Physicians in France make about $55,000 per year. Can that be realistically applied here?
France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don’t have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians””a tax that’s typically 40% of income . . .. . . Many French doctors, in fact, earn more by increasing their patient load, or by prescribing more diagnostic tests and procedures””a technique, also popular in the U.S., that inflates health-care costs.
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At this address http://www.sante.gouv.fr/drees/etude-resultat/er457/er457.pdf you will find what appears to be a French government study. It states that the “revenu libéral” in 2004 was 81,600 euros for all French physicians and 63,700 euros for general practitioners. “Revenu libéral” I believe means fee as opposed to salary income. Perhaps these numbers are gross income and the $55,000 is net income in some sense. 81,600 euros are $110,511 today.
I think both sides of the fence want the best and the brightest taking care of their loved ones. How could you get the best and the brighest to spend 11-13 years to become a physician when they can do better financially as a RN,CRNA, PT, Radiology Tech, or a Pharmacist and still be the the field of medicine. If my salary was capped at 55,000 I’d quit tomorrow and start teaching. At least then I’d get the summer’s off and a good retirement plan.
I think that the “best and brightest” is a bit overblown… particularly with the creeping political correctness when it comes to admissions for the few medical school slots that the AMA, through the CME has allowed to remain open. In my time, I have met clinicians that are purported trauma experts but instead turn out to be utter doofuses when it comes to trauma mechanics.
Anyway… the issue in my mind is not one of compensation per se, but one of autonomy. Incumbent with the French system of medicine would be the loss of a certain degree of autonomy when it comes to running one’s work environment in the manner that one wishes. Clinicians, just like others, should not be forced to work for peanuts in the midst of a socialist environment solely because someone else feels as if they have a free right to the labor of the former.
~Crimnallopath~
Obviously, cutting physician salaries by 66% is not going to happen. It has never happened anywhere; in France physician salaries simply never increased with inflation. Any attempt to do so here would result in a mass exodus/retirement and disaster, even if it were politically palatable (which it’s not).
There are other issues with it, like the fact that allied health practictioners are already getting close to the tipping point on the economic sense of becoming a physician. PAs make 75k a year with 5 years less training. Hmm. What’s the average PCP salary now, 140? Don’t have to decrease that too far before becoming a PA makes a whole lot more sense. *shrug*
America simply pays its professionals more as a reflection of lure of the greater entrepreneurial opportunities available here. It’s not just doctors, lawyers and dentists make substantially more as well. To the extent that “French style” medicine requires this, it’s not a particularly relevant lesson for us.
People always talk about French workers without presenting the full story. Physicians in France can only work a maximum of 35 hrs per week in accordance with strict French labor laws (add to that the cost American Drs pay for health insurance for themselves and their families)
Let’s see…
*55k for 35hrs/wk with no med school debt
*a large % of taxes paid for by the gov
*extremely low malpractice premiums
*no mounds of paperwork to fill out just to get paid by multiple insurance companies (the combo of single payor and low malpractice lawsuits actually lets them concentrate on practicing medicine)
*no worries about how to provide health insurance for your employees and family
*never considering patients’ ability to pay in their treatment
*attractive non-obese/chain smoking/McDonalds eating fashion conscious women to boot…
How much would these things be worth to you?
“in France physician salaries simply never increased with inflation”
This is exactly what is happening here. Our group increases the salaries of our staff overall each year at the rate of inflation or better but reimbursements are not keeping up, even if they are not reduced at the last minute as scheduled by the government. The result is to enhance revenue with noncovered services, nonmedical goods or services, drop plans that reimburse inadequately such as Medicaid, and cut staff or use more part time employees. The answer is NOT to spend a small fortune on risky luxuries such as EMR, a new phone system, or purchasing any new technologies which cannot pay for themselves. Of course labor costs are the largest costs at a medical practice. This is why you get a voicemail menu now when you call a doctors office, why you get put on hold if you do reach a live person, and why you may wait in a long line to check in or out with that person on the phone multitasking insurance referrals, allowables, and trying to figure out what you owe.
Income is relative to ones options. If I lived in France with extremely high unemployment rates and a system that severly limits entrepreneurial opportunities and punishes hard work, I might just be thankful to have a job and settle for that. Here on the other hand, anyone with the scientific aptitude to get into medical school in the first place who is responsible and willing to work hard has a great many opportunities to make a great deal more than that.
To see what kind of work ethic you get for that reimbursement, try to get medical care in France in August.
The lowest that docs in the USA could be paid without ending the profession would be about 100k. Anything below that, and it becomes a no-brainer to do something else besides medicine, such as law or engineering, or MBA.
You gotta keep in mind that even though docs in France make only 55k, they are STILL BY FAR the highest paid group of workers. Lawyers make about 40k, engineers make about 35k, teachers make about 30k. In other words, EVERYBODY gets paid a lot less in France than they do in the states.
Really? I cannot believe bankers and other executives in France don’t flee if that is the truth. It seems there would be a large brain drain to the States. Funny how I don’t know many French physicians but know tons of Indians/Pakistanis/etc.
The link is Business Week.
That magazine frequently lists the starting salaries of the better law school and business school graduates.
Their starting salaries are a multiple of that fifty-five grand.
If fifty-five grand is the best you can expect in medicine, why bother?
Even if you wanted to stay in healthcare, right now you could easily make that sort of money with any kind of specialized credential and willingness to work the sort of shifts and “on-call” duties doctors are expected to work for free.
I know nurses who do two twelve-hour shifts a week, but able to cover ICU, ER, pediatric specialties, that sort of thing, and do better than that fifty-five grand.
A CRNA asked to cover an opthalmology or endoscopy suite would laugh at that salary.
Funny, in my own academic days, I would encounter European docs working in the USA, often to polish credentials for something prestigious back in their own country.
They often spoke of relatively low pay, for doctors on the low end of “le totem pole”. If they rose high enough in “das pecking order”, they somehow seemed to be able to charge whatever they wanted.
Oh, sure enough there it is in the article:
“Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation. But American-style compensation is rare. “There is an unspoken and undefined limit to what you can charge,” says Dr. Paul Benfredj, a gastroenterologist in Paris…..”
I don’t know many American docs who get $675 for a consultation.
After achieving a certain status, French physicians, about a third of the total, can charge what they want and the third party pays according to it’s schedule, with the physician collecting the difference depending on what the traffic will bear–the way medicare would work here if we were the free people that our forefathers were and wanted us to be. Those physicians of course earn more.
So there is a story to be told!
Which is to say, medicine is two-tiered in France, as it is everywhere in the world.
What I have believed is, don’t avoid two-tiered medicine, just make sure the bottom tier is something you’d accept for your mother’s care. ’cause ya never know….
It seems the French have done this…..now I say this as an outsider, so feel free to disagree if you’ve experienced this first-hand.
If my mother had arthritis and I wanted to see some famous rheumatologist…..in France, I may have to pay more. In the USA, I’m stuck in the Medicare fee schedule, and maybe the rheum is accepting new Medicare, maybe not.
Actually, not exactly true, in that large academic centers seem to find ways to exempt themselves from these rules under which we ordinary mortals have to line.
In some ways, our healthcare is more socialized than the Europeans and Brits.
“In some ways, our healthcare is more socialized than the Europeans and Brits.”
Wouldn’t it be revelation to Americans to find that they had fewer choices than Europeans due to government regulation! I know this would not be a revelation to Canadians.
Sure, give me French pay. If you go by their published rates, it is not $55,000 per annum BTW, but more like E 200,000. But also, give me a French workweek, French legal protections, a French government-financed university education, French annual leave, a French pension and social-security retirement, and French food and culture.
I promise not to complain, or at least seulement en mode francaise. D’accord?
I agree, give me the French model any day of the week, I’ll stick in medicine. Honestly, maybe its because I’m in med school and not practicing yet, but the amount of concentration here on salaries is really shocking. When I think of all the patients I have seen in my days of just volunteering and now in clinic who had to fork over hundreds of dollars, forego care or were generally ignored by the staff b/c they knew they couldn’t pay…I am willing to take a pay cut if it means that more of my fellow human beings will have complete and fair access to healthcare. Anyways, I am sure that if universal care comes, and it will, the government will ensure that our loans, work hours and practice costs are controlled such that we don’t all run away.
Absolutely!
Trust the government, they’ll make it right. They always do.
I’m willing for you to take a pay cut as well. Not that either of us has a choice – it will happen over and over again until our bloated system fails completely; and not that it will benefit your fellow human beings.
The income for French physicians is often misstated to be $55K. That is well below the actual average.
General surgeons in the completely public sector (Secteur I) in 2006 received 77,681 euros per year. In Secteur II, where they take private patients, their average was 146,948 euros. They also can receive additional payments for “associated” work.
Generalists earned, on average, 64,000 euros. Today that is $92,800 at the prevailing exchange rate. (Ref Eco Sante IRDES web site)
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