this anonymous submission today from a pre-med college student looking to enter the medical field. What I can say is this. If you are interested in a primary care tract, think long and hard about your financial security and your quality of life and your expectations. The current financial formula for payment of your 11 years sweat and tears and does not encourage students like yourself to enter the primary/comprehensive care tracts. You will find very quickly, once you are a student, how everything works. You will, almost certainly, change your mind against going into comprehensive care as residency training nears. You would be in the majority. Recent surveys indicated only 2% of internal medicine students plan to do comprehensive care. And I wouldn't blame you for a moment. As for your brother, RN trained, making more than you, MD trained, it's not a possiblity. It's already a fact.
Think long and hard about comprehensive care. I personally would never do it. Ever. I wouldn't even consider it in the current payment model. It would have to double from current levels for me to even be open to the idea of even considering it.
Here is the submission from anonymous pre-med, unedited:
Dr. Happy, I'm a pre-med student who has shadowed and internist and psychiatrist extensively. From this perspective, I can see myself enjoying their jobs. I've been reading your blog for the past year now and enjoy doing so (its on my bookmark bar), but I'm becoming increasingly nervous about becoming a physician because of what you say, especially financially. I have the benefit of having a scholarship that covers my undergrad, and plan on attending my state medical school to lessen the cost there (I think I can graduate with less than 100k in debt). Even despite this, I'm wondering if you can give any advice to me and other pre-meds that are interesting but cautious about becoming a doctor in light of the ever increasing financial strain in the medical field. The doctors that I shadow have mixed feelings. Some say they would probably have done it differently while others say its still an excellent field. I know! I wont be rich and I'm okay with that, but I'm not going to lie and say I wouldn't be irritated if my brother ( studying to be a RN) was making more money than I will be while working less.
Anyone have advice for our future professional? Mine is avoid comprehensive care like the plague, unless you start to see changes in the payment model toward the end of your training. The current financial system highly rewards procedural based interventions and volume of services. It also rewards owning your own equipment. The depreciation of your assets in your business would provide excellent tax benefits. The use of your assets (doing procedures with equipment you own) provides incredible wealth incentives through the payment of facility fees in the current RVU model of payment. Look at the previous post about the gastroenterologist that gutted an empty building to build an endoscopy suite after learning how much money the hospital was making off him. These are the policies of the Medicare National Bank. It's free will economic incentives doing what they do in a capitalistic society. You get paid a bunch doing the procedure (profit center). You get paid a lot of bunches for owning the equipment ( a much bigger profit center). And the economic incentives are entirely driven by fixed formulas determined by hand shakin' and ass slappin' specialists who control the RUC committee.
The ass slappin' and hand shakin' will guide your decision making. I can assure you of that. I'll be waiting for your email in four years to tell me I'm right.
Think long and hard about comprehensive care. I personally would never do it. Ever. I wouldn't even consider it in the current payment model. It would have to double from current levels for me to even be open to the idea of even considering it.
Here is the submission from anonymous pre-med, unedited:
Dr. Happy, I'm a pre-med student who has shadowed and internist and psychiatrist extensively. From this perspective, I can see myself enjoying their jobs. I've been reading your blog for the past year now and enjoy doing so (its on my bookmark bar), but I'm becoming increasingly nervous about becoming a physician because of what you say, especially financially. I have the benefit of having a scholarship that covers my undergrad, and plan on attending my state medical school to lessen the cost there (I think I can graduate with less than 100k in debt). Even despite this, I'm wondering if you can give any advice to me and other pre-meds that are interesting but cautious about becoming a doctor in light of the ever increasing financial strain in the medical field. The doctors that I shadow have mixed feelings. Some say they would probably have done it differently while others say its still an excellent field. I know! I wont be rich and I'm okay with that, but I'm not going to lie and say I wouldn't be irritated if my brother ( studying to be a RN) was making more money than I will be while working less.
Anyone have advice for our future professional? Mine is avoid comprehensive care like the plague, unless you start to see changes in the payment model toward the end of your training. The current financial system highly rewards procedural based interventions and volume of services. It also rewards owning your own equipment. The depreciation of your assets in your business would provide excellent tax benefits. The use of your assets (doing procedures with equipment you own) provides incredible wealth incentives through the payment of facility fees in the current RVU model of payment. Look at the previous post about the gastroenterologist that gutted an empty building to build an endoscopy suite after learning how much money the hospital was making off him. These are the policies of the Medicare National Bank. It's free will economic incentives doing what they do in a capitalistic society. You get paid a bunch doing the procedure (profit center). You get paid a lot of bunches for owning the equipment ( a much bigger profit center). And the economic incentives are entirely driven by fixed formulas determined by hand shakin' and ass slappin' specialists who control the RUC committee.
The ass slappin' and hand shakin' will guide your decision making. I can assure you of that. I'll be waiting for your email in four years to tell me I'm right.
Primary care can be doable. You just need to be willing to undertake financial risk. Our country has been stupid and watered down the quality and safety of medical care. Why play the game where you are 'reimbursed' the same as some one with 1/4 your training? Buck the system and go direct access. There are people who recognize the value and training that a physician can provide. There is no reason we should suffer from the follies of CMS or nursing boards.
ReplyDeleteHere are some excellent resources:
http://impmo.org/
http://impmo.org/
Primary care is alive and well.
edit to the above:
ReplyDeletehttp://www.simpd.org/
I 'm 54 and just graduated for med shool. My friends and family laugh because I left a career (airline pilot) making more than I will ever make as a family practice doc (someday)....or as much as my CRNA wife makes.....but I think that it's worth the effort. Soemwhere, someday in a galaxy far, far away, people will realize that the MD is an essential part of their care; financial gain? don't go into medicine..........
ReplyDelete