However, I find it hard to believe that most people with four-year degrees have done better. According to the Bureau of Labor Statistics, the average family practioner earns $140k a year (this is the salary, not what stays inside the business). In comparison, an RN earns $52k and a PA earns $67k. Perhaps the RNs and PAs start their careers earlier (earning $200k to $250k) and avoid $150k in student loans. For the physician to get ahead over a 35-year period (making up for loans and the delay in working), he or she only needs to earn an extra $12k a year. In fact, it looks like the family doctor returns to breakeven pretty fast.

I witnessed two family members (now FP Drs.) stuggle with their specialty choices around the same time period and don’t recall it being commonly viewed as nobel or prestigeous then. Both went to an excellent med school with a longstanding FP program, where professors would put down students who made mistakes with comments such as “What are you going into, family practice”? These Drs. were at the top of their classes and saw the specialty as among the more complex and intellectually stimulating, although it was assumed that only Drs. at the bottom of the class would choose FP. They also valued long term relationships with their patients.

Today they would not change their specialty choices. They have retained the ideals that drew them to medicine in the first place, and have plenty of opportunity to put those ideals into practice. One of these Drs. is my husband, and one of the things I still love about him is that he is willing to provide free care to the uninsured and working poor in his practice.

For those who are concerned about income, he makes approx. $250000 annually, hasn’t done anything to alter his patient mix, upcode his bills, or refused to see any patient regardless of payor source.

I am not sure I understand the logic in comparing to other specialists. I don’t think you can expect justice in any comparison group, and there is not any correlation between what people make and their value to society. If you really want to feel upset, you should compare yourself to CEOs or investment bankers.

I’ve always wondered whether there is justice in having Drs. control their own supply, which maintains their high compensation compared to other professions. Most Drs. even bad ones make a very decent living, which is atypical for any other profession.

Finally, if I recollect my history correctly, wasn’t it the insurance companies that helped raise physician compensation in the first place?

(1) Notice the primary role that ego plays in this little tirade:

“we are Primary Care Providers now….lumped in with nurses and PA’s and “advanced nurse practictioners”

“Most people with four year degrees have done way better than Primary Care Providers….what a demeaning term given to us now”

Doctors are so ego-driven it’s really pathetic.

(2) No doubt primary care is undervalued by insurance companies, but that in some respects must reflect market realities. The point is that much of what primary care doctors is highly routine and can be performed reasonably well by PAs and nurses.

Now, if this were a market economy, people would pay more for an excellent primary physician–a generalists superior diagnostic ability, ability to synthesize and coordinate specialists, rapport with patients, etc.

But, it isn’t. FP are gatekeepers whose job it is to limit insurance companies costs.

Medical practice is small business. There is no such thing as being able to run in the red for a year. If you do that you go out of business. So as an operator of a small business, private practitioners should seek a return for their enterprise risk. Or do you think that simply because others might “need” their services, they aren’t entitled to that. If you do, then you and I disagree.

Most doctors haven’t gone into medicine for the money. But the up-front costs are large, and have to be repaid at interest, and the opportunity to start to make any progress toward paying those costs off is significantly delayed by the length of education and training required, at a minimum seven years, and frequently more.

Personally, I believe the writer does know his value to his community. What is disturbing is to see how many people seem to think they are entitled to services without facing the responsibility of paying for what they consume.

CHenry