On Tue, 2 May 2017 16:01:42 -0400, Steven Bornfeld
<
dentalt...@earthlink.net> wrote:
>
> I'm trying to stop reading some of the medical mailing lists (like
> KevinMD). To read the comments, you'd think 90% of doctors are
> right-wingers of the "I blame Obama" variety.
Well, many are. Doctors- especially expensive specialists- tend to be
more towards the conservative end of the spectrum IME. Generalists,
family practitioners, internists, etc., seem to tend to be mroe liberal.
Of course, they are making 1/2 of what a radiologist, cardiac surgeon,
ortho surgeon, etc. makes.
> And yet, I probably don't have to tell you (if you participate in any
> insurance panels) that reimbursement rates relatively have gotten
> progressively worse over time, so much of the grumbling is
> understandable (if not justified).
Well, the increases in reimbursement for psychologists over the 27 years
I have been in practice has not kept up with inflation, let alone with
the leaping costs of doing business. Once the office rent, EHR license
fee, phones, internet access, equipment, etc., are paid for the
clinician can readily end up losing money.
I make twice what I made in 1991, but corrected for inflation that's a
bit better than a break-even (what, about 14%, so about a 0.5% raise per
year over my career). And thats way, way better than at least half of
Americans have seenin the same time frame. Many of us are earnign
equivalently less than we made in 1991 or 1968- the median income has
actually fallen since then. The only thing preventing large scale riots
is the ease with which one can get and use a credit card to live beyond
one's means. Of course, them chickens will come home to roost in
another 15 years when the baby boomers are mostly retired and can't
repay their debt (especially the third of us that have zero retirement
savings).
Insurance companies tend to like large practices as provders, believing
that there is a better return for the fees they pay; they may be right,
as the insurance insdustry is very actuary-driven. They parse those
numbers very carefully. There is an interesting trend towards
micro-practices that I have been reading about- a single provider with a
tiny office and very low overhead, seeing a small caseload. By
minimizing costs, it's easier to make a decent living without having to
see 30 patients a day five days a week.
> It is comforting to hear that a kid can still get a decent job out of
> college--mine is finishing her junior year (in Spain) now.
Well, it matters what major they pick. If it's a "supersize major" (as
in they will professionally be asking customers if they want to
"supersize" those fries an soda), then college may not pay off...