"Paying doctors less money is dangerous"

in Uncategorized | 18 responses

The average annual income of a French physician is estimated at $55,000. Some are advocating we follow the French model of health care.

Cutting physician salaries as part of some radical government-dominated health reform would likely lead to this kind of thinking:

Boy, can you imagine the shortage of doctors (and nurses) in the US if we capped salaries at $55K? What would they start out, $35K?
And at what point do aspiring youth decide “Eh, it’s not worth all the effort. I can just go to work at Starbucks part time and get free government health care.”

Update:
Mark Thoma comments.

Comments

Anonymous
So let the believers in the possibility of getting a whole lot more for nothing be the first ones to step forward. Sign up for that insurance policy that really pays low reimbursement schedules and caps the maximum that can be collected. Better yet, sign up for one that does both. Sign up for one that delays payment as long as possible but is quick to threaten any physician who tries to collect when he doesn’t get paid. Sign up, because a policy like that has gotta be cheap.
You don’t even have to wait for a company to offer that kind of policy; Tricare and Medicaid and many of the bottom-feeder HMOs that service them are already in that market. So what if you can’t go to the doctor you want to go to. So what if you have to call thirty doctors’ offices to find one that will accept you with your great new insurance. One is all you need. One is enough.
I can’t believe anyone even seriously thinks this is an idea that has any realistic chance at working.
“Let’s just offer crap reimbursement”–and for the investment in money, time and man-hours from generally top-level graduates, $55K is really crap. I don’t care how many times the “average” salary of a typical American worker that figure is (you aren’t asking a typical American to become a physician).
Try the same exercise with schoolteachers or policemen or firefighters. We could save lots of money if we just paid them a third of what we do now. Hell, teachers from Africa would love to make that kind of money.
People can fantasize all they want about getting something for nothing. Let them. It is what keeps state lotteries rolling and the lights on in Las Vegas. But when you think you are going to just vote your way to low everyday prices for something that is very hard to produce at the quality everyone expects, you are not just fantasizing, you are being foolish. Making medical work pay that poorly would be a disaster. It would drive away the best minds from this field and damage the ability of our educational system to attract talented people to the medical profession.
The U.S. is not France. We don’t have a French school system, a French university system, a French legal system, a French culture. Picking some figure–and an altogether not-too-believable one at that– and saying that is somehow a reasonable alternative to what we compensate doctors for in the U.S. is just ludicrous. It would never ever work. That Time even gives this kind of stuff print inches is a sad testament to how cynical that magazine has become and how stupid and gullible they must think their subscribers have become.
Anonymous
There might be a few bumps in the road but in the end we would do just fine.
Anonymous
If you mean large numbers of deaths are “bumps in the road,” then OK. If having large numbers of people unable to get medical appointments because no one will accept the coverage they have is part of being “just fine,” well have fun with all that.
Seemingly intelligent people who would never find any rational way of justifying price fixing in any other economic enterprise have an uncanny way of suspending their reason when it comes to health care services and goods.
Anonymous
If I was paid 55 thousand a year to be a physician. I’d stroll in 15 minutes late, see one patient, take a coffee break, visit the john. I’d go see another patient, take a 2 hour lunch break. See another patient, afternoon coffee break, see one more and call it a day. 4 patients a day should be about right for $55,000. You can forget about me taking call as well.
Anonymous
Already have the large number of deaths and limited access even with median 130K income figures. The Frenchies seem to do just fine at 55K and can even innovate and do face transplants. As far as price fixing, see above current median income figure.
Richard
Not many people go into medicine (at least in Canada) for the money. But if I only got paid 55k (which is what I’ll get paid as a first year resident) for the rest of my life… I couldn’t afford to raise a family on my single-income in a major city.
Oh, I should ask my partner to go work, since that’s the way most families are. Yeah, but do most families have the main breadwinner working 60 hours a week plus 1 in 4 call?
Someone in my med class did the math once, and unless my partner made a significant income (as in pretty close to 55k) it was actually cheaper to have her stay at home with the kids than shell out the $$$ for daycare and a nanny for 3 kids.
Not to mention that raising kids is a lot more about time and a lot less about money…
Anonymous
France caps the maximum number of hours an employee works per week at 35hrs because of the rampant unemployment rates. Adjust these figures accordingly.
If someone offered me 55k per year right now to work 35hrs a week at my own pace and be guaranteed a job and guaranteed reimbursement without all the headaches I deal with in the office now. I would jump at the opportunity.
Anonymous
Yet in spite of doctors in france getting paid shit wages, there is no evidence that med schools in France are empty is there?
so the real question is why would anybody in france want to be a doctor?
answer: because all the other jobs in France pay shit wages too.
That wont work in America. Lawyers average 110k (according to US Labor Dept) per year in America for only 3 years training past college compared to a minimum of 7 for doctors. If you cahnged the wages of american docs to 55k, they do in fact have another alternative and med schools would quickly empty.
Anonymous
Please note that the actual cost of becomming a physician in France is a small fraction of what it is in the US.
You can’t compare the return on investment without taking into account the difference in the denomenator.
Unless we nationalize the private schools and much more heavily subsidize the ones that are already public. There would be few qualified applicants because people intelligent enought to perform as physicians are smart enough to know that 300,000+ is an excessive investment for an opportunity to earn that income.
Physician net income is not the cause of the high cost of American health care. If you reduced physician net to absolute zero, but changed nothing else (and docs would keep working), you would remove 10% of the costs–only a little more than one years increase at current rates. Physician income only represents 10% of health costs. Reducing it 50% would only take out 5% of the costs–all else being equal.
Petri
Total cost of private medical education: $300,000. This includes the tuition, room and board, and the interest paid on the debt over the 10 year pay back period. That works out to approximately 2,000 dollars a month. Refinance with a thirty year loan, that’s about 850 dollars per month. That my friends is a mortgage. At the salary of 55,000 per year, after taxes, you would make 2600 dollars per month. So, on the ten year payback plan, you have to live off 600 dollars a month, on the 30 year payback you live off of about $1750. So we’re really talking about 7200 to 21000 dollars per year in actual income. Hmmm, seems to me that unless we were to subsudize all medical education in the country, like France, this might persuade a few people not to sacrifice 7+ more years of their life.
Anonymous
Seeing as how so many women (take me to task all you want but in general woman want to work fewer hours to spend time with family) have gone into medicine I think it would work just fine if:
-education was paid for
-35 hour work week
-6 weeks paid vacation
-rent stipend for expensive cities
-generous pension
But I don’t think that’s what the people suggesting this plan have in mind (but it is what they have in France). They want to cut doctors off at 55 or so k a year thinking that it will save money.
I know a good number of dedicated doctors who want nothing more than to do research and help, but taking a vow of poverty (55k in NYC?) isn’t part of the plan.
Anonymous
Stop right there.
“Seemingly intelligent people who would never find any rational way of justifying price fixing in any other economic enterprise”.
Health is not best treated in a for profit model.
That’s where you are wrong.
Happyman
“Health is not best treated in a for profit model”
last i checked we are a capitalist society, and as a doctor i am (as yet) not forced to work for little/nothing.
So all those screaming about healthcare being a “right” need to ponder who will be there to provide it when politicians translate that into universal coverage, which will inevitably mean lower reimbursing docs less than the cost of doing business.
This is no different than medicaid, tenncare, etc., and what is actually becoming of medicare now too.
Anonymous
>>”Stop right there.
” “Seemingly intelligent people who would never find any rational way of justifying price fixing in any other economic enterprise”".
“Health is not best treated in a for profit model.
You might want to believe so, but what is your proof? From medical device innovation, to continuing education, to pharmaceutical development, to investment in medical education and establishment of private practice and surgery facilities, the for-profit, private business capitalist model is the dominant model. Sure, non-profits have had a role in the industry, in hospitals and some insurance entities (sadly perverted at this time)but not in employing private individuals. Doctors have always been allowed to act as private for profit workers, just like every other kind of professional person who work.
People who advocate caps like these are really advocating a form of confiscation (never mind the other destruction their ideas will wreak on the markets they want to regulate.)
>”That’s where you are wrong.
Is this just a polyanna-ish wish, or is there proof? So far, our society does little on the investment side to support the private individual wanting to become a physician (at least no more support that it gives prospective students of any other occupation). We certainly don’t come close to the system in France (and BTW, follow the links; the purported French salary average quoted for doctors is disputed by the EU doctors who say that number is just flat wrong.)
Capping doctors’ income without compensating them for their investment is just outright confiscation. We might as well do the same for other things we think are non-negotiable, like housing and food. Certainly they aren’t less important.
Anonymous
A recent article in the Wall Street Journal discussed the exploding demand for butlers, with salaries averaging 70k to 120k, and the bonus of free lodging. There is a school for butlers, costing 12k. This is a far better situation and return on investment than family practice for those interested. I suspect that French physicians making 55k would be in high demand as butlers should they so choose!
J.David Rice, MD
Do we pay doctors too much?
Americans are struggling with health care expenses and I’m one of them. I am a Physician.
Physician salaries in the US are higher compared to Europe and Canada because of a difference in work ethic. The French are beginning to realize that they have a serious “socialization” problem. French doctors take 10 to12 weeks of vacation per year. I haven’t taken that much time off in the last 3 to 4 years. British doctors often quit working for afternoon “Tea”. It’s a fact that foreign doctors are not as productive. I put in 12 hour plus days for weeks at a time. I do health screenings and health fairs during weekends and evenings off. I “squeeze” surgeries in on my afternoons off. I attend numerous volunteer meetings during my work days. My partners volunteer at the Greenville Free Clinic, and we rotate through the Free Clinic at GMH.
If I’m sick, I want the brightest, most skilled people in the country to take care of me. My medical training was 13 years of higher education. (There went my 20’s.) The French only do 6 years after high school. What’s it worth to Americans to have highly trained individuals care for their health? If you want to pay Physicians minimum wage, then the brightest and smartest in America are not going to go into medicine, simply, because they are the brightest and smartest. It will only weaken our health system. Then we can outsource health care to foreign medical graduates, requiring a translator to communicate, in English, with your physician. Pay me like the French, and then I’ll start taking my 12 weeks vacation. I did not go into medicine only for the money, I like what I do, I took an oath, and I have 3 decades in medicine.
Yes, doctors are paid for procedures. Similar to how a mechanic charges for automotive repair. It’s like being an auto mechanic that gets a flat fee for fixing the problem regardless of what is necessary to correct it. And then for 90 days you give free alignments, oil changes, and wash and waxes. You work on cars, but you can’t sell cars, or gas, oil, or parts, and you have to send them out to diagnose the problem. Then you train to repair the newest models, at your expense. And if the car isn’t better than it was before, they blame you. The human body is not a car.
Physicians are limited by regulations and reimbursements for test and procedures they perform and interpret. We limit tests and treatments we provide because reimbursements are less than our costs. And you seem to think we order test unnecessarily to “pad” our incomes. That is simply not true for any ethical physician. In fact, because we do not order tests needlessly we struggle to pay expenses, maintenance, and payments on expensive equipment. And this equipment is vital to our group in providing timely, convenient, and accurate treatment of our patients, making us More Productive! Of course the insurance companies and Medicare want to further cut reimbursements for these procedures making it harder to pay the “bill” on these diagnostic tools. The insurance industry is the only industry that continued to be profitable during the most recent economic down turns this decade. You want to cut salaries? CEO’s of the Top Ten US insurance companies made a combined $76.6 million, while those company’s profits totaled $25.2 Billion in 2003 (Forbes.com) William McGuire, the CEO of United Health made in 2005 – 124.8 million dollars – and that’s not counting his stock options.
Medicine is one of the most highly regulated industries in the US. It’s not a free market system! Complying with rules and regulations alone drive up the cost of health care. Federal law mandates that any Physician in the US, at their expense, must provide a translator for any non-English speaking patient. Do you think they do that in France or Mexico? The free care we provide is not insignificant. And you know we still have to pay the bills even if we don’t collect on services rendered. We still have all the legal liability associated with patient care regardless of weather we collect payment or not. Also our malpractice premiums have tripled in the last 5 years. Let the federal government and Hillary manage health care!? The VA system and the health care of our injured troops, these are two shining examples of how the government will manage our health care. Just ask any Vet!
The US now has about 800,000 active physicians, and there is predicted to be a shortage. Annual health care costs may be 4 trillion dollars in another decade. Physicians are in the highest tax bracket with 50% of our income going to taxes, and you think we all make $300,000 plus per year. The average internist makes about $150,000 per year. But say at $300,000 we cut physician salaries in half then they will be getting $150,000 per year. Take home pay of $75,000! Britney Spears makes $700,000 per month. I may do better as an entertainer! And actually may get more free time.
Contrary to what you think, American Physicians are the greatest in the world. We do not control the prices!! To balance the health care budget on our back is only going to hurt health care more. We do not just “check feet and eyes” we do inform patients what is good for their health. I can’t make sure that a patient “goes out and exercises”. The average American has no clue about their body and how it works. Most take better care of their car than themselves. I’ll be more than happy to take care of you when you have an illness but don’t get mad at me when you’re sick. This is a complex issue and I don’t have all the answers but I do have a better perspective. And please don’t get me started on smoking!!!
Sincerely,
J. David Rice, M.D.
http://www.businessweek.com/magazine/content/07_28/b4042070.htm
http://www.marginalrevolution.com/marginalrevolution/2007/03/french_health_c.html
http://time-blog.com/curious_capitalist/2007/06/the_filthy_rich_doctors_explan_1.html
Anonymous
Dr. Rice,
You seem to be a genuine, wonderful person and health care practitioner. It is my sincere hope that we are training future MDs with your ethics and social consciousness. Individuals like you deserve every penny they earn.
Anonymous
This is a very interesting post, with lots of different and valid opinions.
As an American who lives in France, I have to say I have witnessed first-hand the issues facing the French medical system.
The new “Sicko” movie has me astonished by it’s slanted perspective of France and the average 8K-euros/month middle class income?? This is entirely FALSE. Perhaps France is leading the world in terms of access to healthcare, but there are a ton of issues that go along with this socialized system.
Pros:
1. French Doctors are SO darn NICE. It seems they are doctors because they are compassionate and have a true desire to help other humans first and foremost. They also have a fond appreciation when I say I’m “American.” I can’t figure out why, but thanks to you American doctors, we have a very good reputation in the healthcare realm. It is not unusual to discuss personal information (small talk) between both the dr. and patient – making for a much more human and trusting relationship.
2. Doctors usually answer their own telephone and book an appointment quickly, most often the same day or the day after. They save expenses of hiring a receptionist and “insurance filer” even though you could be in the middle of a consultation and he/she might need to answer the telephone.
3. The system does work pretty well amid all the red tape.
Cons:
1. I had to take my son for stitches at the hospital ER. Aside from passing through the cloud of cigarette smoke at the entrance door, the place was filthy, no ventilation, a hole in the wall, blood stains on the ceiling/walls. While awaiting a doctor, another patient walked in and vomited on the floor of the entryway. NO ONE cleaned it up. It was there for 1.5 hours. The nurses were stepping over it with their open-toed shoes. Then I asked if anyone planned on cleaning that up. They went and got a sheet and covered it up with a sheet. I seriously felt like I was in the Twilight Zone. The lack of ventilation worried me about tuberculosis, since there are a LOT of 3rd World immigrants in France these days.
2. Hygeine, to expand a little on the above comment, it seems they do not wash their hands between patients. And so darn friendly that a handshake is always polite.
3. The machines and/or equipment is very old and often outdated. They are still doing CT Scans and MRIs are very hard to get access to.
4. French people tend to go to the doctor for the smallest little cough or sniffle so they won’t have to pay out-of-pocket for the medicine. If you have a prescription you are reimbursed. If you want to buy Actifed without a prescription, you pay out of pocket. This makes for unnecessary doctor visits. You really have to scrimp and save around here because salaries are SO low and taxes SO high. Even with 80K-euros/annual income, we live in a town with a very bad reputation and have to budget very, very carefully.
This socialized system has actually enabled its citizens similar to a drug dealer enables an addict. The French look to the government for too much. They have the attitude that there is “no corruption” in the French government and the high taxes are well spent. If you’ve never lived elsewhere, how else could you expect to think differently. However, I have noticed some progress and one they catch on they are quick to implement.
To sum it up, I think there is no perfect system. I can only imagine how hard doctors work and study and they deserve the compensation. It would be great if we could meet somewhere in the middle between the French and American systems.

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