I’m an M2 who recently had a conversation with one of the residents at my school who said that spine salaries will drop very soon. He says this will lower the income of the PP neurosurgeon and neurosurgery depts in general.

Any comments on this? How much will healthcare reform decrease the salary of the general neurosurgeon?

Depends on Obamacare.  If they limit the number of instrumented spine cases and limit reimbursement, salaries will drop.

Perhaps Fairbank’s BMJ paper is finally producing some results?

What is left of our economy is really the medical sector. Socializing that would dry up a lot of research and innovative biomedical companies. Canadian neurosurgeons from what I hear make 300k/yr, with higher tax rates. What has to be watched out for is these tax hikes, especially on the upper class, which will attempt to kill the neurosurgeon. Obama has talked about basically charging corporations more money and eliminating a lot of business tax deductions/advantages as well as the upper income brackets in general. Blanket extortion will be everywhere, there is no doubt about that, not just in the medical field. If someone doesn’t have insurance - they make payments or destroy their credit, but they still get help. The system is practically socialized as it is. What scares me most is the pragmatic philosophy of our government. It has no principles, and only believes in repeated trial and error with no learning allowed from the past.

The government is denying any private practice every incentive with its high employment tax rates. As another person on the forum spoke of merit based paths to wealth - that is truly the way to go - especially if the dollar ceases to become the means of international exchange.

Don’t get me wrong, I enjoy a nice hot cup of fear mongering as much as the next person, but using the word “socialist” to describe U.S. government is both laughable and dishonest. We are still, and until we destroy ourselves because of it will always be, a capitalist powerhouse.

It’s honestly disheartening that I stumble across these same sad lines again and again, both here and at SDN. Sure, let’s make medicine more like free market capitalism - I would love to be the next AIG.

The key is to provide everyone with affordable quality health care without destroying progress.  Maintaining physician salaries above $300,000 thousand shouldn’t be a priority.

md2010 - 01 June 2009 04:53 AM

The key is to provide everyone with affordable quality health care without destroying progress.  Maintaining physician salaries above $300,000 thousand shouldn’t be a priority.

spoken like a medical student.

man, i can’t wait for it not to be profitable for neurosurgeons to do a bunch of instrumented fusions...maybe those surgeries will only happen for people who need them

Starting in 2010, the reimbursement for the ACDF, the bread and butter for neurosurgeons, is likely to drop about 30-50%, because medicare is “revaluing” the reimbursement for the procedure.

Once medicare drops their reimbursement, insurance companies will soon follow.

So it soon will require us to do 4 ACDFs to make the reimbursement we once got with 3 ACDFs.

Yes, reimbursement for spine surgeons will be going down eventually.  Instrumentation is an enormous charge in the cost of spinal surgery, and I’m sure that is going to be targeted very soon.

a good sub-I could probably do an ACDF. why should they be well reimbursed? everyone entering training now should plan to make about $200,000 a year, and be happy with it

neu_o_surgery - 01 June 2009 01:43 PM

a good sub-I could probably do an ACDF. why should they be well reimbursed? everyone entering training now should plan to make about $200,000 a year, and be happy with it

with all due respect, you obviously don’t know what your talking about.

moneduloides - 31 May 2009 08:47 PM

Don’t get me wrong, I enjoy a nice hot cup of fear mongering as much as the next person, but using the word “socialist” to describe U.S. government is both laughable and dishonest. We are still, and until we destroy ourselves because of it will always be, a capitalist powerhouse.

It’s honestly disheartening that I stumble across these same sad lines again and again, both here and at SDN. Sure, let’s make medicine more like free market capitalism - I would love to be the next AIG.

Fear mongering my ass. AIG was precisely the result of government interference in the market. Let it crash - big deal? It’s one company - and surely another company will learn the lesson to not let that happen again. How can you call it fear mongering when the government owns major banks and GM - and even the medical sector? I don’t care if we’re still the most capitalist country there is - that doesn’t mean we can violate principles the country was built on. I’m not just saying this TO say it. If you don’t believe something wrong is happening, fine be it by you, but you’d be wrong.

In addition to that - the reason medical salaries in general are going down is because doctors have no voice when matched with government regulation and the special interest groups funded by insurance companies. What else can be expected when you let people who extort you (government associations, regulatory bodies, special interest groups) decide your salary. The problem is precisely caused by people like you calling people like me fear mongers, when people like you then go on to complain why your salary is dropping when the nature of increasing demands/education/work in the field should yield a sustaining and increasing salary, not one of decline. This is why plastic surgeons have sustained their income if not increased it. The fundamental ideas you are preaching are wrong, and you need to check your premises or stop complaining - and I would highly recommend the former, because you do have a voice. Neurosurgeons don’t have to remove tumors for $500 (example) - the only person/group declaring this is a regulatory body that could not sew an incision and would be left dead on an operating table if it weren’t for you. Don’t let this conspiracy to lower the standard of living infiltrate our number one field in the US - medicine. This war is being fought by people who don’t know what they are losing or gaining - the ideology you see is real .

Yes, the government pointed a gun at AIG and told it to swap credit-defaults, a market that amounts to not only 50 times the amount of the subprime mortgage derivates market, but an amount larger than the entire global economy. Oh wait, I’m sorry… that was unchecked capitalism.

The reason calling the government “socialist” is fear mongering is because Obama is, just like any other Democrat or Republican president would, doing everything he can to reestablish the U.S. as the capitalist “city upon a hill.” The only difference between Obama and a conservative president in this respect is the likelihood of success. If a president was in place that allowed an unchecked market to continue on down the path it was going the U.S. would have bigger things to worry about than its international power.

Oh, and by the way, there are plenty of “principles this country was built on” that need a good violation or two.

In addition to that - the reason medical salaries in general are going down is because doctors have no voice when matched with government regulation and the special interest groups funded by insurance companies.

I am in 100% agreement; what physicians need is to unionize.

Let me be perfectly clear. Government is, along with the capitalist economic model, the constant and unjustifiable problem that perpetuates the vast majority of socioeconomic problems in the world. When I argue that you are fear mongering I am not doing it in defense of Obama or government; I am doing it in defense of logic and in offense to your ridiculous tactic of malignant propaganda.

How can you call my words malignant propaganda when you agree with some of them? What you don’t agree with clearly has not been properly communicated to you. I am not saying AIG did the right thing by investing in credit default swaps. Repealing of the Glass- Seagal Act made every bank an investment bank that could appraise its own securities and repackage, buy, and sell them. This is like legalizing heroine, where everyone goes out and overdoses over the ensuing months until a dropoff rate occurs. The solution is not prohibition - it is the free market. Companies fail and face consequences- however how big. That is what BK court is for - just like GM is now seeing after it guzzled tax dollars. Maybe you don’t realize that banks were FORCED to lend to sub prime candidates as well- every variation of the let’s house everyone who cannot afford it before the meltdown act was shoved down the throats of banks by the government - and today they are being FORCED to accept millions to billions of bailout money (even solvent banks) to which some of them pay up to 52% APR on, whether they need it or not. You clearly don’t understand the role of the government in the economy. The government protects individuals from the use of force (economic, physical, malpractice, etc.)/against each other by acting as a medium. That’s its only job. Maybe if insurance companies were a little deregulated the people wouldn’t be at the mercy of such high premiums. Throughout history the government’s attempted involvement in business in this country has always failed. Look at the transcontinental railroads that competed with unfair advantage - the government that runs the same enterprise that abolishes “monopolies” based on “anti-trust laws” that make absolutely no rational sense and penalizes them for doing well. If you have employees, you’ll know that nearly a third of their salary is added to pay to the government. If the government wanted business to prosper here, they’d first lower employment taxes. It is not the fault of capitalism. We have never lived in true capitalism - maybe for a brief period in the 1800s.  Even our Sec of Treasury- Geitner is admitting that governments “put on the brakes too fast” on the economy, and cause it to collapse. Rome was a perfect example. 

What is the alternative in your mind to capitalism? It is it right that I pay my neighbor’s rent? We live in a mixed economy as it is, and never experienced government deregulated capitalism that would allow the free market to shine. When the government interferes, wealth can be seen rapidly decreasing - and currently the country’s standard of living is heading down the toilet. The more prosperous people there are, the more money there is. Funny money doesn’t work - and extorted money through taxes is so easily spent on wars and things that we have apparently no say over. If that’s your ideal, I hope you like what you see, unless you’d rather live somewhere where free market principles have further hit the wall - like a dictatorship or be a doctor in socialized Canada where you can pay even higher tax rates. The money has to come from somewhere, right?

By conservative I’m assuming you mean a Thomas Jefferson type that believes in separation of state and the federal of government to some degree- limited government, etc. Do you really think that bailing out and owning AIG was the solution? Bailing out GM? Bailing out bad banks still ran by the people who ran them into the ground? Do you call that capitalism? Do you think your patients families that will ultimately be paying their insurance companies to pay you will ultimately make your work better off for this now and in the future? Do you think further involving the government to regulate medicine will produce more innovation that is necessary to lift this country back off its feet from a police power that has to maintain an international police empire to maintain economic dominance? The only thing the government is good at is spending our tax dollars - on things other than education. I’m all for the war in Iraq if we were to invade, destroy the enemies, and get out. Obviously there is not even a relevant plan for that - and every week you and your children pay for it. Do you really like how the government manages money as it is and makes decision? Do you like the fact that your future is currently a game of hot potato?

Also- the market clearly doesn’t determine interest rates. How can a bank logically lend money when interest rates (prime) is artificially manipulated by a government agency? Does that make any sense? If you won the powerball for 200 million tomorrow would you lend it out half secured for 7% a year when you have alternative investments that are safe at 6%? The FED buys treasury bonds with funny money- further inflates your bills - and calls it a days work. Afterall, we must payback our debt to the East - which is quickly becoming a superpower and collections agency to America’s children.