The Glade 4.0

By the way, SG, I'm lttp on that Rant thread, but since it came up here, just wanted to express my sympathy/support re the lousy predicament you're in. Debates about the current health care reform package aside, I definitely agree that doctors' compensation levels are overly skewed toward procedures, resulting in patient-focused specialties getting shafted.

This is just anecdotal (ha!), but a good friend of mine is actually a PM&R doc as well. He's currently in the military, but according to him, in the civilian world PM&Rs can make really good money if they focus their practice on procedures (e.g. EMGs, nerve/joint injections, etc.), provided they work in a market where they can count on plenty of outside referrals. I'm sure that's not news to you, but if you can stomach becoming a procedure machine for a while, might be worth pursuing. Of course, my friend's plan when he goes civilian in a couple of years is to try building a practice that splits his time between patient consultation and procedural work, because he can't stand the idea of doing nothing but EMGs and injections for the rest of his life!

Yeah, I know, but I am personally unable to refrain from addressing such an obvious mistake.

It's part of the curse of being who I am. Sorta like my affection for humps. I'm a victim! Please send help!

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In time, this too shall pass.

This. How many of us have made wild claims in the past. Saying something like this and actually doing it are two completely different things. That doesn't mean we should go ahead with the policy, but half of doctors are not going to abandon the field. No way.

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Holy shitsnacks!

How many will stop seeing Medicare patients?

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"Dress cops up as soldiers, give them military equipment, train them in military tactics, tell them they’re fighting a ‘war,’ and the consequences are predictable." —Radley Balko

There are many who already have.

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Ezekiel 23:19-20 

That's hard to say, as it very much depends on the number of non-Medicare patients in a given market and what the effect of reform will be on the compensation rates for those patients. If non-Medicare patients are vastly more profitable for doctors, and there are enough of them in a given market to sustain a practice, then doctors will be inclined to drop the Medicare folks. On the other hand, if there aren't enough non-Medicare patients in a particular market, and reform narrows the gap between Medicare and non-Medicare compensation rates, then doctors will be more likely to treat both. I honestly don't know how it's all predicted to play out.

Also remember to factor in the fact that doctors have undergraduate degrees, and a fair number have graduate degrees.

Falling back to, say, a BS in chemical engineering is, at the moment, a very feasible financial argument.

Falling back to a BS or MS in biochemistry or chemistry is also a very real option, and with the added MD to the title, it's not that hard to secure a research based position at a pharmaceutical company.

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Darksiege: You are not a god damned vulcan homie.

RD, your analysis is a little short-sighted. It doesn't matter how many non-Medicare patients there are; if Medicare reimbursement rates cause treating Medicare patients to become unprofitable and unsustainable, doctors will be forced to stop treating Medicare patients.

Their success or feasibility at remaining in practice on non-Medicare patients alone, on the other hand, will do as you suggest, and dictate whether they drop only Medicare patients, or end their practicing alltogether.

In both situations, though, doctors will stop treating Medicare patients. Until the government compels them to and forces them to work, I suppose.

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"Aaaah! Emotions are weird!" - Amdee
"... Mirrorshades prevent the forces of normalcy from realizing that one is crazed and possibly dangerous. They are the symbol of the sun-staring visionary, the biker, the rocker, the policeman, and similar outlaws." - Bruce Sterling, preface to Mirrorshades

You folks are ignoring the real windfall here.

If doctors stop seeing Medicare patients
1) they stop billing for Medicare patients.
2) Medicare patients do not get health care.
3) Medicare patients start dying off earlier.

Endgame: The inhumane policy nets the Government many billions in unspent benefit payments.

Of course the medicare patients will now be able to be recruited to become terrorists because their country turned its back on them. What the heck, I'mma gonna die anyway, lets show the Middle Eastern terrorists they have no imagination, no depth of vision, lets take out the National Oil Reserves.

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The U. S. Constitution doesn't guarantee happiness, only the pursuit of it. You have to catch up with it yourself. B. Franklin

"A mind needs books like a sword needs a whetstone." -- Tyrion Lannister, A Game of Thrones

My honey works for a spinal/orthopedic surgeon. That specialization tends to draw an older group of patients. He is currently faced with the prospect of either laying off two of the girls in his employ or refusing medicare patients, as the 21% reduction in compensation that was already passed by congress makes the expense of treating them higher than the rate of compensation for many procedures.

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Ezekiel 23:19-20 

I don't see the average medicare patient being either A) competant or B) motivated enough to do that.

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"Hysterical children shrieking about right-wing anything need to go sit in the corner and be quiet while the adults are talking."

The average, no. The average Iraqi doesn't walk into a marketplace and blow themselves up either. Luckily for us, the average terrorist minded individual tends to trade their imagination in for blinders.

Imagine what could happen if there was a terrorist with the imagination of Michael Bay.

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The U. S. Constitution doesn't guarantee happiness, only the pursuit of it. You have to catch up with it yourself. B. Franklin

"A mind needs books like a sword needs a whetstone." -- Tyrion Lannister, A Game of Thrones

The problem with this analogy is that the average Iraqi means the average for the whole country, while the average medicare patient means the average for.. people on medicare which not only isn't the whole country but is also.. well.. mainly old people.

In other words, the demographics of the situation even before accounting for cultural differences, mean that a much smaller proportion of medicare patients would be willing and able to do those sorts of things.

Then there's the fact that "doctors not taking medicare" <> "My coiuntry just got WTFPWND by the U.S."... and the sheer absurdity of blowing yourself up because you're not getting medical care.

Ok.. problem solved. Now you don't need healthcare! NEXT!

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"Hysterical children shrieking about right-wing anything need to go sit in the corner and be quiet while the adults are talking."

Nor do the other people you just blew up...

BRILLIANT!!! We should encourage this.

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Holy shitsnacks!

Then, Democrats decide to fix the HUGE problem the Republicans caused by increasing taxes and instituting a single payer system.

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In time, this too shall pass.

Doctors, AARP support new health overhaul bill

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What we have here is a genuine Mexican stand-off.

Bill passes as is = doctor's retiring early or not going into the field at all, thus being unable to provide health care

Bill doesn't pass = staying where we are, with millions of Americans still not being able to afford their medical bills/procedures

Sam,

Everyone needs to understand that the AMA does NOT represent doctors. The majority of doctors do NOT belong to this organization. The AMA makes most of their money from selling ICD-9 and CPT code stuff to insurance companies and others, and little from dues from doctors.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

My understanding of the AMA is that its membership is made up of approximately half physicians, and half residents and med students. The physician membership is only about 15-20% of the population of practicing physicians.
Of course, the percentage of practicing doctors that were members was a major point against them, as far as the left was concerned, when the AMA was against Obama-care.

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"Dress cops up as soldiers, give them military equipment, train them in military tactics, tell them they’re fighting a ‘war,’ and the consequences are predictable." —Radley Balko

Please don't confuse medicare with medicaid.

Medicaid:Welfare as Medicare:Social Security

Why is that SG? That the majority of doctors aren't members I mean.

The short answer is that most doctors aren't members because most doctors don't think the AMA represents them. Or at least, this is what I gather from conversations with my sister (a radiation oncologist, FWIW).

Those doctors who are members of the AMA tend to mostly be very politically liberal east coast doctors (unless I've totally confused my organizations).

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Sail forth! steer for the deep waters only!
Reckless, O soul, exploring, I with thee, and thou with me;
For we are bound where mariner has not yet dared to go,
And we will risk the ship, ourselves and all.

Many physicians dropped membership in the AMA over the past ten to fifteen years because they do not represent doctors. We would say one thing and they would agree with others to do the exact opposite.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

For what it's worth, Dad isn't AMA anymore either. He still gets their research literature, but he isn't AMA.

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Grenade 3 Sports Drink. It's fire in the hole.. Your hole!