My last article discussed Obamacare and how it will be more difficult for Doctors to make money. Here are some calculations to compare the money my brother, an investment banker, will make compared to the money I, an aspiring doctor, will make over about a twenty year period.
Brother:
Four years: 4 years at Georgetown University Undergrad: 4 x ($56,485) = -$225,940
Two Years: First Year Analyst: 2 x $80,000 = $160,000
Three Years: Third Year Analyst: 3 x $120,000 = $360,000
5 years have passed from the end of college and you are making close to $125,000 a year. You then decide you want to attend a graduate school and get an MBA to make yourself look even more attractive to companies:
One Year: Full-Time MBA student (taking Wharton's numbers): 1 x $65,000 = -$65,000
Two Years: First Year Associate: 2 x $200,000 = $400,000
Two Years: Third Year Associate: 2 x $300,000 = $600,000
Five Years: Vice President: 5 x $500,000 = $2,500,000
Five Years: Managing Director: 5 x $800,000 = $4,000,000
This is about 20 years after college so my brother would be about 41, and making near a million dollars. With a total value of about $7,730,000
Myself:
Four years: 4 years at Georgetown University Undergrad: 4 x ($56,485) = -$225,940
Four Years: 4 Years at medical school (using Stanford): 4 x ($64,000)= -$256,000
Five Years: Orthopedic Surgery Residency: 5 x $40,000 = $200,000
Eleven Years: Average Orthopedic Surgery Salary: 11 x $500,000 = $5,500,000
This is about 20 years after college so I would be about 41, and making about half a million dollars. With a total value of $5,218,060.
To be honest these are both very impressive salary figures. Being an Investment Banker you can be promoted even higher in position and make much more money. For doctors, the salary remains pretty constant unless they decide to start their own practices. As stated in my last article, Obamacare will dissuade Doctors from wanting to start their own practice.
Ultimately there is still money in medicine, but if you want to become a doctor just for monetary purposes you are making the wrong decision. There is a lot more money in finance and business jobs with a lot less effort. Do medicine because you enjoy it, not for the money.
Sunday, August 11, 2013
Sunday, August 4, 2013
Exploring "ObamaCare"
The term "Obamacare" is often referred to in the news. Recent polls and studies report that much of the general public does not fully understand America's healthcare reform plan. This entry will give a brief overview about the changes to come with Obamacare.
Let's start with the definition of two other important government funded programs called Medicare and Medicaid. These terms are important to understand to fully understand Obamacare.
Medicare- A government administered insurance program that guarantees health insurance to Americans 65 years and older regardless of income or medical history. Medicare covers about 50 million people in the USA and consists of four main parts. Part A covers inpatient hospital visits, part B helps pay for outpatient visits, part C allows one to receive Medicare benefits through a private insurance plans, and part D subsidizes the cost of prescription drugs. It is important to note that medicare part A is covered for free if one has paid medicare taxes for at least 10 years, otherwise a monthly premium is paid at about $441 for similar benefits. The baseline costs for Part B are about $105 monthly for premium costs which increases based on income, and a $147 annual deductible. Part B coverage only covers 80% of medical fees. Part C depends on which package is selected. Part D also changes based on plan but similar to Part B there is a deductible and a 20% co-pay.
Medicaid- A government administered program for citizens which serves at the primary source of health insurance for people with low income. About 58 million Americans rely on Medicaid for insurance. Each state has its own eligibility rules to qualify for medicaid but ultimately the rule has to do with how an income compares to the federal income poverty line. Medicaid covers a broad array of services from inpatient hospital care to outpatient doctor visits. Many other options like coverage for prescription drugs and dental care are optional and cost money. Most medicaid programs are free or low paid, and are funded by the government through tax payers money.
Both Medicare and Medicaid are controlled by a federal agency called the Centers for Medicare and Medicaid Services (CMS). About $716 billion will be cut from Medicare in the next ten years to help fund ObamaCare and expand Medicaid
Patient Protection & Affordable Care Act
The official name for Obamacare is the Patient Protection & Affordable Care Act. The Affordable Care Act was signed by President Obama in 2010 and is the largest expansion to healthcare since the addition of Medicare and Medicaid. The main idea of the Affordable Care Act is to make sure that every citizen in the United States has some form of health insurance. The Affordable Care Act will offer different/cheaper packages than private insurance, through a Health Insurance Marketplace, that an uninsured citizen can purchase. If an uninsured person opts not to buy a health insurance package they will be penalized through a penalty income tax. Similarly, starting in 2014 the Affordable Care Act creates a national Medicaid minimum eligibility level of 133% of the federal poverty level (About $30,000 for a family of four in 2011). Which is a much larger expansion for medicaid compare to what it is now.
The Affordable Care Act does NOT replace medicare, medicaid, or private insurances. Instead it allows more individuals to have a more cost effective alternative option than private insurance coverage. The Affordable Care Act also offers other provisions and incentives to increase the quality, coverage, and cost of healthcare throughout America. For example Obamacare prevents private health insurance from charging different premiums based on age, race, or pre-existing conditions.
To learn even more about Obamacare read more at this link: http://www.obamacarefacts.com
I will be writing more about certain regulations regarding ObamaCare in the future as well.
What does Obamacare mean for Doctors?
One of the biggest concerns of universal healthcare comes from doctors. I have talked to many doctors recently and they are all concerned. Why?
1. Since the funding for Medicare is being slashed critically, the payment by the government for patients over 65 will be much less. Many doctors will attempt to limit their Medicare patients or not accept them at all.
2. Many regulations and incentives are being imposed by the government, which will allow private practice doctors to earn back money from the government if they are being efficient with their healthcare.
3. America is already in a shortage for doctors, with Obamacare the shortage will increase. Many doctors have planned to retire early due to the new healthcare laws. Similarly many students are opting not to go into medicine since the pay will be reduced.
4. More doctors are moving out of private practice for a fixed salary hospital job. Working for a hospital allows for more secure payment rather than having to deal with the government for payments.
5. There will not be the traditional doctor-patient relationship. Doctors will be forced to focus on quantity over quality and try and see as many patients as possible to make a similar pre-Obamacare salary.
Ultimately ObamaCare will help millions of people in America access affordable healthcare. On the other hand, it will lower the total amount of money doctor's made. There must be an approval agreement between patients and doctors if ObamaCare is to work effectively in the United States. It must be affordable for patients, and feasible for doctors. I am interested to see what the Government's next steps will be.
Let's start with the definition of two other important government funded programs called Medicare and Medicaid. These terms are important to understand to fully understand Obamacare.
Medicare- A government administered insurance program that guarantees health insurance to Americans 65 years and older regardless of income or medical history. Medicare covers about 50 million people in the USA and consists of four main parts. Part A covers inpatient hospital visits, part B helps pay for outpatient visits, part C allows one to receive Medicare benefits through a private insurance plans, and part D subsidizes the cost of prescription drugs. It is important to note that medicare part A is covered for free if one has paid medicare taxes for at least 10 years, otherwise a monthly premium is paid at about $441 for similar benefits. The baseline costs for Part B are about $105 monthly for premium costs which increases based on income, and a $147 annual deductible. Part B coverage only covers 80% of medical fees. Part C depends on which package is selected. Part D also changes based on plan but similar to Part B there is a deductible and a 20% co-pay.
Medicaid- A government administered program for citizens which serves at the primary source of health insurance for people with low income. About 58 million Americans rely on Medicaid for insurance. Each state has its own eligibility rules to qualify for medicaid but ultimately the rule has to do with how an income compares to the federal income poverty line. Medicaid covers a broad array of services from inpatient hospital care to outpatient doctor visits. Many other options like coverage for prescription drugs and dental care are optional and cost money. Most medicaid programs are free or low paid, and are funded by the government through tax payers money.
Both Medicare and Medicaid are controlled by a federal agency called the Centers for Medicare and Medicaid Services (CMS). About $716 billion will be cut from Medicare in the next ten years to help fund ObamaCare and expand Medicaid
Patient Protection & Affordable Care Act
The official name for Obamacare is the Patient Protection & Affordable Care Act. The Affordable Care Act was signed by President Obama in 2010 and is the largest expansion to healthcare since the addition of Medicare and Medicaid. The main idea of the Affordable Care Act is to make sure that every citizen in the United States has some form of health insurance. The Affordable Care Act will offer different/cheaper packages than private insurance, through a Health Insurance Marketplace, that an uninsured citizen can purchase. If an uninsured person opts not to buy a health insurance package they will be penalized through a penalty income tax. Similarly, starting in 2014 the Affordable Care Act creates a national Medicaid minimum eligibility level of 133% of the federal poverty level (About $30,000 for a family of four in 2011). Which is a much larger expansion for medicaid compare to what it is now.
The Affordable Care Act does NOT replace medicare, medicaid, or private insurances. Instead it allows more individuals to have a more cost effective alternative option than private insurance coverage. The Affordable Care Act also offers other provisions and incentives to increase the quality, coverage, and cost of healthcare throughout America. For example Obamacare prevents private health insurance from charging different premiums based on age, race, or pre-existing conditions.
To learn even more about Obamacare read more at this link: http://www.obamacarefacts.com
I will be writing more about certain regulations regarding ObamaCare in the future as well.
What does Obamacare mean for Doctors?
One of the biggest concerns of universal healthcare comes from doctors. I have talked to many doctors recently and they are all concerned. Why?
1. Since the funding for Medicare is being slashed critically, the payment by the government for patients over 65 will be much less. Many doctors will attempt to limit their Medicare patients or not accept them at all.
2. Many regulations and incentives are being imposed by the government, which will allow private practice doctors to earn back money from the government if they are being efficient with their healthcare.
3. America is already in a shortage for doctors, with Obamacare the shortage will increase. Many doctors have planned to retire early due to the new healthcare laws. Similarly many students are opting not to go into medicine since the pay will be reduced.
4. More doctors are moving out of private practice for a fixed salary hospital job. Working for a hospital allows for more secure payment rather than having to deal with the government for payments.
5. There will not be the traditional doctor-patient relationship. Doctors will be forced to focus on quantity over quality and try and see as many patients as possible to make a similar pre-Obamacare salary.
Ultimately ObamaCare will help millions of people in America access affordable healthcare. On the other hand, it will lower the total amount of money doctor's made. There must be an approval agreement between patients and doctors if ObamaCare is to work effectively in the United States. It must be affordable for patients, and feasible for doctors. I am interested to see what the Government's next steps will be.
Sunday, July 28, 2013
Hardy Heart Problems
This summer I shadowed a Cardiologist for about three weeks. The Cardiologist had his own private practice and I was responsible for following him to see patients, helping out to organize/distribute a clinical trial, and financially/logistically plan out a new health & wellness center. Heart disease is critical to know about and I will share some facts to educate the public.
The leading cause of death in the United States are cardiovascular diseases. Similarly, cardiovascular diseases are the leading cause of death for women- not cancer. According to the American Heart Association about one out of three women's deaths per year is due to heart disease. What most people do not understand is that the risk of heart disease starts at a young age. Changes are needed as soon as possible to ensure a healthy and prosperous life.
Lets start with defining some of the most common heart diseases:
1. The most common heart disease is Coronary Artery Disease (CAD). CAD occurs when the coronary arteries, the blood vessels that supply the heart with blood, oxygen and nutrients, become damaged due to plaque build up. Plaque is a waxy substance made up of cholesterols, fats, and other substances found in blood. The build up of plaque in an arteries is called Atherosclerosis. CAD can cause myocardial infarctions (heart attacks).
2. Arrhythmia is basically a fancy way of saying a heart rhythm problem. In this, the heart either beats too fast or too slow due to the electrical signals. Most arrhythmia are harmless, but some can prove to be devastating. Some heart defects occur during birth while others happen due to high blood pressure, smoking, CAD, stress, heart attacks and diabetes.
3. Cardiomyopathy is the deterioration of the heart muscle by becoming either thick, enlarged or rigid. Cardiomyopathy makes it difficult for the heart to pump blood to the rest of the body. The change in pumping habits of the heart can lead to heart failure or arrhythmias. Cardiomyopathy is either inherited or acquired through another disease. These other diseases are related to drugs, alcohol, CAD, and infections.
4. Heart infections branch over a whole variety of possibilities. Most infections are caused when bacteria, viruses, and parasites reach the heart. This can cause inflammation to the heart called myocarditis. Myocarditis can cause anything from mild disease to a heart attack.
There are many other heart diseases, but these are some of the most common.
An example of the difference between healthy arteries and blocked arteries
How to fix this for young adults?
Probably the obviously similarity between most of these diseases are that they are mostly caused by a heart attack which connects to CAD. The plaque that builds up and causes atherosclerosis is due to eating unhealthy, lack of exercise, genetic reasons and other unhealthy habits. Of course nothing can be done due to genetics but solutions can be found to fix the other issues.
Diet- Eat more vegetables and fruits. Instead of buying unhealthy snacks, fruits/vegetables can be cut up and put in the fridge so whenever you get hungry you can just snack on them. Since much of the plaque is caused by cholesterol, you should cut out most saturate and trans fat products from your diet. This means limit the red meat, frozen foods, coconut oil, some full fat dairy products, deep fried foods, and margarine. Lastly replace simple white carbohydrates with complex grains to avoid extra sugar and feeling more full. Eating healthy helps you avoid the bad cholesterol (LDL). By losing weight and exercising, it helps you gain the good cholesterol (HDL).
Exercise- As stated above exercise helps increase HDL cholesterol. Exercise should be done most days of the week for about 30 minutes. Exercises can be anything from running to playing basketball with friends. Also always attempt to take the healthier option, for example stairs over elevator. Ultimately the goal is to stay in shape with a healthy weight and always be physically active.
Obesity- Obesity is usually the result of having poor dieting and exercise habits. It is suggested that someone's Body Mass Index (BMI) should be under 25 to be considered a healthy weight. Check your BMI here.
Smoking- People who believe smoking only affect the lungs are wrong! The chemicals in tobacco smoke damages blood cells and vessels, which causes a greater risk for Atherosclerosis. Smoking and secondhand smoking also raises blood pressure, damages heart tissue, and lowers HDL cholesterol. This is because the nicotine makes the heart work faster by narrowing arteries and increasing your heart rate and blood pressure. Anyone who smokes is at a high risk for a heart attack. All smoking should be removed permanently.
Medication- Medication called statins can be used to help lower LDL and increase HDL. Although most of these medications are not 100% effective, many new drugs with this purpose are under clinical trials. Of course medication should be the last resort, as weight loss and eating habits should be the priority. Similarly, if a heart attack has already occurred drugs like Plavix can thin the blood to prevent future blood clots.
Genetics- One should always be aware of his or her genetic history. The genetic history can act as a guideline to how cautious one should act.
Stress- Lowering stress causes a more stable blood pressure, which helps the heart!
Visit to Doctors- Many young adults avoid going to the doctor because they believe they are healthy. Yet one should always go for screenings (maybe every 1-3 years) so they are aware of blood pressure, cholesterol levels, and their risk of diabetes.
The leading cause of death in the United States are cardiovascular diseases. Similarly, cardiovascular diseases are the leading cause of death for women- not cancer. According to the American Heart Association about one out of three women's deaths per year is due to heart disease. What most people do not understand is that the risk of heart disease starts at a young age. Changes are needed as soon as possible to ensure a healthy and prosperous life.
Lets start with defining some of the most common heart diseases:
1. The most common heart disease is Coronary Artery Disease (CAD). CAD occurs when the coronary arteries, the blood vessels that supply the heart with blood, oxygen and nutrients, become damaged due to plaque build up. Plaque is a waxy substance made up of cholesterols, fats, and other substances found in blood. The build up of plaque in an arteries is called Atherosclerosis. CAD can cause myocardial infarctions (heart attacks).
2. Arrhythmia is basically a fancy way of saying a heart rhythm problem. In this, the heart either beats too fast or too slow due to the electrical signals. Most arrhythmia are harmless, but some can prove to be devastating. Some heart defects occur during birth while others happen due to high blood pressure, smoking, CAD, stress, heart attacks and diabetes.
3. Cardiomyopathy is the deterioration of the heart muscle by becoming either thick, enlarged or rigid. Cardiomyopathy makes it difficult for the heart to pump blood to the rest of the body. The change in pumping habits of the heart can lead to heart failure or arrhythmias. Cardiomyopathy is either inherited or acquired through another disease. These other diseases are related to drugs, alcohol, CAD, and infections.
4. Heart infections branch over a whole variety of possibilities. Most infections are caused when bacteria, viruses, and parasites reach the heart. This can cause inflammation to the heart called myocarditis. Myocarditis can cause anything from mild disease to a heart attack.
There are many other heart diseases, but these are some of the most common.
How to fix this for young adults?
Probably the obviously similarity between most of these diseases are that they are mostly caused by a heart attack which connects to CAD. The plaque that builds up and causes atherosclerosis is due to eating unhealthy, lack of exercise, genetic reasons and other unhealthy habits. Of course nothing can be done due to genetics but solutions can be found to fix the other issues.
Diet- Eat more vegetables and fruits. Instead of buying unhealthy snacks, fruits/vegetables can be cut up and put in the fridge so whenever you get hungry you can just snack on them. Since much of the plaque is caused by cholesterol, you should cut out most saturate and trans fat products from your diet. This means limit the red meat, frozen foods, coconut oil, some full fat dairy products, deep fried foods, and margarine. Lastly replace simple white carbohydrates with complex grains to avoid extra sugar and feeling more full. Eating healthy helps you avoid the bad cholesterol (LDL). By losing weight and exercising, it helps you gain the good cholesterol (HDL).
Exercise- As stated above exercise helps increase HDL cholesterol. Exercise should be done most days of the week for about 30 minutes. Exercises can be anything from running to playing basketball with friends. Also always attempt to take the healthier option, for example stairs over elevator. Ultimately the goal is to stay in shape with a healthy weight and always be physically active.
Obesity- Obesity is usually the result of having poor dieting and exercise habits. It is suggested that someone's Body Mass Index (BMI) should be under 25 to be considered a healthy weight. Check your BMI here.
Smoking- People who believe smoking only affect the lungs are wrong! The chemicals in tobacco smoke damages blood cells and vessels, which causes a greater risk for Atherosclerosis. Smoking and secondhand smoking also raises blood pressure, damages heart tissue, and lowers HDL cholesterol. This is because the nicotine makes the heart work faster by narrowing arteries and increasing your heart rate and blood pressure. Anyone who smokes is at a high risk for a heart attack. All smoking should be removed permanently.
Medication- Medication called statins can be used to help lower LDL and increase HDL. Although most of these medications are not 100% effective, many new drugs with this purpose are under clinical trials. Of course medication should be the last resort, as weight loss and eating habits should be the priority. Similarly, if a heart attack has already occurred drugs like Plavix can thin the blood to prevent future blood clots.
Genetics- One should always be aware of his or her genetic history. The genetic history can act as a guideline to how cautious one should act.
Stress- Lowering stress causes a more stable blood pressure, which helps the heart!
Visit to Doctors- Many young adults avoid going to the doctor because they believe they are healthy. Yet one should always go for screenings (maybe every 1-3 years) so they are aware of blood pressure, cholesterol levels, and their risk of diabetes.
Thursday, July 25, 2013
Introductory Blog
I am an undergraduate student at Georgetown University. I am majoring in Human Sciences and am planning to apply to med school soon. With this blog I hope to target spreading the knowledge of medicine, nutrition, and wellness to other college students and adults. At this young age our health is usually an afterthought, but the habits we create now will help us remain healthy for the rest of our lives.
Who am I? I am sure you are ALL probably wondering what qualifications I have to be giving advice. So let me introduce myself in a little more detail. I have been surrounded by medicine my whole life. My dad, Dr. Rajiv Lakhanpal, is a general surgeon who stopped practicing to start an online health management website called HealthAtoZ. After having his first company acquired by United Healthcare, he started another company called SpectraMD. SpectraMD helps healthcare providers accelerate their quality improvement efforts and achieve their financial goals. My uncle, Dr. Sanjiv Lakhanpal, is board certified in general surgeon and cardiovascular & thoracic surgery. A few years ago he started his own practice in the treatment of varicose & spider veins. Currently, my uncle's practice is the second largest varicose treatment center in the country. Other medical family members are my grandpa who was named the "Radiologist of the Millennium" in India, my aunt, Dr. Cantero, a revered endocrinologist who owns a practice in Annapolis, MD, and finally my recently deceased Grandma who was a medical professor.
These blog posts will basically be interviews with doctors/surgeons, opinions on articles that I read from sources, or insights about what I learned from working with doctors.
I plan to write one to two short blogs a week about every facet of medicine. I will post the blogs on twitter and some even on facebook. Questions and comments always welcome!
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