Inflation=Physician Pay Cut

[AR]

When I was at the university we got no cola ever. At the VA we get them yearly plus you get these step increases every 2 years that are like a bigger increase on top of that, like maybe 1.5%? And supposedly we will get like a 25k increase this year but that remains to be seen. Overall the VA does a much better job with compensation than the university.

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.

[wideopenspaces]

When I was at the university we got no cola ever. At the VA we get them yearly plus you get these step increases every 2 years that are like a bigger increase on top of that, like maybe 1.5%? And supposedly we will get like a 25k increase this year but that remains to be seen. Overall the VA does a much better job with compensation than the university.

[Hoopoe]

You have a hospital contract, right?

Contract to allow us to work the ER. Stipend is negligible, mainly to cover some admin meetings. The rest is based on collections from patient care.

[ENT Doc]

Despite no conversion factor increases for inflation hourly compensation for emergency medicine has gone up significantly in the last few years. A portion of that has been increased efficiency (ie adding midlevel providers and more patients/MD provider/hr) but improved collections per patient is also a large driver of that. My hourly wage has gone up by 22% in the past 4 years since I was first hired in 2017. I suspect that this won't last but hope that at least salary holds on for a little bit. I'm in a private SDG group though, doubt salaried position would have increased this much.

You have a hospital contract, right?

[Hoopoe]

Despite no conversion factor increases for inflation hourly compensation for emergency medicine has gone up significantly in the last few years. A portion of that has been increased efficiency (ie adding midlevel providers and more patients/MD provider/hr) but improved collections per patient is also a large driver of that. My hourly wage has gone up by 22% in the past 4 years since I was first hired in 2017. I suspect that this won't last but hope that at least salary holds on for a little bit. I'm in a private SDG group though, doubt salaried position would have increased this much.

[CordMcNally]

Edited to add: we have a compensation adjustment. When I was hired, admin told me it’s pegged to inflation. Before COVID, it was 3%. For the last two years it has been 1%.

It sounds like the Fed is your admin. Try to downplay or even ignore inflation.

[ObgynMD]

This is why I appreciate WCI and this forum so much. I am an early career physician and I’m not blind. Between the EMR, the multi-level admin structure, RVU based reimbursement, insurance companies squeezing corporate hospital systems now…the future does not look rosy. I want to be FI so I have a chance to practice medicine my way. We all need to be FI or we will could be burnt to a crisp running the rat race.

Edited to add: we have a compensation adjustment. When I was hired, admin told me it’s pegged to inflation. Before COVID, it was 3%. For the last two years it has been 1%.

[CordMcNally]

I don’t disagree with this at all. It’s easy to not pay physicians more.

And maybe increasing the conversion factor wouldn’t get passed on to employed physicians anyway and the hospital administrators will simply get bigger bonuses. However in private practice it’s a big deal. If small increases would have even been half inflation, my partners and I would make up to 30% more money for the same work.

People (public and politicians) complain about fee for service because it incentivizes physicians to see more people and do more procedures, ie spend less time on each patient, but we’re making less money for the work we do every year. So it’s absolutely the natural progression to try to do more work in the same amount of time just to maintain income. I know everyone on this forum knows this, I guess I’m just venting. In 20 years, if the system exists like it does, and Medicare is still paying $35/wRVU, it’ll be hard to continue to do what a lot of us do.

I think you're 100% correct about it likely not flowing down to physicians if the conversion factor increased. If a physician or group has that money go directly into their bank account or if a compensation structure is based off collections then obviously it would be different but I would guess most physicians aren't in that scenario. 20 years would put me at 55 and I would hope I'm out of medicine unless I'm truly just working for esses & gees.

[abds]

Most physicians don't control their own purse strings and not giving rich doctors raises is easy to do. The general public doesn't view hospital administrators as rich although many decent-sized hospital administrators make more than some/many physicians. Most nursing administration jobs may not be on par with physician compensation but the amount of work per dollar that gets done is minimal. But again, it's easy to give these white coat administration 'heroes' raises and let them continue in a cush role.

I don’t disagree with this at all. It’s easy to not pay physicians more.

And maybe increasing the conversion factor wouldn’t get passed on to employed physicians anyway and the hospital administrators will simply get bigger bonuses. However in private practice it’s a big deal. If small increases would have even been half inflation, my partners and I would make up to 30% more money for the same work.

People (public and politicians) complain about fee for service because it incentivizes physicians to see more people and do more procedures, ie spend less time on each patient, but we’re making less money for the work we do every year. So it’s absolutely the natural progression to try to do more work in the same amount of time just to maintain income. I know everyone on this forum knows this, I guess I’m just venting. In 20 years, if the system exists like it does, and Medicare is still paying $35/wRVU, it’ll be hard to continue to do what a lot of us do.

[Tim]

With the incredible job market right now many people should be able to switch to a higher paying job right now that keeps up with or surpasses inflation (at least my relatives in tech certainly have). That being said, employed doctors might consider this strategy as well.

The contracts for physicians are much more akin to employment contracts for C-suite executives than the normal employed individuals. The vast majority of employees do not even have a contract that has a required notice of resignation period.
The policies and pandemic have seemed to create an environment for upward wage pressures. Seems to be cyclical. The energy industry for example is not participating.
Feel free to assume that that the wage opportunities are NOT transient. I personally feel like these opportunities will be transient. Policy proposals are already on the table,
unlimited import for work visas etc. I agree with the "right now" description of the job market for segments. Just don't count on it lasting.

[CordMcNally]

This is of course true, however with Medicare part A premiums increasing 6% and part B premiums and deductibles increasing 15%, which the federal government is blaming partially on inflation/increased cost of care (and partially on increased utilization), the question remains where that money is going? I assure you there are plenty of high-earning administrators at hospitals and nursing facilities that are getting cost of living raises. The fact that conversion rates have remained stable for the past 20 years while Medicare premiums have risen and inflation totals something like 60%, is obscene.

Obviously we need a better lobby. Perhaps all these physician bloggers can divert some of their side-gig attention that way.

Most physicians don't control their own purse strings and not giving rich doctors raises is easy to do. The general public doesn't view hospital administrators as rich although many decent-sized hospital administrators make more than some/many physicians. Most nursing administration jobs may not be on par with physician compensation but the amount of work per dollar that gets done is minimal. But again, it's easy to give these white coat administration 'heroes' raises and let them continue in a cush role.

[abds]

It's difficult to give those with high income inflation adjusted raises, especially physicians. There's always pressure to lower reimbursement and adjusting physician wages strictly on inflation can really wreck a budget.

This is of course true, however with Medicare part A premiums increasing 6% and part B premiums and deductibles increasing 15%, which the federal government is blaming partially on inflation/increased cost of care (and partially on increased utilization), the question remains where that money is going? I assure you there are plenty of high-earning administrators at hospitals and nursing facilities that are getting cost of living raises. The fact that conversion rates have remained stable for the past 20 years while Medicare premiums have risen and inflation totals something like 60%, is obscene.

Obviously we need a better lobby. Perhaps all these physician bloggers can divert some of their side-gig attention that way.

[ENT Doc]

ENT doc, Sorry for my ignorance, what is the conversion factor in the graph? ACS = American College of Surgeons?

It’s the CF applied to the end of the physician fee schedule formula.

Yes, ACS = American College of Surgeons

[HikingDO]

Hello,
just curious how many of y’all are getting raises to offset inflation?

I’m going to show this post to my employers and see how long it takes them to laugh.

[Dusn]

why limit this to physicians? inflation=paycut for everyone

With the incredible job market right now many people should be able to switch to a higher paying job right now that keeps up with or surpasses inflation (at least my relatives in tech certainly have). That being said, employed doctors might consider this strategy as well.