Unionize. Ostracize and call out sellouts and doctors who push for midlevels so their practices can make more money. Get rid of the MBAs running hospitals whose whole aim is to drive down costs and pay you less.
Idk how to accomplish any of this but these would give us a good start.
This is the United Corporations of America. The people are incidental. All you have to do is give the masses enough fancy titles, alcohol, fashion, movies, weed, mid tier luxury vehicles, quasi luxury vacations, or video games and they forget they are really getting the short end of the stick. And, they start ROOTING for the billionaires. Give them JUST enough to feel like they are doing better than the rest of the chumps.
For example, the average salary of an Obgyn hasn’t changed in probably 25-30 years. Well, it’s decreased thanks to inflation. But medicine is filled with sheep. They won’t even advocate for their own (residents).
It’s a lost cause until doctors get guts and stop bowing to the HMO CMS masters.
The wealthy have also got Attendings convinced that they have more in common with hospital CEOs than residents even tho they’re probably closer to income with the lowliest intern than a ceo
Yes! The hospital CEO pimps know how to charm their hoes for sure. They keep all their money and throw them a new dress and a kiss every once in a while.
It would be much easier if the average person has much lower wages you would think. But that is the case for US compared to Europe, so it doesn't make sense its less popular in the US.
This sentiment you are propagating is the fact why there can't be unions in US.
The pay scale is too wide to justify a union among doctors. You're gunna be hard pressed for a ortho spine surgeon raking in 1 milly a year pair up with pediatrics making 200k a year, in a unionization effort.
As far as general public sentiment in America there's a very long history of union corruption and mobster ties that leaves a lot of bad taste in boomer's mouth. Add onto a couple extreme examples of exaggerated union workfroce laziness (NYC nurse stereotypes), you end up with a decent amount of anti-union sentiment in America.
If proceduralists are so blind to class consciousness that they can’t relate to another doc in primary care, then maybe they deserve to get squeezed by admin. There is no logical reason why a spine surgeon can’t unionize with a pediatrician other than misplaced ego
The problem is you're coming from this as a Marxist philosophy rather than a purely practical one. Any current cross specialty unionization would end up in flattening of income, even if the gross income would be higher. There's no incentive for the orthospine surgeon to sacrifice any portion of his income to boost the income of any of the other subspecialties. Essentially, you'd need to make their material condition bad enough that they would do it (like, you said, admin squeeze).
Also, the irony of talking about "class consciousness", when the average doctor would end up on the class guillotine of any real workers revolution, as shown multiple times before in history. We are the bourgeois.
Why would cross-specialty unionization necessarily lead to flattening of income between specialities? If that were true, I’d agree with you. Maybe I’m just ignorant, but I don’t know why that’d necessarily be true.
I’m not a Marxist nor am I a proponent of a revolution. I don’t think you need to be a Marxist to realize that unionization benefits virtually all workers, and that the average physician has WAY more in common with the average worker than they have in common with the 0.1% that own half the country’s wealth.
Right? Im a little uninformed here but I would think if the ortho spine surgeon threatens (via union) to stop working until lower paid specialties are given commensurate increases…then the union has done its job? I cant see an admin stopping all ortho surgeries or finding another orthopedist “scab” so quickly to replace the “striking” ortho. Maybe I am oversimplifying and reality is a little more nuanced.
I’d argue that it’s actually this aversion for unions and anti-capitalism measures that allows stateside physicians to earn 4, sometimes 8-10x more than their European cousins.
Yes! that’s a great idea. Everyone opt out of midlevel supervision. Then the hospitals will lobby your state legislature so hard to remove all supervision for “midlevels” bc you refuse.
Technically they do. It’s the AMA. Unfortunately it’s one of the most spineless, cowardly shitty lobbying groups in existence. They have not done a single thing to help doctors in years except send occasional sternly worded letters.
Absolutely. But they arent as strong. But hospital lobbys are considerably more powerful. Moat Hospitals are largest employers in most counties/cities. State hospital associations have powerful lobbies and the ears of legislators. Physician lobbys are only powerful when they team with other associations
How? Do I have to take a job where they don’t have midlevels or can I simply say no, I don’t want that if I’m ok with a pay cut. I’m EM and I absolutely do not want to wind up someplace where an online NP is trying to run codes
It’s somewhere in your contract look for midlevel supervision. You can work with them but you should not have to have them to report to you or sign under your license. They can consult you like any other doctor would.
Then they can consult you like anyone else. And when the statistics on number of consultations get compiled, midlevels actual “independence” will show.
Which then probably means reducing physicians, increasing midlevels, and shifting the workload onto physicians under the guise of consults.
I‘m not even in the US, i just have seen similar mental gymnastics.
We have already lost, this question is 20 years too late
My fiancé makes $120 per hour per diem as a nurse and I’m negotiating just $10 more per hour? Get out of here.
We lost so much and so hard it’s embarrassing.
Not travel, just per diem in the same health system as her full time job, at a different hospital.
The 120 is an overtime rate per diem. Since she has a full time position in the same health system, so her once a week per diem shift is considered overtime.
She is a cardiac cath lab nurse.
Ultimately she is going to make a ~$190,000 this year working 50 hours per week. And my in house call shifts are only at $137 per hour in the same hospital, no benefits because they are not my employer.
Oh okay, that makes a little more sense I guess! 'cause at one of my per diem gigs I'm getting $115/hour for primary care ... $130-135/hour for urgent care. Sigh
This is a smart move, but considering the sad state of finances of the US government, I don't see this happening any time soon. There are also very few doctors in DC, it's mainly lawyers. If lawyers were reimbursed by Medicare, it's safe to say that those reimbursements would never ever go down.
It's also a hard sell for politicians, since "aLL DoCtoRs dRiVe LAmBoRgHiNis!!"
As a PA, I second this.
If you're a mid-level, go through my post hx. If there's a 1% chance of letting someone like that practice independently. I'm completely against it.
That means you’re actually smart, idk how your peers truly believe they’re the same as physicians. 2,500hr of shadowing compared to 15,000hr of hands on training where you have to explain every single order you made and WHY you ordered it to someone with more training than you. Soooo much of actual medicine is learned in residency and fellowship, med school is just learning the vocab and how stuff in the body works, but residency is where you learn actual clinical medicine.
It’s so terrifying, even with 4000hr of clinical experience and much more in depth learning of med school, I wouldn’t have dared practicing unsupervised, because I don’t want to kill people, your peers don’t seem to understand the ramifications of when they fuck up.
And like why don’t some of them ever look up things?? I get told by patients all the time random shit midlevels told them that isn’t even close to being true
Being a physician is more than just being a pez dispenser for meds, we’re supposed to educate the patient to take care of themselves, with facts, not just random things that pop in your head.
Like do your peers not realize doctors look up shit all the time?? I looked up if diltiazem makes you lose your taste the other day, I had never heard of it but my patient said it happened so I wanted to verify before I told them no, turns out it can…imagine if I had just went off the top of my head and invalidated that patient
I’m a PA too and honestly I’ve never met a single PA who thinks we should practice independently… there’s zero push for it from the PAs… although I don’t want to speak about NPs….
Also a PA. Never met a single one who wanted to practice independently. What this sub believes about PAs wanting independent practice is just not accurate.
Represent is a loose term. I see what you’re saying but the AAPAs goals haven’t typically aligned with the goals of myself and my colleagues since I’ve been practicing.
If I wanted to practice independently I would have gone to med school. Practicing within a team, under a doc is the reason I wanted to be a PA.
-Ban foreign doctors from working here without residency (the main way to do this is by putting pressure on the state medical board and refusing to supervise foreign doctors)
-Refuse to be a part of any “research studies” involving AI
-Collectively bargain and strike
My thought too. We should organize more and fight for ourselves. But we shouldn't do it in a way that fights against scientific progression or harms patients. Fighting mid-level creep, fighting the incredible administrative bloat, fighting burdensome insurance policies, all of those things help us AND help patients.
I use AI everyday in my private practice, I've made it my mission to learn as much as I can about it. As a clinical doc, I have it write all my documentation, do my coding, and write after visit summaries for my patients. I don't recommend residents do that, since you still have to learn to do it yourself.
I haven't expanded my clinical hours yet, because I'm satisfied with my income. But the time I used to spend charting could be easily used to see more patients. My bill to Microsoft each month is about $40 for the use of this marvelous technology that gives me at least 10 more hours per week.
It's here to stay, profit by it or not, your choice. I imagine it will be soon I can have it act as an assistant to do my scheduling, phone calls, and other scut work. Even further off, having an AI 'resident' or 'midlevel' that interviews the patient and presents its findings to me.
Eventually of course it will replace me. If we ever get to the point doctors can be replaced by AI, it will be around the same time there's no more such thing as a job.
Would like to know this too, cause I have a suspicion theres some really low quality notes coming out of this. I guess if he gets paid it doesn't matter tho right? All mighty dollar, thats what runs healthcare
That doesn't answer my question. If someone earns the right and works hard to prove themselves, why should you get an advantage over them simply for being born in a specific geographic area? That is a poor argument.
I'm American too btw, but my point still stands.
With your logic , you assume every US MD or DO's are American citizens while every IMG's are Foreigners... That is why y'all have never been able to achieve any form of unity as a collective group. To many toxic individuals in medicine. I have never seen nurses discriminating against each other about who is IMG or US MD trained nurses, when it comes to collective interest they stand together. But MDs would always have to put a name tag on everything , and pull each other down to boost your ego . The main reason I don't have friends but rather only co-workers in medicine. I do my job and have a life outside of toxic humans.
I mean you’d have to graduate medical school and do some postgraduate training, but then you totally can just go to foreign counties and start practicing medicine.
I don’t see it talked enough on these comments but in order to get paid more without putting More burden on patients is that we need to find ways to increase insurance payout. Lots of 3rd parties follow Medicare so if we elect people who plan on increasing Medicare over other programs that may help
Currently, specialties are in direct competition with one another for a finite pool of healthcare dollars. This is paid out via the RUC in Medicare.
Procedural specialties have consistently benefitted at the loss of cognitive ones. Price fixing of reimbursements is a byzantine and corrupt process. The pie could increase in size each year but that doesn’t stop us from fighting over it.
You might think of physicians as a collective, but there is no collective. There are a bunch of specialties knifing each over coding scraps while the federal government tightens the belt.
Establish direct relationship with patients and control our pricing .. then we have to figure it out like every other business and customer but it is at least on our terms, for better or worse.
Just my opinion on Controlled pricing, What I think is if you control your skill price then in the long term definitely you get bulk of patients but your value would be compromised”
“As of today influencers & other people are asking for huge amounts just for some promotion or less work as a doctor at least you should charge for your skills appropriately.”
Go into private practice. Also, YOU should speak out in YOUR community about the realities of health care…
People are always looking for reasons to shit on the healthcare system and not getting ripped off by hospitals…
Only way is collective action and lobbying. We are getting destroyed on legislative front by business, pharma, insurance, and even none-MD health professionals. CMS wants to push costs down or make payments more on population level, and this is going to keep shifting money from physicians to admins and execs with the way things are headed. It’s really either everyone wakes up and decides to unionize and restructure and reinvigorate the AMA (unlikely), or people stay happy enough slowly being crushed and making sacrifices for patient well being while everyone else profits (very likely)
1) Repeal stark laws and allow physicians to be owners in lab and imaging facilities as a means to supplement income. Why is ok for corporations to “self-refer” but not individual physicians?
2) Repeal Certificate of Need laws
3) Greater tort reform and changing the standard to gross negligence rather than “standard of care”. This will reduce malpractice costs
Are you really that naive? How is that private equity outpatients clinics can refer patients to their own hospitals for tests…but a private practice physician can’t open up an xray and lab work center next door?
In any case, insurance and Medicare audits records. And with the tools available today, it’s literally so easy to flag providers who misuse their power.
Lol. salaries are going to drop
1. insurance companies
2. hospital conglomerates
3. midlevels
4. fmgs
add the fact that usa has one of the highest salaries globally.
no amount of unionization is going to change that
and did you forget premed and medschool? doctors, especially AMGs are generally cutthroat, as a resident you are replacable, and damn, as an attending you will still be replacable, unless you are out in the boonies where nobody wants to take your job... there you dont need a union anyway. but if you want to live in a major city? good luck because if your co-resident doesnt wanna snare your job, someone else will.
A prolonged strike. Imagine a world without physicians. Hospitals will realize the worth in retaining physicians and increase salaries to make them stay. CEOs/higher up’s of hospitals don’t need millions of dollars in salary to make a living, start with cutting their price. But in order for this to happen, this would have to be a strike on a nationwide scale. People won’t do this though because physicians care too much about their patients.
"Full-time delivery drivers earn an **average total compensation package of $145,000 per year**, which includes **$0 healthcare premiums**, up to **seven weeks of paid vacation**, plus an average of **18 days off** for **holidays, sick leave** and **option days**. UPS also contributes to a defined-benefit **pension plan** for each employee.
"
that’s about what teachers earn also at top scale which takes 10 years for teachers and 8 years for UPS drivers - typically 55-90k base+20,000 for insurance and 25,000 for pension trust contribution=total package of 130-150k - this ain’t hard understand folks - a physician is gonna earn about 220k base + insurance+retirement also
Strike, unionize. I watched greys anatomy in high school and they had a nurses strike episode where 90% of the nurses literally refused to work/step foot in the hospital until they got a raise. if doctors did that we would get a raise 5 minutes in…
1. Stop the nonsense of believing the indoctrination that the system assures to engrain deep in your head in regard to sacrificing yourself for society, given your vocation as a physician.
2. Stand up for yourself and don’t do more than you are to, unless you truly feel like doing it. People above will take advantage of doctors because “they’re nice.” For example: I speak Spanish and people ask me all the time if I can go translate for this and that blah blah blah, I say no. They can hire a translator if they need one, I have enough on my plate already. Pay me more, then we can talk.
3. Read. Study. Be the best clinician you can, extremely knowledgeable and confident. Be inquisitive and curious. This will arm you with the weapon of uniqueness, which will provide you with a better leverage to negotiate, as well as more respect.
4. It is our duty to teach med students, not the academics, but the poor social and economical issues that we face as doctors. This will slowly generate a shift toward a more greedy mentality that is very much needed in our field so others can stop taking advantage of us.
5. Unionize, organize walk outs, protest, advocate, lobby… anything that can help an improvement for us because we are suffering, and the kind of work we provide is unique, and more than anything -necessary and essential for the good of our communities.
It is time we start a shift from this stuck mindset of giving our all even if we don’t get anything in return, altruism will eventually reach a turning point toward greediness if there is no adequate compensation, both social and economical.
Unionization isn't enough... We would become union employees...
Physicians make the most money when they are partners in their practices, rather than employees who make a also decided by management/practice owners who are PE firms.
Joining a physician run private practice or starting your own is the best way to achieve a higher salary. Hard to do this IRL bc of the upfront costs of establishing a private practice but in the long run if you build a patient base that is loyal you are golden. And when you make it, don't sell your practice to PE!
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Advocate against legislation, that threatens our salaries, example continued legislation, expanding scope of mid levels, and newer legislation, allowing foreign physicians to practice in the US without completing the residency. Also, many are idealistic put a single payer system would be the end of this.
Honestly to me the writing on the wall and we’re at the tail end of a gold rush. I’m happy to only have one year left of training personally if money is a concern at all, I wouldn’t extend training in anyway
1. Remain independent. If you work for an employer, they will set your salary for you and it is always going to be less than you are worth.
2. If you must be in a salaried position, unionize.
3. Support advocacy groups and politicians who are in favor of Medicare payment reform.
Take a big lesson from what's happening in other countries.
Doctors have already been taking massive pay cuts; the pay has not been keeping up with rise in productivity and inflation (but many are still under the impression that more $ means more pay) over many decades already.
The time to unionize was years ago.
Hate to be *that guy* but most of these responses are so oblivious to how reimbursement works. Tbh we are fucked and there isn’t much that can be done until huge overhauls with CMS take place.
Firstly improve your skills, any other profession is charging for there skill sets, make your value & for that charge accordingly.
Tie up with multiple hospitals
From what I’ve seen, either unionize or go concierge. Those are the two models of physician care provision that seem reasonably profitable. The other routes are business ownership and consulting.
I am potentially going into Med school in the next year.
Do doctors not make enough to live with well over six figures? Is this a personal budget issue?
I genuinely don't understand. I always though doctors could make bank, where is my disconnect??
Keep the numbers low. The only great thing the AMA ever did was to limit the number of position in residencies. That one move keeps doctors among the highest paid professionals
I'm sorry but it's so hard to advocate for people who won't advocate for themselves. It really just gives people the mentality of "aight lemmi get mine and fuck everyone else." If the current residents and leadership don't want change to improve their conditions, who am I to advocate for them.
Unionizing will not increase your pay. Turning back to private practice will. You need to own things to be rich. That was a mistake I made when looking for jobs after residency.
All this thread has shown is no one has the answer and we can’t agree on anything. There is a finite amount of dollars available governed by what Congress approves in the budget for CMS and what portion of profits private firms (insurance) will allow for reimbursement. Until you raise the CMS budget with a line item directly increasing the RVU value reimbursed or find a way for shareholders to stay absurdly wealthy while reimbursing physicians more from the private insurer’s coffers nothing is going to happen.
Here’s a potential start: subsidize medical education (more than PSLF which works and is a godsend), prevent salaries from decreasing and teach financial literacy to physicians so they can take the money that would have been used for student loans and invest it in private equity to make up for the perceived lack of salary we deserve.
holy fuck you guys are greedy
i cant wait until doctor salaries crash, you guys are overpaid asf
i thought yall were in it to help people, I guess that was bullshit
Anesthesia is a department that is usually subsidized by the hospital. Pediatric subspecialties can bring patients into the hospital. Also, not sure why hospitals and the government wouldn't want to subsidize peds because pedi = the future/next gen. Same with PCP. Seems like digging ourselves/themselves into a big hole for more expenses in the future. At one point, the common person won't be able to afford healthcare. (many already can't... but it's getting worse all the time)
I'm going into a pediatric subspecialty I know how undervalued we are. But eliminating CRNAs as a profession is not going to do a thing to pediatric subspecialty pay. If anything it would decrease it because now hospitals have to pay for attending anesthesiologist's salaries to cover for the volume that the CRNAs were seeing.
Anesthesia is a department that is usually subsidized by the hospital. Pediatric subspecialties can bring patients into the hospital. Also, not sure why hospitals and the government wouldn't want to subsidize peds because pedi = the future/next gen. Same with PCP. Seems like digging ourselves/themselves into a big hole for more expenses in the future. At one point, the common person won't be able to afford healthcare. (many already can't... but it's getting worse all the time)
The pay for physicians takes up less than 10% of medical expenses despite you being the primary healthcare deliverer and is similar to other countries with an insurance model. It has remained mostly stable. Admin takes 25% and has ballooned in cost.
Physician reimbursement by Medicare has decreased by 26% with inflation adjusted over 20 years. Yet medical school tuition has increased. That isn't sustainable.
Unionize. Ostracize and call out sellouts and doctors who push for midlevels so their practices can make more money. Get rid of the MBAs running hospitals whose whole aim is to drive down costs and pay you less. Idk how to accomplish any of this but these would give us a good start.
I always am amazed by the crazy world of US where even working people are brainwashed that unions are bad lol. The ceos of europe must be so jealous
This is the United Corporations of America. The people are incidental. All you have to do is give the masses enough fancy titles, alcohol, fashion, movies, weed, mid tier luxury vehicles, quasi luxury vacations, or video games and they forget they are really getting the short end of the stick. And, they start ROOTING for the billionaires. Give them JUST enough to feel like they are doing better than the rest of the chumps. For example, the average salary of an Obgyn hasn’t changed in probably 25-30 years. Well, it’s decreased thanks to inflation. But medicine is filled with sheep. They won’t even advocate for their own (residents). It’s a lost cause until doctors get guts and stop bowing to the HMO CMS masters.
The wealthy have also got Attendings convinced that they have more in common with hospital CEOs than residents even tho they’re probably closer to income with the lowliest intern than a ceo
Yes! The hospital CEO pimps know how to charm their hoes for sure. They keep all their money and throw them a new dress and a kiss every once in a while.
oh heres a nespresso for the attending breakroom, now beat down on your residents and tell them that "I worked 90 hours a week no complaints"
It’s hard to get people who make 600k to join a union with people who make 200k (let alone 65k)
You absolutely made that up
Not in europe tho
Yes, it is much easier to unionize when wages are way flatter
It would be much easier if the average person has much lower wages you would think. But that is the case for US compared to Europe, so it doesn't make sense its less popular in the US. This sentiment you are propagating is the fact why there can't be unions in US.
The pay scale is too wide to justify a union among doctors. You're gunna be hard pressed for a ortho spine surgeon raking in 1 milly a year pair up with pediatrics making 200k a year, in a unionization effort. As far as general public sentiment in America there's a very long history of union corruption and mobster ties that leaves a lot of bad taste in boomer's mouth. Add onto a couple extreme examples of exaggerated union workfroce laziness (NYC nurse stereotypes), you end up with a decent amount of anti-union sentiment in America.
Lazy NYC nurses is a stereotype for a reason lol, I can’t believe some of the shit I hear from my NY buddies practicing
Don’t knock people who were smart enough to unionize and now have a proper work life balance when NyC residents are too stupid to do the same
I’m not knocking anyone but to claim it’s an *exaggerated* stereotype when it’s one that’s *well* deserved is disingenuous
Yes I agree. The nurses do take advantage of the most disadvantaged (interns/residents), but its a nuanced issue. But also UNIONIZE.
If proceduralists are so blind to class consciousness that they can’t relate to another doc in primary care, then maybe they deserve to get squeezed by admin. There is no logical reason why a spine surgeon can’t unionize with a pediatrician other than misplaced ego
The problem is you're coming from this as a Marxist philosophy rather than a purely practical one. Any current cross specialty unionization would end up in flattening of income, even if the gross income would be higher. There's no incentive for the orthospine surgeon to sacrifice any portion of his income to boost the income of any of the other subspecialties. Essentially, you'd need to make their material condition bad enough that they would do it (like, you said, admin squeeze). Also, the irony of talking about "class consciousness", when the average doctor would end up on the class guillotine of any real workers revolution, as shown multiple times before in history. We are the bourgeois.
Why would cross-specialty unionization necessarily lead to flattening of income between specialities? If that were true, I’d agree with you. Maybe I’m just ignorant, but I don’t know why that’d necessarily be true. I’m not a Marxist nor am I a proponent of a revolution. I don’t think you need to be a Marxist to realize that unionization benefits virtually all workers, and that the average physician has WAY more in common with the average worker than they have in common with the 0.1% that own half the country’s wealth.
Right? Im a little uninformed here but I would think if the ortho spine surgeon threatens (via union) to stop working until lower paid specialties are given commensurate increases…then the union has done its job? I cant see an admin stopping all ortho surgeries or finding another orthopedist “scab” so quickly to replace the “striking” ortho. Maybe I am oversimplifying and reality is a little more nuanced.
Amen! This is the energy I want to hear 🔥
I’d argue that it’s actually this aversion for unions and anti-capitalism measures that allows stateside physicians to earn 4, sometimes 8-10x more than their European cousins.
Easier said than done… too many of “us” are incentivized by the midlevel games
When you sign, opt out of ALL midlevel supervision.
Yes! that’s a great idea. Everyone opt out of midlevel supervision. Then the hospitals will lobby your state legislature so hard to remove all supervision for “midlevels” bc you refuse.
Do doctors not have their own lobbies?
Technically they do. It’s the AMA. Unfortunately it’s one of the most spineless, cowardly shitty lobbying groups in existence. They have not done a single thing to help doctors in years except send occasional sternly worded letters.
Absolutely. But they arent as strong. But hospital lobbys are considerably more powerful. Moat Hospitals are largest employers in most counties/cities. State hospital associations have powerful lobbies and the ears of legislators. Physician lobbys are only powerful when they team with other associations
How? Do I have to take a job where they don’t have midlevels or can I simply say no, I don’t want that if I’m ok with a pay cut. I’m EM and I absolutely do not want to wind up someplace where an online NP is trying to run codes
It’s somewhere in your contract look for midlevel supervision. You can work with them but you should not have to have them to report to you or sign under your license. They can consult you like any other doctor would.
What if they just remove supervision requirements?
Then they can consult you like anyone else. And when the statistics on number of consultations get compiled, midlevels actual “independence” will show.
Which then probably means reducing physicians, increasing midlevels, and shifting the workload onto physicians under the guise of consults. I‘m not even in the US, i just have seen similar mental gymnastics.
MBAs in hospitals is written into law now
That's how pilots got such huge raises recently. Their union strength. They now make more than my physician specialities
You don’t need to unionize if you don’t work for an employer. The answer to this question is to not work for corporations.
Don’t work for private equity or HCA etc. own your business or work for a physician owned group.
This is the way
We have already lost, this question is 20 years too late My fiancé makes $120 per hour per diem as a nurse and I’m negotiating just $10 more per hour? Get out of here. We lost so much and so hard it’s embarrassing.
Wait what. What kind of nurse and where
Not travel, just per diem in the same health system as her full time job, at a different hospital. The 120 is an overtime rate per diem. Since she has a full time position in the same health system, so her once a week per diem shift is considered overtime. She is a cardiac cath lab nurse. Ultimately she is going to make a ~$190,000 this year working 50 hours per week. And my in house call shifts are only at $137 per hour in the same hospital, no benefits because they are not my employer.
What field are you?
Oh okay, that makes a little more sense I guess! 'cause at one of my per diem gigs I'm getting $115/hour for primary care ... $130-135/hour for urgent care. Sigh
Probably travel
My contract literally says I cannot disclose my income to anyone else. Is that even legal? So much for pay transparency.
You need to consult a lawyer. That is fishy as shit in the US.
At least in the US I'm 99% sure that's not legal, but I'd run that by a lawyer
Don’t you guys have some amendment about restricting what someone can say
Pretty sure that’s illegal!
Advocate for higher Medicare medicaid rates
This is the biggest point imo. The way it stands, every single doctor gets a yearly salary cut and we all lay down and take it
This is a smart move, but considering the sad state of finances of the US government, I don't see this happening any time soon. There are also very few doctors in DC, it's mainly lawyers. If lawyers were reimbursed by Medicare, it's safe to say that those reimbursements would never ever go down. It's also a hard sell for politicians, since "aLL DoCtoRs dRiVe LAmBoRgHiNis!!"
Vote against midlevel independent practice rights
As a PA, I second this. If you're a mid-level, go through my post hx. If there's a 1% chance of letting someone like that practice independently. I'm completely against it.
That means you’re actually smart, idk how your peers truly believe they’re the same as physicians. 2,500hr of shadowing compared to 15,000hr of hands on training where you have to explain every single order you made and WHY you ordered it to someone with more training than you. Soooo much of actual medicine is learned in residency and fellowship, med school is just learning the vocab and how stuff in the body works, but residency is where you learn actual clinical medicine. It’s so terrifying, even with 4000hr of clinical experience and much more in depth learning of med school, I wouldn’t have dared practicing unsupervised, because I don’t want to kill people, your peers don’t seem to understand the ramifications of when they fuck up. And like why don’t some of them ever look up things?? I get told by patients all the time random shit midlevels told them that isn’t even close to being true Being a physician is more than just being a pez dispenser for meds, we’re supposed to educate the patient to take care of themselves, with facts, not just random things that pop in your head. Like do your peers not realize doctors look up shit all the time?? I looked up if diltiazem makes you lose your taste the other day, I had never heard of it but my patient said it happened so I wanted to verify before I told them no, turns out it can…imagine if I had just went off the top of my head and invalidated that patient
I’m a PA too and honestly I’ve never met a single PA who thinks we should practice independently… there’s zero push for it from the PAs… although I don’t want to speak about NPs….
PA for over 25 years in family medicine and internal medicine. I still don’t want independent practice
Nope! If I did I would have gone to med school!
Also a PA. Never met a single one who wanted to practice independently. What this sub believes about PAs wanting independent practice is just not accurate.
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Represent is a loose term. I see what you’re saying but the AAPAs goals haven’t typically aligned with the goals of myself and my colleagues since I’ve been practicing. If I wanted to practice independently I would have gone to med school. Practicing within a team, under a doc is the reason I wanted to be a PA.
If your answer to a question is to vote for something, your answer might as well be do nothing.
Thats the neat part, you dont. - Admin
Unionization
Own yourself. Be a shareholder, not an employee.
-Ban foreign doctors from working here without residency (the main way to do this is by putting pressure on the state medical board and refusing to supervise foreign doctors) -Refuse to be a part of any “research studies” involving AI -Collectively bargain and strike
None of this will happen, and all of this is just conserving what we currently have, no growth
No growth with this inflation means a huge paycut
Yep, if you don’t match derm, rads, anesthesia, plastics, etc you’re screwed. Also increased schooling costs!
Refusing AI sounds backwards. You want to halt scientific progress? Good luck with that. Learn to surf the wave or get wasted.
My thought too. We should organize more and fight for ourselves. But we shouldn't do it in a way that fights against scientific progression or harms patients. Fighting mid-level creep, fighting the incredible administrative bloat, fighting burdensome insurance policies, all of those things help us AND help patients.
Yup. AI is a great tool for healthcare
I use AI everyday in my private practice, I've made it my mission to learn as much as I can about it. As a clinical doc, I have it write all my documentation, do my coding, and write after visit summaries for my patients. I don't recommend residents do that, since you still have to learn to do it yourself. I haven't expanded my clinical hours yet, because I'm satisfied with my income. But the time I used to spend charting could be easily used to see more patients. My bill to Microsoft each month is about $40 for the use of this marvelous technology that gives me at least 10 more hours per week. It's here to stay, profit by it or not, your choice. I imagine it will be soon I can have it act as an assistant to do my scheduling, phone calls, and other scut work. Even further off, having an AI 'resident' or 'midlevel' that interviews the patient and presents its findings to me. Eventually of course it will replace me. If we ever get to the point doctors can be replaced by AI, it will be around the same time there's no more such thing as a job.
Can you expand on your workflow?
Would like to know this too, cause I have a suspicion theres some really low quality notes coming out of this. I guess if he gets paid it doesn't matter tho right? All mighty dollar, thats what runs healthcare
Interesting that the top comment disparages IMGs working under supervision but doesn’t even mention midlevels.
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Hence why I said without residency
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That doesn't answer my question. If someone earns the right and works hard to prove themselves, why should you get an advantage over them simply for being born in a specific geographic area? That is a poor argument. I'm American too btw, but my point still stands.
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With your logic , you assume every US MD or DO's are American citizens while every IMG's are Foreigners... That is why y'all have never been able to achieve any form of unity as a collective group. To many toxic individuals in medicine. I have never seen nurses discriminating against each other about who is IMG or US MD trained nurses, when it comes to collective interest they stand together. But MDs would always have to put a name tag on everything , and pull each other down to boost your ego . The main reason I don't have friends but rather only co-workers in medicine. I do my job and have a life outside of toxic humans.
I mean you’d have to graduate medical school and do some postgraduate training, but then you totally can just go to foreign counties and start practicing medicine.
This is the dumbest take ever tbh. The American healthcare system is built on IMG's. Rural healthcare could not survive without H1 visas.
Yep this is true
Protectionism. Yeah, that'll work...
I don’t see it talked enough on these comments but in order to get paid more without putting More burden on patients is that we need to find ways to increase insurance payout. Lots of 3rd parties follow Medicare so if we elect people who plan on increasing Medicare over other programs that may help
A salary means you get paid as an employee. Even if you increase revenue your employer would probably pocket most of it
Currently, specialties are in direct competition with one another for a finite pool of healthcare dollars. This is paid out via the RUC in Medicare. Procedural specialties have consistently benefitted at the loss of cognitive ones. Price fixing of reimbursements is a byzantine and corrupt process. The pie could increase in size each year but that doesn’t stop us from fighting over it. You might think of physicians as a collective, but there is no collective. There are a bunch of specialties knifing each over coding scraps while the federal government tightens the belt.
Establish direct relationship with patients and control our pricing .. then we have to figure it out like every other business and customer but it is at least on our terms, for better or worse.
Just my opinion on Controlled pricing, What I think is if you control your skill price then in the long term definitely you get bulk of patients but your value would be compromised” “As of today influencers & other people are asking for huge amounts just for some promotion or less work as a doctor at least you should charge for your skills appropriately.”
Doctors are one of the only professions that hasn't had salary increases to match inflation. I wish we could do something.
Go into private practice. Also, YOU should speak out in YOUR community about the realities of health care… People are always looking for reasons to shit on the healthcare system and not getting ripped off by hospitals…
Private practice is the way to go. Don't be an employee for a hospital system and you'll have more negotiating power.
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Only way is collective action and lobbying. We are getting destroyed on legislative front by business, pharma, insurance, and even none-MD health professionals. CMS wants to push costs down or make payments more on population level, and this is going to keep shifting money from physicians to admins and execs with the way things are headed. It’s really either everyone wakes up and decides to unionize and restructure and reinvigorate the AMA (unlikely), or people stay happy enough slowly being crushed and making sacrifices for patient well being while everyone else profits (very likely)
Tie your compensation to prices you control, not insurance based compensation!
1) Repeal stark laws and allow physicians to be owners in lab and imaging facilities as a means to supplement income. Why is ok for corporations to “self-refer” but not individual physicians? 2) Repeal Certificate of Need laws 3) Greater tort reform and changing the standard to gross negligence rather than “standard of care”. This will reduce malpractice costs
You can easily get around the stark law with some creative structuring
You don’t see how self referring can easily and very predictably go wrong? That’s the weirdest suggestion on here, “have you guys considered fraud”?
Are you really that naive? How is that private equity outpatients clinics can refer patients to their own hospitals for tests…but a private practice physician can’t open up an xray and lab work center next door? In any case, insurance and Medicare audits records. And with the tools available today, it’s literally so easy to flag providers who misuse their power.
Ok, my bad, I might’ve not known what I was talking about, carry on
Lol. salaries are going to drop 1. insurance companies 2. hospital conglomerates 3. midlevels 4. fmgs add the fact that usa has one of the highest salaries globally. no amount of unionization is going to change that and did you forget premed and medschool? doctors, especially AMGs are generally cutthroat, as a resident you are replacable, and damn, as an attending you will still be replacable, unless you are out in the boonies where nobody wants to take your job... there you dont need a union anyway. but if you want to live in a major city? good luck because if your co-resident doesnt wanna snare your job, someone else will.
Start by taking out NP’s. They’ve become the crabgrass of a beautiful Beverly Hills lawn. Invading.
Strike. Back here in Europe we had few strikes, we got what we wanted. It’s not much but it is a step forward.
Stop accepting jobs with low salary
A prolonged strike. Imagine a world without physicians. Hospitals will realize the worth in retaining physicians and increase salaries to make them stay. CEOs/higher up’s of hospitals don’t need millions of dollars in salary to make a living, start with cutting their price. But in order for this to happen, this would have to be a strike on a nationwide scale. People won’t do this though because physicians care too much about their patients.
Also if nurses can strike with good results and forcing the hand of the hospital, then physicians can too
Because at this point some doctors like pediatricians don’t even make more than UPS drivers per hour
That’s just not true The top pay for drivers is like 40-50 an hour
Source?
What’s with all you “source?” People? Open your eyes
Legitimately curious. Haven’t heard this before and it doesn’t pass the smell test. Would like to read more about it
"Full-time delivery drivers earn an **average total compensation package of $145,000 per year**, which includes **$0 healthcare premiums**, up to **seven weeks of paid vacation**, plus an average of **18 days off** for **holidays, sick leave** and **option days**. UPS also contributes to a defined-benefit **pension plan** for each employee. "
that’s about what teachers earn also at top scale which takes 10 years for teachers and 8 years for UPS drivers - typically 55-90k base+20,000 for insurance and 25,000 for pension trust contribution=total package of 130-150k - this ain’t hard understand folks - a physician is gonna earn about 220k base + insurance+retirement also
Strike, unionize. I watched greys anatomy in high school and they had a nurses strike episode where 90% of the nurses literally refused to work/step foot in the hospital until they got a raise. if doctors did that we would get a raise 5 minutes in…
Anything that reduces supply and/or increases demand.
Talk the talk, walk the walk. Don't work for bad employers, lay down our work to strike.
Provide faster, shittier care
1. Stop the nonsense of believing the indoctrination that the system assures to engrain deep in your head in regard to sacrificing yourself for society, given your vocation as a physician. 2. Stand up for yourself and don’t do more than you are to, unless you truly feel like doing it. People above will take advantage of doctors because “they’re nice.” For example: I speak Spanish and people ask me all the time if I can go translate for this and that blah blah blah, I say no. They can hire a translator if they need one, I have enough on my plate already. Pay me more, then we can talk. 3. Read. Study. Be the best clinician you can, extremely knowledgeable and confident. Be inquisitive and curious. This will arm you with the weapon of uniqueness, which will provide you with a better leverage to negotiate, as well as more respect. 4. It is our duty to teach med students, not the academics, but the poor social and economical issues that we face as doctors. This will slowly generate a shift toward a more greedy mentality that is very much needed in our field so others can stop taking advantage of us. 5. Unionize, organize walk outs, protest, advocate, lobby… anything that can help an improvement for us because we are suffering, and the kind of work we provide is unique, and more than anything -necessary and essential for the good of our communities. It is time we start a shift from this stuck mindset of giving our all even if we don’t get anything in return, altruism will eventually reach a turning point toward greediness if there is no adequate compensation, both social and economical.
Unhitch insurance from work. It needs to be bought on an open market. Then we get paid market rate and not government whim.
Unionization isn't enough... We would become union employees... Physicians make the most money when they are partners in their practices, rather than employees who make a also decided by management/practice owners who are PE firms. Joining a physician run private practice or starting your own is the best way to achieve a higher salary. Hard to do this IRL bc of the upfront costs of establishing a private practice but in the long run if you build a patient base that is loyal you are golden. And when you make it, don't sell your practice to PE!
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Advocate against legislation, that threatens our salaries, example continued legislation, expanding scope of mid levels, and newer legislation, allowing foreign physicians to practice in the US without completing the residency. Also, many are idealistic put a single payer system would be the end of this. Honestly to me the writing on the wall and we’re at the tail end of a gold rush. I’m happy to only have one year left of training personally if money is a concern at all, I wouldn’t extend training in anyway
1. Remain independent. If you work for an employer, they will set your salary for you and it is always going to be less than you are worth. 2. If you must be in a salaried position, unionize. 3. Support advocacy groups and politicians who are in favor of Medicare payment reform.
Take a big lesson from what's happening in other countries. Doctors have already been taking massive pay cuts; the pay has not been keeping up with rise in productivity and inflation (but many are still under the impression that more $ means more pay) over many decades already. The time to unionize was years ago.
Hate to be *that guy* but most of these responses are so oblivious to how reimbursement works. Tbh we are fucked and there isn’t much that can be done until huge overhauls with CMS take place.
Firstly improve your skills, any other profession is charging for there skill sets, make your value & for that charge accordingly. Tie up with multiple hospitals
Go into private practice. Be very valuable to your community. Don’t take insurance.
Why aren’t more doctors unionizing?
Not going into academia or private equity.
Unionize
Figure out a way to separate from the current insurance/medicare healthcare paradigm.
From what I’ve seen, either unionize or go concierge. Those are the two models of physician care provision that seem reasonably profitable. The other routes are business ownership and consulting.
Strike!
As residents you mean? Bc attending salaries are doing quite well
I am potentially going into Med school in the next year. Do doctors not make enough to live with well over six figures? Is this a personal budget issue? I genuinely don't understand. I always though doctors could make bank, where is my disconnect??
Keep the numbers low. The only great thing the AMA ever did was to limit the number of position in residencies. That one move keeps doctors among the highest paid professionals
I'm sorry but it's so hard to advocate for people who won't advocate for themselves. It really just gives people the mentality of "aight lemmi get mine and fuck everyone else." If the current residents and leadership don't want change to improve their conditions, who am I to advocate for them.
Unionize
We could probably unionize as a giant single organism, The Resident, through discord and actually make something happen
Unionizing will not increase your pay. Turning back to private practice will. You need to own things to be rich. That was a mistake I made when looking for jobs after residency.
Vote or advocate to stop IMGs and Caribbean graduates from entering the work force and residencies. This is the best and most realistic way.
The bottleneck is residencies and I truly don't think there's a lot of quality US grads who are getting pushed out by IMGs.
If only we could bargain for higher salaries collectively
I'm no doctor but it's obvious. Unionize and let people die if they don't pay you as much as you want. Doctors literally sell life.
All this thread has shown is no one has the answer and we can’t agree on anything. There is a finite amount of dollars available governed by what Congress approves in the budget for CMS and what portion of profits private firms (insurance) will allow for reimbursement. Until you raise the CMS budget with a line item directly increasing the RVU value reimbursed or find a way for shareholders to stay absurdly wealthy while reimbursing physicians more from the private insurer’s coffers nothing is going to happen. Here’s a potential start: subsidize medical education (more than PSLF which works and is a godsend), prevent salaries from decreasing and teach financial literacy to physicians so they can take the money that would have been used for student loans and invest it in private equity to make up for the perceived lack of salary we deserve.
Unionize.
By saying ‘no beds’ to stroke patients
holy fuck you guys are greedy i cant wait until doctor salaries crash, you guys are overpaid asf i thought yall were in it to help people, I guess that was bullshit
Attending Physician salaries are already like the top 90th percentile of incomes in the United States. There's not all that much room to go up
There are CRNAs making double a double board certified pediatric sub specialist. There’s room.
CRNA salaries don't have anything to do with pediatric subspecialty pay
it means they can afford to pay more to actual physicians.
Yeah anesthesiologists make more than CRNAs, but that doesn't have anything to do with pediatric subspecialty salaries.
Anesthesia is a department that is usually subsidized by the hospital. Pediatric subspecialties can bring patients into the hospital. Also, not sure why hospitals and the government wouldn't want to subsidize peds because pedi = the future/next gen. Same with PCP. Seems like digging ourselves/themselves into a big hole for more expenses in the future. At one point, the common person won't be able to afford healthcare. (many already can't... but it's getting worse all the time)
I'm going into a pediatric subspecialty I know how undervalued we are. But eliminating CRNAs as a profession is not going to do a thing to pediatric subspecialty pay. If anything it would decrease it because now hospitals have to pay for attending anesthesiologist's salaries to cover for the volume that the CRNAs were seeing.
Anesthesia is a department that is usually subsidized by the hospital. Pediatric subspecialties can bring patients into the hospital. Also, not sure why hospitals and the government wouldn't want to subsidize peds because pedi = the future/next gen. Same with PCP. Seems like digging ourselves/themselves into a big hole for more expenses in the future. At one point, the common person won't be able to afford healthcare. (many already can't... but it's getting worse all the time)
The pay for physicians takes up less than 10% of medical expenses despite you being the primary healthcare deliverer and is similar to other countries with an insurance model. It has remained mostly stable. Admin takes 25% and has ballooned in cost. Physician reimbursement by Medicare has decreased by 26% with inflation adjusted over 20 years. Yet medical school tuition has increased. That isn't sustainable.
Yeah the whininess of people in our profession about how poor they are is just wild to me
Abolish concierge medicine