The dangers of declining physician pay

Between inflation, reimbursement declines and Medicare pay cuts, physician pay is struggling to keep up. 

Additionally, CMS floated a 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024, which could mean an even starker decline in physician pay. 

Eight physicians recently joined Becker's to discuss the dangers of physician pay declines. 

Question: What is the danger of declining physician pay?

Editor's note: These responses were edited lightly for length and clarity. 

Thomas Castillo, DO. Ophthalmologist in Beaver Dam, Wis.: We already see the effects of declining physician pay in regards to insurance coverage for minor invasive glaucoma surgery: physicians won't offer it. In regards to the long-term dangers of declining physician payment for surgical procedures, there will be fewer surgeons performing these procedures, resulting in longer waiting times for these surgeries. This situation has also been accelerated by the push for more primary care physicians and fewer specialists. As in any industry, failing to pay a fair wage for the work that is done will only cause the employee to seek other work.

Margarett Ellison, MD. Oncologist at Sterling Physician Group (Tallahassee, Fla.): Most likely Americans will see a decline in college students interested in going to medical school. The amount of debt that individuals incur while going to medical school will be too high to be paid back in a reasonable time frame. As a result, we will have more foreign medical grads providing medical services.

Todd Harburn, DO. Orthopedic Sports Medicine Surgery Specialist in Mackinaw City, Mich.: Most everyone would agree that, aside from doing what they believe is their calling for their life's career, a legitimate and equally important goal is to have a nice income to support their family and to enjoy some amenities and do some of the activities they would like to do during their lifetime. Without question, those who chose the medical profession and are fortunate enough to be accepted into medical school and successfully complete their training have that opportunity and potential for a very nice income and lifestyle. At the same time, there might be some challenges and/or detriments to people in choosing to consider entering the profession, one of which could be the danger of declining physician pay. The high and continued rising cost of college and medical school education and the resulting fear of having to take years to repay massive loans, along with increased hours and sometimes overbearing mandates from bureaucracies that contribute to less optimal patient care, as well as potential resentment of the huge corporations overseeing medical systems whose administrators and business executives are making millions of dollars in salaires, while services, programs and physician and nursing employee staffing cuts contribute to shortages, all are potential factors that could be a detriment to young people choosing the medical profession as a career. These latter factors also affect those who have already been established in the profession for years. The bottom line is that each individual obviously has to make their own decision based on their personal goals, desires and own situation as to how they meet the challenges in life as a medical professional. Certainly, declining reimbursement for dedication and sincere hard work in providing medical care to patients and services will continue to have an effect on decisions as to where to, how to practice, or even remain in the profession/retire early as has been seen recently across the country. The cold truth and reality is that the resolution of these concerns and problems is unlikely to be resolved easily or soon.      

Emme Jackson, MD. Plastic Surgeon at UPMC Western Maryland (Cumberland): I plan to leave medicine early if decline is significant. 

Keith Korver, MD. Cardiothoracic Surgeon at Sutter Health (Santa Rosa, Calif.): The danger is fewer physicians working in healthcare, changing careers or never going to medicine as a choice. If you go to medicine as just a job, then there will be more of an hourly pay mentality and more manpower/woman power will be required.

Linda Smith, MD. Breast Surgeon at X-Ray Associates of New Mexico (Albuquerque): The work area is hostile to physicians. The employee model does not recognize us as customers. All will be looking for other outlets: insurance reviewer, etc.

Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: How does the government expect to attract knowledgeable, competent people to the medical profession when part of the incentive, that is adequate compensation, is being jeopardized? Certainly, part of the incentive of going into medicine is to administer quality healthcare and improve mankind. However, I fear that motivation is dissipating since taking on an enormous financial debt to achieve that goal is becoming harder and harder to accept. The solution to me is pretty obvious: Adequately compensate physicians and allied healthcare personnel for the healthcare they provide. Basically, give these people a bigger piece of the "healthcare pie."

Stewart Wilkey, DO. Family Medicine Physician at Waring Court Pediatric and Adult Medical Group (Oceanside, Calif.): Ultimately, the saddest part of declining physician pay is that it will affect patient care. By the time we are attending physicians, we are simply catching up from years of minimal pay. Since the debt burden on most physicians is enormous, it forces physicians (including me) to supplement income by working extra. As we know from data on residency training, extra hours of work can lead to burnout, exhaustion and ultimately poor patient care. We need to have our proverbial "oxygen mask on first," to better do our job. Self-care is difficult when there is an ever-worsening financial burden to consider. 

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