Health reform impacting your decision?

[rmitch8]

I'm curious if the newly passed health insurance reform is affecting anyone's decision to head stateside for medical school. Are you guys more or less willing to become a doctor in the states since reform passed on Sunday?

 

It looks like some of the most significant things in this bill will begin in 2014, when most of us are starting residency. It will obviously change the landscape of healthcare in the US, but I have no idea how it’s actually going to affect doctors. The uncertainty makes me a little bit nervous, but this nervousness isn’t really substantiated by any solid facts or numbers. Ideologically, I think it’s great that more people will be covered, and would rather be a doctor in the “new” system. What do you guys think about it all? More likely or less likely to go US?

[ChicoMaki]

To be honest. My decision to study in the US is purely based on the educational/learning opportunity that may not exist for myself in the next 5-10 years.

 

With the new HC reform, I may be slightly more inclined to study medicine in the US as it would give me an opportunity to really see what the system is going to be like when I start practicing and I can compare it to the Cdn system (which I doubt will change over the next 4 years). By seeing the two, I will be able to make an informed decision about where I want to practice.

 

From what I've been reading on theheart.org, medicare payments are being cut for cardiologists on a variety of procedures so in therory, there may be a decrease in earning potential for some specialities. At the same time, more patients will be covered so we can make an impact on many more people.

 

Just think about --> about 35 millions Americans will have insurance in the next couple years. That's greater than the population of Canada so physicians will probably be more busy seeing more patients, which I would argue isn't a bad thing at all.

 

Just my 2 cents, although I won't be making any decisions until classes are full and financial aid packages come out

[keith_015]

I won't lie, but I'm nervous also. Even if things aren't gonna set in big time until 2014, the winds of change have started blowing today. I still think the education we can get down there will be great, even considering cuts I'm sure that will be made.

 

Its hard to really grasp right now the full impact, although I'm sure there will be a little extra pressure on foreign doctors, and US trained aliens to become physicians in the US. Come to think of it, the 30+ million that will receive care are probably some of the sickest in the US right now without insurance. They will certainly be holding down the system to a larger degree and the need to treat these people will be that much higher.

 

One bonus that could come out of this is possibly easing of the consistently thick red tape that is called visas and immigration for physicians. In the end, they will probably need all that they can get for physicians. But yes, the specialist salaries could fall, while the primary care salaries could rise.

 

I'm in a position of wait and see right now, but definitely nervous.

[Rach]

 

Just think about --> about 35 millions Americans will have insurance in the next couple years. That's greater than the population of Canada so physicians will probably be more busy seeing more patients, which I would argue isn't a bad thing at all.

 

I actually do think this it is a bad thing, at least from a career standpoint (maybe from the patient's perspective as well). From what I've read, and from shadowing US docs, physicians in the US are already operating pretty much at capacity. If medicare reimbursements are cut further, docs will have to see more patients to make the same salary. Even if salaries aren't a concern to some people, I'm thinking that the increase in patients (with or without reimbursements being cut), will cause a pretty big strain on physicians trying to fit more patients into their already full schedules. Could possible affect how well physicians can do their job. Who knows.

 

 

One bonus that could come out of this is possibly easing of the consistently thick red tape that is called visas and immigration for physicians. In the end, they will probably need all that they can get for physicians. But yes, the specialist salaries could fall, while the primary care salaries could rise.

 

Hopefully you're right and we'd have fewer problems with working there as physicians though I'm a bit nervous that our residency opportunities will be hurt. If I'm not mistaken, residencies are funded by medicare. If medicare is being downsized, I wonder if hospitals will get less money for residencies, which I suppose could affect how many residents they're willing to take on. I don't know if this could happen since it's unclear to me where all of the supposed cost-saving measures in medicare are coming from. Maybe they just come from reimbursement cuts and residencies won't be affected.

 

Like all of you, I'm a bit apprehensive since it's hard to understand what will come of all of this. If anything, I'm thinking that Canadian schools are looking better than before. Because it's all so uncertain, having less school debt at the end of med school seems more important to me now. I'm also in "wait and see" mode, I'll really worry about this if I get accepted to McGill, otherwise I'll happily head down south.

[trickybox]

Without having read the entire healthcare bill, I'm still not aware of all the changes that will occur. Reading through those SDN topics and posts (including official links) have left me even more confused.

 

One thing that strikes me positively is that almost all developed countries have some sort of universal health care system in place, and now the states are trying to move towards that. So yes, I'm nervous to practice down in the US, but it should be a more familiar situation, as they've now gone almost in between where they were before and Canada's healthcare system.

 

Btw, with the 35 million more patients, and no increase in the number of residency spots, is there a plan for how to serve this new population?

[Rach]

Without having read the entire healthcare bill, I'm still not aware of all the changes that will occur. Reading through those SDN topics and posts (including official links) have left me even more confused.

 

One thing that strikes me positively is that almost all developed countries have some sort of universal health care system in place, and now the states are trying to move towards that. So yes, I'm nervous to practice down in the US, but it should be a more familiar situation, as they've now gone almost in between where they were before and Canada's healthcare system.

 

Btw, with the 35 million more patients, and no increase in the number of residency spots, is there a plan for how to serve this new population?

 

This is exactly what I don't get. Either everyone's care will go downhill to accommodate for more peeps, or the people who couldn't afford care before, still won't be able to find physicians, and they'll just continue to go to the ER for care. Hopefully there's a brilliant plan in place to deal with this that I'm just missing.

[Guest viscous]

I did not come across any hint that medicare was going to be downsized. On the contrary, I read that taxation will increase on people who make above $200,000 etc.

[keith_015]

Don't worry...those 11 new med schools opening up in next few years will help fill the void eventually. HA. HA. HA.

 

If there was any money allocated in this bill for training physicians, I'm sure we would've heard about it by now. With the amount physicians pay for insurance, hefty lawsuits, higher workloads and possibly lowered salaries in the future, the US might have to resort to getting even more doctors from overseas who can't speak English. Can't see too many Cdn trained doctors wanting to get into that mess.

[trickybox]

Don't worry...those 11 new med schools opening up in next few years will help fill the void eventually. HA. HA. HA.

 

If there was any money allocated in this bill for training physicians, I'm sure we would've heard about it by now. With the amount physicians pay for insurance, hefty lawsuits, higher workloads and possibly lowered salaries in the future, the US might have to resort to getting even more doctors from overseas who can't speak English. Can't see too many Cdn trained doctors wanting to get into that mess.

 

This is what's driving me insane. By opening up those new med schools without including new residency spots, there won't be a significant increase in physicians. At the same time, I remember reading somewhere that they wanted to decrease the amount of foreign trained doctors practicing in the states. So you're basically increasing the physician workload, cutting medicare reimbursements, and attempting to decrease the amount of foreign doctors. I foresee many doctors retiring in the next several years who wouldn't have before.

[keith_015]

Yeah...haha and maybe you will actually see others go North.

[rmitch8]

This is what's driving me insane. By opening up those new med schools without including new residency spots, there won't be a significant increase in physicians. At the same time, I remember reading somewhere that they wanted to decrease the amount of foreign trained doctors practicing in the states. So you're basically increasing the physician workload, cutting medicare reimbursements, and attempting to decrease the amount of foreign doctors. I foresee many doctors retiring in the next several years who wouldn't have before.

 

Damn, why would they want to decrease the number of foreign trained doctors practicing in the states? That's bad news. It makes sense to let foreign trained doctors practice in the US since the extremely high cost of a physician's training is essentially subsidized by a foreign government.

 

I was hoping initiatives like this one in Ontario (http://www.healthforceontario.ca/Work/OutsideOntario/PhysiciansOutsideOntario.aspx) would start popping up in the US.

[Rach]

I did not come across any hint that medicare was going to be downsized. On the contrary, I read that taxation will increase on people who make above $200,000 etc.

 

Well I might be going off of earlier versions of the bill, haven't really had time to look at what changes might have come about in the last little while. From what I know, there will definitely be cuts in medicare advantage (which covers 25% of medicare participants). They may have changed things a bit but in earlier versions of the bill, I'm pretty sure they planned on saving $400 billion over 10 years entirely through cuts linked to medicare. Not sure how/if this will affect us in the end.

[moo]

I think this is a good step for physicians in the US, especially if you're doing primary care. While you may make less in a procedural based specialty in the future, I think that is really a moot point. You will make a comfortable salary if you do a procedural based specialty (even in Canada) and you guys should not worry about getting lower fees or what not.

 

The biggest problems about being a physician in the US, IMO, are 1) malpractice premiums and worrying about getting sued, 2) headaches in dealing with the uninsured/getting paid for seeing them, 3) dealing with insurance companies/denial of claims, and 3) dealing with the visas/immigration as a Canadian.

 

Whether the health care reform will be good for America remains to be seen. Watching Bill O'Reilly on Fox News yesterday, he seems quite optimistic (for a right wing guy), but he also said something that I totally agree with: similar reforms have failed in Massachussetts. For me though, I think this is a first step in a series of steps over the next few years (?decades) that will see the US slowly transition to a single payer system. Only truly then will the US system be free of the red tape that clogs its system today.

[keith_015]

The US will never see single payer moo. The attitude is too individualistic. Why would a poor person deserve to get the same level and urgency of treatment as rich person?

[moo]

The US will never see single payer moo. The attitude is too individualistic. Why would a poor person deserve to get the same level and urgency of treatment as rich person?

 

I think they eventually will get there. Perhaps not in our lifetime but eventually they will.

 

Remember, people in the 60s said the same thing in Canada when universal health care was brought in. Doctors went on strike. Citizens took to the streets. Canadians don't realize it but the health care debate in the 60s was just as heated and divided the nation just as the health care debate is dividing the US today. And now, few here will deny the benefits of universal health care.

 

There are single payer advocates in the US. Dennis Kucinich, Bernie Sanders, to name a couple. I suspect more Dems support single payer than the public is lead to believe (perhaps even Obama) but right now the climate is such that the US is not ready. They realize that incremental change is what is needed so that's why they're taking that step.

 

I think that eventually one of the more liberal states will institute universal health care, and then the rest of the nation will slowly realize the benefits of it.

[Rach]

I think that eventually one of the more liberal states will institute universal health care, and then the rest of the nation will slowly realize the benefits of it.

 

Doesn't Hawaii have a quasi universal health care system? Poor Hawaii, no one will listen to them.

[moo]

Doesn't Hawaii have a quasi universal health care system? Poor Hawaii, no one will listen to them.

 

Not as far as I know. San Francisco has a "public option" called healthy SF only available to SF residents though.

[trickybox]

I think they eventually will get there. Perhaps not in our lifetime but eventually they will.

 

Remember, people in the 60s said the same thing in Canada when universal health care was brought in. Doctors went on strike. Citizens took to the streets. Canadians don't realize it but the health care debate in the 60s was just as heated and divided the nation just as the health care debate is dividing the US today. And now, few here will deny the benefits of universal health care.

 

There are single payer advocates in the US. Dennis Kucinich, Bernie Sanders, to name a couple. I suspect more Dems support single payer than the public is lead to believe (perhaps even Obama) but right now the climate is such that the US is not ready. They realize that incremental change is what is needed so that's why they're taking that step.

 

I think that eventually one of the more liberal states will institute universal health care, and then the rest of the nation will slowly realize the benefits of it.

 

Wasn't the Massachusetts health care reform considered an institution of universal health care in that state? If I recall, even though it has one of the lowest uninsured percentages in the country, the reform is still considered an overall failure. I think most people described it as health care INSURANCE reform, not health care reform. I'm definitely not an expert on this, but I was hoping you had some insight into both this reform and how the current health care reform corrected its mistakes?

[bannie22]

Yeah. Massachussets has universal health care.

 

Either ways, I don't really care about reforms as long as I make 10million a year...

 

 

no?

 

 

no 10 million?

aw shucks. =/

[Rach]

Not as far as I know. San Francisco has a "public option" called healthy SF only available to SF residents though.

 

Well it's not a true universal health care model but I think most Hawaii residents have insurance provided to them by law, from employers. I thought they also had true universal health care for kids at one point but I think they dropped that.

 

trickybox, I'm also no expert but I believe that in Massachusetts, health care cost per person ended up being quite a bit higher than the rest of the nation. So even though people technically had health insurance, the cost of care was worse than before (spiraling costs is the biggest problem in the US, IMO). I have also heard that people there had a hard time finding physicians. Not sure how the current reform aims to do better than MA wrt providing enough physicians for the population. I also haven't seen anything in the current reform that will manage to constrain cost growth.

[moo]

Well it's not a true universal health care model but I think most Hawaii residents have insurance provided to them by law, from employers. I thought they also had true universal health care for kids at one point but I think they dropped that.

 

trickybox, I'm also no expert but I believe that in Massachusetts, health care cost per person ended up being quite a bit higher than the rest of the nation. So even though people technically had health insurance, the cost of care was worse than before (spiraling costs is the biggest problem in the US, IMO). I have also heard that people there had a hard time finding physicians. Not sure how the current reform aims to do better than MA wrt providing enough physicians for the population. I also haven't seen anything in the current reform that will manage to constrain cost growth.

 

I think costs spiralled out of control. I'm not entirely sure about it, but it definitely wasn't universal coverage.

[Rach]

Yeah. Massachussets has universal health care.

 

 

I think costs spiralled out of control. I'm not entirely sure about it, but it definitely wasn't universal coverage.

 

Not universal health care. General idea seems to be pretty similar to what is in the current bill. People were required to get health insurance one way or another, and the gov helped people who couldn't afford it.

[silvermen85]

Obama care aim to have 95% of the population covered, consider the remaining 5% include illegals that number pretty much means universal coverage for the US population. It is individual mandate which means everyone are "REQUIRED" to purchase health insurance, with subsidies provided for low income individuals and families. People will pay a fine if they don't have health insurance based on their annual tax return. The bill also expands Medicare coverage as well as close the donut hole in prescription coverage of Medicare. Would it affect physician practice? Maybe if they change the Medicare compensation rate in the future.

[trickybox]

"The bill lowers Medicare provider payments to hospitals, hospice, and home health agencies."

 

As Rach said before, if Medicare to hospitals is deducted, does this affect residency positions? I guess most importantly for us, could this affect hospitals that were willing to give out H1B visas before, but because of these cuts, they now aren't?

[Rach]

"The bill lowers Medicare provider payments to hospitals, hospice, and home health agencies."

 

As Rach said before, if Medicare to hospitals is deducted, does this affect residency positions? I guess most importantly for us, could this affect hospitals that were willing to give out H1B visas before, but because of these cuts, they now aren't?

 

That's what I was mainly worried about when I replied. It just seems like an easy way for hospitals to cut costs (though in the grand scheme I'm not sure now much that would save so maybe it won't matter).