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The discussion around student debt & healthcare rarely seem to intersect. However, lurking under the radar is the fact that the amount of debt accrued by those trying to become doctors or dentists is putting a vast strain on the healthcare system as it is structured today. If the ancedotal trend we are seeing continues, small group & solo practices may go the way of the land line.

Let me explain. By the time a person has gone through undergraduate, medical or dental school, & residency they have gone through what many feel is substantial delayed gratification. They are for the most part deeply in debt, are lagging behind their peers in adult milestones, & are very stressed.

Finally, graduation looms, & they want a big payoff. After all they have worked hard & are finally in a place where they will earn "the big bucks". However, they don't seem to teach a course where the real world would throw cold water on these dreams.

They don't tell these kids that the insurers are ratcheting down on payments. They don't tell them the lag time between billing and payment are extended. They don't tell them about the routine denial of care just to put off paying a claim. They just say "Show me the money" even if the salary they "require" is more than the partners are bringing home.

Many small group and/or solo practitioners are around my husband's age, heading towards 60. They are looking to bring in new associates, with the goal of having them take over the practice as they edge out after working for 30 to 40 years. Not so fast, as these kids have different ideas. Please note that it is not just the experience of this practice. Talking with other local physicians and dental practices we hear the exact same refrain.

These kids don't want to OWN a practice. They don't care about anything but earning what they think they deserve. They don't want to deal with administrative details like payroll, 401K's, taxes, inspections, regulations, and insurance companies.They don't feel the need to buy into the practice with hard labor. In fact, speaking with someone at the gym the other day, they said their new associate comes in at 9:30am and leaves at 4 & refuses to see any patients from the other physicians in the practice. I understand residency has changed since our day, but really, who does that?

They also don't include the benefit package in their calculations.To a person each rejected offer said the same thing: they have too much debt to accept that salary. Period. End of discussion. Least you think that these are pathetic salaries, one practitioner in a more rural part of Maryland offered MORE THAN HIS OWN SALARY plus benefits. Not a single nibble.

As we explained in our response to these candidates, we too had debt, which was proportional to our income to the amount faced by today's graduates. We still managed to eventually buy into the practice, while still raising a family, send the kids to school, & have a very blessed life. However it seems we were a bit more patient, & understood that our path in life included delayed gratification for certain goals.

So what will happen? These practices will fold. Even the practices where they do land, will either ask them to eventually buy them out or they will fold. Where will they work then? Perhaps this will be the driver for single payer healthcare, so that no one needs to own a practice at all. Maybe they will increase the opportunities to exchange service for education, so that graduates don't feel crushed by all those zeros at the end of the amount owed. Maybe a combination of both?

Well, we have another candidate to interview tonight. Ever the optimist, I am always hopeful. However even I am having trouble seeing this glass as half full. Maybe if I fill it with wine tonight things will look better?

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Comment Preferences

  •  Sounds like eventual large corporate (0+ / 0-)

    ownership of practices, with salaried doctors as employees.  And looking forward, even if it starts out with OK pay for the employees, it will go downhill fast with cost reduction and productivity targets every year.

    My Dr. is in the 60 y/o category too - and the last few times I've seen him he's complained a lot about the new productivity standards he has to meet - patients per day, response time on email, written sign offs on lab reports within a certain time from when he receives them, .....

    I don't know where the standards are coming from - but I know he feels that they interfere with patient care.

  •  IMHO (0+ / 0-)

    it is pernicious to make students pay for their education. I include the Medical professions.

    "If I pay a man enough money to buy my car, he'll buy my car." Henry Ford

    by johnmorris on Tue Apr 29, 2014 at 01:29:27 PM PDT

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