Payors (insurers and Medicare/Medicaid) have to put their money where their mouth is–if they claim that internal medicine and family practice is important, they have to reimburse it better so there is more financial incentive to go into such fields. Money makes a difference, especially when folks graduate with big loans.
My primary just decided to go concierge and will not be accepting Medicare. I expect he will retire before I hit Medicare age, but YIKES on having to find a new doc at some point. My oncologist and cardiologist are my age. Cardiologist leaves her practice tomorrow and will decide where she’s going in a couple of months. Am staying with her practice until she decides what she’s doing, but she will not be able to help me with the appeal process on my chemo meds until she’s employed somewhere.
I’m beginning to realize that staying in this area for my doctors may be a pointless exercise, except that there are likely to be more docs who take Medicare here than in other parts of the country.
I’m very nervous about continuing medical care, even with excellent private insurance. My Pulmo has been treating me for over a decade, but going to his elevation of 5,200 feet is increasingly tough on my junk lungs. He’s transferring my care to his buddy in SF, who is also about 70. I wonder how long he will practice and whether he’ll refer me on, sooner than later. As it is, it will take at least one or more plane trips to get to CA or Denver.
I’m still concerned about who will provide primary care when my internist and his partner retire–his twin brother (pathologist in CO) is already retired. We are the state with the 2nd oldest population of MDs in the US, with > 1/3 of HI active MDs 60 or older! Many are not taking any new patients and others aren’t taking new Medicare patients. My youngest MD is 49 years old–the others are in their 60s!
For orthopedics, NPs/PAs see a lot of patients here. They run an 7 day/wk urgent care ortho clinic with some MDs providing some assistance. That’s the best way to be able to see the ortho surgeons, by first going to the urgent care ortho clinic, even if your issue ISN’T urgent.
Our neighbor islands have a ton of NPs and PAs providing a lot of care. The community health centers do as well. Most of Oahu still has care mostly provided by MDs.
My internist has been selected as a top MD in HI for countless years. He says he’s made the same salary for all the past 28 years of his practice! He’s discouraged that new hospitalists make $300,000/year (impiedly way more than him), and in his opinion don’t have the huge caseload he and his partner have.
Does anyone know the average loan amount doctors have to pay each year? For how many years after graduation?
I’m not sure there’s an “average,” as med school costs vary widely and did even back in the 1980s, when my peers were in med school. Some students are fortunate to graduate without debt, especially if they attend public Us, some get merit aid (yes, I know a student who received merit aid for med school), some borrow the entire amount and some are able to borrow much less.
CBS article quoted $166K as average medical school debt for “newly minted” MDs. That could easily be the price of a modest home in parts of the US.
Unless a medical student has wealthy parents, at $50,000 per year, the debt is $200,000. The interest rates are around 6%. A few months ago, my daughter figured out what her monthly payment would be and while I don’t recall the exact figure, I know it was more than our mortgage payment.
Thirteen new MD medical schools have opened in the US since 2010 and about a half dozen more are developing. Will this help alleviate these shortages?
It’s supposed to, Tom. And look at the number of new PA/NP programs. Also PAs will be able to work more indepently of doctors (this may have started.)
On med school debt, google offers info. And there are some programs to support loan payback.
Here is the AAMC debt fact card showing (on the last page) example repayment schedules for medical school student loan debt:
https://www.aamc.org/download/447254/data/debtfactcard.pdf
The example student loan debt amount of $183,000 would take $2,700/month over 10 years or $1,600/month over 25 years to pay off after completing a 3 year residency.
http://www.tax-rates.org/income-tax-calculator/ indicates that someone earning $160,000 (entry level pay level of internal medicine physician, eventually does rise somewhat) in Hawaii would net about $103,000 after income and payroll taxes as a single person with no dependents or itemized deductions.
$2,700 per month is $32,400 per year, while $1,600 per month is $19,200 per year. So the net after income and payroll taxes and debt service would be $70,600 to $83,800 per year. This is a high income, but probably not as high as what people think physician income is. (Remember also that a physician starts earning significantly later than most people do, due to the extended schooling needed.)
@HImom: In your opinion, what’s the reason for the shortage of primary care doctors in Hawaii?
Just curious because for a small (population) state, the U of Hawaii has a nationally ranked medical school for primary care and Hawaii is held out as a model health insurance state. See http://www.latimes.com/nation/la-na-healthcare-coverage-20140406-dto-htmlstory.html
Our largest insurer, a BCBS that insures over 75% of the state, has very low reimbursement rates, including for primary care. Our cost of living in HI (especially housing) is very high, and many of those who can send their kids to private school, which is a significant added expense. Most of the MDs in our state are solo or very small practices.
The MDs I know claim that the BCBS reimbursements are nearly as low as Medicare/Medicaid and that there is slow payment of claims by insurers. They are also frustrated by pre-approvals and paperwork required by insurer.
Paying for translators (MDs have to pay if patient can’t understand) is also very costly and higher than their limited reimbursement.
Dang–my allergist just announced she’s closing her practice effective immediately! She’s one of the docs who fits us in when we need to see someone and has been treating us for over a 15 years as a family.
She was always there for us, even when our health issues were complicated and is just an amazing person. She will be a tremendous loss. She just got me to transfer to a new Pulmo, whom I like very much.
Sadly, she’s having her own personal health crisis. I sent her a text message of support. I’m not quite sure what to do at this point.
H retired after 34 years in internal medicine less than 3 years ago. I do not think he ever earned more than $160,000 and the first 15 years were around $55,000. I remember when we hit $100,000 thinking we were rich (not). He worked 40 hours plus many nightcalls.
D is finishing medical school and headed for a specialty and is close to $300,000 in debt.
She could never pay those loans off, have a family, if she stays in internal medicine.
Wow, $300K in debt is scary and it’s sad that internists are so poorly compensated. They really deserve higher reimbursements, especially as they’re being asked to be the “medical home” and talk with patients about advanced directives and coordinate care among specialists!
You are enjoying the fruits of a managed economy. Remember, Washington knows how many primary care physicians to produce and regulates the number of slots. There is not a shortage, just over-utilization. That is exacerbated by a mal-distribution of physicians who are motivated by greed to aggregate in inappropriate areas. Don’t worry though because more intense centralized planning and regulation are on the way. Don’t forget that all of this effort will result in accessible, high-quality care at low cost.
I think the net income would be higher because student loan interest is tax deductible.