Why OB/GYNs are becoming harder to find

Why would you want this job?

Wanted. Part-time. Private practice seeks obstetrician and gynecologist. Forty hours a week, some nights and weekends. Pretax income $70k/yr and falling. Life-altering medical malpractice claims average only 1/3 years. Electronic medical record – partially functioning. Administrative skills required. Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above plans. Keep up with this ever-changing medical field and all technical skills on your time. $80k exit fee due at termination of employment. Expect childcare expense approaching $35k/yr.

Comments

CJD
$70K and falling? Hmm, according to ModernHealthcare.com, the salary range for an OB-GYN is $221,000-$295,000.
http://www.deltamedcon.com/MHC/MHC2.asp
Here are some other interesting numbers, none of which seem remotely close to $70K:
http://www.hschange.com/CONTENT/851/
And I don’t know where OB-GYN’s fall on this scale, but according to Managed Care Matters website,
“According to physician recruiting firm Merritt, Hawkins & Associates, job offers for internists and family practice docs came with average salaries of $162,000 and $145,000 respectively. In contrast, cardiologists and radiologists were offered $$342k and $351k.”
Wonder where the disparity comes from. Can’t be rural area – urban, because child care doesn’t cost $35K a year in rural areas.
lawyersux
CJD must be right. I wonder why nobody is going into OB-GYN when this Plaintiffs attorney says the career is SO GREAT. OB-GYNS should ignore the fact that every day they go to work they put their licenses, careers and most importantly their mental health and stability at risk, becuase, lo and behold, average salary is pretty good. It’s a mystery why OB-GYN can’t fill it’s residency positions despite such a great salary. It’s unclear why plaintiff’s attorneys don’t simply deliver all pregnancies themselves anyway, since according to their retrospectoscopes, they find i so EASY to figure out when a delivery is Hgh risk.
Jason Sellers
CJD,
I’ll agree with you that the income is not 70K and falling from what I have seen, but there are definitely reasons to not go into OB beyond what’s mentioned in the post. The hours are awful and doctors within the specialty tend not to be the happiest. For new med students OB is not the sexy place to be.
Going forward something needs to be done to make this specialty more appealing. I fear the best and the brightest will look elsewhere leaving us with less competent OB-GYNs (or we could simply import the best and the brightest from other countries).
CJD
Jason,
I’m not arguing the other points at all. But I think it’s disingenuous to claim that the pay is that poor and when you make such an obvious misstatement it throws the rest of one’s claims into doubt.
I wouldn’t think improving the hours is a possibility, is it?
DocInKY
To follow up on CJD’s comment on the pretax income. The stated offer had as its first words “Part time.” It was a woman in the position working part time. One should read the entire linked post. There is not ‘an obvious misstatement’ there.
If a provider is not working full time to meet compensation goals and productivity, it is hard to cover expenses (Rent, on going malpractice premiums, AR buyins, hard asset buyins).
It is not linear for “50% work – 50% income. It is much like how we are all working for the government until “Tax Freedom Day” somewhere in April (4/26/06 according to Taxfoundation .org). I recognize tax freedome day references post tax. However, all the costs in a practice are front loaded and comeout before any pretax compensation.
DocInKY
To follow up on CJD’s comment on the pretax income. The stated offer had as its first words “Part time.” It was a woman in the position working part time. One should read the entire linked post. There is not ‘an obvious misstatement’ there.
If a provider is not working full time to meet compensation goals and productivity, it is hard to cover expenses (Rent, on going malpractice premiums, AR buyins, hard asset buyins).
It is not linear for “50% work – 50% income. It is much like how we are all working for the government until “Tax Freedom Day” somewhere in April (4/26/06 according to Taxfoundation .org). I recognize tax freedome day references post tax. However, all the costs in a practice are front loaded and come out before any pretax compensation
CJD
Doc, I saw the “part time”, but it is followed with “40 hours per week plus nights and weekends”. I took the “part time” to be a joke.
urmed02
My wife is an OB (just finished residency) and 40 hrs would not be full-time…no one in her residency class was offered a job >$150,000/yr for full-time work…Those that make >$200K/yr are ones who have been working for years on end…and, if she wants to move practices…it will be $40K to keep her malpractice after 2 yrs..afterall, they can be sued up to 18 yrs after the birth..
Dr Samson Isberg
I am an OB and have been so for 20 years now.
Yes, the job definitively has its downs – about twice or thrive a year for me; bad outcomes, deformed children, the occasional intrauterine death, shoulder dystocia and so on and so forth.
And yes, some of the patients – about once a year – are complete assholes and psychopaths.
But on the other cup of the scale there are happy, contented mothers experiencing the joys of a normal birth and delivering a healthy baby, leaving the hospital without scars on their bellies, on their perineums or in their minds; – around 4.200 times a year.
So in my mind there is no problem as to where the scale tips.
chucky
40 hrs / week would be part time for ob/gyn.
Gasman
Considering maternal mortality exceeds 5% for each term pregnancy in the third world (http://select.nytimes.com/gst/tsc.html?URI=http://select.nytimes.com/2006/09/17/opinion/17kristof.html&OQ=_rQ3D1Q26showabstractQ3D1&OP=22158618Q2FMDQ26(MrPQ24llrM!bbSMbuMeQ7DMlcQ51Q5DQ51lQ5DMeQ7DVQ24Q51PrlRQ25Fra2), and it is less than 0.01% in the developed world, OBs have earned their due.
Are we better off ‘compensating’ a very few who may or may not have been injured, or shall we punish many when there simply aren’t enough OBs to go around?
‘Negotiated rates’ by insurers are not the result of any negotiation. They represent a oligopoly within any market region. Physisicians are prohibited from negotiating collectively in the same manner that patients are colletivized. If the insurer can weild 40% of a market of patients, why shouldn’t 40% of the OBs not be able to collectively bargain as a similar unit of parity. The insurers have banned this activity through their lobying of the federal legislature.
medstudent24
CJD,
I agree with you that 70k is too low for ob/gyn. HOwever, I cringe when I see numbers spouted by Merritt Hawkins and other recruiters.
Recruiters lie early and often about job salaries. They get a cut (up to 30%) of a year’s income for any placement they get. Therefore they lie and inflate salaries in an effort to draw interest from job seekers.
The best source for real ob/gyn salaries would be ACOG or US Labor Department. Recruiters numbers are absolutely bogus.
medstudent24
HOurs are long in general surgery, but med school applicants are choosing that field in numbers unheard of in years. Its now one of the most competitive specialties to match into.
So its not the hours that are keeping med students away.
At my school, we only had one person go into ob/gyn the last 4 years.
Its about malpractice, but its not just malpractice either. The fact is that there is a perception (rightly or wrongly) that women today prefer female ob/gyns and that a male going into that specialty will be placed at a disadvantage for securing patients.
Most of the ob/gyn residency programs that I know of are at least 70% female, and many are 100% female with no men in several years.
ACOG needs to correct this. Its hard for a specialty to survive when only half the talent pool even considers it as an option.
anonymous
Merritt, Hawkins and other “headhunters” largely recruit for jobs that nobody in their right mind would take. These jobs may be salaried employee with no partnership offers, subsidized jobs in undesirable locales, or areas with high malpractice incidence/claims (you don’t really think the doctors are worse in those areas do you?). These are often high turnover positions once they are filled. That is what keeps headhunters in business.
Starting salaries in my profession are down about 50% in inflation adjusted terms over the past 12 years. Starting salaries in other professions, including the legal profession, continue to skyrocket. So do the billable hours, and the chances of partnership in a big firm become ever slimmer. I really wouldn’t want to be a lawyer; however, I would rather be earning six-figures as a lawyer 3 years out of college than just completing my third year of medical school with 5-7 more years of accumulating debt before getting my first “real job”. The opportunity costs of delayed entry into the workforce are huge as is the interest owed on educational debt. When you do emerge into the workforce, you are in the highest tax brackets and not eligible for a Roth IRA. Wonderful.
Anirban
anonymous 1:43
A better thing is to do now is to have a Combined MD/MBA course ,as its there in UCLA .i know one who is earning 7 figures from a HMO only reviewing the claims .The flip-side is that no one will know you as a doctor . I dont think there are no side ways our doctors cant see , but possibly the joys of being a physician still eludes us a lot . Just wait 50 yrs (if you can ) eithr the odds will be racked up more , with a NHS like system or god willing we will get the blessing of the invisible hand of Adam Smith ,as society will always need us.
All the best
CJD
” however, I would rather be earning six-figures as a lawyer 3 years out of college than just completing my third year of medical school with 5-7 more years of accumulating debt before getting my first “real job”. “
Very few lawyers earn 6 figures 3 years out of college. The average attorney salary is only $100K, a full $50K behind physicians.
anonymous
I would wager that the American trained doctors I know would be landing six-figure jobs at silk-stocking firms. My contemporaries who are attorneys all make $500k to $1million+. The fact is that we would not have to import doctors if things were so wonderful or standards were not so high. You would see more people applying to medical school and fewer entering legal or business professions.
chucky
“Very few lawyers earn 6 figures 3 years out of college. The average attorney salary is only $100K, a full $50K behind physicians.”
I guess that helps explain why they have to play the bogus lawsuit lottery.
anonymous
I would add that NO physicians earn 6 figures 3 years out of college (in fact there are no physicians 3 years out of college, at least US trained ones), but MOST are 6 figures in debt!
In 2000, there were about 600k doctors and 1 million lawyers in the US. Given the differences in length of training and opportunity costs, competiveness of admissions, and the fact that there are no physicians on the Forbes 400 who got there from practicing medicine, but a few lawyers who got there practicing law, I certainly do not think doctors are overpaid compared to lawyers. My contemporaries are the best and brightest regardless of profession. Some are certainly not valued fully in economic terms. This applies across professions. In the long run this does influence what professions the best and brightest choose.
CJD
“Given the differences in length of training and opportunity costs, competiveness of admissions, and the fact that there are no physicians on the Forbes 400 who got there from practicing medicine, but a few lawyers who got there practicing law, I certainly do not think doctors are overpaid compared to lawyers”
Your information is incorrect, like the post that began this thread. There is one lawyer on the Forbes 400 who got there practicing law – Joe Jamail. The case that put him there – a business litigation case – Pennzoil v. Texaco.
“My contemporaries are the best and brightest regardless of profession.”
Please. What a load of crap. How many physicians do you know that you would not even think of sending your family to? All physicians know one of their colleagues like that.
“I would wager that the American trained doctors I know would be landing six-figure jobs at silk-stocking firms. My contemporaries who are attorneys all make $500k to $1million+. The fact is that we would not have to import doctors if things were so wonderful or standards were not so high.”
Who do you consider your contemporaries? How old are you? Where do you live? I guarantee that unless it’s Manhattan, the average salary of your “contemporaries” in law is certainly nowhere near yours. You guys are taking a few people and assuming that all of them make that. Clearly, the top in any profession do well, and would likely do well in any other profession, assuming they don’t have a particular gift unique to their own.
We’re importing doctors because your profession has universal skill sets. To be a lawyer in another country requires basically relearning the law of that jurisdiction, which may be vastly different from your own. Apples to Oranges.
anonymous
Sorry if those little things called “facts” are inconvenient. I’ll stand by them. You would be wise not to guarantee anything, as any experienced physician knows.
I do guess John O’Quinn dropped off the Forbes 400 list as he has added to his auto collection depleting his funds by millions per auction.
My contemporaries span some of the best in all professions: medicine, law, business, as well as sports.
I would just consider myself older and wiser.
CJD
You’ve offered anecdotes, and they may well be factual. If anecdotal evidence is how you make the majority of your decisions, I would bet most of them aren’t very good.
Many very good lawyers who are your “contemporaries” work for far, far less for the public defender’s office, for nonprofits, at smaller firms, for the Justice Dept., for the district attorney, etc. They’ll be lucky to make $1 million in 7 years, much less 1.
O’Quinn hasn’t been on, if ever, for years. Facts, indeed.
DocInKY
On the comwent by CJD 1152am, I now had a chance to see the continuing comments. 40 hours a week is very part time for an OB or surgery practice. My points about critical mass of work once a partner to produce pretax income after expenses are still valid. If the payor mix and case dynamics are not prime, then 40 hours a week may not even allow enough to tread water versus expenses.
anonymous
“Many very good lawyers who are your “contemporaries” work for far, far less for the public defender’s office, for nonprofits, at smaller firms, for the Justice Dept., for the district attorney, etc. They’ll be lucky to make $1 million in 7 years, much less 1.”
This is true. It is equally true for many of my friends who are medical professors, family physicians, architects, etc.
I am primarily referring to the best and the brightest and what they may choose to do.
Rich or poor, famous or infamous, celebrity or street person, the physician by and large cannot command a higher price for one versus the other. You cannot capture the economic value of your work. How much is saving life with a cardiac bypass or removing a tumor worth? In economic terms it varies. You will be compensated the same regardless. If you are a really excellent lawyer or business person, you can command higher prices and better compensation. Many of the best physicians are not the highest paid, and some of the worst are. I think the same is largely true of other professions.
As far as keeping to the facts, I will restate: ONE of the Forbes 400 2006 made the list practicing law. There are NO physicians who made this list practicing medicine (and there really shouldn’t be).
anonymous
By the way: “We’re importing doctors because your profession has universal skill sets” assumes that I am a doctor. This may or may not be true. I am not interested in doctor/lawyer bashing or envy of average incomes. Medical training is longer, in all reasonable probability more expensive, and with higher opportunity costs than other professions on average. When I am sick, I want the best and the brightest, as well as a physician who is more than a machine. I expect this person to be fairly compensated.
CJD
“Rich or poor, famous or infamous, celebrity or street person, the physician by and large cannot command a higher price for one versus the other. You cannot capture the economic value of your work.”
This is absolutely true, at least outside what I’ll call the “vanity” specialties. And this is the fundamental problem with your system. You receive no reward for being great.
Orac
“Doc, I saw the ‘part time,’ but it is followed with “40 hours per week plus nights and weekends”. I took the “part time” to be a joke.”
For most doctors, particularly OBs, 40 hours a week is part time!

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