Kevin, M.D. - Medical Weblog

The definition of a Medical Perfect Storm:

Most NY physicians are members of a nearly bankrupt non-profit liability insurance plan. They face a proposed $50,000 one-time surcharge on top of massive liability insurance rate increases in he very near future.

This will occur at about he time of a proposed 10.4% decline in Medicare payments and (I believe) the lowest Medicaid payments in the US to private NY doctors.

The upstate NY economy is in permanent economic recession due to the massive taxes destroying the upstate economy. The only outpost is the bureaucrat infested, taxpayer funded Albany area. There is a colossal real estate equity collapse downstate in the NY City suburbs.

Something big and unpleasant is going to happen in NY State medicine over the next year.
 

Our local hospital mandates Medicaid and Medicare participation in the loan forgiveness contract. This all all but guarantees new physicians can't make a living in private practice and must work in the hospital's clinics.

Better pay for our work will help retention beyond the loan repayment and allow some private practices to survive. Choice, for patients and physicians, is good.
 

Oregon went a step further. They have a tax credit for rural medical practice.

They just got the idea to require, as a condition of participation, that you accept Medicare and Medicaid patients proportionate to the Medicare and Medicaid population in the county of residence.
 

That wouldn't be worth doing for a doc in our county. We have about 20% Medicaid, which pays less than overhead here. That would more than negate almost any loan forgiveness or tax credit.
 

I grew up in the finger lakes. It was my home. Among the most beautiful country this nation has (and I've been in almost all the states). That stated, there is no way in hell I would practice medicine anywhere in upstate NY for medical, legal, and business reasons. The politicians in Albany (ie NYC) have turned upstate NY from an economic engine to an economic basketcase due to regressive business taxes, ignorance, and neglect. Anybody over 35 yrs in the US drove cars made with bethlehem steel, used smith-corona typewriters and eastman kodak cameras (made in the USA not China), ate from corning plates, and so on and on. No more. Now the state wants the docs to fork over 50 K for insurance insolvency issues mainly brought about by the state's own policies. Then offer a pittance in repayment for moving to an economic distater zone. Throw on top of that a trial attorney (Sheldon Silver) who is speaker of the state assembly, blocks any med-mal tort reform, and oh and by the way is employed by Weitz and Luxenburg one of the state's larger litigation firms (can you say confict of interest). On behalf of all former upstater's who now pracice medicine elsewhere, may I say PISS OFF!!!!!!!!! and thanks for ruining a beautiful place to live and work.
 

Upstate NY is, indeed, quite beautiful. Fifty bazillion tons of snow, but that's another matter.....

What's with this fifty grand thing? Are you being assessed that as some sort of surcharge? I haven't paid close attention.
 

Loan forgiveness is a trap. Debt discharge tied to labor service is a very old idea that replaced outright slavery as a means of securing captive cheap labor and is only one notch above outright slavery. It bogles the mind that the labor here is asking for it. It isn't MBA's that people need before med school, but rather a liberal education generous in history.

It is just a modern version of sharecropping or the 19th century coolie labor market.