quote Originally posted by jaskispyder: Time to tighten the belts... the cash cow is going away.

In southern Oregon where my parents and grandmother live, do you know how doctors are tightening the belt? They are refusing to take on any new Medicare/Medicade patients. Anyone that is on any kind of government healthcare has to get on long waiting lists to get a primary care doctor or get a doctor in the next town over and drive 90 minutes to get seen. The result is that my grandfather who was on Tricare (military retirement healthcare) had to drive 90 minutes to get seen by a doctor.

That is happening today. It will only get worse as more and more of Obamacare is phased in.

quote Originally posted by Formula88: Government mandated reimbursement levels are not "the economy," which is surprising to you, I bet.

yes, it is the economy.

quote Originally posted by theBDub: A doctor should be able to charge whatever he or she wants for a service. It's up to us to decide if the price is "worth it".

That won't COMPLETELY work due to some doctors having training and expertise that is rare enough that there aren't enough other options for people to go to.

quote Originally posted by Doug85GT: In southern Oregon where my parents and grandmother live, do you know how doctors are tightening the belt? They are refusing to take on any new Medicare/Medicade patients. Anyone that is on any kind of government healthcare has to get on long waiting lists to get a primary care doctor or get a doctor in the next town over and drive 90 minutes to get seen. The result is that my grandfather who was on Tricare (military retirement healthcare) had to drive 90 minutes to get seen by a doctor. That is happening today. It will only get worse as more and more of Obamacare is phased in.

We are in for a change, good or bad, right or wrong. Do you feel the doctors are getting the raw end of this, as the article portrays?

quote Originally posted by jaskispyder: Become a doctor for the money or for the love of the job?

As in MANY jobs, why does it have to be one or the other? Since when is that automatically a bad thing?

quote Originally posted by jaskispyder: The future is not written in stone, but keep thinking it, as that is all you can see.... those poor doctors.... oh no, what will we ever do. Quick maybe we should have "doc-aid" and raise money for them and their plight.

I've never suggested that, and I've never expressed concern for the doctors. If you bothered to actually READ my posts instead of just quote them to post your next argument you'd notice I've stated I'm quite confident they'll do just fine. They may retire or move into other fields, but they'll be fine. I've never suggested raising money for their "plight" or made any suggestion about a fix to the problem. I have only commented on what the current trend is likely to cause, and that impact is more on the people needing a doctor than the doctors themselves.

You're loosing sight of the topic in your rush to win the argument. Pay attention to the details. Look, it's obvious you couldn't care less about doctors going broke, regardless of what the ramifications of that may be. As I already stated, I suspect you won't until it impacts you directly. That's fine. That's your opinion. I would only remind you that it's not the "economy" or "capitalism" or anything any normal business has to deal with that's driving these changes. That's the point you keep missing in your rush to say 'tough crap if your business fails.'

quote Originally posted by jaskispyder: We are in for a change, good or bad, right or wrong. Do you feel the doctors are getting the raw end of this, as the article portrays?

Yes, I think they are getting a raw deal. The administration is trying to add millions of people to Obamacare and pay for it by cutting payments to doctors. The end result is going to be worse for those on government healthcare. The doctors who do accept Obamacare will be giving minmal levels of service and will not be paid very well. This is a lose for everyone except the politicians who will claim they were able to give crappy healthcare to everyone.

Our healthcare system needs reforms but what is described in the article is going in the wrong direction IMO.

quote Originally posted by frontal lobe: Well, you lose your bet. Doctors are not surprised they are not immune to the economy. Regarding welcome to the real world, we don't get to live in the real world. That is the issue. We are being influenced by "decision makers" in the federal government. By what stretch is that ever "the real world"? I'm trying to think. What other people have to go through as much education as doctors? I think the list is pretty small. I agree with you that length of education is an excuse for high pay.

Every PhD should make what doctors make.... every professor, researcher, scientist, judge, homemaker, writer.... equal pay for equal education?

The real world is influenced by the government. The fantasy world is where government has no influence over anyone.

If doctors weren't surprised, then why are some of them "going bankrupt"? didn't they plan for this? Or are they using this opportunity to protect their way of life? Don't get me wrong, doctors have skillsets others do not, but again, it is hard for the middle class to feel for them when doctors don't have to think about paying the utilities or buying groceries. Doctors will survive through this, patients will get care, people will make it through. We are at a stage were traditional medicine is being challenged to be more efficient.... the pendulum is swinging and it will continue to do this.

Now... being a vet... there is where the money is at (for a while)

quote Originally posted by jaskispyder: We are in for a change, good or bad, right or wrong. Do you feel the doctors are getting the raw end of this, as the article portrays?

Well, yes, SOME of the doctors are getting a raw deal. Because, as I pointed out, many of the lower earning ones are at the tipping point ALREADY.

You act like it is no big deal. Let them go out of business.

Fine. Read the article again. I looked up Milton, Nebraska. Small town. That guy WILL go out of business. Boo hoo. Too bad. Poor businessman.


Yeah. OK. Now what are the people in Milton, Nebraska going to do?

Well, Lincoln is only 25 to 30 miles away. Big deal. Go there.

OK. Go there. Medicare patients we are talking about now. So over 65. That isn't old. But many will be over 75.

Depending on their car and gas prices, $4 to 6 dollars there. Same amount back.

IF they can get someone to see them for medicare rates.

MOST of the people that age need to see a specialist. OK $10 to $12 more each trip.

Wait. That is IF they can get someone to see them for medicare rates.
Congress is playing a game of chicken with doctors, by jerking around their reimbursement rates. Well, what you don't know is that they have ALREADY reduced them to the tipping point YEARS ago. Now they want to go 27%?

You think doctors will be the losers. You might want to think again. Doctors didn't get to be doctors by being stupid people. If you want to pick a winner between doctors and congressmen? Go ahead and pick congress if you think they are the smartest people in the room in THAT show down.

quote Originally posted by frontal lobe: That won't COMPLETELY work due to some doctors having training and expertise that is rare enough that there aren't enough other options for people to go to.

I'm not sure about that. You already hinted at how the market works in your ealier post. More doctors are becoming specialists because that is where the money is. My GF's brother just finished his residency and is now shopping around. He because a cardiac anesthesiologist rather than a general practitioner because the higher pay will pay off his student loans faster. I believe the market will correct itself if left to itself without the government mucking it up.

Also, there are limits to what a person will charge for a service. Sure, some people would be completely heartless and charge as much as the market will bare. I also see many doctors donating their time to help out lower income people. Doctors without Borders comes to mind.

There are doctors from around the world that come to America because they can't make much in their home country. The supply will naturally grow to meet the demand.

The point of the article is to tell you how Obamacare is killing our current GP system... Oh no, Obamacare will destroy us all. I don't like Obamacare either, but the real story is that there is a business who can't make it... not 80% of the GPs, but just some of them. The whole industry is not collapsing, the sky isn't falling. I am not a fan of Canada's healthcare system, but it is working for them and it isn't perfect, but the world for them, didn't end.

We need to reign in medical costs otherwise no one will be happy. Is cutting medicare the answer, no, but these cuts are not killing GPs. These GPs already had issues and those were related to bad business practices where as they business was spending more than they were bringing in. They counted on the government medicare/aid program to support them. That is the point to be taken from this article... we already know Obamacare is bad news, but pointing out some failing businesses is just bad reporting.

And yes, it is the economy... people have turned to the government for help because they don't have jobs and they can't afford what was once taken for granted. People can't afford insurance (they believe), so they elect Obama who promises them the world. If the economy didn't tank, we probably wouldn't even be talking about this. So, yes, the economy is a factor that created this mess. Some GPs are starting to feel the crunch, just like every other business out there. And yes, I don't feel sorry for them. Tough, I say. Welcome to our world. Being a doctor doesn't automatically protect you from the downturn in the economy, or even the government's reaction to it.

There will be doctors, there will be GPs, there will be order, there will be more funding for medicare, there will be more restrictions, there will be more of everything. If we want a solution, then the economy needs to recover, government needs to pull back, people need to save more, etc....

quote Originally posted by Formula88: I've never suggested that, and I've never expressed concern for the doctors. If you bothered to actually READ my posts instead of just quote them to post your next argument you'd notice I've stated I'm quite confident they'll do just fine. They may retire or move into other fields, but they'll be fine. I've never suggested raising money for their "plight" or made any suggestion about a fix to the problem. I have only commented on what the current trend is likely to cause, and that impact is more on the people needing a doctor than the doctors themselves. You're loosing sight of the topic in your rush to win the argument. Pay attention to the details. Look, it's obvious you couldn't care less about doctors going broke, regardless of what the ramifications of that may be. As I already stated, I suspect you won't until it impacts you directly. That's fine. That's your opinion. I would only remind you that it's not the "economy" or "capitalism" or anything any normal business has to deal with that's driving these changes. That's the point you keep missing in your rush to say 'tough crap if your business fails.'

quote Originally posted by jaskispyder: Every PhD should make what doctors make.... every professor, researcher, scientist, judge, homemaker, writer.... equal pay for equal education? The real world is influenced by the government. The fantasy world is where government has no influence over anyone. If doctors weren't surprised, then why are some of them "going bankrupt"? didn't they plan for this?

Plan for what? The change in government regulations? And how exactly are they going to predict these regulation changes in order to plan for them.
Also, a Ph.D typically takes about 5 years of post-grad work, compared to the 7-12 for an M.D. That's, like, totally the same thing.

[This message has been edited by Formula88 (edited 01-10-2012).]

quote Originally posted by frontal lobe: Now what are the people in Milton, Nebraska going to do?

They find a GP willing to live and work there. This GP may not own two or three homes, 4 cars, and maybe they can't send their kids to a private school or college, but I bet they would make a comfortable living and even have a nice retirement. That doesn't sound too bad, as there are doctors who would love to work in a small town and enjoy a more relaxed environment and have a nice place to raise the kids.

quote Originally posted by jaskispyder: So the world never changes for any other business, the government only targets GPs?

You're absolutely right. Never-mind. Nothing to see here. Move along. Have a nice day.

quote Originally posted by jaskispyder: PhD doesn't have to end at 5 years. Some even go on to earn other degrees.

What degrees? Please list examples. The 7 years post-grad is the "minimum" to become an M.D. Like your Ph.D example you didn't give, specialists have to study much longer. You're trying to offer up some post-doc study just to catch up to the minimum required to become an M.D.

Yup, totally the same. When it impacts you, you'll understand, and I suspect not before.

quote Originally posted by jaskispyder: They find a GP willing to live and work there. This GP may not own two or three homes, 4 cars, and maybe they can't send their kids to a private school or college, but I bet they would make a comfortable living and even have a nice retirement. That doesn't sound too bad, as there are doctors who would love to work in a small town and enjoy a more relaxed environment and have a nice place to raise the kids.

Well, it isn't YOUR fault that you don't know what the doctor world is like. So I can see why you would THINK that your answer was reasonable.


First of all, the 27% cut in medicare payments is NOT an Obamacare issue. This is something congress did over a decade ago. Someone passed a law that medicare reimbursement would be cut 3% EVERY YEAR. That is a LAW. It is a STUPID law. It always WAS a stupid law.

Know how I KNOW it was a stupid law? Because EVERY YEAR congress has voted to RESCIND the 3% cut, and leave the rate where it was. With inflation, that is STILL a relative reimbursement decrease, but at least they didn't reduce the payment.

So EVERY YEAR, it comes down to congress having to rescind it. Well, here we are 9 years later and it is up to a 27% cut, and it is already January 10 and congress hasn't voted yet to rescind it. So every doctor in the country right now (I'm assuming here) is waiting to submit the work they have done for medicare in 2012, until congress rescinds the BY LAW AUTOMATIC cut (the now 27%).
But to your point about Milton, Nebraska. You have no idea what it is like to run a medical practice. If you take patients on, you have an OBLIGATION to provide care for them 24 HOURS A DAY, 7 DAYS A WEEK. If YOU don't want to do that, then YOU are responsible to find someone and DESIGNATE them to provide care while you are gone.

So your theoretical void-filling replacement doctor in Milton isn't going to "enjoy a relaxed environment". He/she is going to be CRUSHED by being on call ALL THE TIME.

OK, well get a partner so you can share the call. Even split 2 ways, it STILL isn't "a relaxed environment." So get a 3rd. Really? Well now, at the medicare reimbursement rates, Milton can't SUSTAIN 3 doctors.


And then, patients are going to need to be hospitalized. That likely is Lincoln. So now the doctors are driving to Lincoln AT LEAST once per day. And if someone goes into the hospital later in the day, then SEVERAL trips per day. But, hey, if they like driving, that will enhance their "enjoy a relaxed environment."
And people simply can't afford insurance and need government health care. Well, then where are they going to get the gas money to get to Lincoln for THEIR multiple appointments (remember, these are sick medicare patients that are older). And then they have to take their spouse to appointments, too.
But, hey, set up a reimbursement system where ONLY HUGE corporate groups can make it and not smaller doctors offices. See what happens with the shrinking of the availability and the LOCALIZATION of doctors into centers, instead of the wide distribution of care available today.

If that is all the country can afford, it isn't going to hurt ME any.

Just remember. It isn't just hurting "doctors with bad business skills" either.

quote Originally posted by Formula88: What degrees? Please list examples. The 7 years post-grad is the "minimum" to become an M.D. Like your Ph.D example you didn't give, specialists have to study much longer. You're trying to offer up some post-doc study just to catch up to the minimum required to become an M.D. Yup, totally the same. When it impacts you, you'll understand, and I suspect not before.

Lawyers, dentists, engineers, social workers, conservators, education administrators, pilots, air traffic controllers, vets. Of course, this can vary as some go one to continue their education, and many PhDs do the same. There are also internships at other jobs, but I am guessing you won't count those either. Oh, what about educators who must continually take courses to maintain their license, but those don't count, right? Only those who attend 7 years in a row count? Well, in that case, nope, only MDs.

quote Originally posted by jaskispyder: Lawyers, dentists, engineers, social workers, conservators, education administrators, pilots, air traffic controllers, vets. Of course, this can vary as some go one to continue their education, and many PhDs do the same. There are also internships at other jobs, but I am guessing you won't count those either. Oh, what about educators who must continually take courses to maintain their license, but those don't count, right? Only those who attend 7 years in a row count? Well, in that case, nope, only MDs.

None of those require 7 years post-grad just "to get started." (FYI, Dentists are doctors, with 4 years of Dental School instead of Med School, but may not have the same residency requirements)
All require staying current with continuing education throughout their career.

Lawyer: Bachelors Degree + 3-4 years Law School
Engineer: Bachelors Degree, plus F.E. exam and 4 years work experience to take your Professional Engineer exam.
Social Worker: Bachelors + Masters
Conservator: Bachelors + Masters
Education Administrator: School Superintendent requires Bachelors + Masters. Many also have a Ph.D, but it's not required.
Pilot: Pilots don't follow a typical college training curriculum. You earn various ratings and get experience at each level. You can find specifics here: http://www.jetcareers.com/civilian-route.html
Air Traffic Controller: http://www.jetcareers.com/b...ffic-controller.html (also not a normal college curriculum)
Veterinarian: Bachelors + 4 years Vet school.

Still looking for anything that requires a Bachelors + 7 or more years before you can get your license.
Did you research any of these or just pull them out of the air?

quote Originally posted by jaskispyder: How do you propose paying for medicare/aid, or weaning people off of it? Who ends up paying for the services? You say that the cut in services is making it too difficult for GPs to survive, so what is the solution? Raise taxes? Force everyone on insurance (non-government controlled)? Cut services? (BTW... serious question here.... as no one wants to pay more, or get less.... something has to change. Everyone cries foul when their life is touched).

Well, you bring up a LOT of good points. I wish we were having this conversation in person so with the tone of voice, facial expression, and body language you could tell we were just having a conversation.


I'm not saying that doctors won't need to be paid less. But it can't be 27% And it can't be all at once like this 27% would be. Well, it CAN be. But then people that COULD have stayed in business if the cuts were graduated, won't have time to adjust things, and will be driven out.

And then reduce the pay more on the doctors that are being relatively over-paid, and reduce less the pay to the worker bees.

That way, you can still have the access points in smaller towns and make it more accessible to more people.
Some malpractice reform is going to be necessary, too. What? Lawyers making less off the system. Yes, them too. EVERYone is going to have to take a hit. But largely ELIMINATE malpractice settlements? No. The system NEEDS that accountability, and patients that get hurt from carelessness or recklessness or whatever need to be compensated.


Hospitals are going to need to make a little less.

Pharmacy is pretty good where they are. And use of formularies is limiting the cost of the expensive drugs.


The LARGEST savings is going to HAVE to come from cutting services.

The BEST way for that to happen is to NEED less services, by living healthier lifestyles.


But, yes, the major expensive technology doesn't need to be within 3 miles of every patient. And doesn't have to be available the same day for every patient.

I gave examples. Feel free to research, but I have a feeling that you won't be happy, as you will try to discount examples even though many of these careers go on beyond what you listed.

quote Originally posted by Formula88: None of those require 7 years post-grad just "to get started." (FYI, Dentists are doctors, with 4 years of Dental School instead of Med School, but may not have the same residency requirements) All require staying current with continuing education throughout their career. Lawyer: Bachelors Degree + 3-4 years Law School Engineer: Bachelors Degree, plus F.E. exam and 4 years work experience to take your Professional Engineer exam. Social Worker: Bachelors + Masters Conservator: Bachelors + Masters Education Administrator: School Superintendent requires Bachelors + Masters. Many also have a Ph.D, but it's not required. Pilot: Pilots don't follow a typical college training curriculum. You earn various ratings and get experience at each level. You can find specifics here: http://www.jetcareers.com/civilian-route.html Air Traffic Controller: http://www.jetcareers.com/b...ffic-controller.html (also not a normal college curriculum) Veterinarian: Bachelors + 4 years Vet school. Still looking for anything that requires a Bachelors + 7 or more years before you can get your license. Did you research any of these or just pull them out of the air?

[This message has been edited by jaskispyder (edited 01-10-2012).]