It is really hard to take this post seriously given the grammar (your vs you're, "there are still lots of good money", "make them sales", etc) but I will post a serious reply.
First, you are right- everything is relative about income and what people feel is "comfortable." It is harder and harder to make over $300k in medical, but it's definitely still possible if you are in the right space. For me, having the ability to make that kind of money isn't so much about lifestyle, but instead it's about saving and investing so I can retire earlier or make a drastic career change and feel comfortable taking a substantial pay cut because I'm financially stable enough to do it. I would feel like a total loser for complaining about making what I make when there are so many other smart and hard-working people in sales and other industries dreaming of a way to crack six figures. Hence, I never complain, but that doesn't mean I'm content... nor does it mean I'm not trying to figure out other industries where I can consistently make over $300k. But the point of this thread (and your question) is to point out why medical is changing and where people may go.
First and foremost you have to understand that about 10% of hospitals are being reimbursed according to the ACA structure. The remaining 90% are simply posturing and attempting to get themselves into position to be ready for it. That being said, what you're feeling of docs losing influence and things shifting to VAT committees, materials management/purchasing, etc. is only a tiny preview of how much influence they will have starting late next year and certainly in 2017 when the ACA is in full-swing. So if you work for a company with a "me too" product, are not on contracts and/or not paying admin fees and your product is not producing better clinical outcomes, you are 100% screwed. Anyone on straight commission should be terrified of that scenario. Physician preference won't matter- you can count on it - as purchasing will be driving vendor and physician compliance and telling them which products to use based on national contracts. So you may want to hope that you have an all-star national accounts team setting you up for success... I believe some of our fate lies in their hands (and some people's fate lies entirely in their hands).
It's a new era - and my opinion is a lot of reps aren't necessarily complaining about not being able to make $200k, $300k, or whatever- but they're wondering how little they are possibly going to make staying in medical. So then the question becomes what other segments of sales do you look at that give you the ability to make more than the realistic "floor" of med device income. I've found several segments where you can make $
Those who choose to stay in medical sales need to find a company with a highly technical and highly differentiated product. I believe disposable products (catheters, pacers, orthopedic/spine implants, etc) will be hit first because hospitals do lots of volume here and can see exactly how much they spend per week/month with each vendor and seek alternative products easily. Capital equipment and highly technical equipment will be a little harder to pin down because they are typically one-time purchases that occur once every 5-10 years or more (depending on how long someone holds onto equipment). Large companies that offer capital and disposable products will be in a good situation to negotiate with the GPO's and purchasing teams.
