[whyrms]

Originally Posted by pman10

We agree more than you realize. In no way did I claim that nurses provide care commensurate to physicians.

You are right, that the ANA is trying to expand the roles that nurses can wield in the field. See my post above for my thoughts on this and how to counter this. I just thought that the poster above you was overplaying the issue, with his claim that they were forcing physicians out of medicine.

Sorry I read too much into your comment. Anyway, cheerio!

On another note: lets hope this doesn't pass http://www.medpagetoday.com/PublicHe...Medicare/27430 and we can sail through this shit storm...
on second thought, that would solve all our problems: less care for the elderly=more death=less patient pool=no more physician shortage! woot woot! genius!

[AngelinIsRich08]

In the states there are people in their 90s getting hip replacements and orthopedic surgeries. Any other country and they'd be told to go home and die. Believe me, what I jet said is true because I'm originally from Bulgaria and have parents who are doctors in the States. A college friend of mine who's an orthopedic surgeon and I were at a party and he told me his latest surgery was that of a 93 y/o who needed knee replacement. Under socialized medicine if you're over 75 you should forget even mentioning such a surgery.

[just4kickz]

lol... anyways. OP what is your major?

[mact3333]

Originally Posted by schoy

My $0.02: If you're going to med school to make money, you're going for the wrong reasons. Frankly, I doubt there's anyone here who wants a doctor treating them who's in it for the money. As someone mentioned above, the money will come when you do your job (any job) well.

Sure we all go into medicine or anything else for the right reasons but then you get a nagging wife, kids, M3's to buy, etc...then you wake up.

I wish someone would have told me what I have stated on this thread many yrs ago...I am doing you guys a huge favor here...dont be naive...to not care about money to like saying "Nah, I wont fukk Megan Fox, my girlfriend, until were married cause its the right thing to do"...exactly something a person who isnt getting any would say...but once you get a taste, you will crumble to the power of greed and lust just like everyone else...when you accept this factoid is when you will get a head start in your career.....

If your character says you will be a caring and devoted doc, then you will be, but you can do it for 200K or 400K, its up to you.

[newdadkel]

pman, dont be so sensitive her in OT. I will play nice since you take things personally.

With all due respect, med school does not teach you shit about the real world and real practice. As a 3rd year, you are busting your ass right now trying to get through each rotation and test, so you dont have time to learn about how the outside world really practices medicine. I have been in private practice for 5 years now and dont pretend to know more than everyone else, but I know a hell of a lot more than I did as a 3rd year med student.
Now to answer some of your specifics, I have personal friends that have been dipslaced by midlevels, and I can promise they are not incompetent in any way. A very good friend of mine is an FP, and was hired by one of the two large hopsitals here to start a clinic; they had several placed around town to give access to all ares. Great idea, but what happens with hospitals is like wall street. Some CEO/CFO/COO group comes in and has their own ideas about what works best. So during a second change, the new groups thought this outlying clinic idea was pulling money away from the hospital. So my friend was let go at the end of her contract, and her clinic is now run by a FNP that has his charts signed by a doctor at the hospital that doesnt even see the patients.
The teaching hospital went to a CRNA program overseen by the attendings, and some of the anesthesiologists did not have their contracts renewed. Ever since, the anesthesiology program has been in shambles because they cannot keep anyone good. This model has not worked. The private hospital that I primarily operate in fought like hell to keep the CRNA's out because they could see the writing on the wall. If CRNA's were let in, they could simply let 1/3 to 1/2 of the doctors walk after their contracts were over. Fortunately, the surgery departments united with the anesthesiologists and prevented this.
See, what REALLY happens is that few doctors are out and out FIRED. They just do not have their contracts renewed, or have their duties restricted to the point where they get pissed and finally leave. Even if a doctor is reported to the medical board, as long as its not a felony, they can simply agree to take more CME or have a short term suspension, and can begin practicing again. They are not fired like you seem to imply. The real business of medicine works differently than what they have been telling you for 3 years. But this is the ugly side you will see later.

Your 3 points of change have merit but again illustrate this altruistic aspect of medicine that you still have, which is not a bad thing, dont get me wrong.
Where is your incentive for increasing primary care coming from. Some areas already have debt forgiveness if they work in an underserved area, but they aree still being encroached upon by midlevels, insurance companies, and healthcare orgs. And who is going to provide the tax benefit you speak of? Can you just give it to one group and not all? How do you define primary care?
In Texas, they have opened up the med school at El Paso just to try and increase primary care in underserved areas and along the border. They are also fast-tracking primary care through in 3 years now instead of 4. This will increase the numbers but not change the process of using lesser expensive options to treat the same issues. Primary care physicians will still deal with more work and less reimbursement, and always have to wonder of they will not have their contracts renewed (since you are particular about the actual term used) and be replaced by a midlevel. Insurance companies could give a shit about the quality of care that patients receive. They dont care. So patient satisfaction will not even be a consideration because they will have to see whoever is on their plan.

And the AMA is practically useless. They have not fought in the past to keep up reimbursements or block increased licensig for midlevels. Would you pay hundreds of dollars a year to an organization that doesnt listen to you? Believe it or not, the AMA was an early supported of the new healthcare chagnes, and that when a lot of doctors left. The AMA has not had the doctor's back on several issues, and people have gotten pissed and left. But it is also the same organization pushing for more board certification and CME requirements because, guess what, they make a ton of money off this BS. YOu will start seeing a backlash againt board certification because it really doesnt not change how you practice or even if you are a good doctor. I am board certified and hate paying 1500 dollars every few years to take the damn test. Many are not paying anymore. Some early words of wisdom: the AMA is a business and run like a business, and you will understand this with your economic background.

So I appreciate your input. This is how I felt as a medical student and wearing the (short) white coat for the first time. But the real world is different bro. It is all business when you get out, and all decisions are based on that. With increasing cost awareness by everyone, its going to get even worse.
So just focus on your clinical rotations, the USMLE, and good luck. Check out Sermo for some other real-life discussion on medical topics and the business side.

[mact3333]

to all the aspiring docs, please dont get caught up in where you graduated from and etc...and if you are in med school or residency and you "think" you know what your talking about, you dont...in reality you dont know jack ...trust me on this one.

Just like any other field, it ultimately doesnt matter where you graduated from or what you even know...its all about communication ability...do you take the time to listen to your pts...do you answer their phone calls in a reasonable amt of time...do you speak in laymans terms so they understand you...are you prepared and do you look them in the eye when you talk with them...dont start typing your note due to electronic med records and avoid eye contact cause pots hate this....it comes down to whether they like you really.

And your partners could give 2 flying fukks how smart you are, they care about revenues...as long as you dont kill your pts and you get along with staff reasonably well they wont care.

Now I know I sound like a greedy insensitive pig from my previous posts, and perhaps I am, but your character is defined by not what you say or how much you make, but rather by your actions.

Often times, if my pts cant pay for meds I will pay for it...I also pay for my pts gas at times too...little things like this will make a much bigger impact on your pts not by the monetary value, but by the gesture itself...sometimes regretfully, i also give some pts my cell number...it is these qualities that will define you in the end...dont be the guy who talks a big game getting all altruistic on a car MB but wont back it up with actions.

[newdadkel]

Could not agree more mact3333.
Being in medicine as well, you have seen the best and worst of what this profession has to offer. There are some really great doctors who are buried in debt but sacrifice to provide the best care to their patients, and there are some horribly greedy docs who would not discount a visit or wave a copy for anything in the world. And most docs fall somewhere in between. This is not to say that a physician is one or the other, but you have to remember why you got into medicine in the first place.
As students like pman get into residency, you are going to start learning more of the business side. One lesson I learned early on is not to compare with what someone else is doing, making, driving, living, etc. It can be easy to "medically justify" procedures that are not needed in order to make more money. AS an example (and this is not to generalize pman so please do not get offended), the rate of angiograms and placement of stents greatly increased as the technology became more widespread and with easier access. Im sure mact3333 can also name some cardiologists who perform "borderline" angio/stent for reimbursement, and are known for doing such. Why do you think separate heart centers have sprung up all over the country? Now this happens across all professions so it is not only this specialty, but this is the challenge as you get into practice: do whats right or do what will pay you the most.

[Matto ELYTE]

At what point do I address someone as Dr?

I feel if I am at their office or under their care, I call them Dr....If I have no relationship with them as their patient, I refer to thejm as Mr.xxxxx if we're not on a first name basis.

Thoughts?

[AngelinIsRich08]

To add to above posts, communicating with primary care docs, family and refferings, is by far the most important thing. Also, the faster you discharge patients the more brownie points you get from the admissions and hospital staff and bosses.

[dvpouldar26]

To the OP:

For those of you who are doing pre-med or are in med school, how do you like it so far?
I'm a 4th year pre-med at UCLA. Physiological Sciences major. Although there is an enormous comitment, I couldn't love it more.

Is it intense?
Yes, it is intense, that's the nature of UCLA, getting into a med school, and my major in general. I'm competing with peers who have gotten into John Hopkins for their MD, MD Phd prgrams at Yale, etc. Classes here have straight curves sometimes with over a 30% drop-out rate in the first class of the major alone. To those who really love it, put the time forth, and see that it is worth it, it is agreed upon that there is nothing more rewarding. I work in 2 research labs doing 18 hours a week of research on top of taking 15 units per quarter. Its intense, but the amount you'll learn and payoff is pretty rewarding.

Is it interesting?
As a Physci major at UCLA, alot of what we learn is normal anatomy, physiology an histology, similar to what is learned 1st year of med school albeit to a much less intense/detailed degree. I cant even describe how interesting the subject is to me, personally, so YES.
Where do you see yourself in the next 5 years?
I'm starting my fourth year and will be taking my MCAT in the next few months. In 5 years, I hope to be in med school.

How are the classes/grades?
Grades are good, but its all what you put into them. I have friends who do well, I have friends who take the classes solely based on learning the information and don't worry much about grades as long as they do their best. I do have a pretty high GPA, but also put in ALOT of work. It's all dependent on what you put into it.

Do you enjoy it?
I personally come from a family filled with doctors or a science-based background. In my immediate family alone I have a molecular biologist, a registered dietician, a radiologist, a nephrologist, orthodontist, orthopedic surgeon, a cardiologist, and a Phd in diabetes research here at City of Hope. I've had experiences with each and every one of them from hundreds of hours in the operating room, the doing cell cultures, PCR's, etc in the lab, to reading MRI's. If you see that you really enjoy the subject, there isn't much that can come close to how much you enjoy it.

I'm asking these questions because i'm a 2nd yer pre-med major.

And as for doing it for the money, there simply are easier ways to make money if that is your primary goal. I know a few people who went into it for those reasons, and without the needed dedication, most of those types don't last. If you're going into it for the money, it is much easier to make more money with the same effort, time investment, and dedication by doing something else. Do not waste your time if that is your motive.

[AngelinIsRich08]

Holy shit. A cardiologist that's been a family friend for over a decade is deciding to upgrade from his 2003 Mercedes ML320 CDI to a $300,000 Maybach!

[Echo M3]

Originally Posted by newdadkel

=.

I wasn't being sensitive. However, I did take offense to your previous statement.

That being said, while I don't completely agree with you, I can respect this post. With regards to physicians being let go...well that is certainly alarming. I certainly hope physicians take a stronger step towards collaborating on future issues. If nurses can do it, why can't we? Other countries routinely have physicians strike on pay and other matters. There's no reason we can't do the same, to safeguard the future of our profession.

My (somewhat) altruistic view is what led me to medicine, so I certainly hope it does not dissipate over time. Otherwise, I'm not sure why else I would remain in the profession.

Best of luck to you, as well. And thanks for taking the time to share your thoughts with me.

[mact3333]

your green-ness sounds abit silly to all that have actually been in practice for more than 5 yrs........thing is, you dont even understand what you dont know yet...it will be enlightening.

Originally Posted by pman10

I wasn't being sensitive. However, I did take offense to your previous statement.

That being said, while I don't completely agree with you, I can respect this post. With regards to physicians being let go...well that is certainly alarming. I certainly hope physicians take a stronger step towards collaborating on future issues. If nurses can do it, why can't we? Other countries routinely have physicians strike on pay and other matters. There's no reason we can't do the same, to safeguard the future of our profession.

My (somewhat) altruistic view is what led me to medicine, so I certainly hope it does not dissipate over time. Otherwise, I'm not sure why else I would remain in the profession.

Best of luck to you, as well. And thanks for taking the time to share your thoughts with me.

[schoy]

Originally Posted by mact3333

Sure we all go into medicine or anything else for the right reasons but then you get a nagging wife, kids, M3's to buy, etc...then you wake up.

I wish someone would have told me what I have stated on this thread many yrs ago...I am doing you guys a huge favor here...dont be naive...to not care about money to like saying "Nah, I wont fukk Megan Fox, my girlfriend, until were married cause its the right thing to do"...exactly something a person who isnt getting any would say...but once you get a taste, you will crumble to the power of greed and lust just like everyone else...when you accept this factoid is when you will get a head start in your career.....

If your character says you will be a caring and devoted doc, then you will be, but you can do it for 200K or 400K, its up to you.

I'm not saying that doctors shouldn't care about the money. Docs deserve to be paid what they get paid. But I don't think many aspiring docs go (or should go) into medicine primarily for the money. To have to suffer through 4 years of med school, 2 years of internship, 2 years of residency, be strapped with a couple of hundred $Ks in student loans, be 8 years behind your peers in income (+ more with time value of money) -- that's a huge sacrifice. There are other jobs that make a ton more money if that's your goal, without the ethical dilemma of money vs. adequate care (law, banking, consulting, etc.).

What I'm saying is: Go to med school because you want to help people, not to make money. You'll be a better doctor for it, and good docs generally make a ton of money.

[mact3333]

agree with everything you just said....just saying things change once you get out...you do realize if you are in private practice you're not really a doctor, you're a small business owner who happens to practice medicine, not the other way around...

Originally Posted by schoy

I'm not saying that doctors shouldn't care about the money. Docs deserve to be paid what they get paid. But I don't think many aspiring docs go (or should go) into medicine primarily for the money. To have to suffer through 4 years of med school, 2 years of internship, 2 years of residency, be strapped with a couple of hundred $Ks in student loans, be 8 years behind your peers in income (+ more with time value of money) -- that's a huge sacrifice. There are other jobs that make a ton more money if that's your goal, without the ethical dilemma of money vs. adequate care (law, banking, consulting, etc.).

What I'm saying is: Go to med school because you want to help people, not to make money. You'll be a better doctor for it, and good docs generally make a ton of money.

[TiAg335i]

Originally Posted by schoy

I'm not saying that doctors shouldn't care about the money. Docs deserve to be paid what they get paid. But I don't think many aspiring docs go (or should go) into medicine primarily for the money. To have to suffer through 4 years of med school, 2 years of internship, 2 years of residency, be strapped with a couple of hundred $Ks in student loans, be 8 years behind your peers in income (+ more with time value of money) -- that's a huge sacrifice. There are other jobs that make a ton more money if that's your goal, without the ethical dilemma of money vs. adequate care (law, banking, consulting, etc.).

What I'm saying is: Go to med school because you want to help people, not to make money. You'll be a better doctor for it, and good docs generally make a ton of money.

There's so much to medicine and people go into it for all different sorts of reasons. Doesn't mean they won't make a good doc or be unhappy.

Have you applied/are you a doctor? Of course helping people is part of it. Putting that on your med school primary or secondary applications certainly won't help you get in, though. You need to be an academic, a scholar, a volunteer, research scientist, clinician, have a well-balanced and moral character, and more to be a successful doctor.

I agree that no one should go into medicine primarily for the money. I'm sure there are plenty of pre-med students out there right now doing so but also PLENTY who are being weeded out of the process as we speak. Med school admissions committees function to only let in those individuals who demonstrate several qualities necessary to be a good physician.

[matthewk]

Originally Posted by M3Bahn

I would go for pharmacist these days, you can start at $100k out of school. Seems like it's boring job though but job growth with all the aging boomers seems strong.

A great thread.

IAMA pharmacist bored at work who will actually answer questions unlike the pharmacy student who just did an AMA, AMA

http://www.reddit.com/r/IAmA/comment...will_actually/

Pharmacist is going to top out at $200k (current dollars) at the absolute high end, unless you go into the business side. But if your counting pills that's likely going to take a hit to. With the automated fillers and patient regimen blister packing growing increasingly prevalent and most large scale pharmacies gravitating to mail-order, the days of lick and stick pharmacists are likely numbered.