Are Physician wages falling off a cliff

[Hatton]

[q-school]

if you compare it to hours spent, especially hours spent on EMR and other non clinical duties thrust upon us, sure.

for those of us who were in true private practice first, we spent a considerable amount of time, or at least i did, running practice operations.  those i no longer have to do.

the death star is about to change us from rvu based reimbursement to salary + tiny component productivity.  this will push off the effect of cot and e/m payments a little while.  i just have to keep limping along a few more years, and then i might start to think about slowing down.  you guys are a bad influence on me  

 

 

[AnotherSecondOpinion]

I foresee two possibilities down the road, (1) the supply/demand for physicians will tilt in the wrong direction so reimbursement will have to hold steady or increase to keep/attract physicians (most of us didn't sign up for the money, but we also didn't sign up to pay off student loans our whole career either) or (2) an increase in non-MD/DO health care providers (NP/PA/CRNA).

[hightower]

I think primary care is about to fall off a cliff (hospitialists included). NP's and PA's are going to be more numerous than actual docs in that field. Once hospital and corporate administrators realize they can hire a groupd of mostly mid levels for less than half the price of docs and just have one or two supervising docs around they will start getting rid of us very quickly. They have already done that with the creation of observation units in many places. Typically a team of 3-4 mid levels will admit and round on an entire floor of obs patients and one doc will be assigned to supervise their work. They just opened one at my old hospital.

That is why I'm working my ****************** off right now picking up as many shifts as possible and picking up different part time positions, paying off debt and then saving like crazy. I predict that in 5-10 years my job will be mostly obsolete. I hope I'm wrong but I'm not optimistic. I hope to be financially independent and living on a farm by then

Sub specialities are generally safe. Especially surgical fields. Doubt you'll see any decrease in pay woth all the money they will save from primary care being gone.

[Donnie]

The drop looks sharp, but there have been other drops in the past.  Also wages still increased or were at least flat according to the chart, so they didn't exactly plummet.

hightower wrote:

I think primary care is about to fall off a cliff (hospitialists included). NP’s and PA’s are going to be more numerous than actual docs in that field. Once hospital and corporate administrators realize they can hire a groupd of mostly mid levels for less than half the price of docs and just have one or two supervising docs around they will start getting rid of us very quickly. They have already done that with the creation of observation units in many places. Typically a team of 3-4 mid levels will admit and round on an entire floor of obs patients and one doc will be assigned to supervise their work. They just opened one at my old hospital.

That is why I’m working my ****************** off right now picking up as many shifts as possible and picking up different part time positions, paying off debt and then saving like crazy. I predict that in 5-10 years my job will be mostly obsolete. I hope I’m wrong but I’m not optimistic. I hope to be financially independent and living on a farm by then

Sub specialities are generally safe. Especially surgical fields. Doubt you’ll see any decrease in pay woth all the money they will save from primary care being gone.

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I think folks have generally been predicting rapid declines in doctor wages for decades.  Hasn't really happened yet.  Personally I am not sure it will in the near future.  I think it would take disruptive technology to really cause a shift like you are describing.  That said, I am with you on saving like crazy because you never know when the music will stop that prevents you from earning a high wage either from what you describe, personal / lifestyle / health issues, or something else.

[TheHappyPhilosopher]

I will take the opposite side of that bet. Physician salaries will remain stable and there will be plenty of jobs for primary care docs.

 

The physician workforce is aging (which means more physicians retiring), and so is our population (more demand for medical care).

 

I've been warned about the death of radiology for over 10 years now. It's like those guys on CNBC that are on every 6 months predicting the next great depression. Stop worrying about tiny red circles on graphs

[Stein]

I think it will be highly geographic, as medicine supply/demand always is. I would guess a tighter job market for PCPs in highly desirable areas (cities, coasts, etc) with plenty of jobs and opportunities in rural/underserved areas. Coming from an underserved area desperate for PCPs, it's funny to hear people discussing the possibility that MDs will be "out of work." Spend some time in the rural West, South, or Midwest or talk to a hospital/clinic administrator in those areas about how desperately they are recruiting fresh PCP grads, or just look online at the unreal job postings - huge sign-ons, huge loan repayment, moving reimbursement, great benefits, for all kinds of specialties, including FM, IM, EM. And of course subspecialists such as surgeons command absurd reimbursement packages when they are willing to move to the middle of nowhere and practice. I don't foresee a near-future scenario when MDs are out of work. People may need to be a bit more flexible in their role/location, however.

[jz]

----Over the decades, reimbursement has shifted from piecemeal tasks to supply/demand for ones skills.

----What happened in 1974?

----I suspect the drop in 2015 was due to HIGH deductibles. Are pts. paying their $6000 annual deductibles?

[Craigy]

hightower wrote:

That is why I’m working my ****************** off right now picking up as many shifts as possible and picking up different part time positions, paying off debt and then saving like crazy. I predict that in 5-10 years my job will be mostly obsolete. I hope I’m wrong but I’m not optimistic. I hope to be financially independent and living on a farm by then

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That's pretty gloomy and doomy as far as your psyche goes  :?  but a great way to live from a financial standpoint, even if things don't go south.   

[childay]

What data is this from?

[East coast]

Yikes, how come no one calls out hatton1 for posting a graph w zero input/commentary and most importantly context, especially from a source where you need a subscription?!

As far as I can tell all this is stating is that urban dwellers didn't spend a whole lot more on physician services than the year before (CPI-U = consumer price index for urban consumers?) That's hardly 'physician wages falling off a cliff' much less even wages going down.

[Hatton]

I simply posted this from the WSJ blog this morning.  It is called the Daily Shot.  It is just graphs with very little comment or explanation about various topics. I thought it was interesting.  East Coast are you calling me out about this.  Do I need to tell my husband?  BTW there was no commentary just the graph on the blog.

[Donnie]

hatton1 wrote:

I simply posted this from the WSJ blog this morning.  It is called the Daily Shot.  It is just graphs with very little comment or explanation about various topics. I thought it was interesting.  East Coast are you calling me out about this.  Do I need to tell my husband?  BTW there was no commentary just the graph on the blog.

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Watch out East Coast!  Her husband runs a trailer park from what I understand, so is undoubtedly tough :P

[East coast]

Haha, yes, nothing better than to receive veiled threats on an anonymous board.

To answer hatton1 directly - yes, ppl constantly call out Crixus for her/his troll posts (as they should), so felt this deserved to get at a minimum a call out.

Back on topic - how did you make the jump to 'wages' from the wsj post? There had to be some context for you to pull that particular word out from a graph showing consumer price index stats and I think that'd be helpful to the discussion.

[VagabondMD]

I am not seeing a cliff, rather a gradual squeeze down of reimbursement per unit of effort, which has been present for my entire career (21+ years). Some years the squeeze felt a little tighter than others, but the trend has been pervasive.

My observation will be difficult to show in graph format, but if you drop a frog in a pot of cool water and turn up the heat...