For those of you in the medical community, what will the refom bill's efect be on....

[AuntieM]

salaries & job opportunities in the field of nursing? I have been considering going back to school - in fact, I have an appointment at the school tomorrow - and I am just wondering what the (new!) future of medicine in America may hold for nurses.

 

Another angle: biomedical engineering? Any idea how that field will be impacted? DS15 has been seriously contemplating going into that. Could he still have a promising career in that field, or will there be a downturn in that area as more physicians are expected to be directed into primary care roles (versus specialties)?

 

FWIW, I am not asking whether or not you like this bill, so please let's not get this thread deleted. I am just wondering if you have any insight into the future of the fields I mentioned. Thanks.

[lollie010]

These are really tough questions to answer right now, because you just cannot tell how these things are going to play out when they actually get down to the business of putting regulations in place to carry out the legislation. I have tried my hardest to stay away from political commentary on this subject. My prediction (which I reserve the right to change) is that nursing will see job growth as the patient base grows. There will be a greater demand for healthcare, while many physicians go into early retirement due to increased regulations and decreased reimbursement rates. Nurses will probably see increased responsibilities, but not necessarily increased pay. I would have to think through the biomed eng. issue a little more before commenting.

 

ETA: I have not read and will not read general threads on healthcare reform, because my bloodpressure cannot handle it!!! LOL

Edited March 22, 2010 by Laurel T.

[AuntieM]

Thanks, Laurel. I appreciate your insight.

 

Anyone else care to speculate?

[IdahoHomeschooler]

I don't know, really. It seems that hospitals use any excuse to cut into the RNs, so I'm not very optimistic about it. I am thinking about options for further schooling, as I won't continue what I am currently doing for less. I would wager that there would be a large trend towards advanced practiced nurses, especially as there becomes more of a shortage of doctor's. If you could hack schooling, get on in an ICU of some sort for 2-3 years and complete a masters and possibly a doctorate and be a nurse practitioner, that would likely pay off. Or perhaps work in L&D and go the midwife route if you don't mind call hours. I can't and won't recommend a career as a floor nurse.

 

If there is some way to cut the nursing budget, the hospital will. More people will have insurance, so in theory that should mean more money for the hospitals. The insurance companies will find a way to cut reimbursements or something so that the hospitals lose out. When hospitals lose out, nurses lose out. That is my pessimistic opinion about the whole thing ;)

[farmgirlinwv]

Nurses will still be in demand. You have a lot of baby boomers who will soon/already do need medical care, ie nursing home/assisted living/increased hospital stays ect. However, I agree that nurses will probably be given more work for the same or less $$. Insurance co's will find ways to reimburse less which means more patients for each nurse. This means more responsibility for you. People will wait longer to be seen. Many docs may quit or retire. Nursing is hard work. Don't go into for the money. Go into it only if you love it. I just got home from my 3-11 shift. It's 1:30am. That tells you how my night went! Good luck!

[MariannNOVA]

I would wager that there would be a large trend towards advanced practiced nurses, especially as there becomes more of a shortage of doctor's.

 

If there is some way to cut the nursing budget, the hospital will. More people will have insurance, so in theory that should mean more money for the hospitals. The insurance companies will find a way to cut reimbursements or something so that the hospitals lose out. When hospitals lose out, nurses lose out. That is my pessimistic opinion about the whole thing ;)

 

Sadly, yes, I agree....especially with what I have highlighted in red. I cannot even count the number of physicians I know who have left the field - taken early retirement, opted for positions in other sectors -- I've had so many who I know tell me that they are thankful for the career they've had but they could not in all good conscience recommend it considering the issues surrounding it today. What a shame.

[asta]

I know that, two years ago, for a board certified Psychopharmacologist (that is a psychiatrist who specializes in finding proper medication combinations, not doing "talk therapy", and has done additional training beyond a psychiatry residency), the going rate was $120 a visit. The "insurance" rate was $80 a visit. Medicaid would pay $40 a visit.

 

As soon as the decrease in medicaid rates becomes effective (which is actually independent of this bill), that reimbursement will drop another 21%. So, in my 2 year old example, the doctor would be being paid $31.60 for each patient. That may not seem like a big difference, but that doctor still has the same overhead. To make up the difference, he will need to drop 12 patients.

 

In mental health, that is 12 unmedicated patients. Does society really want to deal with 12 unmedicated schizophrenics (notoriously hard to treat and the most likely in need of someone who knows how to do "cocktails" of medications) wandering around? It isn't like "county health" can pick them up - county health sent them to THIS guy, because this guy accepts Medicaid. Only now this guy can't accept new patients if he wants to stay afloat, and he has to find ways to drop patients (eg: X number of missed appointments and you're fired).

 

This is going to be a catastrophe from where I sit (mental health).

 

 

a

[KidsHappen]

I know that, two years ago, for a board certified Psychopharmacologist (that is a psychiatrist who specializes in finding proper medication combinations, not doing "talk therapy", and has done additional training beyond a psychiatry residency), the going rate was $120 a visit. The "insurance" rate was $80 a visit. Medicaid would pay $40 a visit.

 

As soon as the decrease in medicaid rates becomes effective (which is actually independent of this bill), that reimbursement will drop another 21%. So, in my 2 year old example, the doctor would be being paid $31.60 for each patient. That may not seem like a big difference, but that doctor still has the same overhead. To make up the difference, he will need to drop 12 patients.

 

In mental health, that is 12 unmedicated patients. Does society really want to deal with 12 unmedicated schizophrenics (notoriously hard to treat and the most likely in need of someone who knows how to do "cocktails" of medications) wandering around? It isn't like "county health" can pick them up - county health sent them to THIS guy, because this guy accepts Medicaid. Only now this guy can't accept new patients if he wants to stay afloat, and he has to find ways to drop patients (eg: X number of missed appointments and you're fired).

 

This is going to be a catastrophe from where I sit (mental health).

 

 

a

 

Ditto. I have talked to all three of my personal physicians all of which are sole practicianors with their own practices and they have all said that they fear they will have to go out of business because there will be no way that can stay in business with a drop in prices. If so many sole practicianors quit practicing, who is going to pick up the slack? :001_huh:

[galtgrl]

He has his own separate business - not connected to a hospital - and handles x-rays, mri's, CT scans, and the like. He doesn't know if he'll be able to stay in business for long.

[catalinakel]

Our family Dr. has been preparing for this. Two years ago he started only taking patients via cash. His patients pay a lump sum for the year and he is their private dr. for the year. Anything not covered under this new plan of his is the patients problem, but his office will bill insurance for it. But we lost him as a Dr. because we don't have $15,000.00 extra to pay to secure his services for our family for a year. We see a nurse practitioner whom he supervises, and this is covered by insurance.

[monk17]

I know that, two years ago, for a board certified Psychopharmacologist (that is a psychiatrist who specializes in finding proper medication combinations, not doing "talk therapy", and has done additional training beyond a psychiatry residency), the going rate was $120 a visit. The "insurance" rate was $80 a visit. Medicaid would pay $40 a visit.

 

As soon as the decrease in medicaid rates becomes effective (which is actually independent of this bill), that reimbursement will drop another 21%. So, in my 2 year old example, the doctor would be being paid $31.60 for each patient. That may not seem like a big difference, but that doctor still has the same overhead. To make up the difference, he will need to drop 12 patients.

 

In mental health, that is 12 unmedicated patients. Does society really want to deal with 12 unmedicated schizophrenics (notoriously hard to treat and the most likely in need of someone who knows how to do "cocktails" of medications) wandering around? It isn't like "county health" can pick them up - county health sent them to THIS guy, because this guy accepts Medicaid. Only now this guy can't accept new patients if he wants to stay afloat, and he has to find ways to drop patients (eg: X number of missed appointments and you're fired).

 

This is going to be a catastrophe from where I sit (mental health).

 

 

a

Please help me understand the logic here, I'm a little tired right now so it may be obvious. But if he drops 12 patients at 31. a pop how's that going to help cover his overhead?

 

Thanks!

[battlemaiden]

Ditto. I have talked to all three of my personal physicians all of which are sole practicianors with their own practices and they have all said that they fear they will have to go out of business because there will be no way that can stay in business with a drop in prices. If so many sole practicianors quit practicing, who is going to pick up the slack? :001_huh:

 

They will import undertrained med prof from other countries. Quality will go down.

 

I'm a RN who has considered going back, but I worry now. Gov't health (medi-care/caid) are the number one deniers of care in the country. We will be in demand, but I don't want to be a part of rationed care, especially in end of life decisions (my heart is in geriatric nursing even though I was trained for labor and delivery).

[m0mmaBuck]

I'm a physical therapist and I can tell you that iwhen Medicare makes changes to capped payments, cuts reimbursement, and limits treatment (either type of intervention or number or both), other insurances follow suit. When I graduated in the early 90s PT was a great field for an entrepeneur. It was a great career with excellent pay, great job choices, and so on. Around '97 Medicare made changes to their payments which ultimately led to PT's needing to see nearly twice the number of patients in the same amount of time to make overhead. In the late 90s, Medicare started cutting reimbursements (as someone above mentioned) and pay from Medicare was about 40% of what was billed. By 2000, treating a Medicare patient meant that you didn't make your overhead for the time they were there. That has been the case since then... We try to keep the number of Medicare, Medicaid, and DSHS patients at a minimum so that we can keep our doors open.

 

Fifteen years ago I would have recommended PT as a career. Now I can't in good conscience tell anyone to go into the field given rising costs of tuition (masters or doctorate degree required) coupled with the relatively low glass ceiling on salary in the field.

[TCoppock]

I don't know, really. It seems that hospitals use any excuse to cut into the RNs, so I'm not very optimistic about it. I am thinking about options for further schooling, as I won't continue what I am currently doing for less. I would wager that there would be a large trend towards advanced practiced nurses, especially as there becomes more of a shortage of doctor's. If you could hack schooling, get on in an ICU of some sort for 2-3 years and complete a masters and possibly a doctorate and be a nurse practitioner, that would likely pay off. Or perhaps work in L&D and go the midwife route if you don't mind call hours. I can't and won't recommend a career as a floor nurse.

 

If there is some way to cut the nursing budget, the hospital will. More people will have insurance, so in theory that should mean more money for the hospitals. The insurance companies will find a way to cut reimbursements or something so that the hospitals lose out. When hospitals lose out, nurses lose out. That is my pessimistic opinion about the whole thing ;)

 

:iagree:

 

They will import undertrained med prof from other countries. Quality will go down.

 

I'm a RN who has considered going back, but I worry now. Gov't health (medi-care/caid) are the number one deniers of care in the country. We will be in demand, but I don't want to be a part of rationed care, especially in end of life decisions (my heart is in geriatric nursing even though I was trained for labor and delivery).

:iagree:

[Sebastian (a lady)]

Please help me understand the logic here, I'm a little tired right now so it may be obvious. But if he drops 12 patients at 31. a pop how's that going to help cover his overhead?

 

Thanks!

 

She may have been referring to dropping 12 patients reimbersed on Medicare rates.

 

When I was pregnant with my 2nd son, the military medicine folks started to jerk around the family members who had received statements of non-availability (the sheet of paper that permited me to see a civilian midwife in an OB/GYN practice rather than go to a military hospital). It was eventually worked out in my favor (with the intervention of an O6 Navy Captain, who was the Fleet Surgeon) but in the process the OB/GYN practice reevaluated their policies and decided that they would no longer accept Tricare patients. I checked a few months back and they still won't accept Tricare patients. (Tricare uses Medicare rates for payments.)

 

My expectation is that there will be a diversification of classes within the health profession and that more and more services will be performed by the least qualified (and least expensive) person who can perform it. On one hand, that would be ok because I think you can often get great service from someone like a Certified Nurse Practitioner or a Nurse Midwife. I'm not sure what it implies for more menial tasks.

 

Here in Japan, there is enough of a shortage of health care staff that they are bringing in nurses from places like Indonesia (this is in civilian Japan, not the US military bases). Talk about culture shock.

[asta]

She may have been referring to dropping 12 patients reimbersed on Medicare rates.

 

Yes. It would open 12 slots in his practice for non-Medicare patients. Every Pdoc only ever has X slots available, and they usually have waiting lists.

 

but in the process the OB/GYN practice reevaluated their policies and decided that they would no longer accept Tricare patients. I checked a few months back and they still won't accept Tricare patients. (Tricare uses Medicare rates for payments.)

 

I don't believe most people realize that the military health system is tied to Medicare rates. As you well know, it isn't just dependents who must rely on the whims of whether or not a civilian doctor will take Tricare - if a soldier is stationed in a place where there is no military healthcare facility (such as a recruiter might be, or a criminal investigator, or even an instructor at a university), they have to utilize Tricare. In some places, there simply are no Tricare options for whatever reason.

 

In one place I lived, there were 2 primary care options, and one pediatric. There were no specialty providers. Not because the people weren't nice, but because there had been a major installation in the town that had been closed by the defense department. The city got very angry, and in their anger, decided en masse to refuse Tricare. The three remaining providers were accepting it out of patriotism, not defiance. Rather sweet, actually. Things like that happen. I can see that happening with Medicare.

 

 

a

[TravelingChris]

I am very worried. There is a way that other countries cover everyone and at a cheaper price. THe universities to train the doctors, nurses, etc, are very cheap so no one comes out with 200K of loans. The facilities aren't fancy in any way. No nice chairs, plain decor, very basic waiting rooms, etc. THe level of services is minimal. No one who has friends or family members relies on the food in the hospital. BUt what did they get? Very good medical care and incredibly short waiting times and quick service. THat was in a system kind of like what we are supposedly getting in the US. Belgium does not have a single payer system and not everyone is actually covered. Oh- two more great differences- everyone pays a co-pay of something, even the 'poor', and there are hardly any lawsuits since loser pays court costs and attorney fees for both sides. Unfortunately, we are not going to get this system so it will not be economical either for the medical workers nor for the government.