Tuesday, March 23, 2010

Tho$e Were The Day$

Can Medicare and insurance reimbursements possibly get much worse in this country? Of course it can. Listening to some older colleagues who have lived through previous government intervention into medicine, they think in five to ten years physician income will drop another 25%. They remember back before the early 1990's anesthesiologists were easily making $800k to $1 million working 40-50 hours per week. That was when gasoline was $1.25 per gallon and a nice house in Beverly Hills cost less than a million. Now most anesthesiologists work like dogs to make half that amount if they are lucky.

Even if there is no actual cut in reimbursement, the likelihood of our incomes keeping up with inflation is remote. While government service workers get annual cost of living adjustments to their paychecks, we consider ourselves lucky if Medicare just pays us the same amount every year. The AMA would declare victory if they can prevent the 21% slashing of Medicare reimbursements that is now due in October. But that is not exactly the same thing as receiving a cost of living inflation raise is it? If our income just holds steady for the next ten years, our inflation adjusted income will have dropped at least 25%, depending on the inflation rate in the next decade.

ObamaCare makes American medicine more and more like a losing proposition for our best and brightest students. Massive Medicare cuts to doctors and hospitals, millions more patients paying Medicaid rates, no medical malpractice reform in sight, and truly soul-breaking student loan debt at the end of residency will only drive our smartest kids away. Becoming a physician used to be an aspirational endeavor, and part of that is the high steady income doctors make. Let's face it, people hold high income earners in greater esteem than low income earners. Why do we idolize Bill Gates or Warren Buffett? They make a lot of money. Ask yourself, what has Warren Buffett done for you lately? Yet people consider him some sort of guru while the doctor who takes care of their sick children are derided on Angie's List.

I've wondered if there is a corollary between declining physician incomes and the increasing lack of respect shown by patients to their doctors. Eventually will patients see us as just another service worker paid to take care of their needs, like their local auto mechanic or cabinet installer? The day is coming when all these factors will stop innovative American medicine in its tracks and we'll all be just government drones clocking in at 8:00 and skedaddling to the parking lot by 4:00, regardless of how long the line is in the reception room. There will be no more incentive to work harder to make medicine one of the few success stories America has against the world.

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