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Inflation=Physician Pay Cut

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  • #31
    Raise? That's a word I've never seen while in a long career in medicine. Would someone be polite enough to explain what this is in the English language?

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    • #32
      I certainly understand the above sentiment, but is anyone here who has worked for 10 years actually making less in nominal terms now than what they were making 10 years ago (assuming full-time work during the entire period). Finding someone like that is almost finding a unicorn. Sure everyone will tell you that they're working harder now, and I don't doubt this is the case for many. However, the reality is that no one outside of other docs is going to take any of this bellyaching seriously if pretty much everyone is making more money than they used to (whatever the reason may be).

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      • #33
        Originally posted by AR View Post
        I certainly understand the above sentiment, but is anyone here who has worked for 10 years actually making less in nominal terms now than what they were making 10 years ago (assuming full-time work during the entire period). Finding someone like that is almost finding a unicorn. Sure everyone will tell you that they're working harder now, and I don't doubt this is the case for many. However, the reality is that no one outside of other docs is going to take any of this bellyaching seriously if pretty much everyone is making more money than they used to (whatever the reason may be).
        Absolutely. Virtually every single physician that I know.

        Edit: Just did the calculation. 18% less/shift currently than about 10 years ago.

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        • #34
          Originally posted by Hawkeye225 View Post

          Absolutely. Virtually every single physician that I know.

          Edit: Just did the calculation. 18% less/shift currently than about 10 years ago.
          Interesting. I know zero. Maybe you folks aren't the unicorns I thought.

          The fact that you had to do a "calculation" tells me that you are not working the same number of shifts. Is that right? Are you working more now?

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          • #35
            Originally posted by AR View Post

            Interesting. I know zero. Maybe you folks aren't the unicorns I thought.

            The fact that you had to do a "calculation" tells me that you are not working the same number of shifts. Is that right? Are you working more now?
            That is correct. Working more days and making less/shift. Perhaps it's in part the part of the country we live in. Seriously though, I believe that there was one year when one of our contracts went up 1-2% but all others have gradually decreased.

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            • #36
              Originally posted by Hawkeye225 View Post

              That is correct. Working more days and making less/shift. Perhaps it's in part the part of the country we live in. Seriously though, I believe that there was one year when one of our contracts went up 1-2% but all others have gradually decreased.
              Ok, but how was your annual income in 2020 vs 2010. Was it higher in 2020 because of the increased amount of work that you did? Obviously, you were making fewer $/hr in 2020 vs 2010. That's clear.

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              • #37
                Originally posted by AR View Post

                In my experience, VA jobs are absolutely fantastic for the amount of work you are expected to do. I have a friend who does what I do. He makes about 35% of what I make (including value of benefits), but does about 20-25% of the work. So in a way he is getting paid more than I am. Of course in absolute terms there is no real way for him to make more than that within the VA system. So he moonlights outside the VA one day a week. He makes almost as much from moonlighting as he does from his full-time VA salary.
                I think it's specialty dependent. In psychiatry where I am, the VA pays the same or better as everywhere else in town. Workload in outpatient at the VA is very similar as outpatient at the university. I see slightly fewer patients per week but they are sicker so it evens out. I think in other specialties the VA workload is much less than what you'd see in the community.

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                • #38
                  Originally posted by AR View Post

                  Ok, but how was your annual income in 2020 vs 2010. Was it higher in 2020 because of the increased amount of work that you did? Obviously, you were making fewer $/hr in 2020 vs 2010. That's clear.
                  No. Overall 6% lower in 2020 (likely more than 6% next year) than 2010 income not factoring in the increased days worked.

                  To be clear, I am speaking of a full time partner's salary of which I was one for many years. I'm now part time as I finish up my career but I'm only referencing full parter's salary. I'm clarifying this since some here know that I'm part time now.

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                  • #39
                    Originally posted by Hawkeye225 View Post

                    No. Overall 6% lower in 2020 (likely more than 6% next year) than 2010 income not factoring in the increased days worked.

                    To be clear, I am speaking of a full time partner's salary of which I was one for many years. I'm now part time as I finish up my career but I'm only referencing full parter's salary. I'm clarifying this since some here know that I'm part time now.
                    Well based on above I don't think you personally qualify, I'm gonna have to take back the unicorn status. In my original post I was factoring increased days worked.

                    Sure everyone will tell you that they're working harder now, and I don't doubt this is the case for many.
                    But I'm a little confused about what you mean by "not factoring" and whether you are saying the 6% reduction is despite the increased work load. So maybe above is not disqualifying. Nevertheless, I also was limiting my claim to people who worked full-time during the entire period:

                    assuming full-time work during the entire period
                    It sounds like that in your case your $/hr rate has gone down between 2010 and 2020. That is very common. In fact, it has happened to most every doc I know, including myself. In my own case, I work a bit more and I am more efficient, so my total income was higher in 2020 than 2010.

                    Come to think of it 2020 to 2010 is really a terrible time period to use because of COVID. 2019 to 2009 would be better.

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                    • #40
                      Originally posted by Hawkeye225 View Post
                      Raise? That's a word I've never seen while in a long career in medicine. Would someone be polite enough to explain what this is in the English language?
                      “This is of course true, however with Medicare part A premiums increasing 6% and part B premiums and deductibles increasing 15%”
                      Your time is coming. Raise is defined as premiums increasing. Not to mention Part D, which is a completely different shell game.
                      A raise is defined as Medicare gives you some but takes more. Net result is a loss.
                      Just math.

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                      • #41
                        Originally posted by AR View Post

                        Well based on above I don't think you personally qualify, I'm gonna have to take back the unicorn status. In my original post I was factoring increased days worked.



                        But I'm a little confused about what you mean by "not factoring" and whether you are saying the 6% reduction is despite the increased work load. So maybe above is not disqualifying. Nevertheless, I also was limiting my claim to people who worked full-time during the entire period:



                        It sounds like that in your case your $/hr rate has gone down between 2010 and 2020. That is very common. In fact, it has happened to most every doc I know, including myself. In my own case, I work a bit more and I am more efficient, so my total income was higher in 2020 than 2010.

                        Come to think of it 2020 to 2010 is really a terrible time period to use because of COVID. 2019 to 2009 would be better.
                        The 70+ partners in my group qualified and I did until last year when I left the partnership and our salaries didn't move much at all last year. Bottom line is that we see more cases, work more days and make less/day compared to the peak of 10-12 years ago or somewhere in there. I'm not factoring in # of cases or days worked but only salary/shift and that is 18%% less/shift. When adding back the increased number of days worked, it is overall 6% less/yr. It is a clear decrease in income and doesn't even take into account the amount paid/case. So if one was able to add the increased case load in, the decrease would be >18%.

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                        • #42
                          It's hard to say with my particular job. I'm on a compensation based model so if the payers pay more I will ultimately get more. But I'm also in still kind of a buildup phase. I've been at my job for over 6 years but my panel continues to grow and the maximum I see in a typical day does not really go up but the average amount of patients I see per day seems to be increasing. I have less lightly scheduled days and more moderate to packed days. Also in primary care we get insurance incentives and ACO incentives based on attributed lives. And as I gain attributed lives I see these numbers increasing. They're also seems to be a delay and when they establish in when those come through.

                          Other than the period where my salary was based on the covid shutdown my salary has gone up consistently every quarter. I feel I must be reaching a plateau but I am quite happy where I am.

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                          • #43
                            Originally posted by wideopenspaces View Post

                            I think it's specialty dependent. In psychiatry where I am, the VA pays the same or better as everywhere else in town. Workload in outpatient at the VA is very similar as outpatient at the university. I see slightly fewer patients per week but they are sicker so it evens out. I think in other specialties the VA workload is much less than what you'd see in the community.
                            primary care at the VA I worked at sucked — tons of phone/message based work, tons of narcotics, dysfunctional system, chronic follow ups only with no acute care done in clinic, surgical specialties that would review the chart and refuse to see the patient as they were not surgical candidates. And the pay was maybe 10% less for the same overall workload. Much happier — even if not overjoyed - in a more traditional setting.

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                            • #44
                              Originally posted by AR View Post
                              I certainly understand the above sentiment, but is anyone here who has worked for 10 years actually making less in nominal terms now than what they were making 10 years ago (assuming full-time work during the entire period). Finding someone like that is almost finding a unicorn. Sure everyone will tell you that they're working harder now, and I don't doubt this is the case for many. However, the reality is that no one outside of other docs is going to take any of this bellyaching seriously if pretty much everyone is making more money than they used to (whatever the reason may be).
                              Agree. Psychiatry went from a median of $135 to $275 over the last fifteen to twenty years. I don't know many production based psychiatrists making less than $300k. The median work RVUs have gone way up due to changes in CMS and AMA code changes peaking in 2021 with the Patients over Paperwork act; the conversion factor has also gone up over the last two decades from about $32 to now around $65 in 2022 and I think it will be near $70 in 2023. 2020-22 are anomalies due to covid and the impact covid had on survey benchmarks but comparing my first year out of residency 2003 to 2023 the typical psychiatrist should see a 100-150% increase in total comp.

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                              • #45
                                Originally posted by gap55u View Post

                                primary care at the VA I worked at sucked — tons of phone/message based work, tons of narcotics, dysfunctional system, chronic follow ups only with no acute care done in clinic, surgical specialties that would review the chart and refuse to see the patient as they were not surgical candidates. And the pay was maybe 10% less for the same overall workload. Much happier — even if not overjoyed - in a more traditional setting.
                                Proceduralists go to the VA to retire. I know very few that are worth their already meager salary.

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