Doctors should be allowed to become a rare commodity

“Why would anyone in their right mind want to go into medicine now?”

A physician vents, in response to the recent articles detailing a future doctor shortage: “Until something is done to corral the HMO and government administrators (who are expensive and time-consuming annoyances); until the pay for family practice and general practice doctors is made equal to that of general pediatricians and general internists; until there are special courts for malpractice complaints instead of the current lawyer-stealing-from-doctor tort system; and until we aren’t having to cope daily with the tragic stories of people who cannot afford medications and of people who are being dumped off insurance when they are sick, I’m advising my bright young patients to look elsewhere for an occupation.

I think we should be allowed to become a rare commodity. Maybe then we will be paid enough and respected enough to make the profession worth doing again.”

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  • Curious JD

    Has there ever been a more highly paid profession that whined as much as physicians these last few years? How much more money do you need to make it worth doing?

    To whom much is given, much is expected.

  • Anonymous

    Are you serious Curious JD?

    Of virtually all careers; being a physician requires the MOST training, is one of the HIGHEST in terms of hours per week, and is burdened with the GREATEST responsibility. Might not have more hours but certainly a general practitioner fields greater responsibility and went through far more strenuous training than a lawyer working in any field.

    Working at least 8 years in Los Angeles, a Tax Attorney with his CPA has a median yearly income of 169,664. A Physician who trained in Family Practice comes in at a median of 162,550. Should these two even be comparable? No way.

    If we lived in a true free market situation there’s no doubt that the services provided would be worth well more than what insurance and HMOs pay. Its as simple as that. Physicians aren’t fixing cars here, this is literally life and death, and there’s a legitimate argument to be made that you should get what you pay for.

  • Anonymous

    A tax attorney is someone in a highly specialized field and has a particular knowledge that the average litigator does not have. A more comparable comparison to a family physician would be a commercial litigator. A tax attorney is comparable to a surgeon in terms of rarity. So what’s a surgeon with 8 years experience in LA make?

    As for whether they are comparable, I guess that depends on what you value. If you’re a multinational corporation, a particular family physician might not have that much value to you, whereas a particular tax attorney would. If you’re the average family of 4, then the family physician probably does matter more.

    Everything a family physician does is literally life and death? Be serious.

    As for the greatest responsibility, well, that’s one opinion. Get in a custody battle and see which people value more – their money, their kids, or their health.

    As for the rest, if you work the most hours and have the most training, on average physicians are compensated at the highest rate of all professions, including nearly 1/3 higher than the average attorney. So I’d say you’re already being rewarded, wouldn’t you? How much more do you need to feel loved?

  • Anonymous

    To anonymous:

    You think 5 years for his CPA and your 3 years of law school for this tax attorney compare in ANY WAY SHAPE OR FORM with 4 years of pre-medical science courses, medical school and a family practice residency?

    Sorry, it doesn’t. Just because of the Tax Attorney’s specialization does not make him more comparable to surgeon who has taken the time to do a fellowship. Not in terms of money, time, and energy put into getting to where the tax attorney and surgeon are. The tax attorney is not comparable to any physician.

    “Everything a family physician does is literally life and death? Be serious.”

    Of course not EVERYTHING is life and death, but people take medical care for granted. Imagine taking ALL doctors out of the world…you seem to simply not realize the incredible number of what are today considered “routine” health problems that would be life threatening if left untreated. This is stuff that a general practitioner sees every day he’s in clinic. The increase in the world’s mortality rate would be significant and the average life expectancy would sink. It is life and death, it’s just that with the advances physicians have made of the past century nobody expects the death result anymore.

    In a utilitarian sense, when dealing with life and death as described above and comparing it with custody battles or patents or taxes or even jail time, the latter situations just seem to pale. The responsibility really is greater. I think of the most responsible laden attorney as a defense attorney but there’s simply not enough capital cases threatening the death penalty in this country to compare to the life and death situations a physician faces. Higher responsibilty should translate into greater pay.

    There are numerous reasons physicians are compensated more than attorneys or other professions but that comparison is not an inherent argument that physicians are paid ENOUGH.

    The trouble is that the world has come, not only to expect miracles out of medicine and thus see what physicians do as “mundane”, but also to come to view health care as a RIGHT. There’s an inherent resentment towards the cost of medical care because people see it as something that should be provided to ALL. But in a theoretical free market dream world where the government did not subsidize health care and physicians dictated what insurance paid them, physicians would be compensated well above what they are now. Of course, the unacceptable trade off would be in the number of people who could not seek health care.

    It is the most necessary of all professions. I can do without an investment banker, a lawyer, police officers, airline pilots. I can build my own house. I can grow and hunt and catch my own food if I put myself ot the task. But the ODDS are at least once in my life I’m going to need someone with the best medical training available, even if it’s on my death bed.

  • Curious JD

    I’ve never seen the God complex laid out so nicely. And coupled with a victim mentality as well!

    So tell me, how much money would it take for you to feel adequately compensated for saving all our lives?

  • Michael Rack, MD

    I don’t know about Dr. Kevin, but for me I think a $160,000 a year salary would be a reasonable compensation for my 65 hrs/week and 4 yrs of college, 4 years of med school, 5 years of residency, and 1 year of fellowship. Since I am an academic physician, I receive no where near this amount. Of course, if I owned my own practice, I would expect to make more to compensate for the risks of owning and running a business.
    Michael Rack, MD

  • Saint Nate

    This reminds me of an interesting comment I heard at the American Academy of Neurology conference. Someone asked the panel if the trend towards supsecialization in this field would lead to competition among the physicians; the expert replied that with the shortage that woun’t be a problem because there won’t be enough doctors to treat the population anyway.

    As for Curious JD’s comments … why is it he’s for huge awards for pain and suffering for malpractice patients, yet is so against compensating those who dedicate their lives to medicine? Sure docs have high salaries, but consider how much they have to pay in malpractice insurance, school loans, continuing education credits, etc. and the years they dedicate to learn how to help others. Add to that the risks they take everyday in their careers and it seems about fair they’re the highest paid profession. But then, I guess in a lawyer’s world, it’s better to be injured than the one who tries to heal injuries.

  • Curious JD

    Nate,

    How nice of you to put words in my mouth. It’s easy to criticize someone else’s position when you make that position up, isn’t it?

    I’ve not said I’m for huge awards. I’ve not said I’m against compensating physicians.

    Try again.

  • Anonymous

    Dr Rack:

    It is good you are satisfied with what you have. For the doctor in private practice, there is no generous institutional participation in your 403b, or family tuition benefits, or faculty practice plan, or academic leave, or tenure. Doctors in private practice bankroll retirement savings out of the residulals after overhead is paid. You must know this, but others may not. And $160,000 spends differently depending on what part of the country you live in. Unfortunately student loan payments are the same everywhere, and practice overhead can vary significantly between regions, much more than reimbursements. I am not sure that would be so happy with that income in a high-cost city like, say, Boston. (And I know many physicians there make do with less). As for what lawyers make, starting
    associates at $125,000, someone at 26 or 27 years old, with a J.D. and maybe a clerkship (or that vaunted LL.M. in Taxation) was a salary mark passed years ago in New York.

  • Curious JD

    Anonymous,

    You’re wrong. The “average” lawyer in a major city will not make $125K their first year.
    If you are in the top 5-10% of your class, you will make $110-125K as a starting associate at a very large defense/corporate firm. While you will occasionally get up as high as $140K salary in LA and NYC, $125K is normally the starting salary for the top of the class in a major city at a big firm. The vast majority will not see that for many years, if ever.

    Who will you represent if you work for those firms? Major corporations, mostly.

  • Saint Nate

    Curious JD:

    You constantly rail against caps. How are you not in favor of large awards? Are we therefore to assume you are in favor of caps or some method of regulating large awards?

    And you started this debate by saying,
    Has there ever been a more highly paid profession that whined as much as physicians these last few years? How much more money do you need to make it worth doing?

    From this I inferred you have a problem with the large compensations physicians get. Your other arguments seem to add to that view, particularly your crack about the God complex.

    If I am in error, I could content the fault lies with you, not with me. I have only followed your words to their logical conclusion. If you don’t like that, I suggest you rethink what you really believe and try stating your views outright.

  • Anonymous

    Nate,

    I’m in favor of letting the people who have actually heard the evidence determine the value of the case. I know sitting through hours of testimony, examining medical records and such doesn’t have the same ease in at is reading a newspaper article about a trial and pronouncing judgment, but I still think that’s a pretty good way to go. What’s more, there are appellate courts to review that decision if necessary. Maybe it’s just the libertarian, power to the people, streak in me.

    You inferred wrong. The question is simple. How much would it take for physicians to quit whining? Everything has a risk/reward component. Physicians are bitching about the risk. How much would it take to quit bitching. You’d think being the highest paid profession by far would do it, but evidently not. So that’s why I asked. I have no qualms with how much physicians make. They do a demanding job and deserved to be paid well for it. I just don’t believe they ought to have immunity as a result, though. So far, only one person has had the guts to answer my question, though.

    Sorry that seemed obtuse. Although I think the fault lies in your willingness to ascribe views to me that I don’t hold.

    By the way, when ever anyone, including lawyers, goes on and on about how important and necessary they are, and whines about how victimized they are, I find humor in that.

    Curious.

  • Michael Rack, MD

    To anonymous:
    I just wanted to clarify that I am not 100% satisfied with what I have, and I do not make $160,000 per year. That’s what I would like to make. I will have to find a different job to make it, though, partly because of my salary cap (which I can not exactly reveal due to contractual obligations) as a university physician (this salary cap includes all sources of medical income, including W-2 income, K-1 practice plan income and 1099 consulting fees).
    Government benefits in Mississippi aren’t that great compared to private practice. But I do agree with you that the cost of living is lower in MS than in most other parts of the country. A haircut only costs $10 for a man, and great housing is availabe for less than $100 per square foot.

  • Saint Nate

    I know sitting through hours of testimony, examining medical records and such doesn’t have the same ease in at is reading a newspaper article about a trial and pronouncing judgment, but I still think that’s a pretty good way to go.

    And med schools is all a big freakin’ party. Besides, you charge how much per hour for that research? Now who’s a overpaid whiner?


    What’s more, there are appellate courts to review that decision if necessary. Maybe it’s just the libertarian, power to the people, streak in me.

    And more money for the lawyers at every level.

    The question is simple. How much would it take for physicians to quit whining? Everything has a risk/reward component. Physicians are bitching about the risk. How much would it take to quit bitching.

    Well, they do go through years of med school, then comes the residency, then work 65 hours a week, then are on call … Im sure there a re plenty of other jobs taht are just as demanding where lives hang in the balance. Id like you to try to name one.


    You’d think being the highest paid profession by far would do it, but evidently not. So that’s why I asked. I have no qualms with how much physicians make.

    Well … in the first sentence it sounds like you do, then you deny what you just said …


    They do a demanding job and deserved to be paid well for it. I just don’t believe they ought to have immunity as a result, though.

    Who said anything about immunity? What do you mean by immunity? Are you thinking of diplomats?


    So far, only one person has had the guts to answer my question, though.

    That Michael Rack, MD, is pretty cool.

    By the way, when ever anyone, including lawyers, goes on and on about how important and necessary they are, and whines about how victimized they are, I find humor in that.

    Well, then let’s just let doctors become a rare community and tell tehm to shut up about being phased out of existence. That brings us back to the original point anyway.

  • Curious JD

    “And med schools is all a big freakin’ party. Besides, you charge how much per hour for that research? Now who’s a overpaid whiner?”

    Nate, you only illustrate your ignorance about the law with this type of post. First, if you’re a plaintiff’s lawyer, you don’t charge anything – you only get paid if you win. Second, no one is debating the difficulty of med school. What I’m talking about is determining malpractice based on a newspaper article, or reviewing the actual facts. You tell me which is better.

    “More money for lawyers at every level.”

    Do you think if we eliminate med mal, we won’t need judges? Who will hear doctors’ complaints when they sue their insurers? Now you’re just being silly. You hate lawyers, but do you ever think about who you will turn to if you are injured? How about if you get divorced? How about if your employer screws you out of your pay? Or if someone breaches a contract with you?

    Other jobs where lives hang in the balance? Lawyer for one. Police officer, numerous types of scientists, OSHA inspector, structural engineer. That’s off the top of my head.

    At this point, you’re reading what you want to, not what I wrote, but that’s OK.

    As for immunity, while that’s hyperbole, it’s to an extent what you’re asking for. If your mechanic told you that you weren’t smart enough to understand a faulty brake job (and I would imagine most of us have no idea how our car gets fixed), and he should only be judged by other mechanics, and even then he deserved a screening panel before the case got to trial and a cap on what you could recover no matter how bad your family was hurt in the accident caused by those faulty brakes, what would you think he was after?

    As for doctors becoming rare, how about we cross that bridge when we come to it, OK? And despite AMA hysteria, we’re not anywhere close. An average salary of $150,000 still attracts a lot of people, and will continue to.

  • Anonymous

    You all need to calm down. Listen, talking about which profession is the most prestigious, or should merit the most compensation just doesn’t make any sense. So many professions offer invaluable assistance to the human race in general, and are underpaid. Why have none of you brought that up, for instance. Social workers is a good example. You try seeing some of the cases a friend of mine has seen, and taking home pittance. My friend doesn’t need a shrink, but if he did he wouldn’t afford one. He doesn’t have children to clothe, feed or send to college, or a wife to take out once a month. And thank God for that. I am using social workers as an example. Without the two professions that are the subject of your risible contentions, society as we know it would collapse. Doctors keep us safe and healthy and lawyers run a system upon which major sociological structures of enormous impact depend. For the ones that are shunning paying doctors more, don’t. Doctors should be paid more, a lot more for every profession. What’s more, at government level, I would opt to enforce a system through which all specialisations warranted similar salaries, with a couple of notable exceptions related to warranting a higher pay structure for those who attend particularly longer residencies. Being a lawyer is no joke either, and takes dedicating most of your life to researching and working after hours in offices. Sure, many lawyers have it nice and comfortable with their Porsches and mansions, but how old are they? How many years did they spend looking up case so-and-so at the public records library until three a.m., when everyone else was asleep? Everyone else, of course, excluding doctors. See what I mean???

  • Anonymous

    Interesting. I’m a young Tax/Transactional Attorney currently interviewing.. and last I looked the offers were not $160K at any of the firms here in San Diego.. more like $60-$70K. Lets see I have a JD/LLM in Taxation/MBA & Masters in Accountancy.. and I was in the top 10-15% of my class in all of my programs at fairly respected schools (USD Law.. the top law school in San Diego and top tax program in Southern California) & Gonzaga U. (The #1 small school basketball program in the country! Is that worth anything?) I know I can make more $ in a larger market but I really don’t like the traffic and smog of L.A. so would prefer to stay here in San Diego. I doubt a new physician starts out at $60K. I’m not saying I won’t likely make decent money down the road.. but with 900 new law school graduates in San Diego alone every year.. there are 100 new canidates fighting for that $60K job to get some experience. And the $125K jobs you talk about… those go to the top 1% of our class and force you to relocate to a bigger market. Not to mention… good luck finding a job as a new attorney if you go to a lower tier/less respected school.. I think I should have gone to Med. School.

  • camille

    that’s assuming that you could get in to any medical school or even survive once you’re in…

    nothing comes close to multiple years of 100 plus hour work weeks during training with the most intense demands – e.g. awake for 30 hours – working the ICU – on the bubble again (next in line for admission responsibilities) and you haven’t finished putting the lines in for the 250 pound alcoholic varix patient who’s bleeding to death in front of you while the family cries not so quietly outside the door…

    compare that to being in a quiet law library counting the hours that you will bill your client

  • Anonymous

    Any psychologist will tell you that the biggest sign of insecurity is when one tries to show more power than they really have, which is the exact case in point with docs and the God complex. In case any of you remember going to a really knowledgeable and professional physician, they don’t put on airs because they feel confident with who they are. It is the insecure that you must beware of.