Doctor salaries: The free-market experiment

What if doctors were really paid what they were worth? Mad About Medicine runs an experiment:

Health care in the United States is reimbursed at below-bargain basement rates. In businesses in this country where you pay bargain basement prices you get bargain basement quality and service. It is only through the ethical nature and dedication of a majority of doctors in this country, who choose to practice blind to the reimbursement and treat individual patients equally and fairly, that this does not happen and medical delivery remains of the highest quality.
Unlike a piggy going to market, doctors are lambs to the slaughter of the business and political agendas at work in this country.

Comments

Anonymous
The average doctor in the US makes $150,000 a year. Net of expenses.
What amount would not make you feel like “lambs to the slaughter”?
Anonymous
“The average doctor in the US makes $150,000 a year. Net of expenses.”
And, if the 10% Medicare cuts go through, will be going down, and down…
While the figure of 150,000 dollars may sound exorbitant to some, it doesnt nearly cover the fact that we also have to be on call nights and weekends (where we can’t charge extra like the plumber or electrician can), the free return phone calls, the paperwork, the script refills, etc.
Anonymous
Lots of people work just as hard for less. But putting that aside, what’s the number?
You say “Pay us what we’re worth!” Well, what do you think you’re worth?
Anonymous
150K, that’s it?? Glad I didn’t waste my time going to med school
Anonymous
The medical curriculum can be altered at any time by the existing providers. One could surmise that they refuse to do so not on an academic basis per se but instead on a basis of requiring future adherents to undergo the same level of “schooling” as they did (regardless of the utility of the training model). It is a bit disingenuous for providers to put forth their self-inflicted battle scars as being indicative of a basis for demands for the highest level of after-expense compensation of all fields of endeavor domestically.
Throckmorton
Average net income for an attorney in Florida is $110,000. No bad for four years of college and 3 years of law school.
Anonymous
Yes, lots of people work hard, but lots of people don’t have the same responsibility or level of training.
So are we now a communist state where everyone makes the same because they work hard? Or do we reward our members of society who have more responsibility, work longer hours, and have extensive educational backgrounds?
RSchoor
That is the free market. The purchaser of the service is the insurer and they use their leverage to force as low a sale price as possible. No one forces the doctors to take it, but they do so because they can make up the low fees with increased volume. Same thing happens when American business goes to a Chinese factory and to order the production of 1 million widgets but negotiate a take it or leave price of 5 cents per widget. The factory decides to take it and make the money on increased production and decreased costs.
Anonymous
Yes, but the point of the article was also to say that is illegal to charge medicare patients over 15 percent (?) what medicare will pay even if you haven’t entered a contract with them!!! If this is true; it seems like this should be struck down by courts!!!
Why doesn’t anyone ever challenge the the monopoly practices of the government and insurance companies (which work together) in federal court? I am not a lawyer so I don’t really know.
Karoli
rschoor:
Insurance companies are the middlemen manipulating the free market, acting as a cartel to fix prices and eliminate competition.
Zagreus Ammon
Well, it is interesting to see one person say $150,000 is not a bad income (it isn’t) and someone else turn around and say that for $150K it’s a waste of time to go to med school (it may be, I’m not that cynical yet.)
Fact is, this is exactly what a free market does. It subjects everyone to set of valuations and when two people agree, a price is set.
I think 150K is fine for a 40 hour work-week, but not for the kind of hours and frustrations I put in.
But that’s OK, someone else makes the decision until I say, blow it out yer ear and start selling insurance, where the real money is!
Most people undervalue medical care, until they need it and can’t find it. Not much of a surprise there. Meanwhile, I won’t be taking any patient calls this week… it’s really not worth the effort.
Anonymous
“Average net income for an attorney in Florida is $110,000. No bad for four years of college and 3 years of law school.”
What is it for a doctor?
“Or do we reward our members of society who have more responsibility, work longer hours, and have extensive educational backgrounds?”
We do, you make more than any other profession on average. But if you want more, how much more do you want?
You guys say we’re not paid enough, reimbursements are too low, etc. So again, what amount do you want?
Anonymous
Anon 1:30
Review the thread and read for comprehension
Ian B Gibson
I think 150K is fine for a 40 hour work-week, but not for the kind of hours and frustrations I put in.
Oh, you poor dear! What’s the matter, did someone force you to go to medical school?
And there isn’t a ‘free market’ – if there was then anyone could practice as a doctor and charge whatever they liked, something that I doubt you’d be too keen on.
I agree that doctors should work fewer hours, but there should also be a lot more of them and they should get paid less. Remove the restrictions on medical school entry and then we can talk about free markets.
Anonymous
The thread is, as always, a complaint about how much money physicians make. You want more. OK. If we consumers say that’s fine, the next question is how much.
So how much? It’s not a difficult question. I presume you’ve thought about it, given how much you complain about how little you’re paid. So again, how much?
Anonymous
What am I missing? You’re complaining you’re not paid what you’re worth. So what are you worth?
Anonymous
Ian,
“Remove the restrictions on medical school entry?”
I admit to being confused. There are several new M.D. schools under construction, schools are increasing their enrollments, and D.O. schools are rapidly proliferating. What restrictions do you mean?
If you mean the educational prerequisites, I’d like to see the results of a simple poll: would someone rather have their sick loved one treated by a CNA, MA, RN or MD/DO?
Each one of those has an increasing educational barrier to entry and training requirements. Increasing medical school enrollments by decreasing standards removes those distinctions. If they really were viable alternatives the market would have done this long ago.
Incidentally, being a doctor in the EU/UK/Canada/Australia is just as competitive. They work less and are paid less because they agree to have the government provide their education and training free of charge. Yet their governments haven’t lowered the requirements or substantially increased the pool, even though their control of the system is significantly greater.
Anonymous
Anonymous 7:59,
How about you help us along in the process by answering what health care is worth to you. Isn’t that the real measure in a market economy?
We should charge what we feel we’re worth. By signing a contract with an insurance company, or participating in Medicare, we give away that right. Shortsighted, no? But when all your patients expect others to pay for them, one finds oneself in the position of accepting it. And yes, then we leave early. But that’s the business of it.
Anonymous
“But when all your patients expect others to pay for them, one finds oneself in the position of accepting it. And yes, then we leave early. But that’s the business of it.”
All patients don’t expect that. It is part of the package many of our employers offer, and you continue to accept. Why should we change things? We get healthcare at what you claim are below market prices – good for us.
The fact that none of you can put a number on what you’re worth illustrates your ignorance on the subject. And it also illustrates why nothing will change for the positive for you. You lack the basic knowledge necessary to create change in your favor.
Anonymous
Ian:
Given this line from your blog I find your statements rather hypocritical
re: “My name is Ian Gibson. I am from northern England but underwent an ultimately successful transplant operation to the United States over eight years ago.”
Anon 9:00: The answer is very easy. We should be able to see pt’s and recieve a profit rather than lose money. The simple fact is I no longer take new state medicaid pts and am one congressional cut away from no longer accepting new medicare pts. Why, because I lose money every time I see a medicaid pt and medicare is only slightly positive at this point. I know very well how much I recieve from each payment plan (much better than you thank you) as I am not only a doctor but a small businessman. If I don’t know what is going on I will go bankrupt. Of course the bigger issue here is that medicaid and now medicare pts are losing doctor access with paltry payments. But I am sure you have much less understanding of that subject than I as I am the one who has seen these people on a daily basis for decades. It is easy to sprout the same $hit over and over again on this website, but you don’t actually contribute anything….must be a lawyer.
Anonymous
>>Incidentally, being a doctor in the EU/UK/Canada/Australia is just as competitive.
Probably more so in fact. Where they control the influx of doctors is at the consultant level. Set the bar high, make it very difficult to pass. Then they get registrars who stay in the system much longer, at reduced pay, subject to government whims. When you become a consultant, you can then practice privately.
Like one anaesthetist I met once. He was complaining about being in the long neurosurgical case all day, never seeing his consultant (our “attending physician”).
I made some observation about the consultant being in the office doing research, writing grants, instead of the clinical work. I figured NHS training hospitals wee like our USA teaching hospitals.
He gave me the “stupid American” look. Of course the consultant was not available to him because he was in the NHS hospital long enough to induce anesthesia. After that he was in the private hospital nearby doing private cases for real money.
Anonymous
” We should be able to see pt’s and recieve a profit rather than lose money.”
How much profit do you need to stop whining so damn much? I don’t care who you treat, but will you ever stop bitching?
Anonymous
“How much profit do you need to stop whining so damn much”
1: Do you realize CJD that lawyer’s annual salary has increased robustly after inflation going back to the late 90′s while DOCTOR’S (on average) have DECREASED.
2: Do you realize that the 1997 budget act requires “budget cuts” for doctor’s medicare reimbursement (which everybody else key’s off of) based on amount of money brought in. Though these cuts in general have not occurred (thanks to yearly last minute congress intervention SO FAR), neither have any realistic increases that take into account inflation and increased costs. Tell me CJD. How much would YOU “whine” if that happened to you?
3: Can you read for comprehension CJD? I no longer take new medicaid pts and am one cut away from taking medicare pts. Why? Because I am not only a doctor but a small businessman. I WILL NOT go into bankuptcy because of the government’s inability to pay at least an amount of money so I can stay in the black on pt’s visits. IS THAT TOTALLY AND UNEQIVICALLY CLEAR ENOUGH FOR YOU CJD? Many docs are in the bind I am. You want to do right by people but you can’t lose your business because of it. In fact I talk to other PCP’s in my situation. Refusing to those who most need it is not an easy thing to do. Of course who suffers in the end? The medicaid/medicare pts further access to doctors.
PS: You don’t actually run a business do you CJD. Because your statments make it rather plain to me you are employee of a governmental agency of some type. It is easy to pontificate when you don’t really understand the situation from the outside.
Anonymous
Actually, I own four small businesses, including a law practice. And when I’ve been in businesses where I didn’t like the return on investment, I sold them. And if they lost money, well, I usually just didn’t buy.
You don’t read very well, do you? I’m glad you’re not taking medicare anymore. I’m glad you had the courage to do it. I don’t want you to be bankrupt. I want you to make money. I just want to know how much you have to make before you’re happy enough to quit bitching incessantly.
By the way, physicians still make, on average, 50% more than lawyers. Cry to someone else that you can’t live on an average salary of $150K a year.
Anonymous
Insurance companies have been cutting reimbursements for the last 20 years, gradually, but relentlessly. 20 years ago an ObGyn physician in Boston earned 400K and that bought a house in a great neighborhood. Today the same physician earns 200K, has to see twice the number of patients and the same house costs 1.5 million. That is what we are talking about.
What nobody wants to admit: You get what you pay for. If you want outstanding medicine, you have to pay more. If you want doctors who drop their stethoscope at 5 sharp and sign out your heart attack to the next shift, continue cutting reimbursements. No administrative control, supervision, performance incentive or other nonsense will change anything about that.
Constantly cutting the income of those who really decide and who truly run healhtcare on a day to day basis sends a very clear message: Doctors, we don’t care about you!
Well, patients, guess how we feel!
Cutting reimbursement is the highway to mediocrity, the medical version of hell. And you will never know it…
Anonymous
Tell me how to differentiate one doctor from another and I’ll be glad to pay out of pocket for the better one.
Anonymous
Why do doctors have to take call from home? I think all doctors should finally unionize. The idea of a union was built on the very essense of creating more say of the worker. In the health care industry, the worker has become the doctor and the insurance company and the government have become the employer. It is time for doctors in the United States to finally unionize. This will bring back the ideal doctor model of spending quality time for our patients and not running from patient to patient of the marathon days occuring in 15 minute intervals which the insurance companies have forced us to do.
Anonymous
DOCTORS NEED TO UNIONIZE!!!
Ado
Allow doctors to compete in the market place. People cant afford the current system! We need competition to drive down prices

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