OMR,
you are correct if SGR or the Medicare cuts hit I am seriously screwed. The one benefit of Obamacare is that more patient's will be funded in general. A lot of our patient's are unfunded initially and it takes three months on hemodialysis before funding kicks in. Obamacare may bridge that statistic. Yeah, my taxes will be higher, but I prefer that to a cut. So far, we have not been cut but we shall see . Buy in is around 150K, but I came in five years before the vascular access centers were in existence. I surmise the buy in will be higher now around 300K or so for the guy coming in this year. Three years to partnership.
Nico
Based on industry forecasts, I'd say that by 2018-2020, the only lucrative medical specialists will be orthopedic surgeons (that can still bill for each nail they insert), plastic surgeons, dermatologists (if plastic surgeons haven't picked up the side services derms do) and anesthesiologists that can piggyback off the numerous surgeries the other guys do (assuming that all private insurance companies don't pony up and offer similar insurance to that of the public option - which is just medicare for everyone under 65 to begin with).
Everything else (GI, Cardiac, Nephro, Neuro, Rheuma, Pulmo etc) will probably have to start living at salaries around 200-300K (tops) AND that's if we don't dive head first into truly socialized medicine (universal healthcare - see Taiwan, Israel, Canada etc).
Then again, that's just my opinion as an old CPA, it could very well not turn out that bad.
My best advice to the kiddies in med school, go for those specialties mentioned above and if not yet in med school, consider becoming a nurse anesthetist (those suckers average around 150-250K, never get sued and can moonlight to various hospitals). As an auditor for the largest academic hospitals in NY city, I always found the crna salaries to be insanely high (with overtime, most were bringing in 250K easy, with no weekends and only working 4-12's).
Another high paying gig, hospital CEO..
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